Passmed Psychiatry

Question 1

blood results for anorexia

Answer 1

Most things low, Gs and Cs raised; growth hormone, glucose, salivary glands, cortisol, cholesterol, carotenaemia

Question 2

investigation necessary before starting an SNRI

Answer 2

• SNRIs (e.g. venlafaxine) are associated with the development of hypertension. NICE recommend that all patients have their blood pressure monitored at initiation and each dose titration of venlafaxine. If the patient is hypertensive a dose reduction should be considered.

Question 3

Investigation required before starting citalopram

Answer 3

The BNF states that ‘QT prolongation, and/or ventricular arrhythmias including torsade de pointes have been reported in people taking citalopram or escitalopram.’ The BNF advises taking an ECG and measuring the QT interval in patients with a history of cardiac disease prior to starting citalopram.

Question 4

investigation required before starting SSRIs

Answer 4

The BNF advises when starting a serotonin specific reuptake inhibitor (SSRI) to ‘observe all people taking antidepressants for signs of hyponatraemia. For people at high risk, measure the serum sodium level before starting treatment, 2–4 weeks after starting treatment and every 3 months thereafter.’

Question 5

3 main side effects of antipsychotics

Answer 5

(1) Acute dystonia – an example of this is oculogyric crisis
(2) Akathasia (severe restlessness)
(3) Tardive dyskinesa (When stopping a SSRI the dose should be gradually reduced over a 4 week period)