Passmedicine Mix

Question 1

how are extrapyramidal side effects of antipsychotics managed?

Answer 1

procyclidine

Question 2

examples of extrapyramidal side effects of antipsychotics?

Answer 2

parkinsonism
acute dystonic reaction
akathisia (restlessness)
tardive dyskinesia (lip smacking, grimacing etc)

Question 3

mechanism of tricyclics?

Answer 3

inhibit monoamine reuptake at presynaptic membrane

Question 4

what type of drug is methylphenidate and what is it used to treat>

Answer 4

dopamine/norepinephrine reuptake inhibitor

type of stimulant used to treat ADHD

Question 5

what type of hallucinations are experienced in PTSD?

Answer 5

pseudohallucinations

Question 6

what is a primary delusion?

Answer 6

not understandable or due to any previous psychopathological state

Question 7

3 things which indicate mania rather than hypomania?

Answer 7

delusions of grandiosity
auditory hallucinations
impaired social functioning

Question 8

what is circumstantiality?

Answer 8

common feature of anxiety disorder or hypomania
over-inclusive speech that is delayed in reaching its final goal
still possible to follow speech and it does eventually get to the point but takes a long time as goes into detail about every tiny aspect

Question 9

metabolic effects of bulimia?

Answer 9

metabolic alkalosis
hypokalaemia
hypochloraemia

Question 10

what are non-epileptic seizures associated with?

Answer 10

childhood trauma (e.g abuse etc)

Question 11

describe a non-epileptic seizure

Answer 11

type of functional disorder
usually unconscious
presents similarly to epilepsy however
- lasts longer
- usually dont have injuries seen in epilepsy
- remain continent 
- different triggers
- no actual brain lesion

Question 12

how are non-epileptic seizures managed?

Answer 12

anticonvulsants dont work

psychotherapy used

Question 13

what is a functional disorder?

Answer 13

same as conversion disorder

Question 14

features of functional disorders as a whole?

Answer 14

generally in keeping with patient’s cultures and beliefs
dissociation is a common symptom
timescale important as clear triggers are often seen

Question 15

fronto-temporal dementia vs lewy body dementia?

Answer 15

both have the same underlying cause (hyperphosphorylated tau protein causing neurofibrilary tangles)
however the tau proteins are more widespread in lewy body

Question 16

how is cortisol affected in long term unipolar depression?

Answer 16

chronically elevated
- increased corticotropin releasing factor (CRF) from hypothalamus > ACTH released from pituitary > cortisol released from adrenal glands (can cause adrenal hypertrophy) > impaired negative feedback of cortisol to hypothalamus/pituitary >continued activation of HPA axis and excess cortisol release

Question 17

effects of excess cortisol in chronic depression?

Answer 17

cortisol receptors are desensitized causing increased activity of pr-inflammatory mediators and disturbances in neurotransmitter transmission
excess cortisol excreted in urine
increased adrenal gland volume

Question 18

how is thyroid function affected in chronic unipolar depression?

Answer 18

dont change

Question 19

how does unipolar depression affect hippocampal volume?

Answer 19

can be reduced but not in everyone

Question 20

best treatment in depression?

Answer 20

combination of antidepressants and CBT

Question 21

first line in depression and why?

Answer 21

SSRI

- not really more effective but better side effect profile

Question 22

describe mental compulsions seen in OCD?

Answer 22

often in keeping with patients own morals and beliefs (e.g someone very religious may have blasphemous mental compulsions et)
compulsions are often the worst thing the person can think of in terms of their morals

Question 23

is heritability seen in OCD?

Answer 23

yes

around 40% concordance seen in identical twins

Question 24

how useful is psychotherapy in OCD?

Answer 24

very (despite strong neurobiological basis of disorder)

Question 25

first line pharmacological treatment in OCD?

Answer 25

SSRI

Question 26

most specific hallmark in schizophrenia?

Answer 26

formal thought disorder (broadcasting/withdrawal/insertion etc)

Question 27

other features which are usually present in schizophrenia?

Answer 27

paranoid delusions of reference

hallucinations

Question 28

definition of hazardous drinking?

Answer 28

14+ units per week

Question 29

harmful drinking definition?

Answer 29

men = 50+ units per week
women = 35+ units per week

Question 30

2 months history of paranoid delusions of the neighbours poisoning the food in his fridge and auditory hallucinations of the neighbours talking about him, some formal though disorder but no mood disturbance
what is the best management?

Answer 30

atypical antipsychotic

Question 31

which atypical antipsychotic is best in type 2 diabetes?

Answer 31

resperidone (doesnt cause metabolic syndrome which is a risk in type 2 diabetes)

Question 32

which atypical antipsychotic has a risk of metabolic syndrome?

Answer 32

olanzapine

Question 33

examples of obesession?

Answer 33

intrusive thoughts about dropping baby or letting go of pram in post partum period

Question 34

features of an obsession?

Answer 34

type of thought that is invasive, irrational, difficult to get rid of and causes distress

Question 35

obsession vs delusional thought?

Answer 35

similar but in obsession, the person knows that the thought is ridiculous and doesnt make sense (insight preserved)

Question 36

what is an overvalued idea?

Answer 36

somewhere between delusion and obsession

Question 37

what is a mixed affective state?

Answer 37

can be a presentation of bipolar disorder
patients have been manic/hypomanic then suddenly develop depressive symptoms and vice versa
(e.g manic symptoms with aspects of depression)
often cycle very quickly (even within same day)

Question 38

example of history of mixed affective state?

Answer 38

was on top of the world, so many amazing ideas, felt great and excited, then after a few days is still restless and very busy with lots of thoughts and ideas but all thoughts are very negative etc)

Question 39

how long must symptoms be present for PTSD diagnosis?

Answer 39

6 months