Practice Questions Flashcards
1
Q
What can one use as an adjuvant to antipsychotics for negative sx of schizophrenia?
A
D-cycloserine
Glycine
Seligine
2
Q
How many patients on SSRIs experience sexual dysfunction?
A
70%
3
Q
What receptor causes sexual dysfunction from SSRIs?
A
5HT2C stimulation
4
Q
How long does untreated depression last for?
A
6-13 months
5
Q
How long does treated depression last for?
A
3 months
6
Q
How long does treated mania last for?
A
4-5 weeks
7
Q
Which class of antidepressants are more commonly associated with switch to bipolar?
A
TCAs
8
Q
What is used to define response to treatment for OCD?
A
A fall of at least 35% in the pre-treatment YBOCS score. after 6-12 weeks of Rx
9
Q
What type of insomnia is related to anxiety?
A
initial insomnia
10
Q
What causes middle insomnia?
A
Medical illness
Pain
Depression
11
Q
For which PD is the term ‘quasi-psychotic’ used in ICD 10?
A
Schizotypal
12
Q
Rate of depressed patients who switch to mania/hypomania?
A
7-12%
13
Q
How do antipsychotics affect QTc?
A
Blocking K+ channels
14
Q
Difference in onset of schizophrenia between men and women?
A
Men develop schizophrenia 5-6 years earlier
15
Q
The strongest predictor of mortality in a patient with anorexia nervosa?
A
Alcohol abuse
16
Q
How many patients with schizophrenia experience recurrent episodes of illness and develop significant progressive impairment
A
35%
17
Q
How many patients with schizophrenia experience a simple episode of acute schizophrenia and have no residual impairment?
A
22%
18
Q
How many patients with schizophrenia experience recurrent episodes of illness and have no or slight residual impairment?
A
35%
19
Q
How many patients with schizophrenia experience recurrent episodes of illness and develop significant non progressive impairment?
A
8%
20
Q
How many middle aged women on Lithium develop hypothyroid?
A
20%
21
Q
DSM 5 diagnostic criteria for NMS?
A
Exposure to dopamine antagonsit in the last 72 hours, along with severe muscle rigidity and elevated temperature as well as mental status alteration (reduced or fluctuating level of consciousness), CK elevation (at least 4 times upper limit of normal), sympathetic nervous system lability, defined as at least 2 of the following:(hypertension, >25% of baseline, blood pressure fluctuation of =20 mmHg diastolic or =25 mmHg systolic change within 24 hours, diaphoresis, urinary incontinence), hypermetabolism, defined as heart rate increase (=25% above baseline) and respiratory rate increase (=50% above baseline).
These features must be present along with a negative work-up for infectious, toxic, metabolic, and neurological causes.
22
Q
Best scale to measure EPSEs?
A
Simpson-Angus scale
23
Q
Which medication is indicated if a patient on antipsychotic develops relapse of mania?
A
Lithium or Valproate augmentation
24
Q
Risk of suicide one year after DSH?
A
1%
25
The proportion of patients diagnosed with schizophrenia that experience recurrent relapse and continued disability?
75%
26
Which parasomnia is more common in women?
Nightmares
27
Which tremor increases on intentional movement?
Cerebellar
28
Where is neurasthenia found in ICD 10?
Neurotic, stress-related and somatoform disorders
29
Diagnostic criteria for neurasthenia in ICD 10
a. either, persistent and distressing feelings of exhaustion after minor mental effort or persistent and distressing feelings of fatigue after minor physical effort; b. accompanied by one or more of the following symptoms: muscular aches or pains; dizziness; tension headache; sleep disturbance; inability to relax; and irritability;
c. inability to recover through rest, relaxation or enjoyment;
d. duration exceeds 3 months;
e. Does not occur in the presence of organic mental disorders, affective disorders or panic or generalised anxiety disorder.
30
Name the subcortical dementias
Parkinson's disease dementia,
Huntington's disease,
HIV-associated dementia,
Binswanger's disease
Wilson's disease.
31
What characterises subcortical dementias?
Gross psychomotor slowing,
Abnormal movements,
Low mood,
Mild amnesia
Apathetic personality.
32
How does Modafinil work?
Activates neurons containing orexins
33
Prevalence of depression in those with heart disease?
20%
34
Best SSRIs for pathological crying?
Fluoxetine
Citalopram
35
What percentage of women with postpartum psychosis will go on to develop schizophrenia later in their lifetime?
16%
36
'Baby blues' are reported in what proportion of new mothers?
3 in 4
37
Which antidepressants should be avoided in Epilepsy?
Amitriptyline
Dothiepin
Clomipramine
Bupropion
38
The male: female ratio of hypothyroidism is
1:6
39
Risk factors of depression in Parkinsons?
Female
Younger onset
Right-sided lesions
Bradykinesia
Gait disturbance
Rapid progression of disease
Poor cognitive status and ADLs
40
Which medication has best evidence for use in HIV dementia?
Zidovudine
41
Prevalence of any MI in HIV patients?
38-73%
42
Which INF has a good link to depression?
INF-Alpha
43
In post-stroke depression, the antidepressant treatment should be continued for at least?
6 months
44
What is the mean duration of a major depressive episode that follows a stroke?
34 weeks
45
The frequency of depressive symptoms in epilepsy is
30-50%
46
Frequency of panic disorder in epilepsy?
20%
47
Frequency of psychosis in epilepsy?
3-7%
48
What is the lifetime prevalence of depressive symptoms in patients with multiple sclerosis?
40-50%
49
Best antidepressants for depression in MS?
SSRIs
Desimpramine
50
Risk of triggering relapse of MS with ECT?
20%
51
The gene for Huntington's disease (HD) is located on which chromosome?
Short arm of chromosome 4
52
During pregnancy, where continued use of Valproate is deemed essential, what is the maximum dose recommended?
1000mg/day
53
When used as mood stabilizers, what is the minimum period suggested to withdraw anticonvulsant drugs?
1 month
54
What is the lifetime risk of suicide in Huntington's disease?
10-15%
55
Neuropsychiatic features of Huntingtons
Subcortical Dementia
Gradual onset,
Early and significant impairment in executive function,
56
Which cognitive functions are preserved until late in Huntingtons?
Visuospatial
Semantic memory
57
Predominant cognitive impairment in Huntingtons?
Executive impairment
58
What is the chance of having a baby with congenital malformation if lithium is continued through the first trimester?
1 in 10
59
The rate of depression during pregnancy is
10%
60
Risk of relapse of depression in a pregnant woman who stops her medications?
5 times the risk
61
Risk of any birth defect from sodium valproate use in pregnancy?
7.2%
62
During what period of postpartum is there a risk of psychiatric disorders?
First 3 months
63
What is the relative risk of developing Ebstein's anomaly for a child when the mother is on lithium throughout her pregnancy?
9.5
64
What percentage of new mothers develop postpartum depression?
10-15%
65
What proportion of women with history of depression relapse when they discontinue antidepressants during pregnancy?
68%
66
What proportion of women with history of depression relapse if they continue their medications in pregnancy?
26%
67
What is the risk of developing spina bifida in the children of women treated with carbamazepine during pregnancy?
0.5-1%
68
Which neurocognitive function is most affected in babies of mothers who took valproate during pregnancy?
Verbal IQ
69
What is the proportion of individuals with epilepsy that commit suicide?
10%
70
Suicide rate in schizophrenia?
6%
71
Prevalence of DSH in psychosis?
25%
72
How many patients with T1 Bipolar attempt suicide?
17%
73
How many patients with T2 Bipolar attempt suicide?
24%
74
How many patients with depression attempt suicide?
12%
75
The proportion of those who progress from having mere suicidal ideas to plans or attempts within one year is
60%
76
Best mood stabilisers for mixed affective disorder?
Lithium
Valproate
77
1st line medication for depression in Bipolar
SSRIs
78
What is Hopkins checklist?
symptom inventory, which measures symptoms of anxiety and depression (not psychosis). It consists of 25 items: Part I of the HSCL-25 has 10 items for anxiety symptoms; Part II has 15 items for depression symptoms.
79
Which depot may have an antidepressant effect?
Flupenthixol
80
Which depot can induce depressed mood?
Fluphenazine
81
Which depot depots not require a test dose?
Risperidone
82
Describe General Health Questionnaire
self-rated screening instrument for the presence of psychiatric illness
83
Describe DIS
a non-clinician administered fully structured interview and used in Epidemiological catchment area study
84
Minimum dose of Risperidone to be effective in first episode schizophrenia
1-2mg
85
Minimum dose of Quetiapine to be effective in first episode schizophrenia
150mg
86
Minimum dose of Amisulpride to be effective in first episode of schizophrenia
400mg
87
Minimum dose of Chlorpromazine to be effective in first episode schizophrenia
200mg
88
Which scale is used to monitor tardive dyskinesia?
AIMs
89
Medication to use in depression & insomnia
Trazadone
90
Antidepressants to use in depression & anxiety
Sertraline
Venlafaxine
91
Which medication can cause hypospasdias in the fetus if used in pregnancy?
Valproate
92
Which TCA is not safe in breastfeeding?
Doxepin
93
Preferred SSRIs in breastfeeding?
Paroxetine
Sertraline
Fluoxetine
94
Best antipsychotic with AF?
Aripiprazole
95
Which antidepressants can provoke AF?
TCAs
96
Which antipsychotics can provoke AF?
Clozapine
Olanzapine
Paliperidone
97
Which antipsychotic is least likely to cause conduction problems?
Risperidone
98
Antidepressants post-MI
Antidepressants are (usually) CI in first 2/12
99
Which SSRIs to avoid in MI?
Fluvoxamine
Citalopram
100
Which neuropsychiatric condition shows hypointensity of striatum?
Fahrs disease
101
Which condition causes high stepping gait, paraesthesia of lower limbs and pupillary abnormalities?
Syphilis
102
What sx are suggestive of stroke-related cognitive impairment?
Apraxia
Visuo-spatial neglect
Reduced attention
103
Prevalence of post-CVE emotionalism?
15-35%
104
Prevalence of pos-CVE apathy?
20%
105
Which disorder is characterized by a peculiar gait of lurching with long strides and quick, involuntary knee flexion?
Neuroacanocytosis
106
Which SSRI has been shown to be particularly effective in MS depression?
Sertraline
107
% of preventable suicides in England according to MH teams?
22%
108
% of suicides that occur within 3/12 of d/c?
25%
109
The proportion of all episodes of self-harm that occur in people over the age of 65
5%
110
The subsequent risk of suicide 10 or more years after an episode of self harm
3%
111
The proportion of individuals who will harm themselves again in their lifetimes
40%
112
Proportion of individuals who self harm that will repeat at least 5 times in a given year
10%
113
Prevalence of DSH w/o suicide intent
2%
114
Prevalence of suicidal attempts
4%
115
Prevalence of suicide thoughts
15%
116
Max dose of Escitalopram
10-20mg/day
117
Max dose of Haloperidol
20mg/day
118
Doses of Venlafaxine
75-375mg/day
119
Doses of Duloxetine
60-120mg/day
120
Doses of Fluvoxamine
100-300mg/day
121
Doses of Paroxetine
20-50mg/day
122
Dose of Amitriptyline
30-200mg/day
123
Doses of Lofepramine
140-210mg/day
124
Doses of Imipramine
10-200mg/day
125
Doses of Dothepin
75-225mg/day
126
Duration criteria for diagnosis of delusional disorder in ICD 10?
3/12
127
Medications to use in treatment-resistant OCD?
Add antipsychotic to SSRI
Clomipramine
Clomipramine + Citalopram
128
First line prophylactic agents for bipolar
Lithium
Valproate
Olanzapine
129
Which type of OCD has high heritability?
Symmetry/ordering
130
Which types of OCD respond poorly to SSRIs?
Hoarding
Sexual/religious thoughts
131
Which types of OCD respond poorly to CBT?
Hoarding
Sexual/religious thoughts
132
Which meds are used to reduce aggressive behaviour in PDs?
SSRIs
133
Which meds are used to help with emotional dysregulation in PDs?
Anticonvulsants
Lithium
134
Best antidepressant in hepatic impairment
Imipramine
135
Best SSRIs for hepatic impairment
Paroxetine
Citalopram
136
Best mood stabilisers in hepatic impairment
Lithium
Gabapentin
137
Best antipsychotics in renal impairment
Olanzapine 5mg/day
Haloperidol 2-6mg/day
138
SSRIs to use in renal impairment
Citalopram
Sertraline
139
Antidepressants to avoid in severe renal impairment
Fluoxetine
Venlafaxine
140
Antipsychotics with minimal pro-convulsive effects
Haloperidol
Trifluoperazine
Sulpride
141
Most common CNS pathogen (opportunistic)?
Cerebral toxoplasmosis
142
What causes Progressive multifocal encephalopathy?
PPV
143
Which 2 antipsychotics have greatest risk of orthostatic hypotension?
Clozapine
Risperidone
144
Which antipsychotic is least likely to cause tardive dyskinesia?
Clozapine
145
Which therapy includes traps, dilemmas and snags?
CAT
146
Prevalence of dysthmia?
4%
147
M:F ratio of dysthmia?
1:2
148
How many patients with vCJD have neurological sx prior to psychiatric?
15%
149
How many patients with vCJD present with both neurological and psychiatric sx?
22%
150
In old age, what percentage of patients that commit suicide have seen their GP on the same day of their suicide?
20%
151
In old age, what percentage of patients that commit suicide have seen their GP within one week of their suicide?
40-50%
152
In old age, what percentage of patients that commit suicide have seen their GP within one month of their suicide?
70%
153
What does deletion of maternal segment of 15q11 lead to?
Prader-Willi
154
How many patients charged with indecent exposure reoffend?
20-30%
155
How many patients charged with indecent exposure have a history of sexual offences?
60%
156
In which type of study is recall bias more common?
Case control
157
The final stage within each cycle of the model described by Prochaska & DiClemente
Relapse
158
How long does your driving license remain suspended if you have had an episode of mania?
3 months
6 months if 4 or more episodes in one year
159
Poor predictors of first episode psychosis
Duration of untreated psychosis
Comorbid substance misuse
Insiduous mode of onset
Negative sx
Poor premorbid adjustment
Male gender
Non-adherence
