Psych Flashcards
A 24-year-old man presents with what appears to be an acute psychotic episode. Which of the clinical features below is most likely to discriminate between this being a schizophreniform psychosis or a manic episode?
The presence of auditory hallucinations
The presence of persecutory delusions
The presence of delusions that are incongruent with the patient’s mood
The presence of cognitive impairment
The presence of a disorder of the form of thought
The presence of delusions that are incongruent with the patient’s mood
A 32-year old man presents to his general practitioner with a 5-week history of worsening low mood, which he attributes to tensions within his marriage. On direct questioning, he admits that he finds it very difficult to concentrate on his work, and finds no interest in it. He routinely wakes 3 hours before he was accustomed to previously, and feels unrefreshed when he wakes. He now feels hopeless about the future, and says that life isnt worth living, although on questioning, he has made no plans to end his life. Direct questioning reveals no relevant past or family history. Physical examination reveals no abnormalities. What would be the most appropriate management plan?
Ask him to return to the surgery in a week’s time to review
Refer him to the practice counsellor
Prescribe temazepam to help with his sleep, and ask him to return for review in a week’s time
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week’s time
Refer him to the local community mental health team for an urgent assessment, in view of his thoughts about ending it all
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week’s time
Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?
1% 5% 10% 25% 60%
25%
A 28-year old woman lives in supported accommodation. She is able to manage most tasks of self-care, but needs help with taking her medications (in the form of a dosette box, filled by a carer). She has a flat occiput, and short, broad hands. On the basis of this information, what is the likelihood that she has an IQ under 50 and has multiple associated physical abnormalities?
0.1% 1% 10% 50% 80%
10%
A 18-year old girl presents to a general psychiatry outpatient clinic. She has had what her mother describes as an eating problem for some years, but it has become considerably worse over the past year. She has lost considerable weight, and at the clinic, her weight is 40 kg and her Body Mass Index is 15 kg/m2. She admits that she is very fastidious about her food, carefully choosing what to eat, and disregarding her mothers advice. She goes to the gym daily for a work-out lasting at least 90 minutes. Her periods had been regular, but she has had none for the last 3 months. At the appointment, she is accompanied by her mother, who is clearly exasperated by her daughters behaviour, and expresses considerable criticism of her. What would be the most appropriate initial intervention?
Refer her to a dietician for specialist dietetic counselling, and arrange to see her again in the clinic after she has seen the dietician
Explain to her the potential hazards of her current behaviour, give her appropriate self-help materials, and tell her that appropriate advice on further interventions will depend on how much progress she makes
Refer her, along with her mother, for family therapy, and arrange further follow-up in the clinic
Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy
Arrange to have her admitted to a specialist eating disorders unit
Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy
Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.
A 24 year old woman who is considerably handicapped by having to wash her hands repeatedly, in a particular way
A. Sertraline B. Procyclidine C. Temazepam D. Diazepam E. Haloperidol F. Doneprazil G. Olanzepine H. Acamprosate I. Methadone J. None of the above
Sertraline
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 23 year old man has been an inpatient under Section 3. Who is responsible for arranging the Care Programme Approach meeting?
A. Approved social worker B. Consultant psychiatrist C. General practitioner D. Nurse (based at mental health unit) E. Key worker F. Occupational therapist G. Patient advocate H. Community psychiatric nurse I. Music therapist J. Clinical psychologist
Key worker
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 23 year old man has been an inpatient under Section 3. Who is responsible for arranging the Care Programme Approach meeting?
A. Approved social worker B. Consultant psychiatrist C. General practitioner D. Nurse (based at mental health unit) E. Key worker F. Occupational therapist G. Patient advocate H. Community psychiatric nurse I. Music therapist J. Clinical psychologist
Key worker
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 17 year old man with severe learning disability shows repeated self-injurious behaviour, that has not responded to any pharmacological intervention
A. Approved social worker B. Consultant psychiatrist C. General practitioner D. Nurse (based at mental health unit) E. Key worker F. Occupational therapist G. Patient advocate H. Community psychiatric nurse I. Music therapist J. Clinical psychologist
Clinical psychologist.
Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.
A 20 year old woman is presents in the Accident and Emergency Department after an impulsive overdose of 10 aspirin tablets, taken during an argument with her mother. Assessment reveals no mental state abnormality, and no suicidal intent is elicited.
A. Approved social worker B. Consultant psychiatrist C. General practitioner D. Nurse (based at mental health unit) E. Key worker F. Occupational therapist G. Patient advocate H. Community psychiatric nurse I. Music therapist J. Clinical psychologist
GP
Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.
Needs clinical monitoring, particularly when treatment is first started, for extra-pyramidal effects
A. Diazepam B. Temazepam C. Olanzepine D. Lithium E. Procyclidine F. Clozapine G. Sertraline H. Amitryptyline I. Zolpidem J. Haloperidol
Haloperidol
Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.
A 36 year old unemployed single man who has been dependent on alcohol for some years presents in the Accident and Emergency Department having been hit by a car when he wandered into the road while drunk. He has undergone two previous detoxifications, but resumed drinking soon after each had ended. He is now asking for further treatment
A. Prescribe naloxone B. Prescribe acamprosate C. Recommend gradual reduction in amount of drug consumed D. Give intravenous vitamin B1 E. Outpatient detoxification F. Prescribe methadone G. Give intravenous flumazanil H. Inpatient detoxification
Inpatient detoxification
A 54 year old man sees his GP complaining of gradually worsening impotence over the last year. He is in debt and had found out 2 months ago that his wife was having an affair. He admitted to drinking up to 40 units of alcohol per week. His PMHx includes HTN, for which he is taking atenolol.
Most appropriate initial management
A Psychosexual counselling B Self-help exercises C Sildenafil D Stop atenolol and reduce alcohol consumption E Use of a vacuum constriction device.
Stop atenolol and reduce alcohol consumption
Psychosexual disorders are non-organic problems preventing an individual from participating in satisfactory sexual relationship. However, there is frequently a combination of physical and psychological factors contributing to the impairment of function. In this scenario, these include marital difficulties, financial strain, excessive alcohol use and prescription drugs (atenolol). Other drugs can cause erectile dysfunction including TCAs, BDZs, antihistamines, oestrogen, statins and anti-Parkinson medication.
Stopping atenolol and reducing alcohol consumption are sensible initial measures in this case. Appropriate investigation will depend on the history. Biological causes should be ruled out (e.g. neuropathy, ischaemic vascular dysfunction, HTN) and specialist referral may be needed. However, if psychological factors are involved, referral to a sexual and relationship clinic may be helpful. In cases of erectile failure, intracaversonal injection of papaverine or PGE1 can be used. Other physical treatments include vacuum device, nitrate creams and rod insertion!
On an MMSE which of the following scores is suggestive of cognitive impairment?
A
27 = normal
Echopraxia
Copying another’s movements, even when asked to stop.
Seen in schizophrenia along with ambitendency, mannerisms, stereotypies, negativism, posturing and waxy flexibility.
