Psych

Question 1

Management of PTSD

Answer 1

BIO

1. SSRI - Sertaline or SNRI
2. Atypicall antipsychotics

PSYCHO

1. Trauma-based CBT (will need to touch on trauma briefly)
2. EMDR

SOCIAL
support groups, help with work/sick leave

Question 2

Diagnosis of PTSD

Answer 2

> 1 month after event, within 6m

1. rexperiencing
2. avoidance of trigger
3. hyperarousal

Other
Sleeping difficultly, emotional numbing, anxiety symptoms, depressive symptoms

Question 3

Definition of alcoholism/dependence

Answer 3

3+ in the last month of:

1. tolerance
2. craving
3. withdrawal symptoms
4. out of control use
   contiune despite harm
5. neglecting other aspects of life addiction
6. returning to the saame place
7. same substance/drink

Question 4

Outline the process of community based alcohol withdrawal

Answer 4

Used when pt drinks 15+ units/day or scores 20+ on AUDIT

ACUTE:
Oral chlordiazapoxide +/- IV pabrinex on a reducing dose
2-4 meetings per week for 3w

CHRONIC:
1. acamprostate/naltrexone
2. Difulsuram
Individualised intervention plan

Question 5

How would you manage a learning disability?

Answer 5

MDT
Psychiatrist, OT, SALT, specialaist nurse, educational support, social worker involvement

BIO:
Treat co-morbid medical/psych problems
Melatonin for sleep
Antipsychotics if challenging behaviour (rispiridone)

PSYCHO:
CBT, family therapy, psychodynamic therapy, art therapy if talking is difficult

SOCIAL:
Education
Finanial support/benefits/carer
SCOPE disability charity

Question 6

Outline the process of inpatient alcohol withdrawal

Answer 6

Used when pt drinks 30+ units/day or 30+ on SADQ score, PMHx of epilepsy, DT,

ACUTE:
Oral lorazepam +/- pabrinex rapid reducing dose

CHRONIC:
1. acamprostate/naltrexone
2. Difulsuram
Individualised intervention plan

Question 7

How would you investigate/diagnose autism?

Answer 7

ADI-R = autism diagnostic inventory
ADOS = autism diagnostic observatory schedule

WISC-V cognitive assessment
SALT and hearing assessment

Question 8

Management of Autism

Answer 8

1. psychosocial play-based therapy with play specialist

Challenging behviours:

1. psychosocial assessment - also investigate for co-existing mental health or physical disorders
2. Pharm: APs, melatonin, methylphenidate, SSRI

Question 9

Diagnostic Criteria for schizophrenia

Answer 9

1m+ of:

1+ schneiders 1st rank sx
OR

2+ paranoia/hebephrenic (disorganised mood and speech)/catatonic/negative sx (simple - these are also the subtypes)
AND
present most of the time 
AND
not caused by substance/organic source

Question 10

Describe the progression of schizophrenia

Answer 10

1. prodrome/at risk mental state - negative sx dominant
2. acute pphase - positive sx dominant
3. chronic phase - negative dominant

Question 11

What are the risk factors for schizophrenia

Answer 11

1st degree relative, 50% concordance in MC twins
substance abuse
ethnic miniority
low premorbid IQ
adverse life experiences

Question 12

How would you manage schizophrenia?

Answer 12

URGENT:
crisis resolution team and home treatment time

NON-URGENT but still an EMERGENCY: Early intervention in psychosis team (psychosis is dangerous, esp if untreated for >3m)
Rapid Tranquilisation = Oral –> IM Lorazepam, Haliperidol/lorazepam

BIO
1. 6w atypical AP - aripip/quietapine (weaker, fewer SE), olanzapine/rispiridone (stronger, weight gain, SE)
augment with BDZ or mood stabaliser is ?schzoaffective
2. 2w Typical AP
3. clozapine

PSYCHO

1. CBT - 16 sessions, testing reality
2. Family therapy

SOCIAL
Risk aassessment
housing, benefits, work, education

Question 13

Define Schizoaffective disorder

Answer 13

affective + psychotic sx equally prpesent

Manic:
Mania + schiz

Depressive:
depression + schiz

1 episode of psychosis lasting >2w without mood disorder
AND
1 episode psychosis with obvious mood overlap

Question 14

Risk factors for Panic Disorder?

Answer 14

Aged 20-30m 
Female
White
Positive family history
Major life stressors/ history of recent trauma
Comorbid disorders
Asthma/ respiratory variability
Cigarette smoking/caffeine use

Question 15

What are some organic causes of Panic disorder?

Answer 15

Hyperthyroidism → TFTs
Too much caffeine → history
Alcohol → LFTs/gGT/MCV
Drugs → UDS
Arrhythmia → ECG/ 24 hour ECG
Hypoglycemia → glucose (while anxious)
Pheochromocytoma → 24 hour urine VMA

Question 16

How would you manage an acute panic attack?

Answer 16

Reassurance that the symptoms are not dangerous and attack will subside (never really more than 30 mins)
Advise on slowing breathing
Quiet side room and support from significant other
MAY use benzodiazepines in ED to terminate attack

Question 17

Management of a panic attack

Answer 17

BIO

1. SSRI - fluoxetine
2. TCAs

PSYCHO
low intensity CBT and self-help

SOCIAL
Management of triggers e.g. recent family something,

Question 18

Management of a panic attack

Answer 18

BIO
1. SSRI - fluoxetine
2. TCAs
NO Benzos, APs or sedating anti-histamines

PSYCHO
low intensity CBT and self-help

SOCIAL
Management of triggers e.g. recent family something,

Question 19

Management of a panic attack

Answer 19

Reassure and self help first of all

BIO
1. SSRI - citalopram
2. TCAs after 12w
NO Benzos, APs or sedating anti-histamines

PSYCHO

1. low intensity self-help
2. high intensity CBT

SOCIAL
Management of triggers e.g. recent family something,

Question 20

What is the diagnostic criteria of a panic disorder?

Answer 20

Recurrent episodes of severe panic lasting <30mins
Several episodes within a month
Minimal anxiety between episodes, no concurrent mood disorder

Question 21

Diagnosic criteria for GAD

Answer 21

3+ of the following sx for >6m:

Restlessness/nervousness	
Being easily fatigued		
Poor concentration	
Irritability			
Muscle tension			
Sleep disturbance

Question 22

What are the cut of values for the GAD-7 and PHQ-9 questionairres for anxiety and depression?

Answer 22

Mild = >5
Moderate = >10
Severe = >15