Psych

Question 1

How do you manage neuroleptic malignant syndrome?

Answer 1

Stop antipsychotic
Bromocriptine

Question 2

What is the classic quadrate of post-traumatic stress disorder?

Answer 2

Reliving the situation
Avoidance
Hyperarousal
Emotional numbing
(prescent for > 1month)

Question 3

How do you treat PTSD?

Answer 3

Trauma-focused CBT and/or Eye movement desensitization and reprocessing (in severe cases)
SSRI’s (2nd line)

Question 4

What are Schneider’s first rank symptoms of schizophrenia?

Answer 4

Thought disorders
Delusional perceptions
Passivity
3rd person auditory hallucinations

Question 5

What are the two pathways in the brain that relate to the symptoms of schizophrenia?

Answer 5

Mesolimbic - ↑dopamine causes positive symptoms
Mesocortical - ↓dopamine causes negative, cognitive and affective symptoms

Question 6

What are the two pathways in the brain that relate to the side effects of antipsychotics?

Answer 6

Nigrostriatal - ↓ dopamine causes EPS & tardive dyskinesia
Tuberinfundibulum - ↓ dopamine causes hyperprolactinaemia

Question 7

What are three examples of atypical (second-generation) antipsychotics?

Answer 7

Clozapine
Risperidone
Olanzapine

Question 8

What are two examples of typical (first-generation) antipsychotics?

Answer 8

Haloperidol
Chlopromazine

Question 9

How should lithium be monitored?

Answer 9

Sample should be taken 12 hours post-dose
After starting lithium levels should be checked weekly & after dose changes
Then when stable 3 monthly
TFT & U&E 6 monthly

Question 10

What are some possible causes of lithium toxicity?

Answer 10

dehydration
renal failure
drugs: diuretics, ACE inhibitors/angiotensin II receptor blockers, NSAIDs & metronidazole.

Question 11

Above what level is considered lithium toxicity?

Answer 11

Lithium toxicity = concentrations > 1.5 mmol/L.

Question 12

What are the symptoms of lithium toxicity?

Answer 12

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

Question 13

What are some of the common side-effects of lithium?

Answer 13

fine tremor
nephrotoxicity
hypothyroidism or hyperparathyroidism
weight gain & IIH

Question 14

What are the medication options for mood stabilisers in bipolar disorder?

Answer 14

1st line is Lithium
2nd line is Sodium Valproate, Olanzapine or Quetiapine

Question 15

What are the differences between grief and pathological grief?

Answer 15

Pathological < 12 months
Wants to die not just to be with loved one
Functional impairment

Question 16

What questionnaire can be used in eating disorders?

Answer 16

SCOFF questionnaire

Question 17

What are the features of neuroleptic malignant syndrome?

Answer 17

pyrexia
muscle rigidity
autonomic lability (hypertension, tachycardia & tachypnoea)
agitated delirium with confusion

Question 18

What is neuroleptic malignant syndrome?

Answer 18

Condition seen in patients taking antipsychotic medication. It occurs within hours to days of starting an antipsychotic

Question 19

What are the features of serotonin syndrome?

Answer 19

hyperreflexia
myoclonus
rigidity
autonomic excitation - (sweating & hyperthermia)
confusion

Question 20

What are the common causes of serotonin syndrome?

Answer 20

monoamine oxidase inhibitors
SSRIs
(if St John’s Wort or tramadol is taken in addition to SSRI’s it may cause it)
ecstasy
amphetamines

Question 21

How do you manage serotonin syndrome?

Answer 21

Supportive including IV fluids
Benzodiazepines
More severe cases - serotonin antagonists such as cyproheptadine & chlorpromazine

Question 22

What are the common side effects of tricyclic antidepressants?

Answer 22

drowsiness
dry mouth
blurred vision
constipation
urinary retention

Question 23

How do you treat acute stress disorder?

Answer 23

trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
benzodiazepines

Question 24

What is acute stress disorder?

Answer 24

Acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event

Question 25

How do you manage alcohol detox?

Answer 25

Long acting benzodiazepine - Chlordiazepoxide

Question 26

How do you treat delirium tremens?

Answer 26

IV Pabrinex and high dose Benzodiazepine.

Question 27

What blood test results would you expect to find in neuroleptic malignant syndrome?

Answer 27

↑ CK (creatine kinase) ↑ white cell count Deranged LFT’s Acute renal failure → abnormal U&E’s Metabolic acidosis

Question 28

What are the features of schizoid personality disorder?

Answer 28

Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions

Question 29

What are the features of schizotypal personality disorder?

Answer 29

Odd beliefs and magical thinking Odd, eccentric behaviour Ideas of reference

Question 30

What are the features of histrionic personality disorder?

Answer 30

Promiscuous Centre of attention Shallow & emotional

Question 31

What are the features of borderline personality disorder?

Answer 31

Unstable relationships Impulsive, self-harms, attention-seeking behaviour

Question 32

What electrolyte imbalances present in refeeding syndrome?

Answer 32

Hypomagnesaemia, hypokalaemia and hypophosphataemia

Question 33

What is used to treat ADHD and what contraindications are there?

Answer 33

Methylphenidate > 5yrs Cardiotoxic

Question 34

What are there features of anorexia nervosa?

Answer 34

High cortisol, amenorrhea, lanugo hair, low T3 levels

Question 35

What do PHQ scores indicate?

Answer 35

5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe

Question 36

What is the difference between mania and hypomania?

Answer 36

Mania - prolonged time course (longer than 7-10 days) and the presence of psychotic symptoms

Question 37

What is section 136 used for?

Answer 37

Someone found in a public place with a mental disorder can be taken by the police to a Place of Safety

Question 38

Which SSRI should be used for children under 18?

Answer 38

Fluoxetine

Question 39

How should you manage acute dystonia secondary to antipsychotics?

Answer 39

procyclidine

Question 40

Which antipsychotic had the best side-effect profile?

Answer 40

Aripiprazole

Question 41

How do you treat borderline personality disorder?

Answer 41

Dialectical behavioural therapy

Question 42

What is the difference between PTSD and Acute stress disorder?

Answer 42

Acute stress disorder = occurs in the 4 weeks after a traumatic event PTSD = diagnosed after 4 weeks

Question 43

How do you manage mania/hypomania?

Answer 43

1. stop antidepressant if the patient takes one 2. antipsychotic therapy e.g. olanzapine or haloperidol

Question 44

What are two examples of SNRIs?

Answer 44

venlafaxine and duloxetine

Question 45

What medication can be used to treat Akathisia (restlessness)?

Answer 45

Propanolol

Question 46

What medication can be used to treat tardive dyskinesia?

Answer 46

Tetrabenazine

Question 47

What is Orthello