Psych

Question 1

Risk assesment components

Answer 1

SAD PERSONS

Sex (male)
Age (older)
Depression
Previous attempts
Ethanol
Rational thinking loss
Social support lacking
Organised plan
No spouse
Sickness (chronic illness)

Question 2

Symptoms of mania

Answer 2

DIG FAST
Distractibility/irritability
Irresponsive or eratic behaviour
Grandiose delusions or delusions of persecution
Flight of ideas
Activity increased, inc libido + weight loss
Sleep decreased
Talkativeness / pressured speech

Question 3

Clang associations

Answer 3

Ideas related only by rhyme or being similar sounding e.g “my mini mouse might make me mumble”

Question 4

Echolalia

Answer 4

Patients repetition of words and phrases used by an interviewer

Question 5

When words are inappropriately substituted e.g “I baked the cake in the dustbin, then I put butter in the dog”

Answer 5

Semantic paraphrasia

Question 6

Word salad

Answer 6

Thought disorder characterised by nonsensical speech with random collection of words forming sentences why have some grammatical coherence and meaning but no significance e.g “Colourless green ideas sleep furiously’

Question 7

Tardive dyskinesia

Answer 7

A SE of antipsychotics after being on the drug for a long time.

Choreoathetoid movements, abnormal + involuntary movements e.g lip smacking.

Question 8

Hypochondriasis

Answer 8

Illness anxiety disorder - the persistent belief in the presence of an underlying serious disease

Question 9

Malingering

Answer 9

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gains e.g getting pain relief.

Question 10

Somatisation disorder

Answer 10

Persistent belief of multiple physical symptoms lasting at east 2 years despite being given reassurance + negative test results.

Different to hypochondriasis (as this is a belief in a serious disease e.g brain tumour - whereas somatisation is a group of Sx)

Question 11

Conversion disorder

Answer 11

Functional neurological symptoms e.g numbness, paralysis & seizures with no associated clear cause + can often be traced back to a psychological trigger

Question 12

Cirumstantiality

Answer 12

The inability to answer a question without giving excessive unnecessary detail

Question 13

Flight of ideas

Answer 13

A feature of mania - thought disorder where there a leaps fromone topic to another but with discernible links between them

Question 14

Knight’s move

Answer 14

A severe loosening of associations - where there are unexpected and illogical leaps from one idea to another.

= feature or schizophrenia

Question 15

Tangeatiality

Answer 15

Wandering from a topic without returning to it

Question 16

SSRI discontinuation symptoms

Answer 16

Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms e.g diarrhoea, vomitting, cramping
Paresthesia

*Paroxetine has higher incidence of discontinuation symptoms. When stopping SSRIs the dose should be gradually reduced over 4 weeks (not neccessary with fluoxetine)

Question 17

SSRI drug interactions

Answer 17

NSAIDs - make sure to co-prescribe PPI
Warfarin / Heparin
Aspirin
Triptans - inc risk of serotonin syndrome
MAOIs - inc risk of serotonin syndrome

Question 18

1st line treatment of PTSD

Answer 18

Trauma - focused CBT or EDMR (Eye movement desensitisation & reprocessing therapy)

Question 19

Zopiclone moa + SEs

Answer 19

GABA agonist

SE = agitation, constipation, hypotonia, dizziness, dry mouth, bitter taste in mouth & Inc risk of falls in the elderly

Question 20

Cotards syndrome

Answer 20

A nilhilistic delusion in which a pt believes they or part of them is dead or does not exist
- Associated with severe depression

Question 21

Extra-pyramidal side effects

Answer 21

Common SE of antipsychotics (mainly typical)
* Parkinsonism
* Acute dystonia - sustained muscle contraction - Torticolis + occulogyric crisis are the main ones
* Akathisia - restlessness
* Tardive dyskinesia - late onset SE usually occuring after months/years of treatment where choreoathetoid movements occur - commonly pouting of the mouth

Question 22

Neuroleptic malignant syndrome

Answer 22

Rare / life threatening SE often with new antipsychotic or a dose increase.
* Muscle stiffness + rigidity
* Autonomic disturbance e.g Fever, tachycardia, labile BP
* Altered conciousness

Bloods show raised creatinine and WCC

Question 23

Schneider’s 1st rank symptoms of schizophrenia

Answer 23

Primary delusions
Thought disorder (withdrawal, insertion, broadcasting)
Somatic passivity - *belief that your thoughts or feelings are being controlled by someone else *
Delusional perception
Auditory 3rd person hallucinations

Question 24

Features of refeeding syndrome

Answer 24

• Hypophosphatemia
• Hypokalemia
• Hypomagnesemia - can lead to torsades de pointes
• Abnormal fluid balance

Question 25

First line management of depression in children and adolescents

Answer 25

Fluoxetine SSRI

Question 25

First line management of depression in children and adolescents

Answer 25

Fluoxetine SSRI

Question 26

Management of tardive dyskinesia

Answer 26

Tetrabenazine

Question 27

Section 2 MHA

Answer 27

Assesment order
Detainment for up to 28 days for assesment.
Medication can be administered if observation of treatment response is needed for diagnosis.

Must be approved by 2 independent doctors (one of whom is a section 12 approved doctor) and 1 AMHP

Question 28

Section 3 MHA

Answer 28

Treatment order
Detainment for up to 6 months for treatment

Must be approved by 2 independent doctors (1 of whom is approved until section 12) and 1 AMHP. Diagnosis and Tx plan needed before section.

Can be renewed indefinitely if needed.

Question 29

Section 4 MHA

Answer 29

Emergency section
Detainment for 72 hours for emergency medical treatment.

Question 30

Section 5 (2)

Answer 30

Doctors holding power.
If voluntarily admitted to hospital, but change mind and wish to leave early, any doctor can hold them on the ward for up to 72hrs if of best interest

Question 31

Section 5 (4)

Answer 31

Nurses holding power. Allows 1st or 2nd level mental health nurse to hold on ward for up to 6 hours (if in best interests) for a 5(2) assesment

Question 32

Section 136

Answer 32

Allows a police officer to remove a person (whom they consider to be mentally disorganised) from a public place to a place of safety for further assesment for up to 72hours.

Question 33

Community treatment orders

Answer 33

Any patient with community treatment order can be returned to hospital against their free will if they fail to comply with a treatment regime in the community.
(i.e power to monitor Tx compliance, not a power to give Tx against will).

Question 34

Section 17

Answer 34

Gives a responsible clinician the power to grant patients leave for specified periods of time

Question 35

Section 117

Answer 35

Health authorities and local authorities have a legal duty to provide free after care indefinetlye for anyone who has previously been detaned under section 3, 37, 47 or 48

Question 36

Section 35, 36, 37

Answer 36

Similar to section 2 & 3 but requires approval from the crown court and is applied to those acused of a crime.