Psych

Question 1

Lithium

Answer 1

Indication - bipolar
Swallow with water, usually nightly
Same time every day, no stopping
If missed no double dose
Bloods 12 hours post dose week > monthly > 3 monthly
6 monthly TFTs, U&Es, calcium
Increased thirst, urine, fatigue, weight gain, fine tremor
A&E if confused, drowsy, vision, seizure
Contraception

Question 2

Schizophrenia

Answer 2

affects thoughts, perception, affect
positive and negative symptoms
bloods, urine culture, drug screen, HIV/ syphillis, lipids, ?CT head
MDT approach - EIS, community, crisis
care programme approach
Treated with antipsychotics

Question 3

Dementia

Answer 3

Progressive - Alzheimer’s, stepwise - vasc, hallucinate - Lewy, irritable - front
Patient education, home safety eval, ?ACE inhibitors - donepezil, rivastigmine ?NMDA receptor antag - memantine

Question 4

SNRI

Answer 4

Contraindication - uncontrolled blood pressure
SE - sleepiness, nausea, abdo pain, palpitations, tingling/numbness, agitation, rash
has withdrawal effects
taken once daily
serotonin syndrome

Question 5

SSRI

Answer 5

Benefit after 4-6 weeks
Usually tablet OD PO
SE - nausea, bowels, agitation, headache, dizziness, sexual dysfunction
Serious - hyponatremia, suicidal ideation
Follow up 1 week, then 4-6 weeks
Withdrawal - flu, GI, anxious, dizzy

Question 6

Olanzapine

Answer 6

Weight gain, increased appetite, sedation

Question 7

Clozapine

Answer 7

agranulocytosis + leukopenia
hypersalivation, tachy, hypotension
WBC weekly for 18 weeks then fortnightly for a year then monthly

Question 8

Anorexia

Answer 8

Fear of gaining weight
Distorted body image
Calorie restriction
Amenorrhoea
Manage - structured eating plan + psychotherapy if stable, else admit

Question 9

Anticholinergic side effects

Answer 9

Dilated pupils, dry mouth, blurred vision, flushed skin, urinary retention, constipation (antipsychotics)

Question 10

Extrapyramidal side effects

Answer 10

Acute dystonia
Akathisia
Parkinsonism
Tardative dyskinesia
Rarer in 2nd gen antipsychotics