Psych Flashcards
A 22-year-old woman recently commenced on an antipsychotic who is pacing her bedroom and says she feels very restless.
Best Management of antipsychotic-induced extrapryamidal side-effects A. Intramuscular procyclidine B. Oral procyclidine C. Propranolol D. Stop anticholinergics E. Oral olanzapine F. Intramuscular haloperidol G. Rescuscitation H. Baclofen I. Dantrolene J. Quinine
C – Propranolol. This woman is probably experiencing akathisia. This is hard to treat but propranolol or benzodiazepines can help. See Fig. 2.10. Ideally the dose of antipsychotic is reduced. Quinine can be used for restless leg syndrome when in bed. The differential includes agitation secondary to psychosis.
A 22-year-old woman recently commenced on an antipsychotic who is staring at the ceiling and has her jaw clenched tight.
Best Management of antipsychotic-induced extrapryamidal side-effects A. Intramuscular procyclidine B. Oral procyclidine C. Propranolol D. Stop anticholinergics E. Oral olanzapine F. Intramuscular haloperidol G. Rescuscitation H. Baclofen I. Dantrolene J. Quinine
F – Intramuscular procyclidine. This woman is experiencing a dystonia with an oculogyric crisis and trismus. Her clenched jaw means oral procyclidine is not possible. Baclofen and dantrolene are for chronic spasticity.
A 22-year-old woman recently commenced on an antipsychotic who is collapsed in her bedroom with a fast pulse, low blood pressure, reduced consciousness level and stiff limbs.
Best Management of antipsychotic-induced extrapryamidal side-effects A. Intramuscular procyclidine B. Oral procyclidine C. Propranolol D. Stop anticholinergics E. Oral olanzapine F. Intramuscular haloperidol G. Rescuscitation H. Baclofen I. Dantrolene J. Quinine
G – Rescuscitation. This woman is acutely unwell. She needs ABC and probably a peri-arrest call/999 ambulance. She may have neuroleptic malignant syndrome, or a range of other differentials (e.g. meningitis, substance intoxication). Dantrolene is not an emergency treatment and is not indicated until the diagnosis is clearer.
A 26-year-old man who commenced antipsychotics a month ago. His face shows little expression and he does not swing his arms when he walks. He does not have a tremor and his gait is not shuffling.
Best Management of antipsychotic-induced extrapryamidal side-effects A. Intramuscular procyclidine B. Oral procyclidine C. Propranolol D. Stop anticholinergics E. Oral olanzapine F. Intramuscular haloperidol G. Rescuscitation H. Baclofen I. Dantrolene J. Quinine
B – Oral procyclidine. This man has drug-induced parkinsonism. In the early stages the features are different to idiopathic parkinsonism. Anticholinergics can help but ideally the dose of antipsychotic would be reduced or an alternative antipsychotic trialled.
A 34-year-old man who has been on antipsychotics and regular procyclidine for over a decade. He makes frequent darting movements with his tongue but seems unaware of this.
Best Management of antipsychotic-induced extrapryamidal side-effects A. Intramuscular procyclidine B. Oral procyclidine C. Propranolol D. Stop anticholinergics E. Oral olanzapine F. Intramuscular haloperidol G. Rescuscitation H. Baclofen I. Dantrolene J. Quinine
D – Stop anticholinergics. This man has tardive dyskinesia. This is hard to treat but stopping anticholinergics (in this case procyclidine) and reducing or withdrawing antipsychotics if possible can help.
A 32-year-old woman, who has previously been very punctual, has arrived late and slightly inebriated for the past six sessions since the therapist was on leave.
Select the most appropriate descriptor: A. Acting out B. Projective identification C. Hypnosis D. Catharsis E. Parapraxis F. Transference G. Rationalization H. Countertransference I. Dream interpretation J. Working through
A – This is an example of acting out: behaving in a certain way in order to express thoughts or feelings that the person feels otherwise incapable of expressing.
The therapist of a 59-year-old man realizes that he has been talking to him as if he were a father figure.
Select the most appropriate descriptor: A. Acting out B. Projective identification C. Hypnosis D. Catharsis E. Parapraxis F. Transference G. Rationalization H. Countertransference I. Dream interpretation J. Working through
H – Countertransference is the process whereby the therapist unconsciously interacts with the patient as if they were a significant figure from the patient’s past.
A 43-year-old man feels better after his first psychotherapy session, because he has ‘got it off his chest’.
Select the most appropriate descriptor: A. Acting out B. Projective identification C. Hypnosis D. Catharsis E. Parapraxis F. Transference G. Rationalization H. Countertransference I. Dream interpretation J. Working through
D – Catharsis is a Greek word meaning ‘cleansing’ or ‘purging’. It is often used to describe a feeling of relief after an outpouring of emotive material.
A 21-year-old says ‘I’m glad we’re almost finished’. She intended to say ‘I’m sad we’re almost finished’.
Select the most appropriate descriptor: A. Acting out B. Projective identification C. Hypnosis D. Catharsis E. Parapraxis F. Transference G. Rationalization H. Countertransference I. Dream interpretation J. Working through
E – Parapraxis is a term used to describe an error of memory, speech, writing, reading or action that may be due to the interference of repressed thoughts and unconscious features of the individual’s personality. It is referred to in common culture as a ‘slip of the tongue’ or a ‘Freudian slip’.
A 29-year-old man has been avoiding his psychotherapist for the past few weeks following what he considered to be a ‘clash of personalities’. He decided to return and is keen to uncover his unconscious reasons behind this.
Select the most appropriate descriptor: A. Acting out B. Projective identification C. Hypnosis D. Catharsis E. Parapraxis F. Transference G. Rationalization H. Countertransference I. Dream interpretation J. Working through
J – Working through describes the concept of working over one’s emotional difficulties from the past. In psychotherapy, it usually follows an ‘impasse’, which can be thought of as a therapeutic stalemate.
A 23-year-old man has recovered from his second episode of schizophrenia. Six months after discharge from inpatient care, he is symptom-free, and insists on stopping all his antipsychotic medication. He lives with his parents in what the clinical team have judged to be a high expressed emotion household. If he goes ahead and stops his medication, what is the probability that he will experience a relapse within nine months?
1% 5% 20% 50% 80%
80%
While giving his past psychiatric history, a 45-year-old man says that he was treated for depression in the past with medication. He cannot remember the name of the medication, but said that he recalls that when he started taking it, he experienced gastrointestinal discomfort. Also, he started taking it at night but had to switch to taking it in the morning because taking it at night disturbed his sleep even more than the depression itself had done. Which of the following medications is most likely to be the one he was taking?
Amitriptyline Mirtazapine Citalopram Zolpidem Olanzapine
Citalopram
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 general practitioner refers a 20-year old woman for specialist assessment, stating that she has a phobia. Which of the following features is most likely to indicate a diagnosis of social phobia as opposed to agoraphobia
History of fear of the dark in childhood Fear of standing in supermarket queues Fear of travelling on the underground Correct Fear of blushing in public Palpitations and sweating accompanying episodes of fear
Fear of blushing in public
A 15-year old girl is brought to her general practitioner by her mother, who suspects that her daughter has an eating disorder. Which of the following features makes it more likely that the daughters diagnosis is bulimia, as opposed to anorexia?
A body-mass index of 18
Visiting the gym daily for a vigorous workout
Making herself vomit after meals
Having very detailed knowledge of the calorific values of different foods
Being very self-conscious about her weight and appearance
A body-mass index of 18
A 22-year old man presents to his general practitioner with a history of gradually increasing concern about contamination. He worries for much of the day that he has become infected by bacteria, and reports that he has to wash his hands thoroughly whenever he touches objects that he thinks are dusty. He has a particular routine that he must follow when washing his hands and if this routine is interrupted, he must begin the routine again. What term best describes his hand-washing specifically?
Obsession Compulsion Delusion Overvalued idea Stereotypy
Correct Compulsion
An 18-year old girl presents in the Accident and Emergency Department following an overdose of aspirin tablets. It appears that this was an impulsive gesture, in front of her boyfriend, during the course of an argument. She and her boyfriend had been drinking, but on examination, she did not appear intoxicated. Examination revealed no specific mental state abnormalities, and she denied wanting to kill herself. Statistically, what is the probability that she will present again with another episode of self-harm within the next 12 months?
50% 20% 5% 1% 0.1%
20%
A 22-year old man comes to the local general practice, asking to be signed on as a temporary patient. The circumstances of his presentation make the doctor suspect that the patient is abusing drugs. As he comes into the consulting room, the doctor notices that he seems to be sweating, has a runny nose and dilated pupils. Such symptoms are associated with withdrawal from one of the following drugs. Which one?
A history of adult-onset diabetes
A history of step-wise decline in her cognitive state
A history of a gradual decline in her cognitive state
The fact that her daughter-in-law first noticed her cognitive impairment a few months previously, when she was already 82 years old
The absence of any family history of cerebrovascular disease
A history of a gradual decline in her cognitive state
You are a medical house officer, asked to assess a 76-year old man, recently admitted to the medical ward because he had become cachectic, presumably because he was neglecting himself. His mental state fluctuates markedly. At times, he appears lucid, while at other times he is very distressed and appears to be responding to auditory and visual hallucinations. During his lucid times, he can find his way without difficulty to the toilet and back to his bed. When he is distressed, he easily gets lost on his way to or from the toilet. What should be the main focus of his management?
Start treatment with olanzepine, titrating dose against the effect on his mental state
Start treatment with diazepam, titrating dose against the effect on his mental state
Transfer him immediately to an old age psychiatry unit, where staff are trained to make specialist mental state assessments
Move him to a bed which is closer to the toilet
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
Conduct a thorough physical examination and investigations to identify an underlying organic cause for the presentation
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
A 45-year old man is brought to Accident and Emergency, having collapsed in a local pub. The ambulance crew state that others in the pub said the man had been drinking heavily, on his own, for some hours, and then had what appears to have been a fit. When you assess him once he has sobered up, he reports that his wife and children left him two weeks earlier, and that he lost his job six months ago because of his drinking. He admits that he has to have a large tot of whisky each morning before he gets out of bed. He has undergone a detoxification regime twice before, once with his general practitioner and once with a specialist alcoholism service. On both occasions, he started drinking again within three weeks of ending the regime. Initial investigations include a raised mean corpuscular volume. What is the most appropriate immediate management plan?
Counsel him about his excessive drinking and discharge him to be followed up by his general practitioner
Admit him for medical observation and then treat him symptomatically
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
Refer him to the local substance misuse service, asking for an urgent assessment
Refer him to the local inpatient psychiatric unit for admission
Admit him for medical observation, starting him on a descending regime of chlordiazepoxide, plus vitamin B1
A 20-year old man has just been discharged from inpatient psychiatric care. He has a definitive diagnosis of schizophrenia. There were no conspicuous precipitating factors apart from stress from his work at university. In particular, he has never taken illicit drugs, and there is no family history of psychosis. He has a non-identical twin brother. What is the lifetime risk of his twin developing schizophrenia?
80% 50% 10% 5% 1%
10%
Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?
1% 5% 10% 25% 60%
25%
A 16-year old boy is referred to Child and Adolescent Mental Health Services. His parents describe a 4-month history of increasingly bizarre behaviour, disorganised speech, and incongruent affect. On direct questioning, the boy himself admits to hearing voices, and also expresses delusional beliefs. He is diagnosed as having a psychotic episode. What is the overall probability that he will recover fully from this episode and experience no further relapses of psychosis?
80% 50% 20% 10% 1%
20%
A 20-year old man has been referred by his general practitioner for specialist mental health assessment. He says that people are talking about him all the time, especially when he turns on the television. He believes that the flight path of aircraft have been specially changed so that they fly over his home, and interfere with his brain waves. He complains that he cannot sleep at night because people come into his flat and talk incessantly. He admits that everything that is happening to him is making him feel depressed. The psychiatrist makes a working diagnosis, and prescribes some medication. Which medication would be most appropriate in these circumstances?
Diazepam Temazepam Fluoxetine Chlorpromazine Olanzepine
Olanzepine
Published research evidence supports the effectiveness of a number of interventions in bulimia nervosa. Which of the following interventions has to date not been supported by robust research evidence?
Fluoxetine (high dose) Cognitive-behaviour therapy Interpersonal therapy Psychoanalytic psychotherapy Self-help materials based on the cognitive model
Psychoanalytic psychotherapy
An 18-year old woman presents in Accident and Emergency having taken an overdose of aspirin tablets. Which of the factors below indicate a particularly increased risk of a further overdose in the future?
That the patient is female rather than male
That the patient binge-drinks alcohol, and the overdose was taken while intoxicated
That she was seen in A&E following another overdose a few months previously
That she lives in a chaotic and dysfunctional household
That the patient is 18 years old
That she was seen in A&E following another overdose a few months previously
Under the Mental Health Act (1983), who can make an application to have a patient admitted to an inpatient psychiatric unit under Section 2 or 3?
The patient’s own general practitioner
The patient’s psychiatrist
The managers of the unit to which the patient is to be admitted
Any doctor who is fully registered with the GMC
An Approved Social Worker
An Approved Social Worker
You are a general practitioner, asked to see an 8-year old boy by his mother, because he has been bed-wetting. Examining the child, you notice several bruises, at different stages of resolution, on the boys arms, and a burn mark on his back, the size of which is consistent with being burned by a lighted cigarette. The mothers explanation for these injuries appears implausible, and you suspect that the boy is being abused. What do you do?
Report your concerns to the police
Report your concerns to the local Primary Care Trust
Report your concerns to Social Services
Organise an urgent child protection case conference
Contact your local Child and Adolescent Mental Health Service (CAMHS) to discuss what best to do
Report your concerns to Social Services
A 23-year old woman presents in the Accident and Emergency Department with what appears to acute appendicitis, and a decision is taken to recommend appendectomy. She is accompanied by her mother, who says that her daughter has a learning disability. Although the daughter now lives independently, she attended a special school because of her learning difficulties. The mother does not think that her daughter will understand the need for surgery. What would be the most appropriate course of action?
Do not proceed with surgery, but manage the patient conservatively until the diagnosis and required treatment are more certain
Ask the patient’s mother to sign the consent form on behalf of the patient
Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
Go ahead with the appendectomy without the patient’s informed consent, under Common Law, on the grounds that it is urgently necessary
Contact the Trust solicitors immediately, giving details of the case, and asking them to arrange an urgent hearing before a judge to get permission to carry out the appendectomy
Explain to the patient what is considered to be the problem, and the need for surgery, to ascertain whether she can give informed consent
A care home for the elderly contacts you as the local general practitioner to see an 86-year old widow who was previously frail but otherwise quite well, but now presents with a 3-day history of confusion. Talking with staff, you learn that she sometimes cannot find her way to the dining room, or back to her own room, and sometimes appears to mis-recognise people she has known for a long time. However, at other times, she appears to be her normal self. The home is finding her behaviour increasingly difficult to cope with. What would be your most appropriate initial response to this situation?
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient’s presentation
Arrange for the practice nurse to visit regularly, to build up a more detailed picture of the presenting problems
Ask for a domiciliary visit by the local psychiatry for the elderly team
Arrange for her to be transferred to a nursing home, where staff are better able to manage her current behaviour
Send her to the local Accident and Emergency Department, so that she can be thoroughly examined and investigated, and admitted if necessary
Carry out a physical examination, blood tests and urine screen to try to identify a physical cause for the patient’s presentation
A 38-year old man comes to see you, his general practitioner, because of persistent gastrointestinal pains. You think his symptoms are likely to be due to a gastric ulcer. You elicit a history of binge-drinking with friends in the local pub at weekends, but the patient insists that he drinks only two cans of lager each evening during the week. He denies having to drink first thing in the mornings, or experiencing craving to drink during weekdays. What would be your most appropriate response to the psychiatric component of this history?
Refer him to the local specialist substance misuse service for further assessment and counselling
Recommend that he starts attending the local branch of Alcoholics Anonymous
Tell him that because he is probably showing the first indications of physical damage due to alcohol, he must now abstain from alcohol
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
Tell him that because he is probably showing the first indications of physical damage due to alcohol, he must now abstain from alcohol, and prescribe a descending-dose regime of chlordiazepoxide
Counsel him about the harmful effects of drinking alcohol, and about safe limits of alcohol intake
You are asked, as a house officer, to assess a man in his 50s who has recently been admitted to an acute medical ward from the Accident and Emergency Department. Nursing staff are concerned that he appears to be disoriented. On examination, you note that, amongst other signs, he has a horizontal nystagmus, and some difficulties in heel-toe walking. What is the most likely diagnosis?
Wernicke's encephalopathy Korsakoff's syndrome Post-ictal state following a temporal lobe epileptic seizure Cerebellar degeneration Vitamin B12 deficiency
Wernicke’s encephalopathy
A 26-year old woman on antidepressant prophylaxis following successful treatment of a first episode of depression six months previously, presents at a follow-up appointment at the local community mental health team with a two-week history of expansive mood and great confidence, feeling on top of the world, having boundless energy, and requiring hardly any sleep. What would be the most appropriate immediate intervention?
Leave her antidepressant medication unchanged and ask her to return again for review in two days’ time
Leave her antidepressant medication unchanged, and prescribe temazepam to help her sleep
Leave her antidepressant medication unchanged, and start her on a moderate dose of olanzepine daily
Leave her antidepressant medication unchanged, and start her on lithium carbonate
Discontinue her antidepressant medication, and start her on lithium carbonate
Discontinue her antidepressant medication, and start her on lithium carbonate
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 42-year old man with a 25-year history of schizophrenia has been on regular monthly injections for approximately 18 years. This medication regime has been kept unchanged, because his mental state has been stable, and he has not had any positive symptoms of schizophrenia. The community mental health team consider that he would probably take oral medication as directed, but he has preferred to remain in the injections. However, he now presents with repetitive involuntary movements of his mouth and tongue, which have become progressively worse over the past two months or so. What would be the most appropriate intervention?
Discontinue the depot antipsychotic medication and start him on oral olanzepine
Discontinue the depot antipsychotic medication and start him on oral olanzepine plus procyclidine
Keep him on the same depot injection regime, but in addition ask him to take procyclidine regularly
Keep him on the same depot injection regime, but in addition ask him to take propranolol regularly
Increase the frequency of his depot antipsychotic medication injections
Discontinue the depot antipsychotic medication and start him on oral olanzepine
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
A 19-year old woman is on the post-natal unit, having given birth to her first baby (at term) three days earlier. There were no complications during pregnancy or labour, but the baby is not feeding well (breast-feeding proved very difficult, and the baby is now being fed by bottle). During antenatal care, she told the midwives that her father told her that her own mother was never quite the same after giving birth to her (she is an only child). Three days after delivery, the woman tells the midwife that she is very worried that there is something seriously wrong with the baby, and over the next 24 hours, she is constantly seeking reassurance that the baby is alive and well. She is very tearful, and her mood appears to fluctuate considerably. When her partner visits, she snaps at him. Which of the statements below most accurately describes this presentation?
Such a presentation is common among women who have just had their first baby, and does not warrant further specific intervention
The patient is likely to have ‘the baby blues’, should be reassured and the clinical picture monitored over time
The patient is likely to have ‘the baby blues’, but given that she is bottle-feeding, she should be started on prophylactic fluoxetine because of the strong likelihood that this will otherwise develop into post-natal depression
The patient is likely to have post-natal depression and should be commenced immediately on fluoxetine
Because of the time of onset after labour, this is likely to be a prodromal presentation of a post-natal psychosis, and the patient should be started on a small dose of olanzepine
The patient is likely to have ‘the baby blues’, should be reassured and the clinical picture monitored over time
A 45 year old man seeks help from his general practitioner. He has never had paid employment but, having left school, devoted himself to looking after his widowed mother who had severe arthritis and was virtually housebound. She died 6 months ago, and he now feels that his life is empty. He thinks about his mother a great deal, and feels guilty that he could not do more to help her in the months before her death. On further questioning, he admits that he has felt this emptiness since childhood, and has never made friends, but has always been a loner. Which of the details below suggest that he has a personality disorder?
The fact that the patient is male
His comment that his feelings of emptiness have been with him since childhood
The fact that he devoted himself to looking after his mother
His comment that he feels guilty about how he cared for his mother
The fact that he has never had paid employment
His comment that his feelings of emptiness have been with him since childhood
A 67 year old man is visited at home by his GP who finds him in squalor, grossly self neglected and expressing ideas that his heart is ‘rotten’ and he believes he is guilty of genocide by causing crops to fail in Africa.
Diagnosis:
A. Grief reaction
B. Hebephrenic schizophrenia
C. Depression with psychotic features
D. Paranoid schizophrenia
E. Depression without psychotic features
F. None of the above
G. Schizophrenia with mainly negative symptoms
H. Mania/hypomania
I. Acute organic brain syndrome (delirium)
J. Mental state shows no specific abnormality
Depression with psychotic features
A 25 year old man says his thoughts are being controlled and that people are reading his thoughts. For the past 2 weeks he has been convinced of a conspiracy against him by his previous employer and he feels certain there are messaged from this person in the newspaper headlines.
Diagnosis:
A. Grief reaction
B. Hebephrenic schizophrenia
C. Depression with psychotic features
D. Paranoid schizophrenia
E. Depression without psychotic features
F. None of the above
G. Schizophrenia with mainly negative symptoms
H. Mania/hypomania
I. Acute organic brain syndrome (delirium)
J. Mental state shows no specific abnormality
Paranoid schizophrenia
A 32 year old man talking quickly with lots of ideas that are difficult to follow. He expresses ideas that he has special powers and can control the weather.
Diagnosis:
A. Grief reaction
B. Hebephrenic schizophrenia
C. Depression with psychotic features
D. Paranoid schizophrenia
E. Depression without psychotic features
F. None of the above
G. Schizophrenia with mainly negative symptoms
H. Mania/hypomania
I. Acute organic brain syndrome (delirium)
J. Mental state shows no specific abnormality
Mania/hypomania
An 80 year old woman is brought to the Accident and Emergency Department with acute shortness of breath. From her history, it appears that she is in heart failure. She knows her name, but thinks she’s in her local church, and that the doctor is a visiting priest
Diagnosis:
A. Grief reaction
B. Hebephrenic schizophrenia
C. Depression with psychotic features
D. Paranoid schizophrenia
E. Depression without psychotic features
F. None of the above
G. Schizophrenia with mainly negative symptoms
H. Mania/hypomania
I. Acute organic brain syndrome (delirium)
J. Mental state shows no specific abnormality
Acute organic brain syndrome (delirium)
A 25 year old man is brought for an assessment by his parents. They give a history of deterioration in social functioning over the past 4-5 months. On examination, the patient displays affect that does not seem to fit with the conversation, and seems to move from one topic to another in an illogical manner.
Diagnosis:
A. Grief reaction
B. Hebephrenic schizophrenia
C. Depression with psychotic features
D. Paranoid schizophrenia
E. Depression without psychotic features
F. None of the above
G. Schizophrenia with mainly negative symptoms
H. Mania/hypomania
I. Acute organic brain syndrome (delirium)
J. Mental state shows no specific abnormality
Hebephrenic schizophrenia
A man holds a strange pose that looks uncomfortable, bending half way over, and when you examine him you notice you can move his limbs to other positions, which he doesn’t resist and he then hold the pose you put him in until you move him again.
Phenomena? A. Thought broadcast B. Catatonic symptom C. Hallucinatory voices D. Thought echo E. Passivity phenomena F. Negative symptom G. Delusional perception H. Neologism I. Overvalued idea J. Paranoid delusion
Catatonic symptom
A man wearing metal helmet to stop his thoughts being projected out of his head, because he believes other people can hear his thoughts unless he wears the helmet.
Phenomena? A. Thought broadcast B. Catatonic symptom C. Hallucinatory voices D. Thought echo E. Passivity phenomena F. Negative symptom G. Delusional perception H. Neologism I. Overvalued idea J. Paranoid delusion
Thought broadcast
A woman keeps repeatedly saluting, and says someone is making her do this using a remote control beaming device.
Phenomena? A. Thought broadcast B. Catatonic symptom C. Hallucinatory voices D. Thought echo E. Passivity phenomena F. Negative symptom G. Delusional perception H. Neologism I. Overvalued idea J. Paranoid delusion
Passivity phenomena
A woman has stopped going out as she has the feeling that she is being followed. She says she can’t be sure about this, but she has read in the newspapers about high crime rates, and she has heard from her neighbours that a few people have been followed home and mugged in the local area recently.
Phenomena? A. Thought broadcast B. Catatonic symptom C. Hallucinatory voices D. Thought echo E. Passivity phenomena F. Negative symptom G. Delusional perception H. Neologism I. Overvalued idea J. Paranoid delusion
Overvalued idea
A woman has been seeing a CPN for many years and when you review her you notice she does very little daytime activities, seems unmotivated and apathetic but not depressed, and she has a limited range of emotional expression.
Phenomena? A. Thought broadcast B. Catatonic symptom C. Hallucinatory voices D. Thought echo E. Passivity phenomena F. Negative symptom G. Delusional perception H. Neologism I. Overvalued idea J. Paranoid delusion
Negative symptom
A 28 year old man feels uneasy and is unable to relax during the day, worried something dreadful might happen. This feeling of unease is with him throughout her waking hours, but sometimes becomes worse. He tends to feel exhausted by the end of the day.
A. Social phobia B. Agoraphobia C. Generalised anxiety disorder D. None of the above E. Specific phobia F. Obsessive-compulsive disorder G. Hypochondriasis H. Mental state shows no specific abnormality I. Panic disorder
Generalised anxiety disorder
A 33 year old woman is convinced that the salmonella germ may be in her kitchen, so she is making her family follow a ritual whereby plates must be dipped in bleach and placed on the drainer to dry for 2 minutes before the plate can be used to eat off. She is really upset by having to perform this ritual but cannot stop herself because she is so worried about contaminating the children.
A. Social phobia B. Agoraphobia C. Generalised anxiety disorder D. None of the above E. Specific phobia F. Obsessive-compulsive disorder G. Hypochondriasis H. Mental state shows no specific abnormality I. Panic disorder
Obsessive-compulsive disorder
A 45 year old woman is repeatedly presenting to her GP convinced that she has a brain tumour. She says she has headaches and sometimes a tightness across her forehead. Investigations have been negative but she keeps coming back to ask for further brain scans to find the cancer.
A. Social phobia B. Agoraphobia C. Generalised anxiety disorder D. None of the above E. Specific phobia F. Obsessive-compulsive disorder G. Hypochondriasis H. Mental state shows no specific abnormality I. Panic disorder
Hypochondriasis
A 20 year old student is unable to go to the pub with friends, or to travel on the Underground, because he is very worried that if someone looks at him, he’ll blush and embarrass himself.
A. Social phobia B. Agoraphobia C. Generalised anxiety disorder D. None of the above E. Specific phobia F. Obsessive-compulsive disorder G. Hypochondriasis H. Mental state shows no specific abnormality I. Panic disorder
Social phobia
A 30 year old woman describes episodes when she cannot catch her breath and her fingers tingle.
A. Social phobia B. Agoraphobia C. Generalised anxiety disorder D. None of the above E. Specific phobia F. Obsessive-compulsive disorder G. Hypochondriasis H. Mental state shows no specific abnormality I. Panic disorder
Panic disorder
An 80 year old woman who lives alone, and presents with increasing forgetfulness, which she finds very distressing. Her score on the Mini Mental State Exam is 22/30
A. Sertraline B. Procyclidine C. Temazepam D. Diazepam E. Haloperidol F. Doneprazil G. Olanzepine H. Acamprosate I. Methadone J. None of the above
Doneprazil
A 35 year old heavy goods vehicle driver with a past history of alcohol dependence who has been strongly advised to remain abstinent from alcohol
A. Sertraline B. Procyclidine C. Temazepam D. Diazepam E. Haloperidol F. Doneprazil G. Olanzepine H. Acamprosate I. Methadone J. None of the above
Acamprosate
A 22 year old man with a history of schizophrenia who has been admitted as an inpatient on Section 3, acutely psychotic.
A. Sertraline B. Procyclidine C. Temazepam D. Diazepam E. Haloperidol F. Doneprazil G. Olanzepine H. Acamprosate I. Methadone J. None of the above
Olanzepine
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
A 19 year old man who regularly uses amphetamines and other stimulants but wishes to discontinue these
A. Sertraline B. Procyclidine C. Temazepam D. Diazepam E. Haloperidol F. Doneprazil G. Olanzepine H. Acamprosate I. Methadone J. None of the above
None of the above
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
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
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
General practitioner
A 28 year old man is assessed under the Mental Health Act. Whose responsibility is it to consider interventions other than inpatient admission?
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
Approved social worker
A 45 year old woman with a history of bipolar affective disorder has been well and stable in the community for the past 18 months. She is due a Care Programme Approach Meeting.
Who is responsible for organising this?
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
Carries a small but important risk of neutropenia and possibly agranulocytosis
A. Diazepam B Temazepam C. Olanzepine D. Lithium E. Procyclidine F. Clozapine G. Sertraline H. Amitryptyline I. Zolpidem J. Haloperidol
Clozapine
Carries a small but important risk of hypothyroidism
A. Diazepam B Temazepam C. Olanzepine D. Lithium E. Procyclidine F. Clozapine G. Sertraline H. Amitryptyline I. Zolpidem J. Haloperidol
Lithium
Has, amongst its most common adverse effects, headache, gastrointestinal disturbance and insomnia
A. Diazepam B Temazepam C. Olanzepine D. Lithium E. Procyclidine F. Clozapine G. Sertraline H. Amitryptyline I. Zolpidem J. Haloperidol
Sertraline
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
Carries a small but important risk of renal failure
A. Diazepam B Temazepam C. Olanzepine D. Lithium E. Procyclidine F. Clozapine G. Sertraline H. Amitryptyline I. Zolpidem J. Haloperidol
Lithium
A 38 year old man, well know to the police as well as mental health services for his long history of schizophrenia with recurrent relapses, is brought to the attention of the police because he is causing a disturbance in a local shopping mall
A. Section 2 B. Involve an independent mental capacity advocate C. Section 3 D. Further treatment cannot be given without the patient's consent E. Section 136 F. Treat under Common Law G. Section 12 H. Section 5(2)
Section 136
A 25 year old woman has recently been admitted as an inpatient. She appears willing to remain in hospital and to accept medication, but is very deluded and the psychiatrist judges that she cannot make decisions about his treatment. She has no known relatives or friends.
A. Section 2 B. Involve an independent mental capacity advocate C. Section 3 D. Further treatment cannot be given without the patient's consent E. Section 136 F. Treat under Common Law G. Section 12 H. Section 5(2)
Involve an independent mental capacity advocat
A 23 year old man is brought to the Accident and Emergency Department in a highly excitable state. He is overfamiliar, expansive, and shows pressure of speech. He says that he is invincible, and to demonstrate this, has been wandering in the traffic. He is not known to mental health services, and denies any past psychiatric history. There is a suspicion that he might be using illicit drugs.
A. Section 2 B. Involve an independent mental capacity advocate C. Section 3 D. Further treatment cannot be given without the patient's consent E. Section 136 F. Treat under Common Law G. Section 12 H. Section 5(2)
Section 2
A 32 year old man who has had several previous Mental Health Act admissions, usually when he relapses after stopping his medications, tells his community psychiatric nurse that he stopped his medications last week. He is unwilling to resume treatment, or to consider any other intervention. Currently, there is no evidence of any mental state abnormalities.
A. Section 2 B. Involve an independent mental capacity advocate C. Section 3 D. Further treatment cannot be given without the patient's consent E. Section 136 F. Treat under Common Law G. Section 12 H. Section 5(2)
Further treatment cannot be given without the patient’s consent
