Psych

Question 1

Management of delirium?

Answer 1

1. Assess patient in a safe environment with someone else
2. Treat any underlying causes
3. Re-orient to environment
4. Can give haloperidol -> benzos if risk to self or others

Question 2

Management of Alzheimer’s?

Answer 2

1. Refer to memory clinic.
2. Acetylcholinesterase inhibitors like donepezil
3. Review in 6 months

Question 3

Mx of Lewy Body?

Answer 3

Biological

1. Acetylcholinesterase inhibitors (rivastigmine)
2. Optimise physical health
3. Don’t give antipsychotics or anti-parkinsons medication as both dangerous

Question 4

What do you see on autopsy in Pick’s disease?

Answer 4

Knife blade atrophy + tau proteins in the substantia nigra

Question 5

General Mx of dementia?

Answer 5

1. MDT
2. Refer to memory clinic
3. For alzheimers and lewy body can give Acholinesterase inhibitors
4. Reminiscence/validation/cognitive stimulation/behavioural therapies
5. Alarms for wanderers/clocks/carers and consider LPA and ADs
6. Tell DVLA

Question 6

Where is there loss in huntington’s?

Answer 6

Basal ganglia, in particular caudate nucleus and thalamus

Also loss in frontal regions

Question 7

Mx of psychosis

Answer 7

first decide where to treat
If first time and patient or others at risk, admit. Once discharged, taken care of by community psych nurse + is given a key worker

If in the community, can instead deal with the early intervention and psychosis team or crises resolution and home treatment team

Then decide on bio treatment 
First gen -> extrapyramidal (haloperidol) 
Second gen -> try for 6-8 weeks 
Doesn't work -> give clozapine 
BDZ/ECT can be used 

Psych
Psychoeducation
CBT
Family therapy

Social
Rehab into community
Care programme approach
DVLA for 3 months after resolution

Question 8

What can you give in depression if SSRIs dont work?

Answer 8

Mirtazapine

ECT if life threatening -> requires full informed consent

Question 9

When do you do a care programme approach?

Answer 9

When there is a disorder affecting insight:

e.g. psychosis, severe depression and mania

Question 10

What is the general treatment for PD?

Answer 10

Dynamic and group psychotherapy

For borderline PD, dialectical behavioural therapy

Question 11

Mx of alcohol misuse?

Answer 11

First thing is give drink diary to note how much of a problem it really is and see in a week

After that, they probably drink a lot, so need intervention. Give them motivational interviewing to encourage them to carry out treatment.

Then give CBT, this will also help if they are depressed or anxious.

Now as they’re stopping, make sure to give pabrinex (3 days IV) and reducing regimen of chlordiazepoxide to stop delirium tremens.

After they’ve stopped, give them either disulfiram or ACAMPROSATE (stops craving for alcohol) as prevention.

To support this whole process, “social” interventions like the 12 step AA programme could be joined

Question 12

What is damaged in Wenicke’s?

Answer 12

Mammillary body

Question 13

Maintenance therapy in opiate abuse?

Answer 13

Methadone and buprenorphine

Question 14

What stupid shit random scale do you use for depressed mums to see if there is baby blue?

Answer 14

The Edinburgh depression scale

Question 15

Which drug should you have ECGs for? And why?

Answer 15

Pimozidine, and because it causes prolonged QT syndrome.