psych

Question 1

anti-depressants

Answer 1

1) SSRI (Selective Serotonin Reuptake Inhibitor):
Ie: fluoxetine, paroxetine, sertraline, citalopram.
S/E: headache, nausea, insomnia, agitation.

2) SNRI (Serotonin-norepinephrine reuptake inhibitor)
ie: venlafaxine, duloxetine.
S/E: hypotension, sedation, weight gain.

3) RIMA (Reversible Inhibitor of Monoamine Oxidase A)
ie: moclobemide
S/E: usually well tolerated.

4) NaSSAs(Noradrenergic and Specific Serotonergic antidepressants).
ie: mirtazepine
S/E: sedating, weight gain, dizziness.

5) NRI (Norepinephrine reuptake inhibitor).
ie: reboxetine
S/E: anticholinergic effects such as dry mouth, palpitations, constipation, dizziness.

6) TCA (tricyclic antidepressants)
ie: clomipramine, nortriptyline, imipramine.
S/E: anticholinergic effect- dry mouth, constipation,blurred vision and impaired concentration.

Question 2

Extrapyramidal side effects of anti-psychotics

Answer 2

1) Dystonia
2) Parkinisonism
3) Akathisia
4) Tardive dyskinesia

Question 3

Unexplained symptoms

Answer 3

Somatisation disorder

• multiple physical SYMPTOMS present for at least 2 years
• patient refuses to accept reassurance or negative test results

Hypochondrial disorder

• persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
• patient again refuses to accept reassurance or negative test results

Conversion disorder

• typically involves loss of motor or sensory function
• the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
• patients may be indifferent to their apparent disorder – la belle indifference – although this has not been backed up by some studies

Dissociative disorder

• dissociation is a process of ‘separating off’ certain memories from normal consciousness
• in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
• dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Munchausen’s syndrome

• also known as factitious disorder
• the intentional production of physical or psychological symptoms

Malingering
* fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 4

TCA

Answer 4

Common side-effects

• drowsiness
• dry mouth
• blurred vision
• constipation
• urinary retention

More sedative
Amitriptyline
Clomipramine
Dosulepin
Trazodone

Less sedative
Imipramine
Lofepramine
Nortriptyline

Question 5

Schizophrenia: prognostic indicators

Answer 5

Factors associated with poor prognosis

• strong family history
• gradual onset
• low IQ
• premorbid history of social withdrawal
• lack of obvious precipitant

Question 6

ECT

Answer 6

absolute contraindication is raised intracranial pressure.

Short-term side-effects

• headache
• nausea
• short term memory impairment
• memory loss of events prior to ECT
• cardiac arrhythmia

Long-term side-effects
* some patients report impaired memory