Psych Management

Question 1

Opiate withdrawalDilated pupils, goosebump flesh

Answer 1

1st line = Methadone (oral) or Buprenorphine (sublingual) once daily

Question 2

Muscle rigidity, mental state change and autonomic instability

Answer 2

Neuroleptic Malignant Syndrome

Ix = Raised CK

Mx = Stop anti-psychotics, supportive Mx

Question 3

Schizophrenia inheritance

Answer 3

FMH = 10%
Both parents = 40%
Monozygotic twin = 50%

Question 4

Manic episode

Answer 4

1. STOP anti-depressants
2. If on valproate, increase dose

1st line = Anti-psychotic (Olanzapine, risperidone, quetiapine)

2nd line = Different anti-psychotic
3rd line = Valproate

Question 5

OCD

Answer 5

1. Low intensity CBT including ERP (Exposure Response Prevention)
2. SSRI or more intesive CBT (+ERP)
3. Combined SSRI + Intensive CBT (+ERP)

Question 6

PTSD

Answer 6

1. Trauma-focused CBT or EMDR (Eye movement desensitisation and reprocessing)
2. Mirtazapine, Venlafaxine or Sertraline

Question 7

Adjustment disorder

Answer 7

Supportive

Question 8

Acute stress reaction

Answer 8

Supportive

Question 9

Postnatal Psychosis

Answer 9

Admit to mother and baby unit + anti-psychotics

Question 10

Switch from citalopram, sertraline or paroxetine to other SSRI

Answer 10

1st one should be withdrawn before alternative started

Question 11

Switch from fluoxetine to other SSRI

Answer 11

Withdraw, leave a gap of 4-7 days, then start LOW dose of new SSRI

Question 12

Switch from SSRI to TCA

Answer 12

Cross-taper (except fluoxetine, which you would withdraw before starting TCA)

Question 13

Switch from citalopram, sertraline or paroxetine to venlafaxine

Answer 13

Cross-taper (start venlafaxine low, increase slowly)

Question 14

Switch from fluoxetine to venlafaxine

Answer 14

Withdraw then start low, increase slowly

Question 15

ADHD

Answer 15

Initial 10wk watch and wait
Refer to specialist/CAMHS

1st line = Parent therapy (ADHD focused)

Medical = Methyphenidate 6wk trial - Cardiotoxic, need ECG + monitor weight/height every 6m

Lisdexamfetamine if the above doesn’t work

Question 16

What is social phobia?

Answer 16

Fear of criticism
Blushing, hand tremor, nausea, urinary frequency in SOCIAL situations

Tolerates anonymous crowds, unlike agoraphobia, but small groups may trigger anxiety

Mx:
1st line = Education, reassurance, self-help
2nd = ERP
3rd = CBT
4th = SSRI

Question 17

What is agoraphobia?

Answer 17

Overwhelming urge to go home
Travelling, queueing, supermarkets, crowds

Mx:
1st line = Education, reassurance, self-help
2nd = ERP
3rd = CBT
4th = SSRI

Question 18

Panic disorder

Answer 18

1. Education, reassurance, self-help
2. Low-intensity psych intervention (self-help)
3. CBT ± SSRI (citalopram), 2nd line = TCA or BDZ