Psych Misc

Question 1

Which antipsychotic can cause myocarditis?

Answer 1

Clozapine

Chest pain, malaise, fatigue, sweating etc

Question 2

4 first rank symptoms for schizophrenia?

Answer 2

At The Police Department

Auditory hallucinations
Thought disorder (insertion, withdrawal, blocking, broadcasting)
Passivity phenomena
Delusional perception

Question 3

Can schizophrenic patients get insomnia? Why?

Answer 3

Yes

Disruption of circadian rhythm

Question 4

Which SSRI is associated with QT prolongation?

Answer 4

Citalopram

Question 5

What should you be mindful of when starting an SSRI in someone with cardio Hx?

Answer 5

Aspirin –> Aspirin + SSRI = GI bleed risk

Start PPI as well

Question 6

What is Othello syndrome?

Answer 6

Delusional jealousy, usually that a partner is being unfaithful when they are not

Question 7

What is erotomania?

Answer 7

Delusion where a person believes someone else, usually a celebrity, is in love with them

Question 8

Which antipsychotic can cause severe constipation

Answer 8

Clozapine - can lead to faecal impaction

Question 9

Why can you get weight gain with TCA antidepressants?

Answer 9

Antihistamine effect

Question 10

Which scoring system can be used to assess the severity of alcohol withdrawal?

Answer 10

Clinical Institute Withdrawal Assessment (CIWA-Ar)

Question 11

What is Conversion disorder?

Answer 11

Motor and sensory loss usually brought on by stress, the patient is usually not bothered about the symptoms

Question 12

What is the difference between somatisation and factitious disorder?

Answer 12

Somatisation - patient presents with physical SYMPTOMS for >2 years and refuses to accept reassurance

Factitious (hypochondriasm) - patient believes they have a serious DISEASE and refuses to accept reassurance

Question 13

Which personality disorder is: prefers to be alone, doesn’t like forming new relationships, asexual, emotional detachment?

Answer 13

Schizoid

Schizotypal is when u prefer to be alone but have unusual behaviours and believe in fantasy/magic etc

Question 14

Patient with bipolar disorder presents to GP with symptoms of mania, what should you do?

Answer 14

Refer urgently to the community mental health team

Question 15

What to give for acute manic episode within bipolar?

Answer 15

Olanzapine

Question 16

What to give for acute depressive episode within bipolar?

Answer 16

Quetiapine

Question 17

Can valproate be prescribed by the GP for bipolar mania/hypomania?

Answer 17

No

Question 18

What to do if someone presents with hypomania to GP (i.e. no psychosis or delusions)?

Answer 18

Refer routinely to community mental health team

Question 19

Woman with bipolar takes olanzapine and lithium, complains of feeling tired all the time, reduced appetite and bouts of constipation - cause?

Answer 19

Hypothyroidism due to lithium

Question 20

What electrolyte abnormality would be seen in bulimia nervosa?

Answer 20

hypokalaemia, hypochloraemia, metabolic alkalosis

Question 21

3 signs of hypokalaemia on ECG?

Answer 21

1st degree heart block
tall P waves
flattened T waves

Question 22

4 risk factors for the development of generalised anxiety disorder?

Answer 22

Age 35-55
Living alone
Being divorced/separated
Being a single parent

Question 23

What investigations should be performed on a person presenting with new onset psychosis?

Answer 23

FBC, U&E, TFT, B12 etc
ECG
CXR (hypercalcaemia from SCC)

If elderly or suspicion, perform CT head (malignancy, stroke, trauma, infection)

Question 24

Treatment for PTSD?

Answer 24

1st line - CBT or EMDR
2nd line - Paroxetine
3rd line - Mirtazapine, Amitriptyline
4th line - Prazosin

Question 25

Management of PTSD?

Answer 25

1 - Education and self-help
2 - Psychological - exposure and response prevention
3 - Pharmacological
3.1 - SSRI
3.2 - Clomipramine
3.3 - Augment with Risperidone or Lamotrigine

Question 26

Which antipsychotic is particularly assoc w QT prolongation?

Answer 26

Haloperidol

Question 27

Which type of antipsychotics are particularly assoc w reduced seizure threshold?

Answer 27

Atypicals

Question 28

Which antipsychotics are particularly assoc w hyperprolactinaemia?

Answer 28

Risperidone and Amisulpride

Question 29

Which antipsychotics are LEAST assoc w galactorrhoea?

Answer 29

Olanzapine and Quetiapine

Question 30

Which antipsychotics are MOST assoc w neuroleptic malignant syndrome?

Answer 30

Haloperidol and Chlorpromazine

Question 31

Which antipsychotics are MOST assoc w metabolic syndrome?

Answer 31

Olanzapine and Clozapine

Question 32

What is depressive personality disorder?

Answer 32

The patient always has a low and gloomy outlook on life but has no actual symptoms of depression

Question 33

20 y/o woman admitted to A&E with a suspected OD. She has threatened to commit suicide several times since breaking up with her abusive boyfriend. She has a Hx of self-harm and depression and takes Citalopram. Which personality disorder does she likely have?

Answer 33

Borderline

–> Hx of recurrent self-harm and intense inter-personal relationship

Question 34

What are pseudohallucinations?

Answer 34

Part of normal grieving process. The patient will commonly ‘see’ or ‘hear’ their loved one briefly, during the period following their death. They retain insight, and are have no other symptoms of psychosis.

Question 35

Treatment of PTSD?

Answer 35

EMDR

If combat-related: combat-related CBT