Psychiatry

Question 1

What are the 5 P’s for formulation?

Answer 1

Problem 
Predisposing 
Precipitating 
Perpetuating 
Protective

Question 2

What are the 10 areas of a MSE?

Answer 2

Appearance 
Behaviour 
Speech 
Mood 
Affect 
Thought form  
Thought content 
Perception 
Cognition 
Insight

Question 3

What would you like to ask in a psychiatric history?

Answer 3

Setting the scene - job, relationships, age, name 
Presenting complaint 
History of presenting complaint 
Past psychiatric history 
Medications 
Past medical history
Family history 
Social history 
Personal History 
Substance use 
Forensic history 
Premorbid history

Question 4

What is the believed aetiology of schizophrenia?

Answer 4

Susceptibility due to genetics and environment that life experiences can then trigger

Question 5

What are the parts of the neurodevelopmental hypothesis?

Answer 5

Hypoxic brain injury at birth or expose to a viral infection.
Temporal lobe epilepsy or smoked cannabis before brain was fully developed.
Changes in brain - enlarged ventricles, small amounts of grey matter loss and smaller, lighter brains.

Question 6

What is the Neurotransmitter hypothesis?

Answer 6

excess of dopamine and overactivity of mesocorticolimbic system. Less dopamine activity in the mesocortical tracts cause negative symptoms therefore dopamine antagonists work best at treating the positive symptoms.
Increased serotonin and reduced glutamate

Question 7

A patient has paranoid delusions and auditory hallucinations what form of schizophrenia are they most likely to have?

Answer 7

Paranoid schizophrenia

Question 8

A 28 year old who first got symptoms at 18 has mood changes, unpredictable behaviour, shallow affect and fragmentary hallucinations. What is the most likely diagnosis?

Answer 8

Hebephrenic Schizophrenia

Question 9

A patient with schizophrenia has only experienced symptoms such as avolition, anhedonia, asocial behaviour and alogia. What are these symptoms and what is the most likely diagnosis?

Answer 9

Negative symptoms

Simple schizophrenia

Question 10

A patient with schizophrenia has problems with posturing, rigidity and stupor. What is the most likely form?

Answer 10

Catatonic schizophrenia

Question 11

A patient with schizophrenia has suffered from both positive and negative symptoms however recently the positive symptoms have appeared to have stopped. What form is this most likely to be?

Answer 11

Residual schizophrenia

Question 12

What are the 4 risk factors in pregnancy/birth for schizophrenia?

Answer 12

Malnutrition
Viral infection
Pre-eclampsia
Emergency caesarean section

Question 13

What are the 9 positive symptoms in schizophrenia?

Answer 13

Thought echo 
Thought insertion or withdrawal 
Thought broadcasting 
3rd Person auditory hallucinations
delusional perception 
passivity 
odd behaviour 
thought disorder 
lack of insight

Question 14

What are the 7 negative symptoms of schizophrenia?

Answer 14

Avolition - lack of motivation 
Asocial behaviour 
Anhedonia 
Alogia - poverty of speech 
Blunted affect 
Cognitive deficits 
poor self control

Question 15

You suspect a patient had schizophrenia what investigations would you want to do and why?

Answer 15

Investigations to rule out other pathology.
Baseline bloods
Urine culture - UTI
Urine drug screen
HIV/Syphilis
Serum lipids (before starting antipsychotics)

Question 16

What are the 2 criteria for schizophrenia diagnosis in ICD-10?

Answer 16

1. 1 first rank symptom or persistent delusions for at least a month.
2. No other cause for psychosis

Question 17

What is the action of typical anti-psychotics?

Answer 17

Generalised D2 receptor antagonists

Question 18

Name 3 typical antipsychotics?

Answer 18

Haloperidol
Chlorpromazine 
Flupentixol Decanoate (depot)

Question 19

What are the side effects of typical anti-psychotics and how do they differ to atypical anti-psychotics?

Answer 19

Extrapyramidal 
Hyperprolactinemia 
Metabolic 
Anticholinergic 
Neurological 
- atypical have reduced extrapyramidal and hyperprolactinemia

Question 20

What is the action of atypical anti-psychotics?

Answer 20

Selective D2 receptor antagonists and block serotonin 5-HT3 receptors.

Question 21

Name 5 examples of atypical anti-psychotics?

Answer 21

Olanzapine 
Clozapine 
Risperidone 
Amisulpride 
Quetiapine

Question 22

What is the action of aripiprazole?

Answer 22

Partial dopamine agonist - even less likely to cause extrapyramidal side effects

Question 23

Why must patients on clozapine have monthly blood tests?>

Answer 23

Risk of agranulocytosis

- neutropenia

Question 24

What is the positive of clozapine for the patient?

Answer 24

No sexual dysfunction

also very effective

Question 25

How well does olanzapine tend to be received?

Answer 25

Well - only symptom tends to be weight gain which should trail off after a few months.

Question 26

What psychological treatments are available for patients with schizophrenia?

Answer 26

CBT

Family Therapy

Question 27

What are schneider’s first rank symptoms of schizophrenia? (6)

Answer 27

Thought echo 
Thought insertion/withdrawal
Thought broadcasting 
3rd person auditory hallucinations 
Delusional perception 
Somatic passivity

Question 28

What are the negative symptoms of schizophrenia?

Answer 28

Alogia (poverty of speech)
Avolition (lack of motivation) 
Anhedonia 
Asocial behaviour 
Affect - blunted 
cognitive deficits

Question 29

What are the 2 factors for diagnosis of schizophrenia?

Answer 29

Must have a first rank symptom or persistent delusion for at least a month.
Must not be accountable to anything else. (drugs, alcohol, brain disease - dementia, depression or mania)