Psychiatry

Question 1

Management of PTSD (lasting more than 4 weeks) - 1st line

Answer 1

EMDR or trauma-focussed CBT

Question 2

Management of PTSD (lasting more than 4 weeks) - 2nd line

Answer 2

Venlafaxine or SSRI

Question 3

Lithium - routine monitoring

Answer 3

6-monthly: BMI + renal function + thyroid function

Question 4

How long post-dose should you check Lithium levels

Answer 4

12 hours post-dose

Question 5

How often must lithium levels be checked when initating or changing dose?

Answer 5

Weekly until stable, then 3-monthly

Question 6

Section 2 - what is it used for

Answer 6

Admission for assessment

Up to 28 days

Question 7

Section 3 purpose + length

Answer 7

Admission for treatment

Up to 6 months, can be renewed

Question 8

Section 4

Answer 8

72hr assessment order

Question 9

Section 5(2)

Answer 9

Patient voluntarily in hospital detained by doctor

For 72 hours

Question 10

Section 5(4)

Answer 10

Nurse can detain patient who is voluntarily in hospital.

For 6 hours

Question 11

Section 17a

Answer 11

Community Treatment Order

To recall patient to hospital if not complying with conditions in community

Question 12

Section 135

Answer 12

Court order - allows police to break into property to remove person to place of safety

Question 13

Section 136

Answer 13

Person in public place taken by police to place of safety

Up to 24 hours

Question 14

DVLA requirements - mania/hypomania - new diagnosis or new episode

Answer 14

Must notify the DVLA + must not drive for at least 3 months

Question 15

DVLA may consider licensing in stable hypomania/mania (<4 episodes/yr) if:

Answer 15

• Stable >=3m
• Adhering to treatment
• Medication not affecting driving
• Specialist agrees

Question 16

DVLA - unstable hypomania/mania (>=4 episodes in 12 months) - licensing may be considered when:

Answer 16

• Stable >= 6m
• Adhering treatment
• No medication effects on driving
• Specialist agrees

Question 17

Switching from citalopram, escitalopram, sertraline or paroxetine to another SSRI

Answer 17

Wean & withdraw 1st SSRI

Then start new SSRI

Question 18

Switch from Fluoxetine > other SSRI

Answer 18

Withdraw fluoxetine
Leave 4-7 day gap
Start low-dose new SSRI

Question 19

Switching from SSRI to TCA

Answer 19

Cross-taper

Exception: fluoxetine

Question 20

Switching from citalopram, escitalopram, sertraline or paroxetine to venlafaxine

Answer 20

Cross-taper cautiously

Start venlafaxine 37.5 mg and slow increase

Question 21

Switching from fluoxetine to venlafaxine

Answer 21

Withdraw Fluoxetine
Then start Venlafaxine 37.5 mg
Increase dose slowly