Psychiatry

Question 1

1st line medical tx of delirium:

Answer 1

Haloperidol 0.5mg PO

Question 2

Name 2 typical antipsychotics:

Answer 2

Haloperidol
Chlorpromazine

Question 3

Name a group of patient who must NOT be given typical antipsychotics:

Why is this?

Answer 3

Any patient with Parkinson’s disease/Parkinsonism

Typical antipsychotics act on dopamine D2 receptors, blocking transmission dopaminergic. Patients with Parkinson’s disease are already deficient in dopamine and this will worsen their extrapyramidal symptoms.

Question 4

Name 4 atypical antipschotics:

Answer 4

Aripiprazole
Risperidone
Olanzapine
Clozapine

Question 5

2 important side effects of clozapine:

What monitoring should a patient on clozapine have as a result?

Answer 5

Agranulocytosis
Reduces seizure threshold

At least one blood test/week for 18 weeks. Then fortnightly blood tests for until 1 year. Then monthly.

Question 6

4 side effects of atypical antipsychotics:

Answer 6

Generally a good side effect profile, but:
- Extrapyramidal side effects (less so than in typical antipsychotics)
- Elevated prolactin
- Weight gain
- increased risk of stroke/TE in elderly patients
- Long term use can cause impaired glucose tolerance/diabetes

Question 7

Extrapyramidal side effects: (4)

Answer 7

Parkinsonism
Acute dystonia
Akathisia
Tardive Dyskinesia

Question 8

7 side effects of typical antipsychotics:

Answer 8

1. Extrapyramidal side effects
2. Hyperprolactinaemia
3. Increased risk of stroke/TE in elderly people
4. Urinary retention
5. Lethargy/drowsiness
6. Lengthens QT interval (particularly haloperidol)
7. Blurred vision

Question 9

3 features of schizotypal personality disorder:
What cluster does this PD come under?

Answer 9

Odd beliefs and magical thinking (with some insight retained)
Lack of close friends
Inappropriate affect

Cluster A: Odd or eccentric

Question 10

3 features of schizoid personality disorder:
What cluster does this PD come under?

Answer 10

Preference for solitary activities
Lack of interest in sexual interactions
Emotional coldness
Lack of desire for friendship/companionship/confidants

cluster A: odd or eccentric

Question 11

3 features of antisocial personality disorder:
What cluster does this come under?

Answer 11

Failure to conform to social norms/laws
Deception, lying, use of aliases/conning others
Lack of remorse

Cluster B: dramatic, emotional or erratic

Question 12

3 features of histrionic personality disorder:
What cluster does this come under?

Answer 12

Inappropraite sexual seductiveness
Need to be centre of attention
Rapdily shifting and shallow expression of emotions

Cluster B: dramatic, emotional, erratic

Question 13

3 features of avoidant personality disorder:
what cluster does this come under?

Answer 13

Preoccupied with ideas of social rejection/criticism
Fear of embarrassment/ridicule
Social isolation but craving social contact

Cluster C: anxious and fearful

Question 14

Tx for chlamydia:

Answer 14

100mg doxycycline BD 7 days OR 1g azithromycin single dose

Question 15

Tx for gonorrhoea:

Answer 15

1g ceftriaxone IM (first line) or 500 mg ciprofloxacin PO (only if sensitivities are known)