Psychiatry

Question 1

What are the many theories of aetiology of mental illness?

Answer 1

Biological- genetics, prenatal damage, infection/disease/toxins, brain defects, chemical imbalances
Environment- life events, emotional stress, abuse, poor parenting, neglect, poverty, social expectations and self esteem

Question 2

What is the assessment in psychiatry?

Answer 2

-History: medication, presenting complaint, history, family, deep personal history, premorbid, risk assessment
-Mental state examination: appearance, behaviour, speech, mood, thought form and context, how slow, fast or slurred speech is
-Investigations: physical examination, collateral history, psychological assessment, risk assessment
-Formulation: diagnosis or diffrential diagnosis, summary of possible aetiological factors, further investigation and management

Question 3

What are the common anti-psychotic medications and their side effects?

Answer 3

Clozapine, olanzapine
-weight gain as increases appetite, drowsiness, dizziness, increased salivation

Question 4

What is lithium used for and what are the potential side effects?

Answer 4

Lithium is a mood stabilizer, used to treat mood disorders like bipolar, treatment resistant depression and hypomania. Lithium can also reduce aggressive or self harming behaviour.
-side effects- feeling or being sick, diarrhoea, dry mouth and metallic taste in mouth

Question 5

What are CNS stimulants like atomexetine and dexamphetamine used for?

Answer 5

ADHD- controversial drug especially for children

Question 6

What is schizophrenia?

Answer 6

Term refers to a number of related conditions in which the patient has abnormalities in the thought process, often accompanied by unusual behaviour and diminished social functioning

Question 7

What are the symptoms of schizophrenia?

Answer 7

Hallucinations, delusions, muddled thoughts, losing interest in daily activities, lack of personal hygeine, wanting to avoid people, feeling disconnected from feelings or emotions

Question 8

What is the prevelance/epidemiology of schizophrenia?

Answer 8

-15-20/100,000 per year
-Increased prevalence associated with poverty, males and urban settings
-Median age of onset- 32 for females and 28 for males
-but usually onset is in younger people

Question 9

What are the many proposed risk factors for schizophrenia?

Answer 9

Migration, lower social class, urban living, being male, winter births, obstetric complications, exposure to influenza in utero

Question 10

What are the many proposed risk factors for schizophrenia?

Answer 10

Migration, lower social class, urban living, being male, winter births, obstetric complications, exposure to influenza in utero

Question 11

What is the suicide rate of schizophrenia?

Answer 11

Up to 10%

Question 12

What health conditions are people at risk of with schizophrenia?

Answer 12

Cardiovascular and respiratory conditions due to drug use, smoking and bad diet as well as medication side effects eg weight gain

Question 13

What is the treatment of schizophrenia?

Answer 13

-Oral antipsychotic therapy or depot in poorly compliant patients
-CBT, family interventions, art therapy, supportive psychotherapy
-Social- attention to housing, finances, activities, social support

Question 14

What is the epidemiology of depression?

Answer 14

-symptoms very common- up to 20% of population
-more females especially women in 30s, males in 40s
-onset usually mid 20s
-higher rates in lower social groups

Question 15

What are the proposed aetiologies of depression?

Answer 15

-genetics- can run in families
-neurotransmitter abnormality eg serotinin, noradrenaline
-neuroendocrine abnormalities eg blunted responses to prolactin, GH and TSH in response to TRH and hypercortisolaemia
-immunological abonormalities eg decreased natural killer cells, decreased interleukin-2 and increased monocyte activity

Question 16

What is the current evidence for toxoplasma gondii in the development of schizophrenia?

Answer 16

Toxoplasma gondii is found in cats, initial infection withToxoplasmais associated with few symptoms in immune-competent individuals, the host is often left with lifelong persistence of tissue cysts in the brain, retina, and muscle. Case control study in 2022 looking at cats and toxoplasma gondii infection in relation to schizophrenia found a link, but only a case control study and didnt look at presence of toxoplasma gondii in the subjects so unreliable

Question 17

What is avatar therapy and what is it used to treat?

Answer 17

Avatar therapy was created at UCL and is used to treat schizophrenia.
In AVATAR therapy, computer software is used to create a visual and auditory representation of the hallucinated voice.
The client sits in front of a computer on which the avatar appears while the therapist, sitting apart from the client, speaks as him/herself or as the avatar.

Question 18

What efficacy has avatar therapy shown so far?

Answer 18

The power of AVATAR was shown by a marked reduction in the frequency of hallucinations and reductions in distress in asmall pilot study.
These results were then replicated in an RCT at KCL which compared AVATAR therapy to supportive counselling among people who had experienced unremitting voices for at least a year despite adequate medical treatment. This study showedstatistically and clinically significant benefitthat was substantially greater than that obtained by the existing gold-standard cognitive behavioural therapy for psychosis.

Question 19

What did the study by correll et al in JAMA psychiatry looking at early intervention psychosis management show?

Answer 19

-In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.
Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment

Question 20

What did the new study by UCL psychiatrists say about the aetiology of depression?

Answer 20

Study showed no clear evidence that serotonin levels or serotonin activity are responsible for depression. Serotonin has been pushed as a cause especially by drug industries to market SSRI medication, but there is no good evidence for it. Some of the studies in the overview that included people who were taking or had previously taken antidepressants showed evidence that antidepressants may actually lower the concentration or activity of serotonin.

Question 21

When has depression and anxiety increased?

Answer 21

During the pandemic (Lancet systematic review on depression in the pandemic)