Psychiatry

Question 1

how can we differentiate sever depression from dementia

Answer 1

severe depression results in GLOBAl memory loss whereas Dementia is just short term memory loss

Question 2

OCD

Answer 2

1) CBT+ Exposure and response prevention (ERP)
2) SSRI or clomipramine
3)refer to secondary mental health team

Question 3

which SSRI is best for people with cardiac problems

Answer 3

Sertraline

Question 4

side effects and names of Atypical Antipsychotics

Answer 4

• clozapine , olanzapine , aripiprazole, quetiapine

side effects of Atypical antipsychoticcs:
+ metabolic side effects ie : weight gain , hyperprolactinaemia ( Arip = least side effects )
+ increased risk of stroke and venous thromboembolisms in the elderly

Question 5

clozapine side effects
name the main ones

Answer 5

• Agranulocytosis and neutropenia ( monitor FBC)
• Reduced seizure threshold
• constipation
  -Myocarditis ( DO ECG BEFORE )
  -hypersalivation

Question 6

TCA side effects

Answer 6

increases serotonin levels by decreasing serotonin uptake
Noradrenaline , blocks the re uptake of NA increasing NA levels too = INCREASED MOOD
- blockade of histamine receptors = drowsiness
- anti muscarinic = can’t see , pee , shit or climb a tree
- anti - adrenergic = postural hypotension
+ LENGTHENING OF QT

MORE SEDATIVE : amitrtyline , clomipramine

LESS sedative : Imipramine

Question 7

management of GAD

Answer 7

1) Education and self monitoring
2) low intensity psychological intervention like groups and self help guides
3) CBT
4) drugs - sertraline , or SNRI ie : duloxetine and venlafaxine

Question 8

in patient with depression with reduced appetite and poor sleep what is the drug of choice

Answer 8

Mirtazipine

Question 9

SSRI in pregnancy risks

Answer 9

1st - increased risk of congenital abnormality
3rd - persistent pulmonary hypertension

Question 10

SSRI side effects and preferred drugs ?
Reviews ?

Answer 10

1) preferred is Citalopram ( lengthens QTC) and Fluoxetine (children )
2) sertraline post MI

Reviews :
- patients under 25 = every week
- patients older= very 2 week
due to increased risk of suicide

SIDE EFFECTS:
- GI upset, bleed so give omeprazole with them pls
- Hyponatremia so monitor U&E

Question 11

how long should SSRI be continue after its achieved its goal

Answer 11

6 months and stop slowly over 4 weeks

Question 12

SSSRI mnemonic for serotonin syndrome with SSRIs

Answer 12

SSRI
S- Suicide risk increased
S-slow onset and taper off
S- Serotonin syndrome risk ! sweaty hot fever
R-Rigid muscles and agitation
I - increased HR

Question 13

Duloxetine uses ?

Answer 13

DUAL- oxetine
1) Depression
2) Fibromyalgia

Question 14

Knights move thinking vs flight of ideas

Answer 14

Knight move = no link between them = Schizophrenia

Flight of ideas= weak links, BIPOLAR disorder

Question 15

De Clerambaults syndrome

Answer 15

1- believes famous person is in love with them

Question 16

ECT indications

Answer 16

severe depression with catatonia
- manic episode
-

Question 17

Diagnosis of chromic insomnia

Answer 17

has to be present for 3 months ( eat least 3 nights per week)

Question 18

Alcohol withdrawal

Answer 18

6-12 hrs = tremors , sweating and tachycardia
36hrs = seizures
72hrs= delirium tremens

Question 19

What is Acute Stress disorder

Answer 19

acute stress reaction that occurs in 4 weeks after the traumatic event as opposed to PTSD which is diagnosed after 4 weeks

Question 20

management of alcohol withdrawal

Answer 20

1) long acting benzodiazepine = chlordiazepoxide or Diazepam
2) carbamazepine

Question 21

how often should we monitor lithium after a dose change

Answer 21

every 1 week until stable , once stable then every 3 months
Blood test should be 12 hrs post dose

Question 22

Obsessive compulsive Personality disorder ?

Answer 22

Rigid with respect to morals , ethics and values and are reluctant to surrender work to others ( lists, details , rules etc)
+ meticulous with things too

Question 23

Anorexia features

Answer 23

most things low but
Gs and Cs raised :
Growth hormone , glucose , salivary Glands rasied
Cortisol, Cholesterol , Carotinaemia

Question 24

Mania treatment

Answer 24

stops the SSRIs and start the anti psychotics

Question 25

PTSD treatment

Answer 25

• venlafaxine ( SNRI)
  -If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI