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Phase3 Specialties - Imperial College London MBBS > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

How can antipsychotic concordance and compliance be improved?

A

Depot medication

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2
Q

Define malingering

A

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

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3
Q

What is the first-line management for anorexia nervosa in young people and children?

A

Anorexia-focused family therapy

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4
Q

What are the symptoms of SSRI discontinuation syndrome?

A

Unsteadiness
Increased mood change
Electric shock sensations (Paraesthesia)
Anxiety
Difficulty sleeping
Restlessness
Gastrointestinal symptoms - pain, cramping, diarrhoea, vomiting

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5
Q

Prior to commencing electroconvulsive therapy, what are the recommendations for Antidepressant therapy?

A

Dose reduction

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6
Q

Define conversion disorder

A

typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

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7
Q

What is the definitive management of acute dystonia?

A

Oral procyclidine

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8
Q

What are the presenting features of acute dystonia?

A

Sustained muscle contractions (torticollis, oculogyric crisis)

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9
Q

What risk is associated with SSRI use in the first trimester of pregnancy?

A

Congenital malformations

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10
Q

What risk is associated with the use of SSRIs in the third trimester of pregnancy?

A

Persistent pulmonary hypertension of the newborn.

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10
Q

What are the typical features of post-concussion syndrome?

A

Headache
Fatigue
Anxiety/depression
Dizziness

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11
Q

What is the difference between Knight’s move thinking versus Flight of ideas?

A

Differentiating between Knight’s move and flight of ideas - Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

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12
Q

What features differentiate depression from dementia?

A

Rapid onset
Biological symptoms and global memory loss

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13
Q

What side effect is associated with mirtazapine?

A

Increased appetite

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14
Q

What is the tyramine cheese reaction?

A

Monoamine oxidase inhibitor - consumption of food high in tyramine (cheese) –> result in a hypertensive crisis

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15
Q

What investigation should be performed prior to initiating clozapine?

A

Full blood count - risk of agranulocytosis

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16
Q

Which category of patients is predisposed to agranulocytosis on clozapine therapy?

A

Afrocarribean patients with benign ethnic neutropenia - manage with lithium and filgastrin

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17
Q

What is the management of tardive dyskinesia?

A

Prescribe tetrabenazine

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18
Q

How regularly should U&Es and TFTs be monitored on lithium therapy?

A

Every 6 months

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19
Q

What happens to clozapine levels if smoking cessation occurs abruptly?

A

Clozapine level increases - therefore necessitating dose adjustment.

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20
Q

What side effects are associated with TCAs?

A

antagonism of histamine receptors
drowsiness
antagonism of muscarinic receptors
dry mouth
blurred vision
constipation
urinary retention
antagonism of adrenergic receptors
postural hypotension
lengthening of QT interval

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21
Q

Nihilistic delusions concerning the belief of death or decay are described as what eponymous psychiatric phenomenon?

A

Cotard syndrome

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22
Q

What class of drug is venlafaxine?

A

serotonin and noradrenaline reuptake inhibitor

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23
Q

What risk factors are associated with bipolar affective disorder?

A
  • Family history of bipolar disorder or suicide – 1st-degree relatives – 7x increased risk.
  • Substance misuse disorders
  • Pattern of psychosocial instability.
  • Earlier age of onset (peak age 15-19 years) – abrupt onset
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24
Q

What is the definition of Type 1 bipolar affective disorder?

A

Mania and depression

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25
Q

What is the definition of type II bipolar affective disorder?

A

Hypomania and depression

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26
Q

What is rapid cyclic BPAD?

A

> 4 episodes/year (respond to sodium valproate)

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27
Q

What is the pharmacological management for rapid cyclic BPAD?

A

Sodium valproate

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28
Q

What are the three core features of a depressive episode?

A

Low mood
Anhedonia
loss of energy

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29
Q

What are the characteristic features of mania?

A
  • Elevated mood, extreme irritability + aggression
  • Increased energy or activity, restlessness, and a decreased need for sleep
  • The pressure of speech or incomprehensible speech
  • Flight of ideas or racing thoughts
  • Poor judgement – risky activities – gambling.
  • Distractibility, poor concentration
  • Increased libido, disinhibition, and sexual indiscretions + sexual promiscuity
  • Extravagant or impractical plans
  • Increased sociability
  • New religious ideas
  • Psychotic symptoms: Grandiose delusions or hallucinations (usually voices)
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30
Q

How long should a manic episode last for diagnosis?

A

7 days

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31
Q

What psychotic symptoms are associated with mania?

A

Delusions of grandiosity + auditory hallucinations

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32
Q

What are Schneider’s 1st rank symptoms?

A

Thought interference
Delusional perception
Auditory hallucinations

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33
Q

What clinical features are consistent with the diagnosis of hypomania?

A

Mild elevation of mood or irritability
Increased energy and activity
Increased sociability, talkativeness, and over-familiarity

N.B: There is an absence of psychotic features + there is no impairment in social or occupational functioning

Minimum period - 4 days

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34
Q

How long should symptoms of hypomania last at least for diagnosis?

A

At least for 4 days

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35
Q

What rating scale is used to assess for BPAD in young children?

A

Young Mania Rating Scale

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36
Q

What is the first-line management in primary care for a patient with suspected Bipolar?

A

Refer to specialist care for mental health assessment
1. CAMHS for <14 years
2. Specialist early intervention service in psychosis for 14-18 years

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37
Q

What mood stabiliser is indicated in the management for bipolar affective disorder?

A

Lithium

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38
Q

When is lithium prescribed after an acute episode of Bipolar affective disorder?

A

4 weeks after the acute episode

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39
Q

What is the alternative to lithium as a mood stabiliser in bipolar?

A

Sodium valproate

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40
Q

What is the therapeutic range of lithium in BPAD?

A

0.6-1.0 mmol/L

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41
Q

At what level does lithium become toxic?

A

> 1.2 mmol/L

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42
Q

Prior to commencing lithium, what investigations are performed at baseline?

A

TFTs
U&Es
FBCs

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43
Q

After a dose adjustment of lithium, when should levels be measured?

A

12 hours since dose change

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44
Q

When should plasma lithium levels be checked after dose adjustment to assess for stability?

A

1 week - aim for 0.6-0.8 mmol/L

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45
Q

How frequently are plasma lithium levels assessed?

A

Every 3 months

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46
Q

How frequently are U&Es and TFTs measured for patients on lithium therapy?

A

Every 6 months

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47
Q

What congenital malformation is associated with lithium during pregnancy?

A

Ebstein’s anomaly

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48
Q

What is the management of mania in Bipolar Affective Disorder (Acute)?

A

Atypical antipsychotics - Olanzapine, quetiapine, risperidone

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49
Q

What is the second line therapy for the management of mania?

A

Switch to a different atypical antipsychotic

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50
Q

What is the third line therapy for the management of psychosis in mania if two atypical antipsychotics have been trialed?

A

Clozapine

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51
Q

What is the definitive management if mania is unresponsive to pharmacological management?

A

ECT

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52
Q

What is the second-line prophylaxis for bipolar?

A

Lamotrigine

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53
Q

Recommended management for anti-depressant therapy in diagnosed bipolar?

A

Discontinue antidepressant

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54
Q

What is the clinical presentation of lithium toxicity?

A
  • GI disturbance
  • Nausea and vomiting
  • Polydipsia/polyuria
  • Sluggishness
  • Giddiness
  • Ataxia
  • Gross tremor
  • Fits
  • Renal failure
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55
Q

What are the long-term complications associated with lithium therapy?

A
  • Renal failure
  • Nephrogenic diabetes insipidus
  • Hyperparathyroidism + hypercalcaemia
  • Hypothyroidism – thyroid enlargement
  • Leucocytosis
  • Idiopathic intracranial hypertension
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56
Q

Which drugs can interfere and potentiate lithium toxicity?

A
  • Diuretics interfere with lithium excretion.
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57
Q

What is the management for lithium toxicity?

A

Stop lithium dose and if severe, consider gastric lavage

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58
Q

What complication is associated with sodium valproate during pregnancy?

A

Spina bifida

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59
Q

What is the ICD-10 definition of acute stress reaction?

A

A transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days.
* Occurs within 3 days to 4 weeks of a traumatic event  >1 month, consider PTSD.

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60
Q

What are the most common traumas associated with acute stress reaction?

A

Common Traumas:
1. Motor vehicle accident
2. Mild traumatic brain injury
3. Assault
4. Burn
5. Industrial accident
6. Witnessing a mass shooting

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61
Q

What are the clinical manifestations of acute stress reaction?

A
  • Initial state of daze (may manifest as stupor)
  • Constriction of consciousness field
  • Narrowing of attention
  • Inability to comprehend stimuli; disorientation.

Negative mood

Intrusion syndrome

Dissociative symptoms

Avoidance

Arousal

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62
Q

What arousal symptoms are associated with acute stress reaction?

A
  • Sleep disturbance
  • Irritable behaviour
  • Hypervigilance
  • Problems with concentrations
  • Exaggerated startle response.
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63
Q

What intrusion symptoms are associated with acute stress reaction?

A
  • Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
    o Children – Repetitive play.
  • Recurrent distressing dreams
  • Dissociative reactions (flashbacks) – as if the traumatic events are recurring.
  • Intense or prolonged psychological distress.
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64
Q

What are the autonomic signs of panic?

A
  • Tachycardia
  • Tachypnoea
  • Sweating
  • Hypertension
  • Hyperactive
  • Partial or complete amnesia may be present.
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65
Q

What is the first line management for acute stress reaction?

A

Trauma-focussed CBT - cognitive restructuring and exposure

CR - Address unrealistic appraisals the patient may have about trauma

Exposure - Confront their feared memories and situations - repeat confrontation of traumatic memories and safe reminders

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66
Q

What medication can be prescribed for short-term distress in a patient with acute stress reaction?

A

Benzodiazepine - manages sleep disturbance and agitation

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67
Q

What caution should be considered when prescribing benzodiazepines?

A

Addictive potential

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68
Q

Define adjustment disorder and prolonged grief reaction:

A

A state of subjective distress and emotional disturbance, interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event.

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69
Q

What are the three diagnostic criterions for adjustment disorder?

A

Adjustment disorder with depressed mood is characterised by the following diagnostic criteria:
1. Low mood, tearfulness, or feelings of hopelessness that occur in response to an identifiable stressor within 3 months of the onset of the stressor.
a. Does not last more than 6 months.
2. Significant distress that exceeds what would be expected given the nature of the stressor.
3. Impaired social or occupational functioning.

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70
Q

What is the duration of adjustment disorder?

A

Symptoms within 3 months of the onset of the stressor until 6 months.

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71
Q

What are common stressors result in adjustment disorder?

A

Divorce
Unemployment
Death

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72
Q

What is the presentation of adjustment disorder?

A
  • Depressed mood
  • Anxiety and worry
  • The feeling of inability to cope.
  • Disability in the performance of daily routine.

N.B: Without biological symptoms of depression (there is no impact on sleep, appetite, energy levels and no suicidal ideation).

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73
Q

What is the difference between depression and prolonged grief reaction?

A
  • The sadness and symptoms are centred around the person who was lost, as opposed to the self; they are specific and not free-floating.
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74
Q

What is the period for prolonged grief reaction?

A

6 to 12 months

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75
Q

What is the first line management for adjustment disorder?

A

Supportive counselling
Antidepressants anxiolytics/hypnotics

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76
Q

What is the time period for PTSD?

A

> 1 Month

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77
Q

What are the four features associated with PTSD?

A

Intrusion symptoms
Avoidance symptoms
Negative condition and mood
Hyperarousal

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78
Q

What investigations are performed to screen for PTSD?

A

20-item self-report measure assessing 20 DSM-5 symptoms

OR
Trauma-screening questionnaire (TSQ)

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79
Q

What is the first line management for PTSD?

A

Trauma-focussed cognitive behavioural therapy within 1 month of a traumatic event

  • Exposure therapy
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80
Q

What is the second line management for PTSD following trauma-focussed CBT?

A

Eye movement desensitisation and reprocessing (EMDR)

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81
Q

What are the indications for EMDR in PTSD Management?

A

> 3 months of symptoms related to non-combat trauma.

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82
Q

What drug is indicated in the management for PTSD?

A

SSRIs

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83
Q

How long should symptoms of GAD be for until diagnosis?

A

6 months

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84
Q

Define GAD

A

Generalised anxiety disorder (GAD) is characterised by excessive and persistent uncontrollable disproportionate worry that manifests as a significant impairment to social and occupational functioning for most days at least 6 months.

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85
Q

What are the risk factors associated with GAD?

A

Divorce, lone parent, living alone, 35-54 years old

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86
Q

What is the DSM-5 criteria for diagnosing GAD?

A

Worry must be greater than expected given the situation accompanied by 3 somatic symptoms:
o Restlessness
o Irritability
o Sleep disturbance
o Muscle tension
o Difficulty concentrating
o Fatigue

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87
Q

What are the somatic symptoms associated generalised anxiety disorder?

A

o Muscle tension or motor restlessness
o Sympathetic autonomic overactivity
 Frequent gastrointestinal symptoms
 Palpitations
 Sweating
 Trembling
 Shaking
 Dry mouth

  • Subjective experience of nervousness
    o Restlessness
    o Irritability
    o Sleep disturbance
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88
Q

What are the coping mechanisms for GAD?

A

Alcohol
Drugs
Avoidance

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89
Q

What questionnaire is used to screen for GAD?

A

GAD-7 questionnaire

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90
Q

What cut off score for severe GAD?

A

15

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91
Q

What cut off score for Moderate GAD?

A

10-14

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92
Q

What is the first line management for GAD?

A
  • Communicate information (Information guide) + active monitoring + exercise.
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93
Q

What is the second step for GAD management?

A

Offer low-intensity psychological interventions:
* Individual non-facilitated self-help – Based on CBT – 6 weeks.
* Individual guided self-help – 6 weeks, weekly therapist appointment.
* Psychoeducational groups – 6 weeks <12/group.

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94
Q

What are low-intensity psychological interventions?

A
  • Individual non-facilitated self-help

Guided self-help

Psychoeducational groups

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95
Q

What is step 3 for GAD management?

A

For patients with marked functional impairment or with GAD unresolved despite step 2 interventions provided.
Pregnant women with GAD
* High-intensity-intensity psychological interventions + Drug Treatment (SSRI)
o CBT – 12-15 weeks, 16-20 hours/day.
o Applied relaxation.

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96
Q

What is the first line management of GAD for patients with marked functional impairment?

A

High-intensity psychological intervention + SSRI
- CBT
-Applied relaxation

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97
Q

What is the difference in clinical presentation (pattern of memory loss) between pseudodementia and dementia?

A

Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia

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98
Q

Duration of social anxiety disorder for diagnosis?

A

6 months

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99
Q

Mean age of onset for social anxiety disorder?

A

13 years (more common in women than in men)

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100
Q

What are the risk factors associated with social anxiety disorder?

A

Anxiety
Mood and substance-use disorders
Positive family history

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101
Q

Define social anxiety disorder

A

A persistent and intense fear of being embarrassed, humiliated or negatively evaluated in social situations  Leading to significant distress or impairment in functioning.

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102
Q

What are the clinical manifestations associated with social anxiety disorder?

A

The social fears are confined to performance situations,
* Shyness + Social skill deficits
- Ill at ease, minimal eye contact, offering. Brief answers to questions.
- Quiet tone of speech
- Difficulty initiating conversations

  • Anxiety heightened
  • Anticipatory – worrying for hours or days prior to a feared event.
  • Avoidance behaviours
    Self-scrutiny on perceived shortcomings after leaving a social situation.
  • Post-event processing – replay social encounters in a negative way.
  • Physical symptoms during social situations:
  • Blushing, sweating, trembling, and palpitations – can manifest in the form of a panic attack.
    o Childhood presentations: Crying, tantrums or freezing.
  • Attentional biases – heightened attention to negative evaluative threat cues, and lack of attention to positive or benign cues.
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103
Q

What are the attentional biases associated with social anxiety disorder?

A

Heightened attention to negative evaluative threat cues, and lack of attention to positive cues

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104
Q

What physical symptoms are associated with social anxiety disorder?

A
  • Blushing, sweating, trembling, and palpitations – can manifest in the form of a panic attack.
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105
Q

Describe a characteristic type of heightened anxiety behaviour in social anxiety disorder?

A

Anticipatory

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106
Q

Which identification tool is used for the diagnosis of social anxiety disorder?

A

3-item Mini-Social Phobia Inventory (Mini-SPIN).

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107
Q

What is the diagnostic assessment tool to confirm a diagnosis of social anxiety disorder?

A
  • Social Phobia Inventory (SPIN) or the Liebowitz Social Anxiety Scale (LSAS).
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108
Q

What is the first line management option for social anxiety disorder?

A

CBT

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109
Q

What two models is CBT based on for the management of social anxiety disorder?

A

Clark and Wells Model
Or

Heimberg Model for 12 weeks

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110
Q

Name 5 forms of CBT for social phobia?

A
  • Graduated exposure to social situations
  • Relapse prevention
  • Cognitive restructuring.
  • Video feedback and systematic training.
  • Education about social anxiety
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111
Q

What is the indication for pharmacological therapy for social anxiety disorder?

A

For patients who prefer pharmacological therapy over individual CBT.

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112
Q

What is the first line drug for social anxiety disorder?

A

Sertraline (starting dose - 25 mg OD, increase by 25-50mg/day)

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113
Q

What is the starting dose of sertraline in social anxiety disorder?

A

25 mg

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114
Q

What is the maximum dose of sertraline?

A

200 mg/day

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115
Q

Name a SNRI used in social anxiety disorder?

A

Venlafaxine

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116
Q

What is the 2nd line therapy for social anxiety disorder?

A

Combination CBT + SSRI therapy

OR switch to an alternative SSRI/SNRI

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117
Q

How long should CBT be commenced until combined with SSRI therapy?

A

10-12 WEEKS

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118
Q

If an alternative SSRI/SNRI is unsuccessful, which class of drug is indicated in social anxiety disorder?

A

Monoamine oxidase inhibitor

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119
Q

Define a panic attack:

A

Panic Attack: A brief and sudden episode of intense fear or apprehension – associated with a sense of impending doom.

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120
Q

Symptoms of panic disorder should occur by at least how many months following an uncued panic attack?

A

At least 1 month

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121
Q

What are the DSM-V symptoms associated with panic disorder?

A

o Palpitations
o Diaphoresis
o Trembling or shaking
o Shortness of breath
o Feeling of choking
o Chest pain or discomfort
o Nausea of GI distress
o Feeling dizzy, unsteady, light-headed or faint
o Chills
o Paraesthesias
o Derealization or depersonalisation
o Fear of losing control
o Fear of dying

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122
Q

Define agoraphobia

A

Anxiety about, and avoidance of, places or situations in which the ability to escape is perceived to be limited or embarrassing.

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123
Q

Agoraphobia is often co-morbid with which disorder?

A

Panic disorder

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124
Q

What is the median age of onset for agoraphobia?

A

20-35 years (F > M()

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125
Q

What is the DSM-5 criteria for the diagnosis of agoraphobia?

A
  • Significant worry about at least two of the following situations:
    o Using public transportation
    o Being in an open space
    o Being in enclosed spaces
    o Standing in a line or being in a crowd
    o Being outside of the home alone
    o Uniting fear  Inability to escape to a safe place  Overwhelming urge to return home to safety.
    o Problem situations  Travelling (trains, buses, etc), queuing, supermarkets, crowds, parks.

N.B: At least 6 months of fear and anxiety, accompanied by avoidance of agoraphobia situation secondary to the anticipatory thoughts of experiencing symptoms and being unable to overcome them when exposed to it.

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126
Q

What is the minimum duration for agoraphobia symptoms for diagnosis?

A

At least 6 months

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126
Q

Which three scoring systems can be used to diagnose agoraphobia?

A
  1. Panic Disorder Severity Scale
  2. Positive PRIME-MD panic screen
  3. GAD-7 cute score
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127
Q

What is the first-line management option for panic agoraphobia?

A

Education, reassurance, and self-help

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128
Q

For mild-to-moderate agoraphobia, what type of CBT can be used?

A

Exposure Response Prevention

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129
Q

What is the first line management for moderate-to-severe panic disorder with or without agoraphobia?

A

CBT

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130
Q

What term describes the following: ‘Recurrent and persistent thoughts, urges or images experienced as intrusive or unwanted’)?

A

Obsessions

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131
Q

Which term describes repetitive mental operations or physical acts?

A

Compulsions

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132
Q

Do patients with OCD have insight?

A

Yes - self-recognised as a product of own mind

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133
Q

What is egodystonic thought?

A

Themes/ideas against that which the person associates with their ego

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134
Q

Why are compulsions performed?

A

Performed to reduce anxiety through irrational belief they will prevent a dreaded event

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135
Q

Which part of the brain is implicated in OCD?

A

Basal ganglia

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136
Q

The basal ganglia is affected by which three disorders?

A

Sydenham’s chorea

Encephalitis Lethargica

Tourette’s syndrome

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137
Q

What type of personality disorder is associated with OCD?

A

anakastic personality disorder

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138
Q

What are the common compulsions associated with OCD?

A

Counting, repeating words silently, ruminating, and attempting to neutralise thoughts.

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139
Q

What are the common obsessions associated with OCD?

A

Fear of contamination, need for symmetry or exactness, fear of causing harm to someone, sexual obsessions, fear of behaving unacceptable

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140
Q

After 12 weeks no-treatment response in CBT, which class of medication is recommended in panic disorder?

A

Impiramine or clomipramine

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141
Q

Which scoring scale is indicated in the assessment of OCD?

A

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

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142
Q

What is severe OCD in terms of obsessions/compulsions/day?

A

> 3 hours/day

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143
Q

What is the scoring threshold for severe OCD?

A

24-31

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144
Q

What are the OCD screening questions?

A
  • Do you wash or clean a lot?
  • Do you check the time a lot?
  • Is there any thought that keeps bothering you that you would like to get rid of?
  • Do your daily activities take a long time to finish?
  • Are you concerned about putting things in a special order or are you very upset by a mess?
  • Do these problems trouble you?
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145
Q

What low-intensity CBT is used for mild OCD?

A

Exposure and response prevention with structured self-help.

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146
Q

What is the first-line management for moderate OCD?

A

Intensive CBT including ERP or SSRI.

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147
Q

What SSRI options are available for OCD management?

A
  • Sertraline, escitalopram, fluoxetine, paroxetine
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148
Q

What is the minimum time period for SSRI therapy in OCD?

A

12 weeks

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149
Q

What is the alternative medication to SSRI in OCD?

A

Clomipramine

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150
Q

How long should SSRI therapy be continued after remission?

A

12 months

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151
Q

What is the starting dose for SSRI therapy in OCD?

A

60 - 80 mg

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152
Q

For severe OCD what is the immediate management?

A

Referral to secondary care mental assessment
-Combined treatment with an SSRI and CBT

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153
Q

What is the risk of starting SSRI therapy in patient <25-30 years of age?

A

Suicide, self-harm , arrange a follow-up in a week

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154
Q

What are the indications for specialist assessment in OCD?

A
  • Severe OCD
  • Risk of suicide/self-harm – same day to Crisis team.
  • Severe self-neglect
  • Significant co-morbidity – substance misuse, severe depression anorexia nervosa, schizophrenia.
  • <18 years of age
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155
Q

What are the complications associated with OCD?

A

Self-harm, suicide

Dermatitis

Reduced QoL

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156
Q

What are cluster A personality disorders?

A

Odd/eccentric
-Weird- paranoid, schizoid, schizotypal

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157
Q

What are the domains assessed in personality disorder?

A
  • Cognitive-perceptual
  • Affect regulation
  • Interpersonal functioning
  • Impulse control
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158
Q

What are cluster B personality disorders?

A

Wild
Dissocial, borderline (EUPD), histrionic, narcisstic

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159
Q

What are the Cluster C personality disorder?

A

Worried - Anakastic, anxious-avoidant, dependent

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160
Q

What are the REPORT criteria?

A

R Relationships affected [Pathological]
E Enduring [Persistent]
P Pervasive
O Onset in childhood/adolescence [Persistent]
R Result in distress [Pathological]
T Trouble in occupational/social performance [Pathological]

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161
Q

What are the features of paranoid personality disorder?

A

S Sensitive
U Unforgiving
S Suspicious
P Possessive and jealous of partners
E Excessive self-importance
C Conspiracy theories
T Tenacious sense of rights

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162
Q

What is the description of the following personality disorder:

A Anhedonic
L Limited emotional range
L Little sexual interest
A Apparent indifference to praise/criticism
L Lacks close relationships
O One-player activities
N Normal social conventions ignored

E Excessive fantasy world

A

Schizoid personality disorder

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163
Q

What personality disorder is described by the following features?

  • Eccentricity and eccentric thoughts/ideas (Main difference between this and schizoid).
  • Paranoid and bizarre ideas
  • Believe in magic and fairies.
  • Social withdrawal
  • Cold/inappropriate affect
A

Schizotypal personality disorder

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164
Q

What is the following personality disorder?

Attention-seeking
Concerned with appearance
Theatrical
Open to suggestion
Racy and seductive
Shallow affect

A

Histrionic personality disorder

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165
Q

Attention-seeking behaviour and emotional liability is associated with which type of personality disorder?

A

Histrionic personality disorder

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166
Q

What personality disorder is marked by recurrent self-harm and explosive behaviour in addition to affective instability?

A

Emotionally unstable personality disorder/borderline

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167
Q

What type of personality disorder is associated with social avoidance, fear of rejection, and apprehension?

A

Avoidant personality disorder

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168
Q

What type of personality disorder is associated with fear of abonnement, and feelings of helplessness when alone?

A

Dependent personality disorder

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169
Q

An immature response whereby one has the inability to reconcile the good and bad in someone and only views people based on two categories: Good or all-bad (I.E often ending relationships explosively and cannot maintain relationships)

  • What ego defence is this in EUPD?
A

Splitting

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170
Q

What is an immature ego defence where one assumes a different identity to deal with a situation?

A

Dissociation

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171
Q

Which mature ego defence is associated with an action that does not conflict with their egos/values/personality trait?

A

Sublimation

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172
Q

What ego defence is associated to reverting to immature behaviour in a stressful situation I.E banging a desk in frustration?

A

Regression

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173
Q

Which criteria is used to diagnose PD?

A

REPORT criteria

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174
Q

What class of medication is indicated for Cluster B personality disorders?

A

Antipsychotics – Reduce impulsivity and aggression

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175
Q

What class of medication is associated with the management of Cluster B,C personality disorders?

A
  • Antidepressants (SSRIs) - Reduce impulsivity and anxiety
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176
Q

What is the first line CBT indicated for EUPD?

A

DBT/Dialectical behaviour therapy

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177
Q

Define anorexia nervosa

A

Anorexia nervosa is an eating disorder characterised by restriction of caloric intake –> Low body weight and intense fear of gaining weight + body weight disturbance.

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178
Q

What is the BMI threshold for low weight?

A

<18.5

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179
Q

What is the clinical presentation of anorexia nervosa?

A
  • Intense fear of gaining weight
  • Preoccupation with food and weight – the pursuit of thinness.
  • Behaviour that interferes with weight gain
  • Compensatory behaviours – self-induced purging (vomiting or use of laxatives)
    o Excessive exercise
    o Use of appetite suppressant medication or diuretics.
  • Restriction of energy intake resulting in low body weight:
  • Low weight is defined as BMI <18.5.
  • Psychological disturbances may include:
  • Distortion of body image, with a dread of being overweight.
  • Low self-esteem and a drive for perfection.
  • Over-evaluation of self-worth in terms of body weight and shape.
  • Amenorrhoea – Seen in low-weight girls and women.
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180
Q

What are the three ICD-10 diagnostic criteria for anorexia nervosa?

A
  1. BMI <17.5 (Or weight >15% less than expected)
  2. Deliberate weight loss
  3. Fear of the fat/distorted body image
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181
Q

BMI threshold for anorexia nervosa?

A

<17.5

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182
Q

What are the common deliberate weight loss strategies employed in anorexia nervosa?

A

Laxatives

Vomiting

Excessive exercise

Appetite suppressants

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183
Q

What endocrine dysfunction manifestations are associated with anorexia nervosa?

A

Amenorrhoea - women

Impotence - men

Loss of libido

Delayed puberty

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184
Q

What type of hair is observed in anorexia nervosa?

A

Lanugo hair

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185
Q

What sign is observed that is associated with self-induced vomiting?

A

Russel’s sign

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186
Q

What cardiovascular complications are implicated in anorexia nervosa?

A

Bradycardia

Postural hypotension

Arrhythmias (2nd to Hypokalaemia)

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187
Q

What gastrointestinal complications are associated with anorexia nervosa?

A

Constipation, pain (ulcers), Mallory-Weiss tears, nutritional hepatitis (low protein, raised BR, LDH, ALP)

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188
Q

What Msk complications are associated with anorexia nervosa?

A

Osteoporosis, proximal myopathy (squat test +ve), hx of fractures

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189
Q

What questionnaire is indicated in the screening for eating disorders?

A

SCOFF questionnaire

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190
Q

What is the first line management for eating disorders?

A

Refer immediately for specialist assessment to the community mental health team or CAHMS (if <18 years of age)

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191
Q

Which guidelines are followed for the management of adults with a suspected eating disorder?

A

MARISPAN guidelines

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192
Q

An urgent referral to what service is required for a severe suspected eating disorder?

A

Community eating disorder service (CEDS)

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193
Q

What bradycardia threshold warrants admission for suspected anorexia nervosa?

A

<40 beats per minute

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194
Q

Which test assesses for muscle power in patients with a suspected eating disorder?

A

Sit-up-squat-stand (SUSS) test.

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195
Q

Reduced muscle power on the SUSS test in a patient with a suspected ED warrants what action?

A

Admission

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196
Q

What factors of cardiovascular instability in a patient with an eating disorder warrants admission?

A

bradycardia <40 BPM, tachycardia on standing, prolonged QT interval or postural hypotension.

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197
Q

What is the first line of management for adult eating disorder following an immediate specialist assessment?

A
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • Up to 40 sessions over 40 weeks, with twice-weekly sessions in the first 2-3 weeks.
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198
Q

What adult focussed treatment for anorexia is recommended?

A

MANTRA (Maudsley Anorexia Nervosa Treatment for Adults) – 20 sessions.

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199
Q

What are the three first-line management options for confirmed anorexia nervosa in adults?

A
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • MANTRA (Maudsley Anorexia Nervosa Treatment for Adults) – 20 sessions.
  • Specialist supportive clinical management (SSCM).
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200
Q

Which charities are available for patients with eating disorders?

A

BEAT charity, MIND NHS

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201
Q

What type of therapy for eating disorders is available for <18 year olds?

A

Anorexia-focussed Family-therapy

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202
Q

Which pharmacological agent is indicated for eating disorder patients with a significant pre-occupation with food?

A

Fluoxetine

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203
Q

Which three ions are significantly low in re-feeding syndrome?

A

Low phosphate

Low magnesium

Low potassium

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204
Q

Why does refeeding syndrome occur?

A

An intracellular shift of already low ions due to insulin release upon refeeding.

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205
Q

Which ion when low in refeeding syndrome presents a significant concern?

A

Potassium - hypokalaemia

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206
Q

What are the symptoms and signs associated with refeeding syndrome?

A

Fatigue, weakness, confusion, high BP, seizures, arrhythmia, HF.

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207
Q

What are the 5 questions asked in the Scoff questionnaire?

A

Do you make yourself SICK because you feel uncomfortably full?
Do you worry you have lost CONTROL over how much you eat?
Have you recently lost more than ONE stone in a 3-month period?
Do you believe yourself to be FAT when others say you are too thin?
Would you say that FOOD dominates your life?

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208
Q

What feature differentiates bulimia nervosa with anorexia nervosa?

A

Recurrent episodes of binge eating

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209
Q

Minimum period for binge eating and inappropriate compensatory behaviours for diagnosis of bulimia?

A

At least once a week for 3 months

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210
Q

What are the common Recurrent inappropriate compensators/behaviours to prevent weight gain in bulimia?

A

a. Self-induced vomiting
b. Misuse of laxatives, diuretics and other medications
c. Fasting
d. Excessive exercise.

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211
Q

Weight for bulimia nervosa?

A
  • Weight is often within normal limits or above the weight range for age.
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212
Q

What are the psychological features implicated in Bulimia Nervosa?

A
  • Over-evaluation of self-worth – in terms of body weight and shape.
  • Fear of gaining weight, with a sharply defined weight threshold set by the person.
  • Mood disturbance of anxiety and tension.
  • Persistent preoccupation and craving for food and feelings of guilt and shame about eating.
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213
Q

What are the physical symptoms (4) observed in bulimia nervosa?

A
  1. Bloating, lethargy, GORD, abdominal pain, and sore throat (from vomiting)
  2. Russel’s sign - knuckle calluses from induced vomiting
  3. Dental enamel erosion
  4. Salivary gland enlargement
214
Q

What is the difference from binge eating disorder from bulimia nervosa?

A

Binge eating episodes without purging pathology

215
Q

In severe bulimia, an urgent referral to which service is required?

A

Community eating disorder (CED) service

216
Q

What is the first line management for moderate bulimia nervosa?

A

Guided self-help, beat charity and monitor for 8 weeks

217
Q

What are the features associated with severe bulimia nervosa?

A

Daily purging, significant electrolyte imbalance, comorbidity

218
Q

What are the features associated with moderate bulimia nervosa?

A

Frequent binging and purging (>2 episodes/week)

219
Q

What is the first line therapy for <18 year olds with bulimia?

A

Family therapy

220
Q

What is the first line management for adults with bulimia?

A

Guided self-help programme (bulimia nervosa focussed)

221
Q

Serotonin syndrome results in the excessive serotonergic stimulation of which two receptors?

A

5-HT and 5-HT2a receptors

222
Q

Which anti-depressant drug is associated with the greatest risk of serotonin syndrome if taken with SSRIs?

A

Monoamine oxidase inhibitors

223
Q

Which drugs when combined with SSRI can predispose to serotonin syndrome?

A

Triptans

Monoamine oxidase inhibitors

Tramadaol

St John’s Wort

  • Ecstasy
  • Amphetamines
  • Cocaine, MDMA, LSD, Lithium
224
Q

What are the symptoms of serotonin syndrome?

A
  1. Neuromuscular excitation
    o Hyperreflexia
    o Myoclonus
    o Rigidity
  2. Autonomic effects
    o Hyperthermia (>38)
    o Sweating
    o Hypertension
    o Tachycardia
    o Dilated pupil
    o Flushed skin
  3. Altered mental status
    o Confusion
    o Anxiety
    o Agitation
225
Q

What autonomic symptoms are associated with serotonin syndrome?

A

o Hyperthermia (>38)
o Sweating
o Hypertension
o Tachycardia
o Dilated pupil
o Flushed skin

226
Q

Which neurological signs can be elicited on examination in patients with serotonin syndrome?

A
  • Clonus
  • Inducible, spontaneous, and ocular.

Babinski’s sign

Hyperreflexia

227
Q

Onset of serotonin syndrome?

A

Within minutes to hours after initiating a new psychopharmacologic treatment or increasing dose

228
Q

What is the management for mild serotonin syndrome?

A

Cessation of offending agent

229
Q

Which drug is prescribed to patients with moderate serotonin syndrome?

A

Benzodiazepines e.g., diazepam

230
Q

What is the management for severe serotonin syndrome?

A

Emergency supportive care
- Activated charcoal (25-100 g orally as a single dose) if overdose occurred within 2 hours.
- IV sedation
- Cyproheptadine and chlorpromazine.

231
Q

Define neuroleptic malignant syndrome

A

A life-threatening neurological emergency associated with the use of antipsychotic agents is characterised by mental status changes, rigidity, fever and dysautonomia.

232
Q

What is the aetiology of Neuroleptic Malignant Syndrome

A

Dopamine blockade induced by antipsychotics - triggers glutamate release and subsequent neurotoxicity

233
Q

Which high-potency antipsychotics are associated with Neuroleptic Malignant Syndrome?

A

Haloperidol
Fluphenazine

234
Q

What is the clinical presentation of Neuroleptic Malignant Syndrome?

A
  • Mental status change
  • Agitated delirium with confusion.
  • Catatonic signs and mutism.
  • Muscular rigidity
  • Generalised
  • Increased tone – lead-pipe rigidity.
  • Hyperthermia
  • > 38 degrees.
  • Autonomic instability
  • Tachycardia
  • Labile or high blood pressure
  • Tachypnoea
  • Diaphoresis
235
Q

What are the first-line laboratory investigations indicated for neuroleptic malignant syndrome?

A

Serum creatine kinase

236
Q

Why is serum creatine kinase raised in neuroleptic malignant syndrome?

A

Due to rhabdomyolysis

237
Q

What is the management for neuroleptic malignant syndrome?

A

Stop anti-psychotic drug

Supportive fluids and dialysis to minimise renal failure

238
Q

What drug is prescribed in patients with neuroleptic malignant syndrome?

A

Dantrolene and bromocriptine

239
Q

Which personality disorder is associated with conduct disorder?

A

Antisocial personality disorder

240
Q

Which gender is predominantly affected in conduct disorder?

A

Male

241
Q

What is the median age of onset of conduct disorder?

A

11 years

242
Q

What are the risk factors of conduct disorder?

A

Risk factors:
* Low socioeconomic status
* Deprived living
* Children in the care system
* ADHD
* Substance misuse
* Male

243
Q

What is the minimum period duration required for the diagnosis of conduct disorder?

A

3 out of the 15 behavioural manifestations in the past 12 months, and at least one in the past 6 months.

244
Q

What four domains are assessed by the DSM-5 criteria in conduct disorder?

A

Aggression against people and animals

Destruction of property

Deceitfulness or theft

Serious violation of rules

245
Q

What is the difference between oppositional-defiant disorder and conduct disorder?

A

ODD associated <10 years of age and defiant behaviour to authority without aggression/destruction

246
Q

What is the first line of management for conduct disorder?

A

Parent training

Group parent training
-Webster-Stratton, Triple-P models

247
Q

A referral to CAMHS is indicated by which criteria for conduct disorder?

A
  1. A co-existing mental health problem (depression, PTSD)
  2. Neurodevelopmental condition (ADHD)
  3. Learning difficulty
  4. Substance misuse.
248
Q

What are the risk factors for delirium?

A

sk Factors:
* Age 65 years or older
* Cognitive impairment and/or dementia
* Current hip fracture
* Severe illness
* Current history of alcohol abuse
* Untreated vision and hearing loss
* Infection – UTI, RTI
* Medication (Anti-Ach, steroids, opiates)
* Encephalitis
* Constipation
* Urine retention
* Stroke
* Hyponatremia

249
Q

Define hypoactive delirium

A

Hypoactive delirium: Withdrawal, slow responses, reduced mobility, and movement, worsened concentration, and reduced appetite.

250
Q

Which assessment method is used for delirium?

A

Confusion Assessment Method (CAM).

251
Q

Which medication is prescribed to manage agitation in delirium patients?

A

Low-dose haloperidol 0.5-1mg

252
Q

Which class of drugs should be avoided in patients with conduct disorder?

A
  • Avoid anticholinergics.
253
Q

What are the four different types of dissociative disorder?

A
  1. Dissociative identity disorder (DID)
  2. Dissociative amnesia
  3. Dissociative fugue
  4. Depersonalisation/derealisation disorder.
254
Q

What are the risk factors for dissociative disorder?

A
  • Chronic stress during adolescence.
  • Witnessing or experiencing acute trauma.
  • Severe childhood sexual abuse is a predictor of dissociative disorders.
255
Q

Define dissociative amnesia?

A
  • Loss of autobiographic memory for previous experiences or before a certain point in time.
256
Q

What is dissociative fugue?

A
  • Dissociative amnesia + sudden and unplanned purposeful travel away from one’s home.
257
Q

What defines the following ‘Patients appear to possess two or more distinct identities or personality states, associated with the patient’s consciousness, perception, thoughts, and actions’

A

Dissociative Identity Disorder (DID)

258
Q

Define depersonalisation disorder

A
  • The patient believes that they have been altered in some way or that they are no longer real.
259
Q

What investigation differentiates between a dissociative convulsion with a real one?

A

Serum prolactin (normal)

260
Q

What is the first line management for a paracetamol overdose if ingested over 1 hour?

A

N-acetylcysteine (NAC)

261
Q

If there are signs of jaundice, hepatic tenderness and raised ALT in a paracetamol overdose (>24 hours), what is the first line management?

A

N-acetylcysteine

262
Q

First line management of paracetamol overdose if within 1 hour of consumption?

A

Activated charcoal

263
Q

What is the cut off for a liver transplant in paracetamol overdose?

A

Prothrombin time >100 s

264
Q

What hepatic complication is implicated with a paracetamol overdose?

A

Hepatic necrosis

265
Q

What is the clinical presentation of an aspirin overdose?

A
  • Hyperventilation
  • Tachypnoea, hyperpnea, and tachycardia.
  • Tinnitus
  • Deafness
  • Vasodilation
  • Sweating
266
Q

At what salicylate concentration results in toxicity?

A

2.2-3.6 mmol/L

267
Q

What is the management for an aspirin overdose?

A

Urinary alkalinization with IV bicarbonate.

Consider haemodialysis

268
Q

What type of features are associated with TCA overdose?

A

Anticholinergic features

269
Q

List the anticholinergic features associated with TCA overdose?

A
  • Dry mouth
  • Seizures
  • Coma
  • Cardiac conduction defects
  • Arrhythmias, hypothermia, hypotension.
  • Hyperreflexia
  • Convulsions
  • Respiratory failure
    Dilated pupils
    Downregulation of parasympathetic system
270
Q

Which ECG changes are observed in TCA overdose?

A
  • Sinus tachycardia
  • Widening of QRS complexes
  • QT interval prolongation.
271
Q

A QRS interval of what > is associated with an increased risk of seizures?

A

> 100 ms

272
Q

What is the first line management for TCA overdose?

A

Intravenous bicarbonate

273
Q

What are the symptoms associated with SSRI overdose?

A

Nausea, vomiting, agitation, tremor.
* Nystagmus
* Drowsiness
* Sinus tachycardia
* Serotonin syndrome

274
Q

What ECG abnormality is associated with citalopram?

A

QT prolongation

275
Q

Within how many hours post-SSRI overdose can necessitate 50 g of oral activated charcoal?

A

4 hours

276
Q

What is the management of QRS prolongation in SSRI overdose?

A

Bicarbonate

277
Q

What are the features associated with a beta-blocker overdose?

A

Bradycardia, hypotension, syncope.
* Drowsiness
* Confusion
* Hallucinations
* Convulsions.

278
Q

Which ECG finding is associated with beta-blocker overdose?

A

PR prolongation

279
Q

What is the management for beta-blocker overdose?

A

Glucagon injection to manage symptomatic hypoglycaemia + IV dextrose

280
Q

What pupillary defect is associated with opioid overdose?

A

Pinpoint pupils (miosis)

281
Q

Respiratory complication associated with opioids?

A

Respiratory depression

282
Q

ECG finding associated with opioid overdose?

A

QRS prolongation

283
Q

Management of opioid overdose (first line)?

A

Naloxone

284
Q

Management of opioid overdose with retained packages?

A

Whole bowel irrigation

285
Q

What are the clinical features associated with benzodiazepine overdose?

A

Drowsiness
* Dysarthria
* Ataxia
* Nystagmus
* Respiratory depression

286
Q

2 investigation performed for suspected benzodiazepine overdose?

A

Urine testing - BZD screen

ABG

287
Q

Management for benzodiazepine overdose?

A

Flumazenil

288
Q

What are the auditory hallucinations associated with schizophrenia?

A

Third person or running commentary

289
Q

What are delusions of reference?

A

Occurrences whereby a special message is delivered to the individual

290
Q

What are the common bizarre delusions associated with schizophrenia?

A

Persecutory/paranoid delusions

291
Q

Which term describes thoughts that are being shared with others?

A

Thought broadcast

292
Q

Which term describes thoughts being inserted and felt to be alien?

A

Thought insertion

293
Q

What term describes a patient becoming increasingly further off-topic without appropriately answering a question?

A

Tangentiality

294
Q

Which speech disorder is associated with ‘Eventually answers a question, but in a markedly roundabout manner’?

A

Circumstantial speech

295
Q

Which speech disorder is associated with ‘Suddenly switches topics without any logic or segue’?

A

Derailment

296
Q

Which term describes the following ‘The creation of new, idiosyncratic words’?

A

Neologisms

297
Q

Which speech disorder term describes ‘Words are thrown together without any sensible meaning’?

A

Word salad

298
Q

What are the symptoms associated with simple schizophrenia?

A

Negative Symptoms (Simple):
- Social withdrawal
- Demotivation
- Self-neglect
o Anhedonia
o Alogia
- Flat affect
o Incongruity/blunting of affect
- Catatonia

299
Q

What are Schneider’s first-rank symptoms?

A

Delusions

Passivity

Thought disorder - insertion, withdrawal, broadcasting

Auditory disorder - thought echo, 3rd person voice, running commentary

300
Q

What type of schizophrenia is characterised by disorganised symptoms, bizarre motor activity and emotional responses?

A

Hebephrenic

301
Q

What type of schizophrenia is characterised by negative symptoms?

A

Simple

301
Q

What rating scale is used to assess for schizophrenia and psychosis?

A

Brief psychiatric rating scale

302
Q

What is the first-line approach for managing and aggressive and violent patient?

A

verbal de-escalation

303
Q

What is the next line management option following verbal de-escalation for an aggressive patient?

A

Rapid tranquillisation

304
Q

What drug is indicated for the rapid tranquillisation?

A

Intramuscular lorazepam

305
Q

What is the urgent management option for patients with schizophrenia and acute psychosis?

A

Crisis resolution team and home treatment team

306
Q

What is the community support intervention for patients with first episode of psychosis?

A

Early intervention in psychosis team

307
Q

Which dopamine pathway is associated with positive symptoms?

A

Mesolimbic

308
Q

Which dopamine pathway is implicated with negative symptoms?

A

Mesocortical

309
Q

THe mesocortical pathway connects cell bodies in the ventral tegmental area to what?

A

Prefrontal cortex

310
Q

Which side effects are associated with the nigrostriatal pathway?

A

Extrapyramidal side effects

311
Q

Extrapyramidal side effects is associated with which dopamine pathway?

A

Nigrostriatal pathway

312
Q

Which dopamine pathway is associated with hyperprolactinaemia?

A

Tuberoinfundiable

313
Q

Typical antipsychotic medications block which specific dopamine pathway that results in hyperprolactinaemia symptoms?

A

Tuberoinfundiable pathway

314
Q

What are the clinical signs and symptoms of hyperprolactinaemia?

A

 Altered menstural period
 Weight gain, osteoporosis
 Risk of breast and pituitary cancer
 Gynaecomastia.

315
Q

Which ethnicity is associated with an increased risk of schizophrenia?

A

Black Caribbean / African 4-6x higher

316
Q

Which adverse life experiences are associated with an increased risk of schizophrenia?

A

sexual or physical abuse

317
Q

The mesocortical pathway is associated with types of symptoms?

A

Negative symptoms

318
Q

What is the first line management for schizophrenia?

A

6 weeks of atypical antipsychotic + CBT

319
Q

Which atypical anti-psychotic is associated with a reduced side effect profile?

A

Aripiprazole

320
Q

Which atypical anti-psychotic is associated with increased weight gain?

A

Olanzapine

321
Q

Name atypical anti-psychotics

A

Risperidone
Olanzapine
Quetiapine
Aripiprazole

322
Q

What is the management option for non-compliant schizophrenia?

A

Once-monthly IM depot injection (i.e., zuclopenthixol decanoate 200mg depot injection; ‘Clopixol’)

323
Q

What is the minimum duration for atypical antipsychotic trial in the management of schizophrenia?

A

6 weeks

324
Q

Following 6 weeks of atypical antipsychotic management, what is the second line option?

A

Change to a different atypical or a try a typical antipsychotic

325
Q

Despite two 6 week trials of different antipsychotic medication, what is the next-line option?

A

Clozapine

326
Q

Dopamine receptor antagonists act on which specific dopamine pathway?

A

Mesolimbic pathway

327
Q

Which specific cerebral region is associated reward, motivation, cognition and version?

A

Ventral tegmental area

328
Q

Dopamine receptor antagonists are associated with an increased risk of what in the elderly?

A

Stroke

VTE

329
Q

Acute dystonia is associated with what 3 clinical manifestations?

A

Torticollis

Oculogyric crisis

Laryngeal dystonia

330
Q

Torticollis and oculogyric crisis is associated with what type of extrapyramidal side effect?

A

Acute dystonia

331
Q

What is the management of acute dystonia?

A

Procyclidine (5-10 mg OD).

332
Q

What term describes an involuntary, painful, sustained muscle spasm resulting in unilateral neck twisting?

A

Torticollis

333
Q

Which disorder of acute dystonia is associated with Eye twists up and cannot look down.

A

Oculogyric crisis

334
Q

What term describes ‘o An unpleasant subjective feeling of restlessness; patients often must pace about or jiggle their legs to cope with it’?

A

Akathisia

335
Q

What is the management of akathisia?

A

Decrease dose/change antipsychotic – Add propranolol or benzodiazepines.

336
Q

What term describes ‘o A triad of Resting tremor, rigidity (experienced as stiffness), and bradykinesia. Patients may have mask-like facies and a shuffling gait’?

A

Parkinsonism

337
Q

Drug-induced Parkinsonism is associated with what type of tremor?

A

Bilateral tremor

338
Q

What is the management for drug-induced Parkinsonism?

A

Decrease/change antipsychotic – prescribe anticholinergic – procyclidine.

339
Q

What term describes the following:

‘Rhythmic involuntary movements of the mouth, face, limbs, and trunks. Grimacing, make chewing and sucking movements with their mouth and tongue?

A

Tardive Dyskinesia

340
Q

What is the management option for tardive dyskinesia?

A

Tetrabenazine

341
Q

What are the four types of extrapyramidal side effects?

A

Acute dystonia

Akathisia

Parkinsonism

Tardive dyskinesia

342
Q

What are the features are associated with tardive dyskinesia?

A

Protrusion and rolling of the tongue

Sucking and smacking movements of the lips

Chewing motion

Facial dyskinesia

Involuntary movements of the body and extremities

343
Q

What are the clinical features associated with akathisia?

A

Restlessness

Trouble standing still

Paces the floor

344
Q

Laryngeal spasms are associated with what type of extrapyramidal side effectt?

A

Acute dystonia

345
Q

Quetiapine, olanzapine, risperidone is associated with what type of side effects?

A

Sedation

Weight gain

Hyperglycaemia
Anticholinergic side effects

EPSE

346
Q

Which specific atypical antipsychotic is associated with an increased risk of weight gain?

A

Olanzapine

347
Q

What is the most common side effect associated with atypical anti-psychotics?

A

Weight gain and metabolic syndrome

348
Q

What are the anticholinergic side effects associated with atypical anti-psychotics?

A

a. Dry mouth and eyes
b. Blurred vision
c. Urinary retention
d. Constipation
e. Postural hypotension

349
Q

Significant hyperprolactinaemia symptoms can be mitigated with which alternative atypical anti-psychotics?

A

switch to aripiprazole

350
Q

What class of drug is aripiprazole?

A

Partial dopamine agonist

351
Q

Which electrophysiological abnormality is associated with quetiapine?

A

QT prolongation

352
Q

QTc prolongation can result in what complication?

A

Polymorphic VT (TDPs) and a loss of cardiac output.

353
Q

What side effects are associated with clozapine?

A

 Agranulocytosis (1%) – Neutropenia (eosinophilia, lymphopenia, neutropenia leucocytosis)  Weekly FBC and prior to initiating management.
 Reduced seizure threshold
 Severe constipation
 Myocarditis
 Interacts with lithium
 Paradoxical hypersalivation

354
Q

Advice for smoking cessation to clozapine dose?

A

Adjust dose - increase if immediate cessation

355
Q

What is the main significant complication associated with clozapine?

A

Agranulocytosis

356
Q

Why is metabolic syndrome associated with atypical antipsychotics?

A

Atypical antipsychotics have a propensity to induce hyperglycaemia and subsequent impaired glucose tolerance.
* Hypertension
* Obesity
* Diabetes – Olanazapine.

357
Q

What frequent monitoring investigation is implicated in clozapine management?

A

FBC

358
Q

What basic observations are associated with atypical antipsychotics?

A

o Weight and waist circumference (weekly for 6 weeks, at 12 weeks, annual thereafter)

Weight, waist circumference, pulse and BP.

359
Q

What preliminary blood tests are implicated prior to initiating atypical antipsychotics?

A

FBC, U&Es, LFTs, fasting BM, HbA1c, lipid profile, prolactin (more frequent if on clozapine).

360
Q

Definition of schizoaffective disorder?

A

Schizoaffective disorder is characterised by both combined features of schizophrenia concurrent with mood symptoms (depression or mania), lasting for a considerable part of a 1-month period.
* Depressive type is more common in older patients
* Bipolar type = young patients

361
Q

What is the first-line management for schizoaffective disorder?

A

Fluoxetine (SSRI) + olanzapine (antipyshocitc)

362
Q

What is the 2nd line management for schizoaffective disorder?

A

Lamotrigine

363
Q

What type of delusional disorder is characterised by the belief that another person is secretly in love with them?

A

Erotomanic (De Clereambault syndrome)

364
Q

What type of delusional disorder is associated with the belief of ‘special prominence or talent’?

A

Grandiose

365
Q

What type of delusional disorder is associated with the belief that a spouse or partner is unfaithful?

A

Orthello syndrome

366
Q

What are the characteristic features of Orthello syndrome?

A

o Accuses the spouse - Aggressive, threatening and possibly violent behaviour (homicide and suicide).
o Delusion of infidelity.

367
Q

What type of delusional disorder is associated with the following description

‘Belief that a familiar person has been replaced by an exact double – an impostor?

A

Capgras

368
Q

What type of delusional disorder is characterised by the following description?

Belief that a complete stranger is actually a familiar person already known to one

A

Fregoli

369
Q

Capgras syndrome is associated with what?

A

Belief that a familiar person has been replaced by an exact double – an impostor.

370
Q

Fregoli syndrome is associated with what?

A

Belief that a complete stranger is actually a familiar person already known to one.

371
Q

What nihilistic delusional disorder is associated with denial or self-existence?

A

Cotard syndrome

372
Q

Which delusional disorder is associated with delusions of infestation?

A

Ekbom syndrome

373
Q

Ekbom syndrome is associated with what type of delusions?

A

Delusions of infestation

374
Q

Which medically unexplained symptom disorder is associated with persistent pre-occupation with a single problem (often associated with cancer)?

A

Hypochondrial Disorder

375
Q

Which medically unexplained symptom disorder is associated with symptoms of objective autonomic arousal e.g., palpitations, sweating, flushing, tremor?

A

Somatoform Autonomic Dysfunction

376
Q

Which syndrome is associated with the intentional production of physical or psychological symptoms (feigning)?

A

Munchausen’s syndrome

Factitious disorder

377
Q

What type of behaviours is associated with feigning symptoms?

A
  • Deceptive behaviours – falsify symptoms and disease.
  • Fabrication of illness
  • Forging medical records
  • Tampering with medical instruments
378
Q

What is the difference between malingering and factitious disorder?

A

Malingering - Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain.

379
Q

What disorder is associated with a loss of motor or sensory function?

A

Conversion disorder

380
Q

What are the clinical manifestations associated with conversion disorder?

A
  • La belle indifference.
  • Nonepileptic seizures
  • Weakness and paralysis
  • Abnormal movement
  • Speech disturbances
  • Globus sensation
  • Visual symptoms
381
Q

What is the management plan for medically unexplained symptoms?

A

1st line: Reassure and Explain
* Broaden clinical agenda from a physical cause to a physical + psychological cause.
o 2nd: Clear about negative clinical findings and links symptoms to psychological aetiology.
 Acknowledge psychosocial distress
 Elicit childhood experience of illness
- 3rd: Explain you’ll conduct no further investigations
- 4th: Emotional support:
o Encouraging coping strategies
o Letting go of inappropriate sick role
o Involve family who may be reinforcing behaviour

382
Q

Which protein is implicated in Alzheimer’s dementia?

A

Beta-amyloid protein

383
Q

Beta-amyloid protein deposition affects which part of brain in Alzheimer’s dementia?

A

Hippocampus

384
Q

What protein implicated in Alzheimer disease is associated with microtubule assembly?

A

Tau protein

385
Q

Hyperphosphorylation of tau forms what?

A

neurofibrillary tangles

386
Q

What forms extracellular plaque deposits in Alzheimer’s dementia?

A

Beta-amyloid

387
Q

What protein forms intracellular neurofibrillatory tangles?

A

Tau

388
Q

What psychosocial risk factors are associated with Alzheimer’s dementia?

A

Low IQ

Poor educational level

389
Q

Which congenital chromosomal disorder is associated with an increased incidence of Alzheimer’s dementia?

A

Down’s syndrome

390
Q

What type of memory impairment is spared in early stage Alzheimer’s dementia?

A

Immediate recall

391
Q

What type of memory loss is associated with early-stage Alzheimer’s dementia?

A

Anterograde

392
Q

What are the four A’s associated with Alzheimer’s?

A
  • Amnesia Recent memories lost first; disorientation occurs early
  • Aphasia Aphasia in finding correct words (Broca’s), speech muddled/disjointed
  • Agnosia Typically “Visual” (i.e. prosopagnosia – recognising faces)
  • Apraxia Typically “Dressing” (skilled tasks, despite normal motor functioning)
393
Q

What three behavioural changes are associated with Alzheimer’s disease?

A
  • Behavioural changes:
    o Mood changes
    o Apathy
    o Memory impairment
394
Q

Which drugs are contraindicated in the management of Alzheimer’s dementia?

A
  • Do not use antipsychotics to manage long-term (Risperidone has a short-term licence)
395
Q

What bedside cognitive testing is associated with Alzheimer’s dementia?

A

Folstein Mini-Metal State Examination

SLUMS examination

396
Q

What MMSE score cut-off is associated with Severe cognitive impairment?

A

<18

397
Q

What MMSE score threshold is associated with mild cognitive impairment?

A

18-23

398
Q

What is the AMTS cut-off for cognitive impairment?

A

<7

399
Q

What tests/investigations are implicated as part of the dementia screen?

A

 TFTs (hypothyroid  cognitive decline)
 LFTs (Korsakoff’s)
 U&Es and dipstick (infection, diabetes)
 HbA1c (diabetes)
 Vitamin B12 and folate
 FBC - Anaemia

400
Q

What is the first line referral recommendation for patients with suspected reversible causes of cognitive decline and suspected dementia?-

A

Specialist dementia diagnostic service (memory clinic or community old-age psychiatry)

401
Q

What is a cause of rapidly-progressive dementia?

A

Creutzfeldt-Jakob disease

402
Q

What further investigations should be performed in patients whereby a dementia diagnosis is uncertain?

A
  • FDG-PET
403
Q

What is the first-line investigation for a patient with suspected CJD?

A

CSF examination

404
Q

What MRI feature is associated with Alzheimer’s dementia?

A

Hippocampal atrophy

405
Q

What class of drug is the first line management for Alzheimer’s

A

Acetylcholinesterase (AChE) inhibitor

406
Q

Name 3 examples of AChE inhibitors

A
  • Donepezil
  • Galantamine
  • Rivastigmine
407
Q

Which drug is second-line if AChE are contraindicated in Alzheimer’s?

A

Memantine monotherapy

408
Q

What drug is indicated for severe Alzheimer’s disease?

A

Memantine monotherapy

409
Q

What class of drug is memantine?

A

NMDA (Glutamate) partial receptor agonist

410
Q

Frequency of follow-up in Alzheimer’s dementia patients?

A

Every 6 months

411
Q

Driving advice for Alzheimer’s dementia?

A

Inform the DVLA and insurers

412
Q

Which drugs are absolutely contraindicated in Alzheimer’s dementia?

A

anticholinergics (block ACh from binding), beta-blockers, NSAIDs, muscle relaxants

413
Q

What type of memory loss is associated with depressive pseudodementia?

A

Global memory loss + deficits in executive function, speech and language

414
Q

What is the 2nd most prevalent type of dementia?

A

Vascular Dementia

415
Q

What are the risk factors for Vascular Dementia?

A

Risk factors
* Advanced age
* Hypertension, diabetes, hypercholesterolaemia
* Lower physical activity
* Low or high BMI
* Smoking
* Coronary artery disease
* Atrial fibrillation.

416
Q

What is the pattern of cognitive decline for vascular dementia?

A

Stepwise cognitive decline

417
Q

What are the clinical features associated with vascular dementia?

A

o 1st: Emotional and minor personality changes (labile emotion – tearful  Elation).
 Difficulty solving problems – Frontal cognitive syndrome
 Apathy
 Disinhibition – Frontal cognitive syndrome
 Poor attention
 Diminished processing of information
 Retrieval memory deficit
o 2nd: Cognitive deficit

418
Q

What is the management for vascular dementia?

A

Daily aspirin

Reduce risk factors (exercise, reduced EtOH intake, HTN, smoking cessation, AF management, DM control).

419
Q

Which type of dementia is associated with Parkinsonism?

A

Lewy-body dementia

420
Q

Which type of dementia is associated with REM sleep disorder?

A

Lewy-body dementia

421
Q

What are lewy bodies?

A

Eosinophilic intracytoplasmic inclusions

422
Q

Which part of the brain is affected Lewy-Body dementia?

A

Cingulate gyrus; deep cortical layers

423
Q

What type of hallucinations are associated with Lewy-body dementia?

A

Lilliputian hallucinations.

424
Q

What are the main features of Lewy-body dementia?

A

Recurrent visual hallucinations

Fluctuating confusion with marked variations in altertness

Rapid eye movement (REM) sleep behaviour disorder

Motor features of Parkinsonism

425
Q

What is parasomnia?

A

Characterised by dream enactment

426
Q

What are the motor features of Parkinoism?

A

Bradykinesia

Rest tremor

Anosmia

Antipsychotic sensitivity

Rigidity

Frequent falls

427
Q

What investigation is indicated in Lewy- body dementia?

A

I-FP-CIT SPECT

428
Q

What is the first line management of lewy-body dementia?

A

Donepezil or rivastigmine

429
Q

What medication is prescribed to manage sleep disturbance in Lewy-body dementia?

A

Clonazepam

430
Q

What protein is implicated FTD?

A

Tau

431
Q

What are Pick’s bodies?

A

Pick’s bodies (hyperphosphorylated tau)

432
Q

What is hallmark feature is FTD?

A

Progressive personality and behaviour change early in the disease course.

433
Q

What is common clinical subtype FTD?

A

Behavioural variant

434
Q

What personality features are implicated frontotemporal dementia?

A

Disinhibition

Apathy and loss empathy

Hyperorallity and dietary changes

435
Q

Cravings and binge eating is associated with which type of dementia?

A

Frontaltemporal dementia

436
Q

What is the pharmacological management of FTD?

A

anti-depressants (do not prescribe AChE inhibitors)

437
Q

What is the pharmacological management for agitation, irritability and restlessness in patients with FTD?

A

Benzodiazepines (Short-acting - lorazepam)

438
Q

What are the CT changes observed in Vascular dementia?

A

Multiple lucencies atrophy

439
Q

What screening questionnaire is used to assess learning disability?

A

WAIS (III) – (Wechsler Adult Intelligence Scale) – Verbal IQ + Performance IQ = Full Scale IQ

440
Q

What medication is prescribed to support poor sleep-wake cycles?

A

Melatonin

441
Q

What are the three core symptoms of depression?

A

Anhedonia

Low Mood

Anergia

442
Q

Minimum duration of symptoms for the diagnosis of depression?

A

2 weeks

443
Q

What is Beck’s cognitive triad of depression?

A

Beck’s Cognitive Triad of Depression:
1. Worthlessness
2. Hopelessness
3. Helplessness

444
Q

What are the adjunctive symptoms of depression?

A

 Insomnia/early waking
 Poor concentration
 Increased or decreased appetite/weight
 Suicidal thoughts or acts
 Agitation or slowing of movements
 Guilt or self-blame
 Reduced libido
 Nihilistic delusions

445
Q

Which medications are associated with causing depression?

A
  • Steroids
  • COCP
  • Beta-blockers (propranolol)
  • Statins
  • Ranitidine
  • Retinoids
  • HIV Medications
446
Q

What are the organic differentials of depression?

A
  • Hypothyroidism
  • Hypercalcaemia
  • Cushing’s disease
  • Vitamin B12/D deficiency
  • Obstructive sleep apnoea
  • Anaemia
  • Alzheimer’s dementia
447
Q

What rating scale is used to screen depression?

A

PHQ-9

448
Q

What is the maximum score for the PHQ-9 questionnaire?

A

27

449
Q

What is the threshold for moderate-severe depression on the PHQ-9 questionnaire?

A

> 16

450
Q

What depression scale is used postnatally?

A

Edinburgh postnatal depressions cale

451
Q

What depression scale is indicated for inpatients?

A

Becks Depression inventoryI-II

452
Q

What is the first line management for uncomplicated and brief depression in children?

A

Active monitoring and supportive care for 6 weeks (2-weeks and follow-up)

453
Q

What self-help charities are available for children and young people with depression?

A

Mind.org

Youngminds.org

454
Q

What is the management of moderate-to-severe depression in children?

A

Refer to CAMHS - family based interpersonal therapy, family therapy or individual CBT

455
Q

If there is a significant risk of suicide, what service should be referred?

A

Crisis Resolution and Home Treatment Team

455
Q

Which anti-depressant drug is indicated for the management of depression in young children?

A

Fluoxetine

456
Q

What is step 1 of adult depression management?

A

Watchful waiting with follow-up in 2 weeks - education on sleep hygiene, exercise, self-help, and support

457
Q

What is step 2 of depression management in adults (mild-to-moderate depression)?

A

Low-intensity psychological interventions - individual-guided self, help based on CBT

Computerised CBT

Structured group physical activity programme

458
Q

What is step 3 for adult depression (Persistent sub-threshold depressive symptoms or mild-to-moderate depression with inadequate response or moderate-to-severe depression)?

A

Medication + CBT

459
Q

What are the examples of high-intensity of psychological interventions?

A

Individual CBT

Interpersonal Therapy/IPT

460
Q

What is the first-line management for moderate-to-severe depression?

A

Medication, high-intensity psychological interventions

460
Q

What is the management for unresponsive severe and complex depression with risk to life?

A

ECT

461
Q

What is the first-line anti-depressant medication in adults with depression?

A

50 to 200 mg Sertraline (50 mg increase every 2 weeks; over 6 weeks)

462
Q

How many trials of SSRI are required prior to switching to 2nd line?

A

2

463
Q

What is the second line management for depression following an initial 6w trial of sertraline?

A

Switch to SNRI/alternative SSRI

464
Q

What class of drug is duloxetine?

A

SNRI

465
Q

Name 2 SNRIs

A

venlafaxine, duloxetine

466
Q

Which anti-depressant is implicated to improve symptoms of insomnia and appetite reduction?

A

Mirtazapine

467
Q

What class of drug is mirtazpine?

A

alpha2-adrenoreceptor antagonist

468
Q

Which drugs should be given with SSRIs + NSAIDs?

A

PPI prophylaxis for gastric ulcers

469
Q

After starting anti-depressant medication, when should a patient with a low-suicide risk be reviewed?

A

After 2 weeks, and then every 2-4 weeks thereafter for 3 months

470
Q

In patients <30 years of age starting on anti-depressant medication, when should they be reviewed?

A

After 1 week

471
Q

Duration of AD tapered reduction?

A

4-week tapered reduction

472
Q

What class of drug is sertraline?

A

Selective serotonin re-uptake inhibitors

473
Q

Which receptors are affected by SSRIs?

A

Serotonin/5-HT

474
Q

What is the minimum period of a drug to be continued following remission of the first episode of depression?

A

6 months

475
Q

Triptans and SSRIs can cause what effect?

A

Serotonin syndrome

476
Q

Name 5 SSRIs

A
  • Escitalopram
  • Fluoxetine
  • Sertraline
  • Paroxetine
  • Citalopram
477
Q

Which anti-depressant class is recommended in patients with underlying cardiovascular disease- post-MI?

A

Sertraline

478
Q

Citalopram is associated with what ECG abnormality?

A

QT prolongation

479
Q

What investigation should be performed prior to citalopram administration?

A

ECG - calculate the QT interval

480
Q

What is the maximum dose of citalopram?

A

40 mg

481
Q

Citalopram is contraindicated in what congenital condition?

A

Congenital long-QT syndrome (>440 ms)

482
Q

What are the gastrointestinal side effects associated with SSRI therapy?

A

Weight gain

Nausea and vomiting

Diarrhoea

Headache

Dyspepsia

Increased risk of gastrointestinal bleeding (contraindicated with aspirin, NSAIDs and DOACs)

483
Q

What are the sexual side effects associated with SSRI therapy?

A

Erectile dysfunction

484
Q

Which electrolyte abnormality is associated with SSRI therapy?

A

Hyponatraemia

485
Q

When switching Fluoxetine to an alternative SSRI, what is the switching regimen?

A

Reduce the dose of 2 weeks and wait 4-7 days after stopping fluoxetine

486
Q

When switching SSRI to SSRI, what is the protocol?

A

Immediate switch or cross-taper dose

487
Q

Why should fluoxetine be ceased for at least 4-7 days prior to starting an alternative SSRI?

A

Fluoextine has a long half-life

488
Q

What are the discontinuation symptoms associated with a sudden cessation of SSRI therapy?

A
  • Flu-like symptoms
  • Insomnia
  • Restlessness
  • Mood swings
  • Sweating
  • Diarrhoea, abdominal cramps, vomiting
  • Ataxia – Unsteadiness
  • Paraesthesia – shocks, tingles.
489
Q

What investigation monitoring is required for SNRI therapy?

A

Blood pressure monitoring

490
Q

What are the side effects associated with SNRIs?

A

Constipation

Hypertension

Raised cholesterol

491
Q

Clomipramine is associated with what class of anti-depressant?

A

Tricyclic Antidepressants

492
Q

Name 2 types of Tricyclic Antidepressants

A

Amitripyline, and clomipramine.

493
Q

Which class of drug should not be prescribed alongside TCAs?

A

Monoamine oxidase inhibitors

494
Q

What are the side effects of TCAs?

A

Side effects:
* Thrombocytopenia
* Cardiac (arrhythmias, MI, stroke, hypotension)
* Anticholinergic side effects:
- Tachycardia
- Urinary retention
- Dry mouth
- Blurry vision
- Constipation
* Seizures
* Hyponatremia

495
Q

What anticholinergic side effects are associated with TCAs?

A

Tachycardia

Urinary retention

Dry mouth

Blurry vision

Constipation

496
Q

What type of incontinence is associated with TCA overdose?

A

Overflow incontinence

497
Q

Name a Noradrenergic and specific serotonin antidepressant

A

Mirtazpine

498
Q

What are the main side effects of mirtazapine (3)?

A

Sedation
Increased appetite/weight gain
Oedema

499
Q

What type of reaction is associated with monoamine oxidase inhibitors?

A

Tyramine ‘cheese’ reaction

500
Q

Name tyramine rich foods:

A

Cheese
Red meat
Wine

501
Q

Name a monoamine oxidase inhibitor

A

Phenelzine, isocarboxacid, selegiline, tranylcypromine.

502
Q

Selegiline is what class of drug?

A

Monoamine Oxidase Inhibitor

503
Q

What are the symptoms of a tyramine cheese reaction?

A

Hypertensive crisis

504
Q

What is considered as low-risk alcohol consumption (in terms of units/week)?

A

<14 units/week

505
Q

What is considered hazardous drinking (in terms of units/week)

A

15-35 units/week

506
Q

What is considered harmful drinking pattern (units/week)?

A

> 35 units/week (or 6 units/day)

507
Q

Which type of receptors are increased in alcohol withdrawal?

A

NMDA-type glutamate receptors

508
Q

Which type of receptors are decreased in alcohol withdrawal?

A

Inhibitory GABA

509
Q

Symptoms of uncomplicated alcohol withdrawal begin when (e.g., tremor, sweating, tachycarida, psychomotor agitation)?di

A

4-12 hours after last drink

510
Q

At 4-12 hours after the last drink, what symptoms occur?

A

Coarse tremor, sweating, insomnia, tachycardia, N&V, psychomotor agitation, anxiety, hallucination (transitory visual, tactile to auditory), alcohol craving.

511
Q

At what period of time since the last drink do seizures typically occur?

A

36 hours since last drink

512
Q

Type of seizures associated with alcohol withdrawal?

A

Grand-mal seizures

513
Q

When does delirium tremenes occurs since last drink?

A

48-72 hours since last drink

514
Q

What are the signs and symptoms of delirium tremens?

A

Disorientation, anterograde amnesia, psychomotor agitation, hallucinations (Lilliputian hallucinations of little people or animals), hour-by-hour fluctuations (worse at night).

515
Q

Which questionnaire is used to screen for alcohol use?

A

CAGE questionnaire

516
Q

What are the four questions in the CAGE questionnaire?

A
  • Have you tried to cut it down?
  • Have you ever been annoyed by people suggesting that you have a problem with your drinking?
  • Have you ever felt guilty about drinking?
  • Have you ever needed a drink to get you going in the morning – eye-opener?
517
Q

What rating scale is used to assess for the severity of alcohol dependence?

A

AUDIT (Alcohol Use Disorders Identification Test)

518
Q

What threshold score is used for second-line assessment AUDIT alcohol dependence questionnaire?

A

> 20

519
Q

What score is associated with low risk alcohol use (AUDIT)?

A

0-7

520
Q

Which assessment method is used to assess for the scale of severity of withdrawal?

A

CIWA-AR (Clinical Institute Withdrawal Assessment of Alcohol)

521
Q

Which screening is a shortened-4 question version of AUDIT, for use in A&E?

A

FAST

522
Q

What is the first line acute management for alcohol withdrawal?

A

Oral chlordiazepoxide ± IV/IM thiamine / Pabrinex – reducing dose.

523
Q

Admission indications for alcohol withdrawal?

A
  • Acute alcoholic withdrawal symptoms
  • Wernicke’s encephalopathy (ataxia, ophthalmoplegia, confusion).
524
Q

What is the inpatient drug choice for alcohol withdrawal?

A

Oral lorazepam ± IV/IM thiamine / Pabrinex – rapid-reducing dose.

525
Q

What is the first line drug management following detox?

A

Acamprosate or naltrexone

526
Q

How are alcohol withdrawal seizures managed?

A

IV lorazepam

527
Q

How is delirium tremens managed?

A

Oral lorazepam AND IV/IM thiamine/Pabrinex (vitamin B1).

528
Q

Management of Wernicke’s encephalopathy?

A

IV thiamine/pabrinex

529
Q

Which drug reduces the craving for alcohol by enhancing GABA transmission?

A

Acamprosate

530
Q

Which drug results in avoidance of alcohol-based products?

A

Disulfiram

Phase3 Specialties - Imperial College London MBBS (5 decks)

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