Psychiatry

Question 1

34 year-old ex-soldier with history of post-traumatic stress disorder.
Eye movement desensitisation and reprocessing therapy not helpful.
Reluctant to try CBT.
What treatment may be useful?

Answer 1

First line treatment is Venfalexine or a SSRI ( eg. Sertraline )

Question 2

Name some extrapyramidal side-effects ( EPSE ) of antipsychotics

Answer 2

Parkinsonism
Acute dystonia
Akathisia ( severe restlessness )
Tardive dyskinesia ( late onset of choreoathetoid movements, abnormal, involuntary, most common is chewing and pouting of jaw )

Question 3

Name the side effects of antipsychotics

Answer 3

EPSE
Antimuscarinic SE ( dry mouth, blurred vision, urinary retention, constipation )
Sedation, weight gain
Raised prolactin
Impaired glucose tolerance
Neuroleptic malignant syndrome ( pyrexia, muscle stiffness )
Reduced seizure threshold
Prolonged QT interval ( particularly haloperidol )

Question 4

Repetition of someone else’s speech including the questions being asked.

Answer 4

Echolalia

Question 5

A feature of mania, where there are leaps from one topic to another but with discernible links between them.

Answer 5

Flight of ideas

Question 6

Give some examples of high-intensity psychological interventions for moderate or severe depression.

Answer 6

Cognitive behavioural therapy. ( CBT )
Interpersonal therapy. ( IPT )
Behavioural couples therapy
Behavioural activation.

Question 7

Diagnose the condition

Progressive cognitive impairment
Parkinsonism
Visual hallucinations

Answer 7

Lewy body dementia