psychiatry

Question 1

give 4 side effects of SSRI’s

Answer 1

GI side effects
Hyponatremia
increased anxiety and agitation after starting SSRI
increased QT interval ( Citalopram)

Question 2

which medications should be avoided when commencing an SSRI

Answer 2

NSAID’s ( co-prescribe PPI)
Warfarin / Heparin *consider Mirtazapine
Aspirin
Triptans

Question 3

which medication has a higher risk of discontinuation syndrome ?
Which SSRI does not need to be gradually reduced ?

Answer 3

Paroxetine
Fluoxetine

Question 4

What are the symptoms of discontinuation syndrome

Answer 4

increased mood changes
restlessness
difficulty sleeping
unsteadiness
sweating
GI symptoms
Paraesthesia

Question 5

how long should patients be continued on an SSRI if good response has been made

Answer 5

6 months

Question 6

what factors are shown to be associated with an increased risk of suicide

Answer 6

male
self harm
alcohol or drugs
history of mental illness
chronic disease
age
unemployment
unmarried / divorced / widowed

Question 7

what factors are associated with an increased risk of completed suicide at a future date

Answer 7

efforts to avoid discovery
planning
leaving a note
final acts
violent method

Question 8

what factors reduce the risk of suicide

Answer 8

family
kids
religion

Question 9

what are the cluster A , B and C personality disorders ?

Answer 9

Cluster A
Paranoid
Schizoid
Schizotypal

Cluster B
Antisocial
Borderline
Histrionic
Narcissistic

Cluster C
OCD
Avoidant
Dependant

Question 10

what is the different between schizoid and schizotypal personality disorder ?

Answer 10

schizoid ( alone)

solitary activities, lack of interest in companionship, sex, few interests, friends, emotional coldness.

Schizotypal ( odd)
lack of close friends. odd beliefs + magical thinking, ideas of reference, odd perceptions

Question 11

how are personality disorders managed

Answer 11

dialectical behavioural therapy
treatment of co-existing psychiatric conditions

Question 12

what factors are raised in anorexia nervosa

Answer 12

G’s and C’s

growth hormone
glucose
salivary Glands ( enlarged)

Cortisol
Cholesterol
Carotinaemia

Question 13

what factors are reduced in anorexia

Answer 13

BMI
Heart rate
Blood pressure
Hypokalaemia
FSH, LH, Oestrogen, Testosterone
T3

Question 14

which is the SSRi of choice in children

Answer 14

Fluoxetine

Question 15

what are the risks of prescribing SSRI in pregnancy

Answer 15

small risk of congenital heart defects in first trimester
persistent pulmonary HTN in newborn if used in 3rd trimester
Paroxetine increases risk of congenital malformations in 1st trimester

Question 16

give examples of typical and atypical antipsychotics

Answer 16

typical

Haloperidol
Chlorpromazine

Atypical antipsychotics

clozapine
Olanzapine
Risperidone

Question 17

which medications are likely to cause extra-pyramidal side effects? what are they?

Answer 17

Parkinsonism
Acute dystonia : sustained muscular contraction ( torticollis, oculogyric crisis)
Akathisia ( severe restlessness)
Tardive dyskinesia ( abnormal involuntary movements like chewing and pouting of jaw)

Question 18

how is acute dystonia managed

Answer 18

Procyclidine

Question 19

what are metabolic side effects of typical antipsychotics

Answer 19

antimuscarinic
sedation
weight gain
raised prolactin
impaired glucose tolerance
prolonged QT interval

Question 20

what are the warnings given when antipsychotics are used in elderly patients

Answer 20

stroke and VTE

Question 21

what factors suggest a diagnosis of depression over dementia

Answer 21

short history with a rapid onset
patient worried
sleep disturbance, weight loss
upset with results
variable MMSE
global memory loss instead of recent memory loss as seen with dementia

Question 22

what is the management of alcohol withdrawal? how do you manage in patients with hepatic failure?

Answer 22

first line : chlordiazepoxide
lorazepam

Question 23

what is the timeline of symptoms of alcohol withdrawal

Answer 23

symptoms : 6-12 h
seizures : 36 h
delirium tremens 72h

Question 24

what are the two types of bipolar

Answer 24

Type 1 : Mania and depression
Type 2 : Hypomania and depression

Question 25

how long do symptoms need to be present for a diagnosis of PTSD to be made ?

Answer 25

one month

Question 26

what are the 4 features of PTSD

Answer 26

Reexperiencing
Avoidance
Hyperarousal / hypervigilance
Emotional numbing

Question 27

give step wise treatment of PTSD

Answer 27

Trauma based CBT
eye movement and desensitisation ( EMDR)
venlafaxine / SSRI

Question 28

what is the most appropriate SSRi to be used in someone with IHD

Answer 28

Sertraline

Question 29

__________________ is the most common cause of admissions to child and adolescent psychiatric wards.

Answer 29

Anorexia Nervosa

Question 30

what is the first line management of anorexia in

1. Adults
2. Children

Answer 30

1. Individual eating disorder focussed CBT
2. Anorexia focussed family therapu=y

Question 31

what physical features may be seen in a patient suffering from Bulimia

Answer 31

Erosion of teeth
Russell’s sign : calluses on the knuckles / back of the hand due to repeated self induced vomiting

Question 32

what factors are associated with a poor prognosis of schizophrenia

Answer 32

strong FHx
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

Question 33

which SSRI is most likely to cause Torsades De Pointes

Answer 33

Citalopram