Psychiatry

Question 1

How long must symptoms persist for a diagnosis of schizophrenia?

Answer 1

At least 1 month.

Question 2

Name common symptoms of schizophrenia.

Answer 2

Auditory hallucinations, thought insertion, withdrawal, interruption, thought broadcasting, somatic hallucinations, delusional perception, negative symptoms (including catatonia).

Question 3

What is the recommended treatment for schizophrenia?

Answer 3

Antipsychotic medication + Cognitive Behavioral Therapy (CBT).

Question 4

Provide examples of typical first-generation antipsychotics

Answer 4

Chlorpromazine, Haloperidol

Question 5

What are common side effects of typical antipsychotics?

Answer 5

Extrapyramidal side effects, dystonia, parkinsonism, tardive dyskinesia, hyperprolactinemia.

Question 6

Which first-generation antipsychotic is most likely to cause neuroleptic malignant syndrome?

Answer 6

Haloperidol.

Question 7

Name some atypical second-generation antipsychotics

Answer 7

Clozapine, Amisulpride, Risperidone, Olanzapine, Quetiapine.

Question 8

What is a serious side effect of clozapine?

Answer 8

Agranulocytosis, reduced seizure threshold, constipation, myocarditis, hypersalivation.

Question 9

Which atypical antipsychotic is considered third-generation?

Answer 9

Aripiprazole

Question 10

List common symptoms of depression.

Answer 10

A: Low mood, reduced energy, reduced activity, etc.

Question 11

How long must depressive symptoms persist for a diagnosis?

Answer 11

2 weeks

Question 12

What is the first-line treatment for mild depression lasting less than 1 year?

Answer 12

Watchful waiting or low-intensity psychological intervention.

Question 13

For severe depression, what is the recommended treatment?

Answer 13

High-intensity psychological intervention + antidepressant ± Electroconvulsive Therapy (ECT).

Question 14

Which antidepressant is a NaSSA (Noradrenergic and Specific Serotonergic Antidepressant)?

Answer 14

Mirtazapine

Question 15

Differentiate between Type I and Type II bipolar disorder.

Answer 15

Type I involves mania and depression, while Type II involves hypomania and depression.

Question 16

What is the first-line treatment for mania or hypomania?

Answer 16

Stop antidepressant + Atypical antipsychotic.

Question 17

What is the long-term treatment for bipolar disorder?

Answer 17

Lithium (titrated up, needs retitration if dose missed for >48h).

Question 18

Define “baby blues.”

Answer 18

Transient postpartum emotional symptoms including depression, tearfulness, anxiety, irritability, and fatigue.

Question 19

What is the treatment approach for postnatal depression?

Answer 19

Edinburgh Postnatal Depression Scale; offer support and reassurance ± CBT ± antidepressant (sertraline or paroxetine).

Question 20

Describe postnatal psychosis.

Answer 20

Rare condition with delusions, hallucinations, and thoughts of harming the baby or self, starting within 2 weeks of delivery; hospitalization + atypical antipsychotic.

Question 21

List common symptoms of generalized anxiety disorder (GAD).

Answer 21

Nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, etc.

Question 22

How long must symptoms persist for a diagnosis of GAD?

Answer 22

At least 6 months.

Question 23

Describe the symptoms of OCD.

Answer 23

Obsessional thoughts + compulsive acts.

Question 24

How long must symptoms persist for a diagnosis of OCD?

Answer 24

2 weeks

Question 25

What is the recommended treatment for OCD?

Answer 25

CBT with exposure response therapy ± SSRI.

Question 26

List common symptoms of PTSD

Answer 26

Re-experiencing, avoidance, hyperarousal, emotional numbing, depression, drug or alcohol misuse, anger.

Question 29

How long must symptoms persist for a diagnosis of PTSD?

Answer 29

4 weeks

Question 29

What is the treatment for PTSD?

Answer 29

Trauma-focused CBT or EMDR ± Paroxetine or Mirtazapine.

Question 30

Under which section can a person be admitted for assessment and treatment for 28 days?

Answer 30

Section 2

Question 31

What is the emergency admission duration under Section 4?

Answer 31

72 hours

Question 32

What is Section 17 of the Mental Health Act related to?

Answer 32

Leave of absence from the hospital.

Question 33

What is the purpose of Section 136?

Answer 33

Transfer from a public place to a place of safety for ‘care or control’.

Question 34

What is Neuroleptic Malignant Syndrome (NMS)?

Answer 34

A potentially life-threatening condition occurring hours to days after starting or increasing the dose of atypical antipsychotic (haloperidol).

Question 37

What are the symptoms of Neuroleptic Malignant Syndrome?

Answer 37

Pyrexia, sweating, rigidity, tachycardia, raised CK, leukocytosis.

Question 37

What is the treatment for NMS?

Answer 37

Stop antipsychotic + fluids ± benzodiazepine ± dantrolene ± bromocriptine.

Question 38

What are the symptoms of Serotonin Syndrome?

Answer 38

Hyperthermia, autonomic excitation, rigidity

Question 39

When does Serotonin Syndrome typically occur?

Answer 39

Minutes to hours after starting SSRI, MAOI, ecstasy, or amphetamine.

Question 40

Who is needed to sign section 3 of MHA?

Answer 40

2 doctors + AMHP

Question 41

1st rank symptoms of schizophrenia (4)

Answer 41

Delusional disorder
Passivity phenomena
Thought disorders
Hallucinations

Question 42

SE of atypical antipsychotics

Answer 42

Weight gain / Dyslipidemia / Hyperprolactinemia / Nipple discharge / Impaired glucose tolerance

Question 43

What should be coprescribed with SSRIs?

Answer 43

PPI to protect from GI bleed

Question 44

Signs of bulimia nervosa O/E

Answer 44

Callous on the back of the hands (Russel Sign), parotid enlargement, poor oral hygiene