Psychiatry

Question 1

What can precipitate lithium toxicity?

Answer 1

Renal failure - so think things that could cause this eg dehydrations, NSAIDs, diuretics, ARB and ACE-i

Question 2

What are the features of lithium toxicity?

Answer 2

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

Question 3

How do you manage lithium toxicity?

Answer 3

mild-moderate toxicity may respond to volume resuscitation with normal saline
haemodialysis may be needed in severe toxicity
sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

Question 4

What is the management of PTSD?

Answer 4

trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases

drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

Question 5

Which anti-depressant is most likely to prolong the QT interval?

Answer 5

Citalopram is the most likely SSRI to lead to QT prolongation and Torsades de pointes