Psychiatry

Question 1

What things can precipitate lithium toxicity?

Answer 1

Renal failure - so think things that could cause this eg dehydration, NSAIDs, diuretics, ARB and ACE-i
Metronidazole can also induce

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 CBT/ eye movement desensitisation and reprocessing (EMDR)

drugs not routine 1st line:
If used –> venlafaxine/ SSRI
severe cases –> risperidone

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

Question 6

Best anti-depressant for <18s? Best anti-depressant for post-MI? Best for breastfeesing?

Answer 6

children (fluoxetine)
post MI (sertraline)
Breastfeeding (sertraine or parozetine)

Question 7

Section 2 vs 3 vs 4?

Answer 7

Section 2 - for 28 days. Not renewable. For assessment.

section 3 - Up to 6 months, can be renewed. For treatment.

Both involve approved mental health professional + 2 drs

section 4 - 72 hr assessment - emergency and then usually changed to section 2 in hospital - done by a GP and an AMHP or NR

Question 8

Section 5(2) vs 5(4)?

Answer 8

Section 5(2) - a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Section 5(4) - allows nurse to detain a patient who is voluntarily in hospital for 6 hours

Question 9

section 17 (a) vs section 135 vs 136

Answer 9

Section 17a - Supervised Community Treatment (Community Treatment Order) - can recall patient if dont comply with meds

Section 135 - a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

Section 136 - someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety

can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged

Question 10

What are the 4 key presentations of PTSD?

Answer 10

re-experiencing
avoidance
hyperarousal
emotional numbing

Question 11

What are the first rank sx of schizophrenia?

Answer 11

auditory hallucinations
thought disorders
passivity
delusional perceptions

Question 12

Tardive dyskinesia vs acute dystonia?

Answer 12

Tardive dyskinesia - occurs with long term use of antipsychotics
involuntary, repetitive movements that can affect any part of the body but are most commonly seen in the face and tongue.

Acute dystonia- starts days of starting or increasing the dose of an antipsychotic.
It involves sustained muscle contractions leading to abnormal postures

Question 13

How does dosage of mirtazapine correlate to sedation?

Answer 13

Mirtazapine is generally more sedating at lower BNF doses (e.g. 15mg) than higher doses (e.g. 45mg)

Question 14

Social anxiety disorder vs avoidant personality disorder?

Answer 14

AVoidant PD: extreme version of SAD. Will be pervasive from childhood. Will feel inadequate and be very sensitive to criticism. Avoid all new situations

Question 15

Which antipsychotic is most associated with high lipids and obesity?

Answer 15

olananzapine

Question 16

Which antipsychotic has a generally good side-effect profile, particularly for prolactin elevation?

Answer 16

aripiprazole

Question 17

Dementia with lewy bodies vs parkinsons disease dementia?

Answer 17

Parkinsonisms start BEFORE dementia in parkinsons disease dementia.
Lewy body have REM sleep disorders and nightmares

Question 18

RF for suicide?

Answer 18

male
history self-harm
alcohol/ drugs
history MH
chronic disease
old unemployed
live alone
single

Question 19

Fregoli vs capgras syndrome?

Answer 19

Fregoli - delusion that various people you meet are the same person
capgras - delusion that someone you know has been replaced by an idential imposter

Question 20

How do alcool and smoking effect clozapine?

Answer 20

Smoking cessation can cause a significant rise in clozapine levels, and so it should be discussed with a psychiatrist before stopping smoking. Starting smoking, or smoking more, can reduce clozapine levels. Stopping drinking can also reduce levels, as alcohol binges can increase the level. Omitting doses will cause a reduction in clozapine levels, and stress and weight gain won’t have significant effects on the level.

Question 21

What is the biggest RF for psychotic disorders?

Answer 21

Family history is the strongest risk factor for psychotic disorders

Question 22

affect vs mood?

Answer 22

Affect is the current, observed emotional state of the patient (what you see), whereas mood is the more pervasive, predominant state over a longer period (what you ask about)

Question 23

When should N-acetylcysteine be given for paracetamol OD?

Answer 23

-If paracetamol levels above treatment line
-staggered OD
- 8-24 hoursafter ingestion of an acute overdose of more than 150 mg/kg of paracetamol
- > 24 hoursif they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal

Question 24

serotonin syndrome vs neuroleptic malignant syndrome?

Answer 24

serotonin syndrome -acute, hyperreflexia, clonus, diarrhoea, dilated pupils. Mx with chlorpromazine

neuropletic malignant syndrome - slower onset, just started treatment, hyporeflexia, pupils normal, lead pipe rigidity, bradykinesia, raised WCC, rhabdomyolysis, mx with dantrolene

Both: HTN, tachy, fever

Question 25

When can you use activated charcoal in OD?

Answer 25

within 1 hr of OD

Question 26

Anorexia nervosa features on blds

Answer 26

hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3

Question 27

Typical vs atypical antipsychotic examples

Answer 27

atypical - Chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, pimozide, thiothixene, and trifluoperazine

atypical - clozapine, olanzapine,
risperidone, quetiapine. amisulpride. aripiprazole