Psychiatry

Question 1

Which SSRI most commonly causes QT prologation?

Answer 1

Citalopram?

Question 2

What is common side effect of TCAs?

Answer 2

Overflow incontinence (anticholinergic effect)

Question 3

What are the extrapyramidal side-effects of some antipsychotics?

Answer 3

1) Parkinsonism
2) Acute Dystonia
3) Akathisia
4) Tardive dyskinesia

Question 4

Outline timeline of side effects during alcohol withdrawal.

Answer 4

1) symptoms: 6-12 hours
2) seizures: 36 hours
3) delirium tremens: 72 hours

Question 5

What is the management of alcohol withdrawal?

Answer 5

Admit if coplex history of withdrawal

1st line long-acting benzodiazepine (e.g. chlordiazepoxide or diazepam)

If history of liver impairment: lorazepam

Question 6

What is the management of acute dystonia secondary to antipsychotics?

Answer 6

Procyclidine

Question 7

Which antipsychotic has the most tolerable side effect profile?

Answer 7

Aripiprazole

Question 8

What risk do antipschotics increase in the elderly?

Answer 8

Increased stroke and VTE risk

Question 9

What is the management of acute stress disorder?

Answer 9

1st line: trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line

also: benzodiazepines

Question 10

What are atypical antipsychotics?

Answer 10

1) clozapine
2) olanzapine: higher risk of dyslipidemia and obesity
3) risperidone
4) quetiapine
5) amisulpride
6) aripiprazole: generally good side-effect profile, particularly for prolactin elevation

Question 10

What is best antidepressant post-MI?

Answer 10

SSRI

Question 11

How often do you need to do FBC monitoring for Clozapine?

Answer 11

1) Weekly for 18 weeks
2) Fortnightly for up to one year
3) Monthly thereafter

Question 11

Why should you be careful prescribing triptans in someone taking an SSRI?

Answer 11

Increased risk of seretonoin syndrome

Question 12

What is Cotard syndrome?

Answer 12

Cotard syndrome is characterised by a person believing they are dead or non-existent

Question 13

What is erotomania?

Answer 13

Erotomania is a delusional disorder characterised by the mistaken perception that another person is infatuated with them.

Affected patients often exhibit ‘stalking’ behaviour, and targets are classically socially unattainable, such as celebrities.

Question 14

What is Charles Bonnet syndrome?

Answer 14

A phenomenon in which patients with severe visual impairment report vivid hallucinations.

Question 15

What is Capgras syndrome?

Answer 15

Capgras syndrome is a neuropsychiatric phenomenon in which patients believe that a partner/family member/friend has been replaced by an imposter.

Question 16

What is Orthello syndrome?

Answer 16

Othello syndrome, also known as delusional jealousy, is a delusional disorder with male preponderance in which patients hold a firmly held belief that their partner is unfaithful, in the absence of proof.

Question 17

What are the side effects of TCAs?

Answer 17

Anticholinergic:
Blurred vision
Dry mouth
Constipation
Urinary retention

Also:
Postural hypotension
Lengthening of QT interval
Drowsiness

Question 18

What is the SSRI of choice in children and adolescents?

Answer 18

Fluoxetine

Question 19

What factor can cause a rise in clozapine levels after them being stable for a while?

Answer 19

Smoking cessation
Stopping drinking

Question 20

What are symptoms of SSRI discontinuation syndrome?

Answer 20

Dizziness, electric shock sensations and anxiety

Question 21

Which side-effect is more common with atypical than conventional anti-psychotics?

Answer 21

Weight gain

Question 22

What is the management of alcohol withdrawal?

Answer 22

first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam

Also: carbamazepine and phenytoin for alcohol withdrawal-related seizures

Question 23

What is the physiology of the neuroreceptors in alochol withdrawal?

Answer 23

Decreased inhibitory GABA Increased NMDA glutamate transmission

Question 23

What is the management of PTSD?

Answer 23

for mild symptoms can watch and wait 1st line: trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy 2nd line: Venlafaxine or SSRI 3rd line: In severe cases risperidone

Question 23

What is the drug management of generalised anxiety disorder?

Answer 23

NICE suggest sertraline should be considered the first-line SSRI

Question 23

What are the 4 key features in the ICD-11 classification of a personality disorders?

Answer 23

1) Persistent attern 2) Impairment 3) Duration 4) Distress or dysfunction

Question 23

What is somatisation disorder?

Answer 23

- multiple physical SYMPTOMS  present for at least 2 years - patient refuses to accept reassurance or negative test results

Question 23

What is Illness anxiety disorder (hypochondriasis)?

Answer 23

- persistent belief in the presence of an underlying serious DISEASE, e.g. cancer - patient again refuses to accept reassurance or negative test results

Question 24

What is Functional neurological disorder (conversion disorder)?

Answer 24

- typically involves loss of motor or sensory function - the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering) - patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 25

What is Dissociative disorder?

Answer 25

- multiple personality disorder - dissociation is a process of 'separating off' certain memories from normal consciousness - in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor

Question 26

What is Factitious disorder (Munchausen's syndrome)?

Answer 26

- the intentional production of physical or psychological symptoms

Question 27

What is Malingering?

Answer 27

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 28

What is the management of schizophrenia?

Answer 28

1st line: Atypical antipsychotic All patients: CBT