Psychiatry

Question 1

Which physical problem could you treat under the Mental Health Act?

Answer 1

Those that are DIRECTLY DIRECTLY caused by the mental condition
Ie. Feeding in anorexia or giving a fluid drip to someone with such extreme depression they can’t lift up a cup

Question 2

Which section can be used to detain an inpatient by a doctor?

Answer 2

Section 5(2)

But you can’t detain a patient under the mental health act to treat their physical problem (have to use the capacity act to do so)

Question 3

Management of generalised anxiety disorder?

Answer 3

Anxiety + 3 somatic symptoms for 6+ months

Regular exercise
Meditation
CBT
Drugs + psychotherapy: benzodiazepines, SSRIs

Question 4

Differences between OCD and psychosis

Answer 4

OCD Know that thoughts originate from themselves + thoughts don’t make sense

Question 5

What is OCD + Rx?

Answer 5

Obsessions- stereotyped words, ideas or phrases that come into mind
Compulsions- senseless repeated rituals

Rx: CBT
Clomipramine (TCA) or SSRIs

Question 6

Diagnostic criteria of anorexia:

Answer 6

1. Weight <85% of predicted or below 17.5 BMI
2. Fear of weight gain leading to dieting, vomiting, excessive exercise
3. Feeling fat when thin
4. Amenorrhoea for 6 cycles of low libido

Question 7

Screening questions for anorexia:

Answer 7

SCOFF:
Do you ever make yourself feel Sick?
Do you worry you’ve lost Control of eating?
Have you lost more than One stone in 3 months?
Do you believe you are Fat?
Does Food dominate your life?

Question 8

Red flags for anorexia:

Answer 8

PC: BMI under 13, weight loss >1kg in a week

EHx: purpura (low plts), limbs blue + cold, unable to get out of chair without using arms for leverage

IHx: 
Temp <34.5, 
BP < 80/50, 
Sats <92%
K+ <2.5, Na+ <130, PO4 <0.5

ECG- long QT, flat T waves

Question 9

What are the signs of refeeding syndrome?

Answer 9

PC: arrhythmias, seizures, coma, resp/cardiac failure
IHx: falling PO4, high glucose, low K+, high Mg+

Question 10

Features of fragile x syndrome:

Answer 10

Trinucleotide expansion on X chromosome

Epilepsy, mitral valve prolapse, otitis media
Intellectual disability, autism, ADHD, panic disorder

Question 11

Rx of depression:

Answer 11

CBT (if mild, may be all that’s needed)
SSRIs- citalopram, sertraline, paroxetine
Omega 3 supplements

Electroconvulsive therapy

± antipsychotics if delusions/hallucinations

Question 12

Medical causes of mania

Answer 12

Infections
Hyperthyroidism, hyponatraemia
SLE, TTP, stroke
ECT
Amphetamines, cocaine, venlafaxine
Steroids, L Dopa

Question 13

Rx of acute mania

Answer 13

Olanzepine

Atypical antipsychotic

Question 14

What monitoring is required for patients taking lithium?

Answer 14

Lithium levels weekly until constant conc for 4 weeks
Then 6 x monthly, then 3 monthly
U+E, TSH every half year

Question 15

Signs of lithium toxicity:

Answer 15

Reduced vision
D+V
LowK+ 
Ataxia
Tremor
Dysarthria
Coma

Question 16

Medical treatment of bipolar disorder?

Answer 16

Acute mania: antipsychotic (or valproate)

Mood stabiliser: lithium, valproate or carbemazepine

Depression: SSRIs
Refractory: add anticonvulsants or antipsychotics

Question 17

3 groups of personality disorder:

Answer 17

A- paranoid, schizoid, schizotypal
B- antisocial (psychopathic), borderline, histrionic, narcisstic
C- avoidant, dependent, obsessive compulsive

Question 18

Features of borderline personality disorder:

Answer 18

Unstable affect regulation
Poor impulse control
Poor interpersonal relationships/self image

Self injury + suicidality

Rx: dialectical behaviour therapy

Question 19

What are the following sections used for:
Section 2
Section 3
Section 5.2
Section 5.4
Section 135
Section 136

Answer 19

2- 28 days for assessment (needs two doctors, one ‘approved’)
3- 6 months for treatment (needs 2 doctors)
5.2- 72 hours from a ward by a doctor
5.4- 6 hours by a psychiatric nurse
Section 135- medical practitioner + police permitted to search premises once approved by a magistrate
Section 136- 72 hours by police, take to place of safety

Question 20

Features of schizophrenia:

Answer 20

Psychotic symptoms- first rank includes auditory hallucinations, thought broadcast/insertion/withdrawal and delusional perception

Disorganisation symptoms- incongrous mood, abnormal speech

Negative symptoms- self-neglect, apathy, blunted mood, withdrawal, loss of motivation

Cognitive impairment- sometimes

Question 21

In regards to schizophrenic symptoms what aspects are required to make a schizophrenia diagnosis?

Answer 21

Sx last 6 months, with Sx being present for most of the time during 1 month
AND
Marked impairment in work or home functioning

Question 22

How do side effects differ between typical and atypical psychotics?

Answer 22

Typical (haloperidol, chlorpromazine)- D2 receptor blockade
Extrapyramidal SEs:
parkinsonism,
acute dystonia (muscle contraction),
akathisia (constant restless motion),
tardive dyskinesia (irreversible involuntary repetitive movements)
Hyperprolactinaemia

Atypical (olanzepine, quetiapine)
Metabolic syndrome side effects + weight gain
Sexual dysfunction from raised prolactin- quetiapine has least effect on this
Long QT

Question 23

What is the risk of clozapine?

Answer 23

Given for refractory schizophrenia

Agranulocytosis- monitor FBC

Question 24

Management of extrapyramidal side effects in typical antipsychotics?

Answer 24

Procyclidine for parkinsonism and dystonia (anticholinergic)
Propranolol for akathisia
Tetrabenazine for tardive dyskinesia

Question 25

A dependence syndrome of substances is defined by the presence of 3 of the following:

Answer 25

1. Craving
2. Difficulty controlling substance use
3. Physical withdrawal state
4. Tolerance
5. Continuing despite harm
6. Neglect of alternative pleasures and interests

Question 26

What drugs are available to help in opiate detoxification?

Answer 26

Methodone
Disulfiram- blocks DA breakdown causing anxiety, restlessness if cocaine is taken
Buprenorphine
Naltrexone- mu recepor blocks, blocks euphoria

Question 27

When asking about alcohol abuse, what does the TWEAK mneumonic stand for?

Answer 27

Tolerance
Worry about your drinking
Eye opener
Amnesia from alcohol use
Attempts to Cut down

2 points = +ve

Question 28

Signs and management of delirium tremens?

Answer 28

Tachycardia, hypotension
Tremor, fits
Visual or tactile hallucinations- insects crawling under the skin

Rx: diazepam or chlordiazepoxide

Question 29

Which pharmacological Rx may be tried for behaviour and psychological symptoms of dementia?

Answer 29

Risperidone