Psychiatry

Question 1

Drugs for ADHD?

Answer 1

1. Methylphenidate
2. Atomexatine
   (and dexamfetamine)

SAME FOR YOUNG AND OLD

Question 2

SSRIs

Answer 2

Citalopram
Fluoxetine
Sertraline
Paroxetine

Question 3

Best SSRI for pt with chronic health problem

Answer 3

Sertraline
Less drug interactions
(and citalopram)

Question 4

SSRI for < 18yrs?

Answer 4

Fluoxetine only

Careful monitoring to start

Question 5

SNRIs?

Answer 5

Duloxetine

Venlafaxine

Question 6

Diagnosis of ADHD?

Answer 6

Symptoms in at least 2 or more settings
At least moderate impairment on interviewing

DSM-IV criteria:
Inattentive symptoms - 6 or more
Hyperactivity-impulsivity symptoms - 6 or more

ICD-10 (Hyperkinetic disorder)
Inattentive symptoms - 6 or more
Hyperactivity - 3 or more
Impulsivity - 1 or more

Question 7

First rank symptoms (Schneider)

Answer 7

Primary delusions
Delusions of control
Auditory hallucinations - 3rd person
Somatic hallucinations
Delusions of thought control
 - thought broadcasting
 - thought withdrawal
 - thought insertion

Question 8

Weight gain most common in what antipsychotics?

Answer 8

Clozapine
Olanzapine
Phenothiazine

Question 9

Typical antipsychotics MOA?

Answer 9

D2 antagonists

Question 10

Typical antipsychotics examples?

Answer 10

Chlorpromazine
Prochlorperazine
Haloperidol
Flupentixol

Question 11

Atypical antipsychotic examples?

Answer 11

Olanzapine
Clozapine
Risperidone
Aripiprazole
Quetiapine

Question 12

Atypical antipsychotic MOA?

Answer 12

dopamine and 5HT2 antagonists

Question 13

EPSE?

Answer 13

Extra-pyramidal side effects

More associated with TYPICALS rather than atypicals

Question 14

Side effects of typical antipsychotics?

Answer 14

EPSE:

• tardive dyskinesia (invol. movements of mouth/tongue)
• Parkinsonism (cogwheel rigidity, bradykinesia etc)
• Akathisia (subjective motor restlessness)
• Acute dystonic reactions (oculogyric crisis and others)

Prolongued QT

Sedation

Hypotension

Neuroleptic malignant syndrome

Question 15

Side effects of atypical antipyschotics?

Answer 15

Metabolic syndrome
Postural hypotension
Mild EPSE
Mild sedation

AGRANULOCYTOSIS especially clozapine

Question 16

Which system in brain is being targeted for desired effects of antipsychotics?

Answer 16

Mesolimbic dopamine blockade

Question 17

Monitoring antipsychotic drugs?

Answer 17

Weight - weekly 6 weeks, then at 12 weeks, then annually
Waist circumference
Pulse, BP, blood sugar
ECG at start

Response to treatment and side effects

Question 18

Treatment resistant schizophrenia?

Answer 18

Prescribe clozapine if there has been no response to at least two sequential antipsychotics.

Question 19

First drugs for bipolar disorder: acute episode of mania?

Answer 19

Quetiapine
Risperidone
Haloperidol
Olanzapine

Question 20

Second line drugs for bipolar disorder acute episode of mania?

Answer 20

If first antipsychotic isn’t effective or tolerated, try another one. If not effective consider adding:
Lithium

Sodium valproate if lithium is not suitable

Question 21

Bipolar I and II?

Answer 21

Bipolar I = mania and depression

Bipolar II = hypomania and depression

Question 22

Hypomania and mania difference?

Answer 22

Presence of psychotic symptoms in mania, not in hypomania

Question 23

Monitoring Lithium?

Answer 23

Monitor serum lithium at days 4-7
Then weekly until stable (for 4 weeks)
Then every 3 months for 1st year
Then 6 monthly

Question 24

Lithium levels?

Answer 24

0. 4-0.8 mmol/L if newly started on Li

0. 8-1 mmol/L if relapse whilst on Li

Question 25

First drugs for bipolar disorder acute depressive episode?

Answer 25

Quetiapine Fluoxetine with olanzapine Olanzapine Lamotrigine

Question 26

What needs to be checked before starting Lithium?

Answer 26

``` Weight/BMI FBC TFT U+E Ca eGFR ECG ```

Question 27

Most superior antipsychotic?

Answer 27

Clozapine (atypical)

Question 28

Rapid tranquilization drug?

Answer 28

IM Lorazepam if unsure of patients history etc.

Question 29

MHA Section 2?

Answer 29

``` Assessment and treatment 28 days Section 12 approved doctor GP of the patient Approved Social worker (ASW) ```

Question 30

MHA Section 3?

Answer 30

``` Treatment 6 months Section 12 approved doctor GP of the patient Approved Social worker (ASW) ```

Question 31

MHA Section 5.2?

Answer 31

Emergency 72 hours Doctor only

Question 32

MHA Section 5.4?

Answer 32

Emergency 6 hours Nurse

Question 33

MHA Section 4?

Answer 33

Emergency treatment 72 hours Doctor ASW

Question 34

MHA Section 136?

Answer 34

Emergency if someone is thought to have mental health disorder Police may hold someone until assessment