Psychiatry

Question 1

What are the 1st line, 2nd line and 3rd line treatments for moderate/severe depression

Answer 1

1. SSRI’s- escalitopram

2. increase dose, and switch to another SSRI. Or switch to other class of drug eg SNRI, MOAIs, TCA

Question 2

Which types of depressive patients do you use ECT in?

Answer 2

• severe depression if not responding to pharam treatment, if they got psychomotor retardation, suicide or homocide, or if theyve got severe weight loss or biological features
• 1st line in psychotic depression

Question 3

Pharmacological treatment of psychotic depression

Answer 3

Antidepressant with antipyschotic- eg fluoxetine with olnazapine

Question 4

What is treatment resistant depression, and how do you treat it?

Answer 4

• failure to respond to two anti-depressants or 1 antidepressant and ECT
  Tx- add lithium or T2 tryptophan

Question 5

What is the first line treatment for acute manic episodes?

Answer 5

• you either stop anti-depressants or add:

Antipsychotics- haloperidol, olnazapine, risperiodone, quietapine

Question 6

describe 2nd and 3rd line treatments for acute manic episode?

Answer 6

2nd line- add lithium to APA
3rd line- add valporate
- can also Benzodiazapenes if patient already taking anti-psychotics because has sedation effects

Question 7

Management for acute depressive episode in BPD that is moderate/severe

Answer 7

1. Fluoxetine and Olnazapine or 
Quiteapine- taken as monotherapy 
2. LAMTROGINE monotherapy
if taking lithium- then check serum lithium levels 
just add the above onto lithium

Question 8

How long should a normal grief reaction last for?

Answer 8

5 stages of grief, which include denial, acceptance, anger, depression etc
normal grief reaction can last up to 12 months, if beyond this then atypical grief reaction

Question 9

What is the most important blood test to do in a patient on Clozapine?

Answer 9

FBC- due to agranulocytosis

Question 10

What are the four first rank symptoms of Shizophrenia

Answer 10

1) . 3rd person auditory hallucination
2) . Passivity phenomena
3) . Delusional perceptions
4) . Thought alienation- eg thought echo, thought broadcast, thought withdrawal

Question 11

What are the short term side effects of ECT

Answer 11

Nausea
Vomiting 
Headaches 
Short term anterograde amnesia
Cardiac arrythmias

Question 12

Why do you review patients, under the age of 30 who are taking SSRI’s and SNRI’s?

Answer 12

Increased risk of suicide. You do this for the first month

Question 13

If a patient is having a good response to SSRI’s, how long should they continue this treatment for?

Answer 13

Continue treatment for at least 6 months to prevent relapse

Question 14

What is the time period in which symptoms, seizures and delerium tremens develop following alcohol withdrawal?

Answer 14

Symptoms- 6-12 hours
Seizures- 36 hours
Delerium tremens- 72 hours

Question 15

Describe the type of symptoms in post-concussive syndrome and how long they last for?

Answer 15

non specific, and occur 3 months following the initial injury

Question 16

What treatment is 1st line in young patients presenting with anorexia nervosa?

Answer 16

Family based therapy

Question 17

What are two symptoms of acute dystonia, which occur as side effects of anti-psychotics?

Answer 17

torticollis, oculargyrate crisis

Question 18

Which psychiatric condition can mimic AD in the elderly?

Answer 18

Depression with lack of concentration can mimic memory loss. Depression and AD are common in elderly patients

Question 19

As rule of thumb which symptoms do those with hypochondrial disorder and somatisation disorder present with?

Answer 19

Hypochondrial disorder- Cancer

Somatisation- Symptoms

Question 20

According to NICE, what are the three indications for ECT?

Answer 20

ECT is used to achieve rapid and short term improvement:

1. Catatonia
2. prolonged or severe mania in BPD
3. Severe depression which is life threatning

Question 21

What are the six syndromes which result in unexplained symptoms:

Answer 21

1. Somatization disoder
   2) . Hypochrondrial disoder
2. Dissociative disorder
3. Conversion disorder
4. Malingering
5. Factitious

Question 22

Which two medical conditions are most important to exclude before diaganosing GAD? what investigations do you do to exclude these?

Answer 22

• hyperthyroidism: TFT’s

- phaecromocytoma: diagnose using urinary creatinine, catecholamines which are raised and urinary VMA