Psychiatry

Question 1

What are the domains of the MSE?

Answer 1

Appearance
Behaviour 
Speech 
Mood and affect
Thought form 
Thought content 
Perceptions 
Cognition 
Insight 
Risk assessment

Question 2

What are some extra areas in a psychiatric history?

Answer 2

Personal history - school, employment, relationships
Forensic history
Pre-morbid personality
Informant history

Question 3

What are the three key features of depression?

Answer 3

Low mood
Fatigue
Anhedonia
Must have 2 over 2 weeks

Question 4

What are some psychological symptoms of depression?

Answer 4

Reduced self esteem
Guilt or worthlessness
Poor concentration
Thoughts of self-harm/suicide

Question 5

What are some physical symptoms of depression?

Answer 5

Sleep disturbance and early morning waking
Decreased libido
Decreased appetite

Question 6

What investigations should be done for depression?

Answer 6

FBC, UEs, LFTs, TFTs, HbA1c
BP and HR
BMI
ECG

Question 7

What is the treatment for depression?

Answer 7

Mild - sleep hygiene, self-help, exercise
Moderate - talking therapies
Severe - antidepressant and talking therapy

Question 8

What are some side effects of SSRIs?

Answer 8

Nausea, headache, dry mouth, erectile dysfunction

Question 9

What are some side effects of TCAs?

Answer 9

Dry mouth, constipation, urinary retention, drowsiness

Question 10

What should be done for relapse prevention in depression?

Answer 10

Continue effective treatment for 6-9 months after remission

Over 5 episodes or 2 recent episodes - continue for at least 2 years

Question 11

When should depression be referred to psychiatry?

Answer 11

Treatment resistant
Increased risk suicide, harm to others or self-neglect
Psychotic symptoms
?Bipolar 
Under 18 years

Question 12

What are some features of hypomania and mania?

Answer 12

Increased self-esteem
Reduced need for sleep
Increased talking, flight of ideas, distractibility
Goal directed activity

Need 3 or more
Mania if over 1 week or needs hospitalisation

Question 13

What is the treatment of bipolar?

Answer 13

1. Atypical antipsychotic or mood stabiliser - haloperidol, olanzapine, quetiapine or risperidone

Question 14

What are delusions and hallucinations?

Answer 14

Delusions = unshakeable false beliefs 
Hallucinations = perceptions with no external stimulus

Question 15

What are some differentials for psychosis?

Answer 15

Schizophrenia 
Encephalitis 
Thyroid disease
Brain tumour 
Dementia

Question 16

What should be done for a first episode of psychosis?

Answer 16

Check for prodrome of unusual behaviour
Assess for PTSD
FBC, LFTs, TFTs, UEs, bone profile

Question 17

What are the negative symptoms of schizophrenia?

Answer 17

Blunted mood
Reduced speech
Poor self care
Lack of volition

Question 18

What is the treatment of schizophrenia?

Answer 18

Oral atypical antipsychotic
CBT
Family intervention
PRN lorazepam

Question 19

What are the criteria for starting clozapine?

Answer 19

Tried 2 other atypical
Agranulocytosis and myocarditis
Need to have regular FBC

Question 20

What are the police MHA sections?

Answer 20

136 - can be taken from public place

135 - can be taken from residence, magistrates order

Question 21

What are the features of a section 5?

Answer 21

5 (2) - detention of inpatient by doctor
5 (4) - detention of inpatient on psychiatric ward by nurse
Up to 72 hours
Not renewable

Question 22

What are the features of a section 2?

Answer 22

Assessment section
Doctor + independent doctor + AMHP
Lasts up to 28 days
Can treat but no ECT

Question 23

What are the features of a section 3?

Answer 23

Treatment section - known patient, established treatment, presenting as normal
Doctor + independent doctor + AMHP
Up to 6 months then renewable
Must be approved by nearest relative

Question 24

What are the features of a section 4?

Answer 24

Emergency assessment
Psychiatrist + AMHP
Up to 72 hours

Question 25

What is a section 17?

Answer 25

Responsible clinician can authorise leave