Psychiatry

Question 1

Differentials for low mood

Answer 1

• Depression
• Depressive episode of bipolar disorder
• Anxiety
• Substance misuse
• Physical: PD, dementia, MS, hypothyroidism, stroke
• Drugs: Steroids, Beta blockers, anticonvulsants, oral contraceptives

Question 2

Differentials for psychosis

Answer 2

• Severe depression with psychosis
• Schizophrenia
• Mania
• Drug induced psychosis (alcohol, cannabis, LSD)
• Alcohol withdrawal
• Delirium
• Dementia
• Brain injury
• B12 deficiency
• Temporal lobe epilepsy

Question 3

Management of depression

Answer 3

Mild: Watch and wait
Moderate: CBT and SSRI
Severe: Urgent mental health assessment with possible inpatient admission

Question 4

Side effects of sertraline and key counselling points

Answer 4

Side effects: Nausea, Dry mouth, drowsiness, decreased sex drive, impotence, anorgasmia

Counselling points: Increased anxiety in first couple weeks of taking
Can take up to 4 weeks to start working
Do not stop taking suddenly

Question 5

Management of schizophrenia

Answer 5

• CBT and family therapy
• EIS for first episode of psychosis
• Antipsychotics (chosen based on patient medical history and preference)

Question 6

Side effects of antipsychotics

Answer 6

EPSEs (dystonia, akathisia, parkinsonism, tardive dyskinesia) - typicals
Hyperprolactinaemia - 
Weight gain
DIabetes
Sedation

Question 7

Side effects of clozapine

Answer 7

• Sedation
• Weight gain
• Diabetes
• Anti-cholinergic
• Hypersalivation
• Hypotension
• Myocarditis
• Agranulocytosis

Question 8

Different antipsychotics

Answer 8

Haloperidol (Extra-pyramidal side effects, prolactin)

Risperidone (prolactin)

Olanzapine (weight gain, diabetes)

Aripriprazole (less side effects)

Amisulpride (prolactin)

Quetiapine (same as olanzapine but less so)

Clozapine

Question 9

Causes of dementia

Answer 9

• Hypothyroidism
• B12 deficiency
• Hypocalcaemia
• Brain tumour
• Delirium due to infection or drugs (morphine)
• Depression

Question 10

Drug treatment of mania

Answer 10

1: Atypical antipsychotic (Haloperidol, olanzapine, quetiapine, or risperidone)
2: Alternate psychotic from first list
3: Lithium (must be willing to comply to blood monitoring
4: Valproate (absolute contraindication in women of child bearing age)

Question 11

Symptoms of anxiety

Answer 11

Biological: Poor concentration, insomnia, repetitive thoughts, repetitve thougths

Physical: Dry mouth, sweating, palpitations, hyperventilation, nausea, lump in throat, trembling

Question 12

Types of anxiety disorders

Answer 12

Generalised
Panic disorder
Phobia
OCD
PTSD

Question 13

Treatment of anxiety

Answer 13

1: SSRI
2: SNRI (venlafaxine or duloxetine)
3: TCA or MAOI (phenelzine)

Question 14

What are BPSDs

Answer 14

• Agression
• Apathy
• Delusions
• Hallucinations
• Verbal outbursts
• Anxiety

Question 15

Non-pharmalogical treatment of BPSDs

Answer 15

• routine
• programmed activities
• music therapy
• aromatherapy
• exercise
• orientation aids
• regular and familiar staff in hospital
• individual rooms in hospital

Question 16

Features of vascular dementia

Answer 16

• Step wise decline

- Associated with vascular risk factors

Question 17

Features of Lewy body dementia

Answer 17

• Visual hallucinations
• REM sleep disorder
• Parkinsonism
• Fluctuating confusion

Question 18

Features of frontotemporal dementia

Answer 18

• Under 65s
• Insidious onset
• Change in personalty and behaviour
• Speech and language disorders

Question 19

Memory loss history

Answer 19

• Ask about memory?
• Difficulty recognising places or familiar routes?
• Difficulty recognising faces?
• Struggling finding the right words when talking?
• Change in behaviour or personality?
• Recent illness or fever?
• Low mood or anxiety?
• Hallucinations or delusions?
• Parkinsonism features?
• RISK ASSESSMENT (driving, falls, wandering, ADLs, self harm)

Question 20

EPSE’s and their management

Answer 20

Dystonia - Procyclidine
Akathisia - Change drug
Parkinsonism - Procyclidine
Tardive dykinesia - Stop drug

Question 21

Neuroleptic malignant syndrome

Answer 21

• Reaction to antipsychotic drugs
• Symptoms include: autonomic dysfunction (hyperthermia, hypertension, hyperreflexia, tachycardia, tremor, agitation, irritability, sweating)
  muscle rigidity, high fever, confusion elevated WBC and LFTs

Question 22

Psychosis history

Answer 22

Voices - second or third person, commands, running commentary
Delusions - Out to get out? reference? control? Challenge the delusions
Ask about mood? Previous diagnosis of depression or mania?
RISK ASSESSMENT
Check insight

Question 23

3 core symptoms of ADHD

Answer 23

• Inattentiveness
• Hyperactivity
• Impulsivity