Psychiatry

Question 1

What are the three core symptoms of depression?

Answer 1

Low mood
Anergia (loss of energy)
Anhedonia (loss of pleasure)

Question 2

What are other symptoms of depression?

Answer 2

Change in sleep
Change in appetite
Weight loss
Change in libido
Diurnal mood variation
Agitation
Loss of confidence
Loss of concentration
Guilt
Hopelessness
Suicidal ideation
Reduced self esteem

Question 3

Define paranoid

Answer 3

Suspicious, preoccupied with conspiratorial explanations, distrusts others, holds grudges

Question 4

Define schizoid

Answer 4

Emotionally ‘cold’, lacks interest in others, rich fantasy world

Question 5

Define schizotypal

Answer 5

Extreme social discomfort, distorted cognitions and perceptions

Question 6

Define antisocial

Answer 6

Criminals, aggressive, lack of empathy, impulsive, lack of guilt, manipulative

Question 7

Define borderline

Answer 7

Mood swings, self-harm and impulsivity, self-image problems, often history of abuse

Question 8

Define histrionic

Answer 8

Attention seeking behaviour and excessive emotions

Question 9

Define narcissistic

Answer 9

Grandiosity, need for admiration and a perceived lack of empathy

Question 10

Define dependent

Answer 10

Passive, clingy, need to be cared for by other people, feels helpless when not in relationship

Question 11

Define avoidant

Answer 11

Social inhibition and inadequacy, extreme sensitivity to negative evaluation

Question 12

Define obsessive compulsive (anankastic)

Answer 12

Worries and doubts, perfectionism, sensitive to criticism, pedantry

Question 13

Difference between avoidant and schizoid?

Answer 13

Schizoid VOLUNTARILY withdraw from social situations

Question 14

Criteria for mild, moderate and severe depression

Answer 14

Mild: 2 core + 2 others
Moderate: 2 core + 3-4 others
Severe: 3 core + 4+ others

Question 15

Risk factors for depression

Answer 15

Genetic
Childhood experiences
Social circumstances

Question 16

Assessment for depression

Answer 16

PHQ-9

HADs

Question 17

Management for depression

Answer 17

1st line: SSRI - sertraline, citalopram, fluoxetine
2nd line: alternate SSRI
3rd line: Mirtazapine, SNRI - venlafxine/duloxetine

Question 18

Define baby blues

Answer 18

Common transient
3-7 days after birth - may last 2 weeks
Tearful, anxious and irritable
Tx: Reassurance and support

Question 19

Define post-natal depression

Answer 19

10% of all women
Start within a month and peaks at 3 months
Tx: Reassurance and support
CBT, SSRIs - sertraline

Question 20

Define puerperal psychosis

Answer 20

Rare
2-3 weeks after birth - risk to mother and baby
Severe mood swings and disordered perception - psychosis
Hospital admission
Mood stabiliser, antidepressant, ECT
Psychotic symptoms - antipsychotics/long-acting benzodiazepine

Question 21

First rank symptoms for Schizophrenia

Answer 21

Hallucinations - 3rd person
Delusional perception
Thought disorders - withdrawal, insertion, broadcasting
Passivity phenomena

Question 22

Management for schizophrenia

Answer 22

1st line: 2nd generation antipsychotics - risperidone, olanzapine, quetiapine, paliperidone, arirpiprazole

2nd line: 1st generation antipsychotics - haloperidol, chlorpromazine

3rd line: Clozapine

Question 23

Side effects of 1st generation anti-psychotics

Answer 23

extrapyramidal side effects

Dystonia
Dyskinesia
Akasthesia
Parkinsonism

Question 24

Side effects of 2nd generation anti-psychotics

Answer 24

Weight gain
Diabetes
Hyperglycaemia
Dyslipidaemia
Stroke
Drowsiness

Question 25

Side effects of clozapine

Answer 25

``` Agranulocytosis Reduced seizure threshold Myocarditis Weight gain Neutropenia Parkinson's ```

Question 26

Treatment for dystonia

Answer 26

Procycladine

Question 27

Treatment for dyskinesia

Answer 27

Tetrabenazine

Question 28

Treatment for Parkinsonism

Answer 28

Procyladine

Question 29

Treatment for akasthesia

Answer 29

Propanolol +/- cyproheptadine

Question 30

Define schizoaffective disorder

Answer 30

Confusion and affective mood disorder Pt experiences both symptoms of a mood disorder (mania or depression) and schizophrenia (hallucinations/delusions) at the same time Tx: Antipsychotic and mood stabiliser

Question 31

Define generalised anxiety disorder (GAD)

Answer 31

Anxiety that is generalised + persistent. 'Excessive worry' + feelings of apprehension about every day events/problems

Question 32

Risk factors for generalised anxiety disorder

Answer 32

35-54 years old Female > Male Divorced/separated Live alone/lone parent

Question 33

Clinical features for generalised anxiety disorder

Answer 33

``` Restlessness Irritability Easily fatigued Difficulty concentrating Muscle tension Sleep disturbance ```

Question 34

Other features of generalised anxiety disorder

Answer 34

``` Heart palpitations Increased HR Sweating Dry mouth Insomnia Difficulty breathing Chest pain Nausea and vomiting Numbness Dizzy Depersonalisation Fear of dying ```

Question 35

Management for generalised anxiety disorder

Answer 35

``` Exercise Meditation Relaxation techniques CBT Behavioural therapy SSRI - first line Benzodiazepine (Addictive) Propanolol - for somatic symptoms such as tremor and sweating ```

Question 36

Define PTSD

Answer 36

Severe psychological disturbance following a traumatic event. Characterised by involuntary re-experiencing elements of the event

Question 37

Causes of PTSD

Answer 37

Fear response Neurophysical changes Genetic Reduced hippocampal volume

Question 38

Risk factors for PTSD

Answer 38

``` low education lower social class female Previous family history Previous traumatic events ```

Question 39

Symptoms for PTSD

Answer 39

Flashblacks, nightmares Avoidance Hypervilgilance Emotional numbing

Question 40

Treatment for PTSD

Answer 40

CBT Eye movement desensitisation and reprocessing (EMDR) Sertraline and mirtazapine