Psychiatry

Question 1

Tx alzheimers

Answer 1

Mild moderate - acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
memantine (an NMDA receptor antagonist)
→ moderate Alzheimer’s who CI acetylcholinesterase inhibitors
→ add-on drug to acetylcholinesterase inhibitors - moderate or severe Alzheimer’s
→ monotherapy in severe Alzheimer’s

Question 2

Donepezil SE

Answer 2

is relatively contraindicated in patients with bradycardia

adverse effects include insomnia

Question 3

Capgras syndrome

Answer 3

delusion that a friend or partner has been replaced by an identical-looking impostor.

Question 4

Cotard syndrome

Answer 4

delusional idea that one is dead, organs missing etc

Question 5

GAD management

Answer 5

1. Education
2. Low intensity psych interventions
3. high intensity (CBT) or drugs
4. Specialists

Drugs:
SSRI - sertraline
If not, alternative SSRI/SNRI - duloxetine, venlafaxine
If not, pregabalin

Question 6

OCD management

Answer 6

CBT/ clomipramine/ SSRI

Question 7

Panic Disorder

Answer 7

CBT, SSRI

If CI/ not working 12/52&raquo_space; imipramine, clomipramine (TCA)

Question 8

Management of extrapyramidal side-effects from antipsychotics

Answer 8

procyclidine

Question 9

Atypical antipsychotics

Answer 9

Clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole

Question 10

Typical antipsychotics

Answer 10

-azine

Question 11

Section 2

Answer 11

Admission for assessment

<28 days

Question 12

Section 3

Answer 12

Admission for treatment < 6 months

Can be renewed

Question 13

Section 4

Answer 13

72 hour assessment disorder
Emergencies
GP/ AMHP or NR
Changes to 2 once in hospital

Question 14

Section 5(2)

Answer 14

Detaining a voluntary patient in hospital for < 72 hrs

Question 15

Section 5 (4)

Answer 15

Nurse for 6 hours

Question 16

Section 17a

Answer 16

Community treatment order

Recall a patient to hospital if not complying in the community

Question 17

Section 135

Answer 17

Court order
Police break in to property
> Place of safety

Question 18

Section 136

Answer 18

Found in public area
Appears to have MH issue
Place of safety
<24 hours (until MHA)

Question 19

SSRI with dose-dependent QT interval prolongation

Answer 19

Citalopram, escitilopram

Question 20

SSRIs risks in pregnancy

Answer 20

First trimester > small increased risk of congenital heart defects

• 3rd trimester > persistent pulmonary hypertension of the newborn
• Paroxetine - increased risk of congenital malformations, particularly in the first trimester

Question 21

Which SSRIs have the most drug interactions

Answer 21

fluoxetine and paroxetine

Question 22

Breastfeeding SSRIs

Answer 22

sertraline paroxetine

Question 23

Somatisation disorder

Answer 23

Multiple symptoms at least 2 years

Does not accept reassurance

Question 24

Conversion disorder

Answer 24

loss of motor or sensory function
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 25

Best SSRI in pregnancy:

Answer 25

Sertraline or citalopram, but citalopram can’t be used in breastfeeding