Psychiatry

Question 1

Depression 
Psychological Symptoms (3)

Answer 1

Mood changes: low mood, anxiety, anhedonia (loss of pleasure)
Change in thought content: guilt, hopelessness, worthlessness, neurotic symptoms (obsessions, panic), delusions
Perceptions: -ve 2nd person auditory hallucinations eg. criticising clothes

Question 2

Depression
Physical symptoms (6)

Answer 2

Insomnia (early waking, difficulty falling asleep)
Appetite + weight change
Reduced libido
Constipation
Pain
Psychomotor: agitation, retardation, stupor

Question 3

Depression
Social symptoms (6)

Answer 3

Loss of interest 
Irritability 
Apathy 
Lack of confidence 
Indecisiveness 
Reduced concentration

Question 4

Depression

Symptoms in the elderly (3)

Answer 4

Insomnia
Suicide
Memory problems (short + long term, just say don’t know on MOCA)

Question 5

Depression
Scoring symptoms (5)

Answer 5

ICD-10
Hospital Anxiety + Depression Scale (HAD): +ve if >11
Patient Health Questionnaire (PHQ-9): depression if >5
Any psychotic features means immediately becomes severe depression with psychosis
Exclude physical causes eg. hypothyroid, dementia, HIV, B-blockers, steroid withdrawal

Question 6

Depression

ICD-10 (3)

Answer 6

Lasts >2 weeks with no manic/hypomanic episodes in lifetime, not attributable to psychoactive substance or another psychoactive disorder
With at least 2 of: depressed most days for past 2 weeks, anhedonia, increased fatiguability + decreased energy
And at least 4 (mild), 6 (moderate) or 8 (severe): loss of confidence/self esteem, unreasonable/excessive guilt, suicidal thoughts/behaviours, reduced concentration, agitation/retardation, sleep disturbance, appetite changes

Question 7

Depression

Treatment of mild to moderate (4)

Answer 7

Individualised guided self-help based on CBT
Computerised CBT
Group based CBT
Drugs not routine but consider if past history of moderate –> severe depression or if symptoms >2y or still persist after other interventions

Question 8

Depression

Treatment of moderate to severe (6)

Answer 8

Antidepressant for at least 6m and high intensity psychological intervention, review 2w after starting unless suicide risk then review after 1w
SSRI 1st
TCA
MAOI
SNRI
NaSSA (Noradrenergic and Specific Serotinergic Antidepressant- mirtazapine)