Psychiatry

Question 1

What questionnaire is used to screen for depression?

Answer 1

PHQ-9

Question 2

What are the 3 core symptoms of depression?

How long should these symptoms be present for and how frequently?

Answer 2

Persistent low mood, Loss of interest or pleasure, Fatigue or low energy
For at least 2 weeks on most days, most of the time

Question 3

Which blood tests should be considered when managing depression? (7)

Answer 3

FBC, U&Es, LFTs, TFTs, glucose, bone profile, ESR

Question 4

What differentials should you consider when diagnosing depression? (8)

Answer 4

Grief, anxiety, bipolar, premenstrual dysphoric disorder, substance misuse
Neurological conditions
Hypothyroidism
OSA

Question 5

What are some psychiatric differentials for anxiety?

What are some medical differentials for anxiety?

Answer 5

Adjustment disorder, OCD, PTSD, depression, anorexia, substance misuse, somatoform

Cardiac or pulmonary disease, hyperthyroidism, anaemia, infection, IBS, phaeochromocytoma

Question 6

What are the symptoms of serotonin syndrome?

Answer 6

Hyperreflexia, hypertension, hyperthermia, tachycardia, agitation, sweating, irritability, diarrhoea, dilated pupils

Question 7

What are the symptoms of discontinuation syndrome?

Answer 7

Headaches, dizziness, nausea, hypomania, electric shock sensations

Question 8

What are 4 core symptoms of schizophrenia?

Answer 8

Auditory hallucinations
Broadcasting thoughts
Control (delusions of control or passivity)
Delusions

Question 9

What are some psychological differentials for psychosis? (6)

What are some medical differentials for psychosis? (7)

Answer 9

Schizophrenia, schizoaffective disorder, bipolar, depression, substance misuse, PTSD

Epilepsy, dementia, B12 deficiency, thyroid disease, medication, SLE, sepsis

Question 10

Which of the antipsychotics are most likely to cause:

1. Hyperprolactinaemia
2. Weight gain
3. Prolonged QTc

Answer 10

1. Risperidone
2. Olanzapine
3. Quetiapine

Question 11

What are the main side effects of antipsychotics? (5)

What is the monitoring for those on antipsychotics?

Answer 11

Hyperprolactinaemia, extra-pyramidal symptoms, metabolic syndrome, arrythmias, drowsiness

Bloods - glucose, HbA1c, lipids, prolactin
BMI, waist cirucmference, pulse, BP

Question 12

What are the symptoms of neurleptic malignant syndrome?

What is the general management? (5)

Answer 12

Hyperthermia, hypertension, hyperreflexia, tachycardia, sweating, irritability, tremor

IV fluids, active cooling, dopamine agonist, benzos for agitation, ICU support

Question 13

What is required for an application to for section 2 or 3 under MHA?
How long do each of these sections last?
What is the appeal process?

Answer 13

AMHP, two doctors (one whom is section 12 approved)

2 - up to 28 days, can appeal within first 14 days
3 - 6 months (must be reassessed after 3 months), can appeal at any time

Question 14

What are the symptoms of a manic episode of bipolar disorder? (7)

Answer 14

Distractibility
Irritability
Grandiose ideas
Flight of ideas
Activity increase
Sleep deficit
Talkativeness

Question 15

What medication is used during the acute phase of manic?
What medication is used long-term for bipolar?
What medication is used for depressive phase in bipolar?
What social management should you consider?

Answer 15

Antipsychotics
Lithium
Quetiapine, olanzapine, lamotrigine, fluoxetine with olanzapine
Care plan and lasting power of attorney

Question 16

When are lithium levels measured?
What are the long-term effects of lithium? (3)
What two blood tests are monitored? How often?

Answer 16

After 5 days, weekly and when stable, every 3 months
Renal toxicity, diabetes insipidus, hypothyroidism
U&Es, TFTs - every 6 months

Question 17

What is included in the criteria for dependency? (5)

Answer 17

Craving, tolerance, withdrawal, salience, loss of control

Question 18

What questions should you remember to ask when taking a alcohol history? (3)

Answer 18

Any physical symptoms e.g. jaundice, seizures
Any contact with police
Any admission due to alcohol

Question 19

What are the 3 main categories of symptoms in those with ASD?

Answer 19

Problems with communication
Difficulties with social relationships
Absorbing and narrow interests

Question 20

When should you refer a young person to the autism team or paediatrics?

Answer 20

<3 with regression of language or social skills
>3 with regression in language
Any age with regression in motor skills

Question 21

What options are there in the management of ASD?

1. Biological
2. Psychological
3. Social

Answer 21

1. SSRIs, risperidone (aggressive), melatonin (sleep)
2. CBT, behaviour management, specific autism programmes
3. Carers, respite care, educational support

Question 22

What are the causes of irreversible dementia?

What are the causes of reversible dementia?

Answer 22

Alzheimer’s, vascular dementia, DLB, frontotemporal

Substance misuse, hypothyroidism, SOL, normal pressure hydrocephalus, pellagra, syphyllis, B12 or folate deficiency

Question 23

What cognitive assessment tools are there for assessing dementia?

Answer 23

10-CS
6CIT
Memory Impairment Screen (MIS)

Question 24

What are behavioural and psychological symptoms of dementia? (5)
What should be considered first when managing BPSDs?

Answer 24

Hallucinations, agitation, anxiety, delusions, aggression

Non-pharmacological interventions e.g. aromatherapy,, music therapy