Pysch

Question 1

extrapyramidal side effects of antipsychotics

Answer 1

1) Parkinsonism
2) Acute dystonia: sustained muscle contraction (e.g. torticollis, oculogyric crisis)
3) Akathisia (severe restlessness)
4) Tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

Question 2

Specific warnings when antipsychotics are used in elderly patients

Answer 2

1) increased risk of stroke

2) increased risk of venous thromboembolism

Question 3

Other side-effects of anti-pyschotics

Answer 3

1) antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
2) sedation, weight gain
3) raised prolactin
may result in galactorrhoea
due to inhibition of the dopaminergic tuberoinfundibular pathway
4) impaired glucose tolerance
5) neuroleptic malignant syndrome: pyrexia, muscle stiffness
6) reduced seizure threshold (greater with atypicals)
7 ) prolonged QT interval (particularly haloperidol)

Question 4

antimuscarinic

Answer 4

dry mouth, blurred vision, urinary retention, constipation

Question 5

Benzodiazepines

Answer 5

enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels.

Question 6

GABAA drugs effect on chloride channel
Benzodiazipines
Barbiturates

Answer 6

benzodiazipines increase the frequency of chloride channels

barbiturates increase the duration of chloride channel opening

Question 7

Anton’s syndrome

Answer 7

rare symptom of brain damage occurring in the occipital lobe characterised by cortical blindness, but will not accept they are blind despite being told that they are.

Question 8

Cotard syndrome

Answer 8

believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.

Question 9

Dead or non existent part of body

Answer 9

Cotard syndrome

Question 10

Othello syndrome

Answer 10

Patients partner is committing infidelity despite no evidence of this. It can often result in violence and controlling behaviour.

Question 11

Patient believes their partner is cheating on them. They may be threatening or stalk their partner. This seems to affect males more than females.

Answer 11

Othello syndrome

Question 12

De Clerambault syndrome

Answer 12

patient believes that a person of a higher social or professional standing is in love with them.

Question 13

Celeb is in love with me

Answer 13

De Clerambault syndrome

Question 14

Ekbom syndrome

Answer 14

Delusional parasitosis and is the belief that they are infected with parasites or have ‘bugs’ under their skin. This can vary from the classic psychosis symptoms in narcotic use where the user can ‘see’ bugs crawling under their skin or can be a patient who believes that they are infested with snakes.

Question 15

Capgras delusion

Answer 15

friends or family members have been replaced by an identical looking imposter.

Question 16

Person believing their friend or relative had been replaced by an exact double.

Answer 16

Capgras delusion

Question 17

Couvade syndrome

Answer 17

‘sympathetic pregnancy’. It affects fathers, particularly during the first and third trimesters of pregnancy, who suffer the somatic features of pregnancy.

Question 18

Expectant Fathers: suffer the somatic features of pregnancy.

Answer 18

Couvade syndrome

Question 19

Bouffée délirante

Answer 19

Acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour.

Question 20

Fregoli delusion

Answer 20

Mistaken belief that some person currently present in the deluded person’s environment (typically a stranger) is a familiar person in disguise.

Question 21

Severe Depression in Elderly

Dementia

Answer 21

Global memory loss

Dementia characteristically causes recent memory loss

Question 22

ECT ( Electroconvulsive therapy)
Absolute contradincation

Short- term side effects

Long-term side effects

Answer 22

The only absolute contraindications is raised intracranial pressure.

Short-term side-effects
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia

Long-term side-effects
some patients report impaired memory

Question 23

5-HT1A partial agonist

Answer 23

Buspirone can be used in GAD ( Generalised anxiety disorder)

Question 24

Generalised anxiety disorder mangement

Answer 24

SSRIs are the first-line pharmacological therapy.

If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered

Question 25

Features of atypical grief reactions include:
Delayed grief
Prolonged grief

Answer 25

Delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins

Prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months

Question 26

Korsakoff’s syndrome

Answer 26

Features

1) anterograde amnesia: inability to acquire new memories
2) retrograde amnesia: unable to recall past memories
3) confabulation: making up new memories

Question 27

Wernicke’s encephalopathy

Answer 27

1) ataxia,
2) ophthalmoplegia
3) confusion
4) Nystagamus

Question 28

Lithium

Answer 28

It has a very narrow therapeutic range (0.4-1.0 mmol/L)

A long plasma half-life being excreted primarily by the kidneys.

Question 29

Lithium Adverse Effects

Answer 29

1) nausea/vomiting, diarrhoea
2) fine tremor
3) nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
4 ) thyroid enlargement, may lead to hypothyroidism
5) ECG: T wave flattening/inversion
6) weight gain
7) idiopathic intracranial hypertension
8) leucocytosis
9) hyperparathyroidism and resultant hypercalcaemia

Question 30

Post-Traumatic Stress Disorder (PTSD)

Mangement

Answer 30

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

Trauma-focussed CBT

If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

Question 31

OCD mangement

Answer 31

Exposure-response prevention (ERP) therapy

Question 32

Schizophrenia: features 1st rank symptoms :4

Answer 32

Auditory hallucinations

Thought disorders

Passivity phenomena

Delusional perceptions

Question 33

Schizophrenia: prognostic indicators 5

Answer 33

1) strong family history
2) gradual onset
3) low IQ
4) premorbid history of social withdrawal
5 )lack of obvious precipitant

Question 34

SSRI in MI

Answer 34

sertraline is useful post myocardial infarction

Question 35

SSRIs should be used with caution in children and adolescents Drug of choice

Answer 35

Fluoxetine is the drug of choice when an antidepressant is indicated

Question 36

Citalopram and the QT interval

Answer 36

associated with dose-dependent QT interval prolongation and should not be used in those with: congenital long QT syndrome

maximum daily dose is now
40 mg for adults;
20 mg for patients older than 65 years
20 mg for those with hepatic impairment

Question 37

SSRIs and pregnancy

Answer 37

• Use during the first trimester gives a small increased risk of congenital heart defects
• Use during the third trimester can result in persistent pulmonary hypertension of the newborn
• Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Question 38

discontinuation symptoms seen more in which SSRI

Answer 38

When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.

Question 39

Serotonin and noradrenaline reuptake inhibitors ( venlafaxine and duloxetine) uses

Answer 39

• major depressive disorders
• generalised anxiety disorder
• social anxiety disorder
• panic disorder
• menopausal symptoms

Question 40

Sleep Paralysis

Answer 40

REM sleep

Transient paralysis of skeletal muscles which occurs when awakening from sleep or less often while falling asleep.

Question 41

Safest TCA in overdosage

TCA avoid as dangerous in overdose

Answer 41

Lofepramine - the safest TCA in overdosage

Dosulepin and amitriptyline - avoid as dangerous in overdose

Question 42

• multiple physical SYMPTOMS present for at least 2 years

- patient refuses to accept reassurance or negative test results

Answer 42

Somatisation disorder

Question 43

Hypochondrial disorder

Answer 43

• persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
• patient again refuses to accept reassurance or negative test results

Question 44

Factitious disorder/ Munchausen’s syndrome

Answer 44

the intentional production of physical or psychological symptoms