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1
Q

Three features of autism required for diagnosis?

A

Impaired social relationships Ritualistic and compulsive phenomena Global impairment of language and communication

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2
Q

What screening tool is used to diagnose post natal depression?

A

Edinburgh Postnatal Depression Scale >13 is positive Important to distinguish between baby blues, post natal depression and puerperal psychosis Baby Blues : 3-7 days, anxious fearful and irritable. Health visitor PND: 1/12-3/12, resembles depression. CBT, SSRIs (preferable paroxetine due to low milk/plasma ratio. Avoid fluoxetine due to half life)

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3
Q

Postnatal depression: Best Drug Pick Worst Drug Pick

A

Paroxetine - Low milk/plasma ratio - SSRI Fluoxetine - Long half life - SSRI

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4
Q

Which SSRI has a the highest incidence of discontinuation syndrome ?

A

Paroxetine When stopping SSRI the dose should be gradually reduced over a 4 week period (except with fluoxetine).

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5
Q

What anti depressant is recommended for patients on warfarin or heparin?

A

Mirtazapine

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6
Q

Features of PTSD

A

Re experiencing Emotional Numbing Avoidance of resembling situstions Hyperarousal Depression Substance Misuse Anger Somatisation

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7
Q

How many symptoms are required from the DSM - IV criteria to be diagnosed with depression?

A
  1. Mild, moderate and severe refer to the interference with functioning PHQ9 - 9 questions marked 0-3 each. Not depressed: 0-4 Mild: 5-9 Moderate: 10-14 Moderately Severe: 15-19 Severe: 20-27 HAD - 14 questions each 0-3 Normal : 0-7 8-10 : Borderline 11+ : Depressed/Anxious
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8
Q

Drug Management for Alzheimer’s: mild - moderate: Moderate - Severe:

A

mild - moderate: ACHesterase Inhibitors (Donepezil, Galantamine and Rivastigmine) Moderate - Severe: NMDA receptor antagonist (Memantine)

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9
Q

Pharmacological Management for Sleep Paralysis?

A

Clonazepam

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10
Q

Therapeutic Drug Monitoring Timing: How long after each of these drugs is administered should the dose be measured? Lithium, Cyclosporine, Digoxin, Phenytoin

A

Lithium: 12 hours post dose. Cyclosporine: Trough levels immediately before dose Digoxin: 6 hours post dose Phenytoin: If adjusting dose, suspected toxicity or non adherence is suspected then the TROUGH dose should be checked immediately before the next dose

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11
Q

What is the therapeutic Range for lithium?

A

0.4-1.0 mmol/l Taken 12 hours after dose

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12
Q

Adverse effects of clozapine

A

Agranulocytosis Neutropenia Reduced seizure threshold

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13
Q

What seasons are suicide more common in?

A

Spring and early summer

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14
Q

What term is given to a strong belief that regarding someone of a higher status being in love with them?

A

Erotomania

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15
Q

What are features of catatonic schizophrenia?

A

Motor immobility Strange movements excessive negativism

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16
Q

Features of EPS following administration of antipsychotic medication - what drug?

A

Procyclidine - anti muscarinic agent

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17
Q

Somatisation Disordee

A

Multiple physical symptoms 2 years Refuses to accept reassurance or negative test results 6 or more symptoms from 14

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18
Q

Conversion disorder

A

motor or sensory loss non-conscious feigning of symptoms

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19
Q

Safest antidepressant post-MI

A

Sertraline

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20
Q

SSRIs contraindicated in people with long QT risk or taking other QT prolonging drugs

A

Escalitopram Citalopram

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21
Q

SSRI of choice in adolescents and children

A

Fluoxetine

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22
Q

Which SSRIs have a higher rate of drug reactions (2)

A

Paroxetine Fluoxetine

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23
Q

NICE guidelines on giving SSRI alongside NSAID

A

AVOID but if you have to give alongside PPI

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24
Q

NICE guidelines on giving SSRIs alongside warfarin or heparin

A

AVOID and give mirtazapine

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25
Q

NICE Guidelines on giving SSRIs alongside triptans

A

AVOID

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26
Q

Which SSRI doesn’t need four week discontinuatiojn period

A

Fluoxetine

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27
Q

Which SSRI has a higher risk of discontinuation symptoms

A

Paroxetine

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28
Q

Discontinuation Symptoms

A

Mood change Restless Difficulty Sleeping Unsteady Sweating GI sx Paraesthesia

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29
Q

ICD 10 for depression diagnosis Severity system

A

2 Weeks of: 2 + core sx: Low mood, Anhedonia, Low energy AND 2 +: -inattention, low self esteem, guilt, pessimistic views, self harm, suicide, disturbed sleep, diminished appetite Mild - 4 + sx Moderate - 5 + sx and difficulty in continuing normal activities Severe - 7+ sx including all core sx. Unable to continue normal activities Severe with psychosis - delusions, hallucinations or psychomotor retardation

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30
Q

BPAD: Type 1 Type 2 Rapid cycling

A

Type 1: Manic predominantly + depressed episodes type 2: long recurrent depressive episodes + hypomanic Rapid cycling - 4 or more affective episodes per year.

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31
Q

What drug is thought to help in rapid cycling BPAD?

A

Sodium Valproate

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32
Q

ICD for schizophrenia

A

One or more First Rank symptom lasting more than one month: Delusion, auditory hallucinations, thought disorder, passivity phenomena OR 2 or more: non auditory hallucination, thought disorganization, catatonic symptoms, negative symptoms, change in behavior PRESENT for A MONTH

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33
Q

Features of catatonic schizophrenia

A

Stupor - unresponsive Excitement - purposeless motor activity Abnormal positing Waxy flexibility Automatic obedience Perseveration - also seen in frontal lobe diseases

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34
Q

Hebephrenic schizophrenia

A

Young onset Changes to affect Disorganised speech Fleeting delusions and hallucinations

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35
Q

Negative symptoms - Social decline

A

Simple Schizophrenia

36
Q

Social withdrawal after a period of treated psychosis

A

Residual - Have to have had a clear cut psychotic episode

37
Q

Sudden onset psychotic episode following intense bereavement

A

Schizopheniform Disorder

38
Q

Dependence Syndrome criteria (6)

A
  1. Strong compulsion to take drug 2. Difficulties in controlling drug use 3. Withdrawal symptoms 4. Tolerance to drug 5. Neglect of other activities 6. persistence despite awareness of harms
39
Q

Delirium features (4)

A
  1. Acute changes to mental state with fluctuating course 2. Inattention 3. Disorganised thinking 4. Altered level of consciousness
40
Q

Cortical blindness but the person has no insight into this blindness

A

Anton Syndrome - often following bilateral occipital lobe injury

41
Q

Left Right disorientation Dyscalculia Finger agnosia Agraphia

A

Gestmann’s Syndrome - Parietal lobe injury

42
Q

dementia unsteadiness urinary incontinence

A

Normal pressure hydrocephalus

43
Q

Rapidly evolving myoclonus and cerebellum signs High signal in anterior basal ganglia

A

Sporadic CJD

44
Q

Puvlinar Sign - posterior thalamus high signal

A

vCJD

45
Q

Tx of Parkinson’s Dementia

A

Parkinson’s Dementia : Motor sx should precede the dementia by at least a year Tx: anti- parkinson + anticholinesterase

46
Q

Generalized Anxiety Disorder: ICD 10

A

6 months < Apprehension Motor Tension Autonomic Hyperactivity Non specific trigger

47
Q

i) Fear of unable to easily escape to safe place ii) Fear of scrutiny and humiliation iii) Sudden attacks of panic with physical symptoms without an identified trigger

A

i) agoraphobia ii) social phobia iii) panic disorder

48
Q

PTSD: Symptom duration requirement?

A

Precipitate between 1-6 months after event and symptoms present 1 month< Symptoms: Re- Experiencing, avoidance, hyperarousal etc. you

49
Q

3 Specific examples of somatiform Disorders:

A

Heart : da costa Resp: Psychogenic hyperventilation GI: IBS psychogenic polydypsia

50
Q

i) Deliberate production of symptoms to get medical treatment ii) Deliberate production of symptoms to get a reward iii)Parent induces or fabricates illness in child

A

i) Factitious disorder ii) Malingering iii) Münchausen Syndrome

51
Q

Loss of a domain of function following an acutely stressful event

A

Dissociativa disorders

52
Q

Anorexia Nervosa: ICD 10. 4 domains for diagnosis

A
  1. Low BW: 15% below expected/ <17.5 kg/m^2 2. Intent to lose weight 3. Overvalued idea of being overweight 4. Endocrine disturbance due to the weight loss
53
Q

Bullemia: ICD 10 4 domains for diagnosis

A
  1. Binging
  2. Cravings
  3. Prevenging (weight gain - purging, exercise)
  4. Obsessing (ideas about being overweight)

BMI should be above 17.5 otherwise consider AN

54
Q

ADHD/ Hyperkinetic Disorder: Age limit?

A

Onset before <6 years old >1 year of symptoms

55
Q

Learning difficulties Mild IQ Range Moderate IQ range Severe IQ range Profound IQ Range

A

Mild IQ Range - 50-69 Moderate IQ range - 35-49 Severe IQ range -20-34 Profound IQ Range - <20 Mild is more heritable than the severe and profound causes

56
Q

Personality Disorders: Describe characteristics of each cluster and specifically what personality disorders

A

Cluster A - Odd/ Eccentric - schizoid, paranoid, schizotypal Cluster B - Dramatic/ Erratic / Emotional - Histrionic, Emotionally unstable, dissocial, narcisstic Cluster C - Anxious/ Fearful - Anankastic, Anxious, Dependent Remember REPORT: Relationships affected Enduring Pervasive Onset in childhood Results in distress Trouble in occupation/ socially

57
Q

Define Primary Insomnia

A

Lack of sleep not associated with other psychiatric or medical illness or with substance abuse

58
Q

What is Narcolepsy? Four features of narcolepsy

A

Narcolepsy is the abnormality of the REM inhibiting mechanism 1. Sudden irresistible bouts of refreshing sleep at any time 2. Cataplexy - sudden bilateral loss of muscle tone caused by emotion 3. Hypnogognic (upon sleeping) and hypnopompic (awakening) hallucinations 4. Sleep paralysis - at the end or beginning of sleep

59
Q

Cognitive and behavioural techniques and relaxation techniques.

A

Dialectic Behvioural therapy

60
Q

Antipsychotic particularly associated with prolonged QT

A

Haloperidol

61
Q

What differentiates hypomania from mania?

A

The presence of psychotic symptoms points towards mania diagnosis: - Delusions of grandeur - Auditory hallucinations

62
Q

TCA - drug examples - side effects (5)

A

Amitryptilline, Imipramine, Dosulepin, Lofepramine Drowsiness, Dry Mouth Blurred Vission Constipation Urinary Retention

63
Q

Neuroleptic Malignant Syndrome: Common precipitants? Features? Management

A

Common Precipitants - commencing a new drug or increasing a dose Features - Young male patients, within 10 days of drug change. - Pyrexia, rigidity and tachycardia - Increased CK Management- stop drug, IV fluids (prevent renal failure due to rhabdomyolysis), dantrolene, dopamine agonists (bromocriptine)

64
Q

Four indications of commencing antidepressant treatment for persistent subthreshold depressive symptoms/ mild-moderate depression.

A
  • A past history of moderate or severe depression - Initial presentation of subthreshold depressive symptoms (if lasting for long period of time >2 years) - Subthreshold depressive symptoms or mild depression continuing after psychological therapy - Chronic physical health problem alongside mild depression
65
Q

Neuroleptics should be avoided in which type of dementia?

A

LBD - severe risk of irreversible parkinsonism

66
Q

Progressive cognitive impairment Parkinsonism Visual Hallicination

A

Lewy Body Dementia Dx: Clinical New imaging: DaTscan

67
Q

28 Days admission assessment

A

Section 2 - AMHP or nearest relative makes the application - 2 doctors recommendations one of which section 12 approved

68
Q

6 months treatment

A

Section 3 - AMHP, 2 doctors - both having seen patient within last 24 hours

69
Q

72 hour emergency assessment order

A

Section 4 - Used where section 2 would take too long - GP, AMHP or Nearest Relative

70
Q

Voluntary general hospital patient detained by doctor for 72 hours

A

Section 5(2)

71
Q

Voluntary patient detained by a nurse in a hospital for 6 hours

A

Section 5(4)

72
Q

CTO

A

Section 17a - Community treatment order

73
Q

Court order to grant police permission to enter a property and remove person to safe place

A

Section 135

74
Q

Public place with mental disorder can be taken by the police to a place of safety

A

Section 136

75
Q

Women with PMH of unprovoked DVT being treated with long term warfarin. She is diagnosed with moderate depression. Which pharmacological therapy could you initiate?

A

Mirtrazapine is thought to be the best idea where warfarin/heparin are being used Don’t start SSRI

76
Q

Elderly Women presents to GP with symptoms of moderate depression. She is being treated for ACS with aspirin How do you manage?

A

Add Sertralline and Add Lansoprazole

77
Q

When do you review patients after starting them on antidepressants? When do you stop them?

A

Review period: >30 year old/ low risk of suicide : 2 weeks <30 years old/ high risk of suicide: 1 week review Stopping: Antidepressants should be stopped >6 months after remission from symptoms

78
Q

First-line treatment of acute confusional state (delerium)? What are contraindications to this treatment and what would you use in this instance?

A

First line: 0.5mg Haloperidol as sedative Contraindicated in: Parkinson’s, Lewy Body Dementia - Lorazepam probably best here as - short acting benzodiazepine class drug.

79
Q

In elderly patients, antipsychotics + acetylcholinesterase greatly increases the chance of what

A

CVA

80
Q

Bad prognostic markers for schizophrenia (5)

A

Strong FH Premorbid social withdrawal Lack of precipitant Gradual Onset Low IQ

81
Q

Side effects of ECT: 5 short term 1 long term

A

Short term: -Headache -Nausea -short term memory impairment -loss of memory of time priod just before ECT -cardiac arrhythmias Long term: - Impaired memory

82
Q

oral, live attenuated virus Theoretical risk of intussusception if given after 24 weeks

A

Oral Rotavirus -given at 2 and 3 weeks

83
Q

ADHD characteristics (4)

Management (pharma)

A

Characteristics:

Uncontrolled Activity

Restlessness

Inattentiveness

Impulsiveness

Management:

Methylphenidate (norepinephrine-dopamine reuptake inhibitor)

Atomoxetine (norepinephrine reuptake inhibitor)

84
Q

Alcohol Withdrawal timeline When do the following occur following alcohol cessation? symptoms: seizures: delirium tremens:

A

Symptoms: 6-12 hours Seizures: 36 hours Delirium Tremens: 72 hours

85
Q

MMSE of less than ? indicates depression

A

24

86
Q

What is DBT

A

DBT is Dialectic Behavioural Therapy Specifically for Borderline Personality Disorder Involves accepting the way the patient is: “It makes sense that you feel like that in certain situations” Then making positive changes. i.e. in response to DSH and Suicide. Developing new strategies

87
Q

What is mentalisation based treatment?

A

Type of psychodynamic psychotherapy Used in BPD Helps separate the clients own thoughts and feelings from those around them. Helps identify the clients intentions and those of others.

Psych from passmed (2 decks)

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