Firms: Psych

Question 1

Depression sx screen

Answer 1

Core: low mood, anhedonia, anergia

Biological: appetite/wt change, low libido, sleep disturbance

Cognitive: memory impairment, beck’s triad, suicidal

PLUS hx of hypomania, psychosis, mood incongruence

Question 2

The sensitivity and specificity of the depression screen

Answer 2

Core+Bio - sensitive but not specific

Cognitive - specific but not sensitive

Question 3

What are the different types of depression?

Answer 3

Unipolar
Bipolar
Psychotic
Psychosocial

Ddx: dysthymia, pseudo, adjustment disorder, hypothyroidism

Question 4

Biological vs Psychosocial

Answer 4

If it was: spontaneous, episodic, responded to prev tx, strong fhx etc all point towards a biological cause

Question 5

Depression vs Adjustment Disorder

Answer 5

Depression may not necessarily have a preceding event and is likely to be more severe

Question 6

Which drugs shouldn’t you give to a bipolar entering hypomanic state?

Answer 6

Antidepressants w/o mood stabilisers

Question 7

What drugs shouldn’t you give to a Parkinson’s pt?

Answer 7

Antipsychotics

Question 8

Duration of schizophrenia to dx

Answer 8

> =1m

Question 9

Schizophrenic sx screen

Answer 9

ICD-10 states >=1 of Schneider’s first rank sx OR >=2 ABCD

Question 10

What are Schneider’s first rank sx?

Answer 10

Auditory Hallucinations: thought echo, third person voices, running commentary

Abnormal Thoughts: insertion, withdrawal, broadcasting

Delusion of Control: SIVA

Delusional Perception

Question 11

What is a hallucination?

Answer 11

Perception in the absence of a stimulus

Question 12

What is an illusion?

Answer 12

Misinterpreted perception

Question 13

What is a delusion?

Answer 13

Fixed false belief

Question 14

What does the SIVA in delusion of control stand for?

Answer 14

Somatic
Impulse
Volition
Affect

Question 15

What is the ABCD part of the schizophrenia screen?

Answer 15

Always present hallucinations in any modality every day for a mnth

Breaks in train of thought, incoherent speech, neologisms

Caratonic behaviours: WRENCHES

Defeatist sx: 5A’s

Question 16

What are the WRENCHES of catatonic behaviours?

Answer 16

Waxy Flexibility
Rigidity
Echopraxia
Negativism
Catalepsy
Hyperactive
Echolalia
Stupor

Question 17

What are the five A’s of the negative sx?

Answer 17

Apathy
Anhedonia
Affect Blunted
Asociality
Alogia

Question 18

What are the acute and chronic sx of schizophrenia?

Answer 18

Acute, +ve sx, hallucinations, thought interference, delusions

Chronic, -ve sx, 5A’s

Question 19

What is the cause of these acute and chronic sx?

Answer 19

Acute: XS dopamine in mesolimbic tracts

Chronic: def dopamine in mesocortical tracts

Question 20

Outline the MSE

Answer 20

ASEPTIC

Appearance + Behaviour

Speech: rate, quantity, tone, volume, fluency

Emotion: Mood + Affect

Perceptions: Hallucinations + Illusions

Thoughts: Form, Content, Possession

Insight + Judgement

Cognition: oritentation, attention, memory

Question 21

What is inc in appearance + behaviour during the MSE?

Answer 21

Kempt, eye contact, distracted

Question 22

What is mood + affect?

Answer 22

Mood - generally (flat/labile)
Vs
Affect - currently (blunted/elevated)

Ask to rate their mood on a scale of 1-10

Question 23

What is typical thought broadcasting?

Answer 23

They’re in the newspapers/TV

Question 24

What is inc in insight + judgement during the MSE?

Answer 24

Tbc

Question 25

How is one orientated?

Answer 25

Time, place, person

Question 26

Outline the capacity assessment

Answer 26

Understand Retain Weighup Communicate

Question 27

Which screening tools are their for alcohol misuse/dependency?

Answer 27

CAGE, AUDIT, SADQ

Question 28

What are the four CAGE qs?

Answer 28

Have you ever felt you need to cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about drinking? Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Question 29

What is considered a positive CAGE?

Answer 29

>=2

Question 30

What are the seven DSM-IV criteria for alcohol dependence?

Answer 30

Restricted Cravings Primacy Tolerance Withdrawal Relief Drinking Reinstatement

Question 31

How could you word asking about primacy?

Answer 31

Do you find yourself neglecting other aspects of your life because of alcohol

Question 32

How could you word asking about tolerance?

Answer 32

Do you find you have to drink more to reach the same affect

Question 33

How many of the DSM-IV criteria are required for alcohol dependence?

Answer 33

>=3 occurring at any time in the same twelve mnth period

Question 34

What should you briefly ask about after screening for alcohol dependency?

Answer 34

Ascertain what exactly they’re drinking Ask about smoking and drugs Anything they see the GP for reg Ask for them to fill in AUDIT whilst you liaise w the rest of the team

Question 35

How often should pts in isolation be checked?

Answer 35

2hrly by nurse + 4hrly by dr

Question 36

What are T2 (consent form), T3 (certificate of second opinion) and S62 forms?

Answer 36

Apply to meds used to alleviate sx of mental disorder and their SEs after the initial 3m w/o consent period

Question 37

When does the T2 become invalid?

Answer 37

If the pt loses capacity to consent or withdraws consent -> SOAD If the tx changes or additional meds are prescribed -> new form

Question 38

SSRI SEs

Answer 38

GI disturbance, drowsiness, fatigue, dry mouth, sexual dysfunction

Question 39

What is the Braak staging for Alzheimer’s disease?

Answer 39

Stage I+II: transentorhinal - autonomic and olfactory disturbances Stage III+IV: limbic - sleep and motor disturbances Stage V+VI: neocortical - emotional and cognitive disturbances

Question 40

How are non-fatal offences sentenced?

Answer 40

Offences Against the Person Act 1861: Assault + Battery - 6m S47 ABH + S20 GBH - 5y S18 GBH w Intent - up to life