Mental Health, neurodevelopmental and disability

Question 1

What is the best initial management of grief with bereavement hallucinations?

Answer 1

Reassure, normal part of grief process

Question 2

What pyschological treatment should all individuals with newly diagnosed schizophrenia be offered?

Answer 2

CBT
- Family intervention should be offered to families of those living with schizophrenia (or close contact)

Question 3

Name 3 medications where an SSRI would not be your first line choice in mod-severe depression.
What alternative?

Answer 3

Warfarin, heparin or non-steroidal anti-inflammatory drugs
- Don’t px SSRI due to bleed risk

Mirtazapine instead

Question 4

What is the single most common form of self-harm?

Answer 4

Cutting

Question 5

What are the most common precipitants of lithium toxicity in stable patients?

Answer 5

Dehydration (i.e. D+V illness)
Sodium imbalance

(Caution with diuretics)

Question 6

How do you distinguish between bullaemia and binge eating disorder?

Answer 6

Bullaemia - Purge after binge (could be vomiting but could also be extreme exercise or laxatives)

BED - No purginging

Question 7

How do you distinguish between anorexia and Bulimia?

Answer 7

Anorexia - Low BMI and often ammenorrhoea. Avoid food, calorie tracking

Bulimia - May have normal BMI. Vomiting (and dental problems from this). Binge eating and then purging

Question 8

What is the name of the questionnaire which can be useful in screening for anorexia and Bulimia?

Answer 8

Sick control one fat food (SCOFF) questionnaire

Question 9

What are the 5 questions of the SCOFF questionnaire?

Answer 9

Do you make yourself sick because you feel uncomfortably full?
Do you worry you have lost control over how much you eat?
Have you recently lost more than one stone in a three month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that Food dominates your life?

Question 10

What SCOFF questionnaire score indicates possible anorexia or Bulimia?

Answer 10

5 questions, 1 point each

2 or more points = Likely anorexia or Bulimia

Question 11

What is the MINIMUM recommended duration of treatment for patients where drug therapy has been found to be effective?
a) In generalised anxiety (GAD)
b) In panic disorder

Answer 11

a) 12 months
b) 6 months

From the time was at the dose that worked for them

Question 12

Social anxiety is MOST LIKELY to be associated with which mental health disorder?

Answer 12

Drug and alcohol misuse

Question 13

You see a 28-year-old patient who takes escitalopram for severe depression. She reports that she has recently stopped smoking and is asking for advice regarding her anti-depressants. What do you need to consider?

Answer 13

Dose reduction by 25%

Smoking increases metabolism of many psychotropic medications and upon smoking cessation, doses may require immediate dose reduction to prevent medication toxicity. If smoking is resumed, original doses need to be reinstated. For escitalopram, monitor closely and consider 25% dose reduction.

Question 14

What blood test needs checking on initiation of clozapine?
How often?

Answer 14

FBC
- Before
- Weekly for 18 weeks
- Bi-weekly after
- After 1 year, check 4 weekly

Question 15

What is the evidence to decide on which treatment in depression of children and preventing further relapse - medicine/ pyschotherapy/ combination - which is best?

Answer 15

Limited evidence about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these in the prevention of relapse or recurrence of depression in children and adolescents.

Question 16

When should lithium be initiated for bipolar disorder?

Answer 16

Start immediately after 1st severe mania episode

Question 17

When may lamotrigiene be considered as a treatment for bipolar?

Answer 17

Consider lamotrigine in patients who have severe recurrent depression but only mild manic episodes (Bipolar II).

Question 18

Which is the antidepressant of choice for patients with bipolar disorder who develop severe depression?

Answer 18

Fluoxetine
(often in combination with olanzapine and done in secondary care)

Question 19

What is the minimum monitoring requirements for lithium (what and how often)?

Answer 19

BMI
U+E
Calcium
TFT’s
Lithium levels

Every 6 months min, if deterorating then do 3 monthly

Question 20

When should lithium levels be monitored at initiation?

Answer 20

One week after initiation/ dose change
Then weekly til stable

Once stable 3 monthly for first year and 6 monthly thereafter

Question 21

How would you characterise the symptoms of PTSD?

Answer 21

PTSD usually involves overarousal states including dysregulation of emotions (hyperacute emotions which are difficult to control), nightmares and sleep disturbance.

Question 22

OCD, what is the first line therapy? If medication is used which one?

Answer 22

a) CBT
b) Sertraline

Question 23

Name 3 features of abnormal grief?

Answer 23

Delayed – when more than two weeks have elapsed before grieving begins
Inhibited

Question 24

How long after death is it considered delayed for someone to develop grief symptoms?

Answer 24

2 weeks

Question 25

What group of medicines are linked to cognitive and functional decline in dementia?

Answer 25

Anticholinergics (i.e. amitryptiline)

Question 26

What characterises social anxiety disorder?

Answer 26

The hallmark of social anxiety disorder is excessive fear and anxiety when facing the possibility of humiliation or embarrassment. Autonomic symptoms and avoidance

Question 27

When is the peak incidence of: a) baby blues b) Postnatal depression

Answer 27

a) First few days, peak at one week, tapers by two weeks b) 0-5 weeks

Question 28

Which therapy has the strongest evidence for treating gambling addiction?

Answer 28

CBT

Question 29

If antidepressant medication is used in pregancy which medication is preferable?

Answer 29

SSRI Or TCA

Question 30

What, if any, is the MINIMUM duration of unexplained, appropriately investigated symptoms before a formal diagnosis of medically unexplained physical symptoms (MUPS) should be considered?

Answer 30

3 months

Question 31

What is the Care Programme Approach (CPA)?

Answer 31

The care programme approach (CPA) is a framework for providing care to those aged 16 years and over with mental health problems (with or without learning disabilities). It involves creating a formal, written care plan agreed by all involved parties (the patient, any carers/family and health and social care professionals). This should include a discussion of the patient's holistic care needs and the patient should be assigned a named care coordinator.

Question 32

In mild depression in adolescents, how long is watchful waiting appropriate for?

Answer 32

Watchful waiting is appropriate for up to four weeks with a reassessment after two weeks to reconsider the need for referral.

Question 33

A patient has hypermetropia and diabetes, which antidepressant should be avoided?

Answer 33

Mirtazapine (Can precipirate angle closure glaucoma)

Question 34

After a first episode of depression, once symptoms are in remission how long should antidepressants be continued for?

Answer 34

6 months

Question 35

What is the usual period of withdrawal for antidepressant therapy if established for over a year?

Answer 35

Around 4 weeks

Question 36

Name 2 antidepressants with a short half life where you may consider longer than 4 weeks withdrawal when stopping?

Answer 36

Paroxetine and venlafaxine

Question 37

Which antidepressant has the longest half life and therefore would need a less slow withdrawal than the usual 4 weeks?

Answer 37

Fluoxetine

Question 38

Sodium valpropate - what monitoring bloods and when?

Answer 38

BMI + FBC + LFT's After 6 months and then annually

Question 39

What advice should be given to reduce adverse effects of vomiting in someone with bulimia nervosa?

Answer 39

Rinse mouth after Avoid acidic food and drink Anorexia advised multivitamin but not bullimia

Question 40

Neuroleptic maligant syndrome: a) 3 characterising features b) 3 most common precipitating drugs

Answer 40

a) fever, rigidity and mental status changes b) haloperidol, olanzapine and risperidone

Question 41

What is the most common form of abuse?

Answer 41

Coercive control

Question 42

Risk of suicide is highest in what time frame following index episode of self harm?

Answer 42

After 1st episode risk of suicide highest in first 6 months

Question 43

What is the recommended treatment for self harm in adolescents?

Answer 43

Dialectical behavioural therapy (DBT) Typically a 16-week programme with both the young person and their family to develop coping skills, manage emotions and develop relationships.

Question 44

What duration of hypomania/ mania symptoms is considered significant in bipolar?

Answer 44

Over 4 days or more

Question 45

What characterises avoidant personality disorder?

Answer 45

Feelings of social inadequacy and fear of rejection.

Question 46

If there is a history of recurrent depression or the risk of relapse is considered high, then treatment with medication should be for a minimum duration of what?

Answer 46

At least 2 years

Question 47

What are the criteria for diagnosis of bulimia?

Answer 47

Binge eating once a week for at least three months WITH - compensatory behaviour (vomiting and excessive exercise) AND - psychological features (a loss of control)

Question 48

Only antidepressant licenced for use in children?

Answer 48

Fluoxetine

Question 49

Name 4 drugs which may be used to treat bipolar disorder?

Answer 49

Lithium, olanzapine, lamotrigine and sodium valproate

Question 50

How often do NICE recommend eye tests in the elderly?

Answer 50

Every2 years

Question 51

When should lithium level samples be taken? What is the target window?

Answer 51

Samples should be taken 12 hours after the dose to achieve a serum-lithium concentration of 0.4–1 mmol/l

Question 52

According to NICE what PTSD pyschological treatments are recommended and when in relation to the event?

Answer 52

Trauma focussed CBT - >1mth after event (can be done not F2F) EMDR - consider 1-3 mths after event, routinely offer if >3 mths after event

Question 53

Annual physical health checks are carried out for those with mental illness, what group of complications are most common?

Answer 53

Cardiovascular

Question 54

According to current guidance, which is the SINGLE MOST appropriate initial psychological management of binge eating disorder in an adult?

Answer 54

Guided self help If ineffective after 4 weeks refer for group CBT

Question 55

What is the peak age of onset of bipolar disorder?

Answer 55

15-19yrs

Question 56

A patient taking lithium should be advised to avoid which OTC medicines?

Answer 56

NSAID NSAIDs reduce the excretion of lithium and increase the risk of toxicity

Question 57

Which is the SINGLE MOST appropriate non-drug intervention for managing social anxiety disorder in adults?

Answer 57

Individual CBT

Question 58

What is the recommended drug-free gap required when switching from fluoxetine to another selective serotonin reuptake inhibitor (SSRI)?

Answer 58

7 days Particular caution when switching from fluoxetine to other antidepressants, because fluoxetine has a long half-life (approximately 1 week). When switching from fluoxetine to another SSRI, either to stop fluoxetine (or taper if dose >40 mg/day), wait 7 days for a washout period,then start the new SSRI at low dose.

Question 59

Caution is recommended when prescribing antipsychotic drugs in elderly patients with dementia owing to an associated increased risk of?

Answer 59

Stroke or TIA

Question 60

You are starting antidepressant medication for a patient. When should they be reviewed?

Answer 60

Suicide risk OR man aged 18-25 - Within a week No suicide risk - Within 2 weeks

Question 61

What IQ cut off's are used for different categories of disability?

Answer 61

<20 Profound 20-35 Severe 35-50 Moderate 50-70 Mild >70 - Normal

Question 62

What are the three characteristics of a learning disability?

Answer 62

* A state of arrested or incomplete development of mind that occurs during child development * Impairment of intellectual functioning (usually measured by IQ) * Impairment of adaptive/social functioning

Question 63

What is the most common cause of non-inherited learning disability?

Answer 63

Foetal alcohol syndrome

Question 64

Name 3 physical features of fetal alcohol syndrome?

Answer 64

Small for age Small widely-spaced eyes (hypertelorism) Short palpebral fissures Thin upper lip Low nasal bridge Often ASD/ VSD

Question 65

Name 3 physical features of Down's syndrome?

Answer 65

Round face Prominent epicanthic folds Upsloping palpebral fissures Oversized tongue Single transverse palmar crease.

Question 66

Name 3 physical features of Turners syndrome?

Answer 66

short stature, low hairline, low set ears and webbing of the neck.

Question 67

An eight-year-old boy with ADHD has been brought to you for a repeat prescription of methylphenidate. The drug has improved his symptoms and you think it is appropriate to continue it. You wish to check for side-effects. Which is the SINGLE MOST relevant examination?

Answer 67

Height/weight/blood pressure Common side-effects include abdominal pain, nausea, dyspepsia, anorexia and reduced weight gain. It is, therefore, advisable to monitor growth during treatment.

Question 68

Dyslexia gives difficulty in which 3 key areas?

Answer 68

Phonological awareness Verbal memory Verbal processing speed.

Question 69

ADHD, 3 key characteristics?

Answer 69

Hyperactivity Impulsivity Inattention.

Question 70

A 15-year-old boy is taking atomoxetine to help control his attention deficit hyperactivity disorder (ADHD). Which is the SINGLE MOST appropriate parameter to monitor?

Answer 70

Blood pressure For people taking atomoxetine for ADHD, the heart rate and blood pressure should be monitored before and after each dose change and every six months.

Question 71

Name three medications which can be used in ADHD, which order should they be used in?

Answer 71

1) Methylphenidate - If unsuccesful 6 week trial: 2) Lisdexamfetamine If no improvement: 3) Atomoxetine or guanfacine

Question 72

You assess a patient with a learning disability needs a hospital admission but is refusing - you have assessed that they lack capacity. How do you proceed?

Answer 72

Make best interests decision - Needs to be balanced and with discussion with close family/ contacts - if no-one available discuss with IMCA NOT mental health act as their is no mental health condition

Question 73

Developmental milestones: vocalising one to six words with meaning is expected by what age?

Answer 73

18mths

Question 74

Developmental milestones: building a tower of 4 bricks is expected by what age?

Answer 74

18 months

Question 75

Developmental milestones: unsupported sitting is expected by what age?

Answer 75

Around 6 months but upper limit is 9 months

Question 76

What is Gowers sign? Which condition is it seen in?

Answer 76

Gower’s sign is seen in Duchenne muscular dystrophy. On rising the child will walk their hands up their legs to achieve an upright posture.

Question 77

Name 3 conditions associated with Down's syndrome?

Answer 77

Hypothyroid Cateracts Deafness Congenital heart disease Congenital GIT abnormalities Atlanto-axial instability Alzheimer’s disease Leukaemia

Question 78

What questionnaire can be used to screen for Autism, what score raises suspicion and need for further assessment?

Answer 78

AQ-10 test Score over 6 needs further assessment

Question 79

When should medication to aid sleep be prescribed? Which medication is used?

Answer 79

Only after behavioural intervention - After discussion with pysch - Together with non=pharma interventions Melatonin is first chocie

Question 80

What are the two most common complications of cerebral palsy?

Answer 80

Intellectual disability (60%) Seizures (50%) Then visual impairment, scloiosis (20%), drooling (30%)

Question 81

A 9 year old boy is on methylphenidate, what should be monitored every 3 months?

Answer 81

Weight Weight should be monitored every three months in children under the age of 10 being treated with methylphenidate. Height, pulse rate and blood pressure need monitoring every six months.

Question 82

A mother reports her child's ADHD symptoms are worse after he eats anything containing artificial colouring. According to current guidance, which is the SINGLE MOST appropriate INITIAL recommendation?

Answer 82

Diet may have some effect on children’s hyperactivity but a formal dietetics opinion is recommended if a possible link is found between food/drink and behaviour.

Question 83

Which is the SINGLE MOST appropriate tool to use when SCREENING for social anxiety disorder?

Answer 83

Mini spin

Question 84

Name groups that may benefit from: a) CBT b) DBT c) Bereavement counselling

Answer 84

a) Depression, anxiety disorders, OCD b) Personality disorders c) Bereavement/ adjustment disorder