PRN - paces and written

Question 1

How long must anxiety be present for a diagnosis of GAD to be made?

Answer 1

6 months

Question 2

What are potential differentials for GAD?

Answer 2

Organic

• Hyperthyroidism
• Substance misuse - either intoxication e.g. with amphetamines or withdrawl e.g. from alcohol or benzos
• excess caffeine
• Depression
• avoidant personality disorder
• Schizophrenia
• Dementia

Question 3

What questions in the social history should you ask if someone is presenting with anxiety symptoms?

Answer 3

• alcohol (withdrawal?)
• Recreational drugs (amphetamines, cannabis)
• Caffeine!!!

Question 4

What is the name of the condition where a person feels an overwhelming urge to get to a place of safety when in a queue?

Answer 4

Agoraphobia

Question 5

What is the name of the experience of feeling like nothing is real?

Answer 5

Depersonalization / Derealization

Question 6

Why can you get tingling in panic attacks?

Answer 6

Hyperventilation involves blowing off carbon diaxide and so reduced levels of pCO2, which increased pH and causes hypocalcaemia. This in turn affects nerve conduction, causing paraesthesia (tingling and numbness) in hands feet and mouth. In extreme cases - carpopedal spasm can happen.

Question 7

What psychological treatments are recommended for anxiety?

Answer 7

1. CBT - aiming to reduce someone’s experience and expectations of threat. Begin with psychoeducation and then progress to sessions involving exploring the likelihood of expected disasters. behavioural experiements.
2. Exposure therapy with desensitization - aim to treat the avoidance / escape hehaviours by incrementally introducing scarier things - make a goal and a hierarchy of feared situations, and then each week step up - aim to stay in the situation until anxieety has gone - habituation - then will learn from it and response will decrease.

Question 8

What drugs are available for Anxiety?

Answer 8

1. SSRIs eg fluoxetine or paroxetine
2. TCAs if SSRIs dont work
3. Benzodiazepines - but must not have for more then 2-4 weeks as patients get dependent - but good for when starting SSRIs which have a delay
4. beta blockers - to help with adrenergic symptoms e.g. palpitations

Question 9

What type of CBT is suggested to treat OCD

Answer 9

exposure and response prevention

Question 10

What are the major clinical features of PTSD?

Answer 10

1. Re-experiencing (vivid, flashbacks of the event)
2. Hyper-arousal - on red alert
3. Avoidance
4. emotional detachment, powerful emotions

Question 11

What treatment options are available for OCD?

Answer 11

1. Psycholocical - CBT with exposure and response prevention - aiming to prevent the compulsive behaviour by forcing to be out of comfort zone and experience anxiety after doing things which normally would require the compusion to relieve anxiety
2. SSRIs

Question 12

When taking a history involving anxiety, what are the key features you should remember to ask about?

Answer 12

SEDATED
Symptoms of anxiety 
Episodes/continuous 
Drink/drugs 
Avoidance 
Triggers 
Effect on life 
Depression

Question 13

What treatment options are available for PTSD?

Answer 13

Treatment is important as it can have a huge impact on patient’s life - helping them to live in the rpesent and not the past.

Psych

• CBT involving exposure therapy
• psychotherapy
• EMDR (eye movement desensitization and reprocessing)

Bio
- SSRIs are first line e.g. fluoxetine

Question 14

2 examples of SNRIs

Answer 14

venlafaxine and duloxetine

Question 15

What is the increased risk of BPAD relapse during the puerperium?

Answer 15

8 fold

Question 16

Which antidepresants are usualyl prescribed when breastfeeding?

Answer 16

Sertraline

paroxetine

Question 17

What is the tool called to assess postnatal depression?

Answer 17

Edinburgh postnatal depression scale

Question 18

What are aetiological factors which are thought to increase the risk of schizophrenia?

Answer 18

• Genetic (1st degree relative increases lifetime risk to 10% instead of 1 %)
• Urban living
• Immigration
• Substance misuse
• obstetric complications e.g. viral, pre-eclampsia, hypoxia,
• adverse life experience e.g. childhood abuse

Question 19

What are shneiders 1st rank symptoms

Answer 19

remember 4:

1. auditory hallucinations
2. thought interference
3. Passivity
4. delusional perceptions

Question 20

how long must schizotypal symptoms have to have been going on for in order to diagnose schizophrenia? (ICD-10)

Answer 20

> 1 month

Question 21

What are negative symptoms of schizophrenia?

Answer 21

Blunted, apathy, poverty of speech, anhedonia, lack of feeling

Question 22

What are the different subtypes of schizophrenia?

Answer 22

Paranoid 
Hebenephric 
Catatonic 
Simple 
Residual

Question 23

Describe resiidual schizophrenia

Answer 23

prominent negative symptoms of schizophrenia reside after episode of another subtype of schiz over a year ago

Question 24

what is simple schizophrenia?

Answer 24

negative features only without the preceding typical episode, progressive decline and inability to meet demands of society. RARE

Question 25

describe the main features of paranoid schizophrenia?

Answer 25

Delusions of persection, reference and special missions | Auditory 2nd person commanding hallucinations

Question 26

What is Hebenephric schizophrenia?

Answer 26

hallucinations and delusions do not dominate but instead disorganised and chaotic mood, behaviour and speech. Affect often shallow and inappropriate and patients behaviour feels aimless. incoherent speech

Question 27

What are the common atypical antipsychotics?

Answer 27

``` Quetiapine Olanzapine Risperidone aripiprazole clozapine ```

Question 28

What are the common typical antipsychotics

Answer 28

haloperidol | chlorpromazine

Question 29

What are the extra-pyrimidal side effects that you can get from antipsychotics?

Answer 29

aDAPT Dystonia (e.g. torticollis or oculogyric crisis) Akasthesia (restlessness) Parkinsonism (triad of resting tremor, bradykinesia, rigidity) Tardive dyskinesia (rhythmic involuntary movements)

Question 30

How would you treat a patient experiencing oculogyric crises due to antipsychotics>?

Answer 30

Anticholinergic drugs e.g. procyclidine

Question 31

What are the features of neuroleptic malignant syndrome (NMS)

Answer 31

- muscle stiffness - rigidity - altered consciousness - disturbed autonomic nervous system e.g. tachycardia, labile BP., fever

Question 32

What is the very dangerous but rare side effect of antipsychotic drugs?

Answer 32

Neuroleptic malignancy syndrome (NMS)

Question 33

What are the 2 features of blood tests that you would probably see in neuroleptic malignancy syndrome?

Answer 33

raised WCC and raised CK

Question 34

What should you AVOID giving a patient showing signs of tardive dyskinesia?

Answer 34

Anticholinergics such as procyclidine because it can make symptoms worse!

Question 35

What is the risk of using clozapine in refractory schizophrenia, and how should you monitor this?

Answer 35

agranulocytosis and neutropenic sepsis - so should monitor neutrophil count weekly

Question 36

How can CBT be useful in treating schizophrenia?

Answer 36

people with schizophrenia sometimes have a tendancy to jump to connclusions without rational thinking - therapy helps to avoid this and an emphasis is put on reality testing - where the therapist will gently challenge illogical beliefs and aid awareness of illogical thinking in the patient. CBT not only helps with building confidence, self-esteem and problem-solving, but it can also help patients to cope with hallucinations and delusions.

Question 37

What are the 3 drugs approved for treating alzheimers symptoms ?

Answer 37

Donepezil Galantamine Rivastigmine