psych

Question 1

questionaires to assess depression

Answer 1

PHQ-9 or HAD

Question 2

features of depression (DSM-IV)

Answer 2

Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in most activities, nearly every day
Significant weight loss/ gain when not dieting, or decrease/ increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness nearly every day
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Question 3

mild depression

Answer 3

Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

Question 4

moderate depression

Answer 4

Symptoms or functional impairment are between ‘mild’ and ‘severe’.

Question 5

severe depression

Answer 5

Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.

Question 6

suspicious personality disorders

Answer 6

Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

Question 7

emotional and impulsive personality disorders

Answer 7

Antisocial personality disorder (ASPD)
Borderline personality disorder (BPD)
Histrionic personality disorder
Narcissistic personality disorder

Question 8

anxious personality disorders

Answer 8

Avoidant personality disorder
Dependent personality disorder
Obsessive compulsive personality disorder (OCPD)

Question 9

borderline personality disorder features

Answer 9

Efforts to avoid real or imagined abandonment
Unstable interpersonal relationships which alternate between idealisation/ devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts

Question 10

ADHD features

Answer 10

group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
≥ 5 symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities.
Several symptoms were present before the age of 12 years.
Several symptoms must be present in ≥2 settings (e.g. at home, school, or work; with friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with the quality of social, academic, or occupational functioning.
Symptoms are not better explained by another mental disorder

Question 11

increased prevalence of adhd

Answer 11

people born preterm
looked-after children and young people
children and young people diagnosed with oppositional defiant disorder or conduct disorder
children with mood disorders & adults with a mental health condition
people with a close family member diagnosed with ADHD
people with epilepsy
people with other neurodevelopmental disorders
people with a history of substance misuse
people known to the Youth Justice System or Adult Criminal Justice System
people with acquired brain injury.

Question 12

alzheimers dementia

Answer 12

Most common form of dementia in the UK. Onset may be from 40 years or earlier.
Abnormal phosphorylation of tau protein leads to build-up as B-amyloid plaques in the neural cortex (neuritic plaques) and vessel walls (amyloid angiopathy). Tau protein would usually protect the neurones against calcium influx.
Neurofibrillary Tangles cause necrosis to neural tissue.
A deficit of acetylcholine develops, due to damage to the forebrain.

Question 13

vascular dementia

Answer 13

Caused by vascular damage to the brain, so should be suspected in patients with signs of cerebrovascular disease e.g. hypertension, IHD and PVD.
Often starts suddenly, following a TIA/ CVA.
Similar to Alzheimer’s, but there are also focal neurological signs e.g. aphasia or weakness.
Can be static, or have a step-wise deterioration.

Question 14

frontotemporal dementia

Answer 14

Also known as ‘Pick’s Disease’. It is mainly early-onset and 10% is familial.
Involves atrophy of the frontal and temporal lobes. Neurones in this area have abnormal swelling: Pick’s bodies – due to a mutation in the tau gene of the microtubules.
Causes early changes in personality and behaviour. Relative preservation of memory and visuo-spatial functioning.
Stereotypical, repetitive and compulsive behaviour; emotional blunting; abnormal eating; language problems.

Question 15

lewy body/parkinsons dementia

Answer 15

If dementia symptoms 12-months before motor symptoms = Lewy Body Dementia.
Accounts for >0-15% of dementias.
Caused by alpha-synuclein protein deposits in the brainstem and neocortex, known as ‘Lewy bodies’. Lewy bodies lead to reduced levels of acetylcholine and dopamine in the brain.
These patients may also have tangles and plaques present on histology.
Fluctuating cognitive impairment.
Classically, there are visual hallucinations, gait and sleep disturbances. Patients may be restless at night.

Question 16

anorexia nervosa features

Answer 16

3 core features:
Intense fear of gaining weight: dread becoming “fat.”
Food intake restriction: this may lead to significantly low body weight.
Distorted body image: generally view themselves as overweight, even if dangerously underweight.
Anorexia nervosa is also associated with physiological abnormalities; summarised below.

Physical Features: reduced body mass index (can be normal in atypical cases), bradycardia, hypotension, enlarged salivary glands
Physiological Abnormalities: Hypokalaemia; low FSH, LH, oestrogens and testosterone; Low T3, Raised cortisol and growth hormone;, hypercholesterolaemia, Impaired glucose tolerance

Question 17

bulimia nervosa features

Answer 17

recurrent episodes of binge eating, and a sense of lack of control over eating during the episode.
recurrent inappropriate compensatory behaviour in order to prevent weight gain.
recurrent vomiting may lead to erosion of teeth and Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting.
behaviours occur, on average, at least once a week for three months.
self-evaluation is unduly influenced by body shape and weight.
the disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 18

mx bulimia nervosa

Answer 18

referral for specialist care is appropriate in all cases.
NICE recommend bulimia-nervosa-focused guided self-help for adults. Otherwise, NICE recommend individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).
children should be offered bulimia-nervosa-focused family therapy (FT-BN).
pharmacological treatments have a limited role.

Question 19

section 2

Answer 19

Admission for assessment for up to 28 days. An Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors. One of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist).
Treatment can be given against a patient’s wishes.

Question 20

section 3

Answer 20

Admission for treatment for up to 6 months, can be renewed. AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours.
Treatment can be given against a patient’s wishes.

Question 21

section 5(2)

Answer 21

A patient who is in hospital can be legally detained by a doctor for 72 hours.

Question 22

section 5(4)

Answer 22

similar to section 5(2), allows a nurse to detain a patient for 6 hour

Question 23

section 135

Answer 23

A court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

Question 24

section 136

Answer 24

Someone found in a public place who appears to have a MH condition can be taken by the police to a Place of Safety. Can only be used for 24 hours, whilst an assessment is arranged

Question 25

atypical antipsychotics

Answer 25

clozapine olanzapine risperidone quetiapine amisulpride aripiprazole

Question 26

illusion

Answer 26

a type of false perception of a real world object is combined with internal imagery to produce a false internal percept

Question 27

hallucination

Answer 27

an internal percept without a corresponding external object. Perceived as in external space, distinct from imagined images, outside conscious control and as possessing relative permanence. 

Question 28

over valued idea

Answer 28

ideas which are reasonable and understandable in themselves but which come to unreasonably dominate a patient’s life 

Question 29

delusion

Answer 29

an abnormal belief which is held with absolute subjective certainty and requires no external proof and which is held in the face of contradictory evidence. Excluded are those beliefs which can be understood as part of the subject’s cultural or religious background. While the content is usually demonstrably false and bizarre in nature this is not invariably so 

Question 30

delusional perception

Answer 30

this is a primary delusion which is recalled as having arisen as a result of a perception. In which the percept is a real external object not a hallucinatory experience. i.e. seeing two white cars pull up outside and thinking they are about to be wrongly accused of being a paedophile

Question 31

thought alienation

Answer 31

patient feels that their own thoughts are not within their control. It includes thought insertion, thought withdrawal, and thought broadcast. Any form of thought alienation is a Schneiderian first-rank symptom, highly indicative of schizophrenia

Question 32

thought insertion

Answer 32

delusional belief that thoughts are being placed in the patient’s head fro, outside. It is a first rank symptom of schizophrenia.

Question 33

thought withdrawal

Answer 33

the belief that thoughts are being removed from their mind

Question 34

thought broadcast

Answer 34

the delusional belief that one’s thoughts are accessible directly to others

Question 35

depersonalisation

Answer 35

An unpleasant subjective experience where the patient feels as if they have become ‘unreal’. A non-specific symptom occurring in many psychiatric disorders as well as in normal people. 

Question 36

derealisation

Answer 36

An unpleasant subjective experience where the patient feels as if the world has become unreal. Like depersonalization it is a non- specific symptom of a number of disorders

Question 37

conversion

Answer 37

The development of features suggestive of physical illness but which are attributed to psychiatric illness or emotional disturbance rather than organic pathology. Originally described in terms of psycho analytic theory where the presumed mechanism was the ‘conversion’ of unconscious distress to physical symptoms rather than allowing its expression in conscious thought. 

Question 38

dissociation

Answer 38

The separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory. Conversion and dissociation are related concepts. In conversion the emotional abnormality produces physical symptoms; while in dissociation there is impairment of mental functioning (e.g. in dissociative fugue and dissociative amnesia). 

Question 39

stereotype

Answer 39

A repetitive and bizarre movement which is not goal-directed (in contrast to mannerism). The action may have delusional significance to the patient. Seen in schizophrenia. 

Question 40

mannerism

Answer 40

Abnormal and occasionally bizarre performance of a voluntary, goal directed activity (e.g. a conspicuously dramatic manner of walking. 

Question 41

obssession and compulsion

Answer 41

An obsession is an idea, image, or impulse which is recognized by the patient as their own, but which is experienced as repetitive, intrusive, and distressing. The return of the obsession can be resisted for a time at the expense of mounting anxiety. In some situations the anxiety accompanying the obsessional thoughts can be relieved by associated compulsions (e.g. a patient with an obsession that his wife may have come to harm feeling compelled to phone her constantly during the day to check she is still alive

Question 42

neologism

Answer 42

a made up word or normal word used in an idiosyncratic way – found in psychosis

Question 43

incongruity of affect

Answer 43

Refers to the objective impression that the displayed affect is not consistent with the current thoughts or actions (e.g. laughing while discussing traumatic experiences). Occurs in schizophrenia. 

Question 44

blunting of affect

Answer 44

Loss of the normal degree of emotional sensitivity and sense of the appropriate emotional response to events. A negative symptom of schizophrenia. 

Question 45

belle indifference

Answer 45

: A surprising lack of concern for, or denial of, appar- ently severe functional disability. It is part of classical descriptions of hysteria and continues to be associated with operational descriptions of conversion disorder. It is also seen in medical illnesses (e.g. cerebrovascular accident [CVA]) and is a rare and non-specific symptom of no diagnostic value. 

Question 46

thought echo

Answer 46

the experience of an auditory hallucination in which the content is the individual’s current thoughts – a first rank symptom of schizophrenia

Question 47

thought block

Answer 47

patient experiences a sudden break in the chain of thought – it could be explained as due to thought withdrawal. In the absence of such explanation it is not a first rank symptom

Question 48

concrete thinking

Answer 48

the loss of the ability to understand abstract concepts and metaphorical ideas leading to a strictly literal form of speech and inability to comprehend allusive language. Seen in schizophrenia and in dementing illness.

Question 49

loosening of association

Answer 49

this is a symptom of formal thought disorder in which there is a lack of meaningful connection between sequential ideas

Question 50

circumstantial thinking

Answer 50

a disorder of the form of thought where irrelevant details overwhelm the direction of the thought process. It is seen in mania and in anankastic personality disorder.

Question 51

perseveration

Answer 51

continuing with a verbal response or action which was initially appropriate after it ceases to be appropriate. (e.g. ‘Do you know where you are?’—‘in the hospital’; ‘do you know what day it is?’—‘in the hospital’. Associated with organic brain disease and is occasionally seen in schizophrenia 

Question 52

confabulation

Answer 52

the process of describing plausibly false memories for a period for which the patient has amnesia. It occurs in Korsakoff psychosis, dementia and following alcoholic palimpsest

Question 53

catatonia

Answer 53

Increased resting muscle tone which is not present on active or passive movement (in contrast to the rigidity associated with Parkinson’s disease and extra-pyramidal side-effects). A motor symptom of schizophrenia. 

Question 54

psychomotor retardation

Answer 54

decreased spontaneous movement and slowness in instigating and completing voluntary movement. Usually associated with subjective sense of actions being more of an effort. Occurs in moderate to severe depressive illness. 

Question 55

flight of ideas

Answer 55

subjective experience of one’s thoughts being more rapid than normal with each thought having a greater range of consequent thoughts than normal. Meaningful connections between thoughts are maintained. 

Question 56

poverty of speech

Answer 56

aka alogia – not speaking much or being monosyllabic 

Question 57

poverty of thought

Answer 57

The mental state of being devoid of thought and having a feeling of emptiness.

Question 58

pressure of speech

Answer 58

The speech pattern consequent upon pressure of thought. The speech is rapid, difficult to interrupt, and, with increasing severity of illness, the connection between sequential ideas may become increasingly hard to follow. Occurs in manic illness

Question 59

anhedonia

Answer 59

The feeling of absent or significantly diminished enjoyment of previously pleasurable activities. A core symptom of depressive illness, also a negative symptom of schizophrenia. 

Question 60

flattening of affect

Answer 60

Diminution of the normal range of emotional experience. A negative symptom of schizophrenia

Question 61

Autochthonous delusion

Answer 61

A primary delusion, which appears to arise fully formed in the patient’s mind without explanation

Question 62

capgras delusion

Answer 62

Delusional manifestation in which patient believes a known person to them has been replaced by a double who is to all external appearances identical, but is not the real person

Question 63

De Clérambault syndrome

Answer 63

Delusion of love, May have persecutory delusion that people are conspiring to keep them apart

Question 64

Delusion of control (passivity phenomena):

Answer 64

First rank sx of schizophrenia. Delusional belief that one is no longer in control of one’s own body → body being forced by external agent to:. Feel emotion = passivity of affect. Desire to do things = passivity of impulse. To perform actions = passivity of volition. To experience bodily sensations = somatic passivity

Question 65

Delusion of reference

Answer 65

Belief that external events or situations have been arranged in a way to have particular significance for, or to convey a message to, the affected individual

Question 66

Grandiose delusion

Answer 66

Exaggerated sense of one’s own importance or abilities e.g., mania

Question 67

Nihilistic delusion

Answer 67

Belief that patient has died or no longer exists or that the world has ended or is no longer real

Question 68

SSRI e.g.

Answer 68

Sertraline, Fluoxetine (can prescribe to <18s), Citalopram

Question 69

SRI MOA

Answer 69

Increase free serotonin by blocking reuptake pumps, stopping serotonin from being recycled in the synapse

Question 70

SSRI SE/interactions

Answer 70

Hyponatraemia, GI sx, citalopram can prolong QT, increased suicide ideation first 4w. NSAIDs (need PPI), Warfarin/heparin=avoid, Aspirin, Triptans and MAOIs: increased risk of serotonin syndrome

Question 71

stoping AD

Answer 71

the dose should be gradually reduced over a 4 week period, continue for 6m after recovery

Question 72

SSRI in pregnancy

Answer 72

SSRI use in first trimester - small increased chance of congenital heart defects. SSRI use during third trimester - risk of persistent pulmonary hypertension of the newborn. Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Question 73

SNRI e.g.

Answer 73

Venlafaxine, Duloxetine

Question 74

SNRI MoA

Answer 74

Inhibit reuptake of serotonin and noradrenaline

Question 75

SNRI SE

Answer 75

Venlafaxine needs monitoring for CV SE as can exacerbate arrythmias + development of HTN

Question 76

what is mirtazapine

Answer 76

Noradrenaline and specific serotonergic antidepressants (NASSAs)

Question 77

SE mirtazapine

Answer 77

Causes drowsiness and increased appetite

Question 78

TCA e.g.

Answer 78

Amitriptyline, Clomipramine

Question 79

TCA MOA

Answer 79

Inhibit reuptake of serotonin and noradrenaline but act as anticholinergics

Question 80

TCA SE

Answer 80

SE such as dry mouth, blurred vison and urinary retention (overflow incontinence), weight gain They also have a high risk of OD and can cause arrythmias

Question 81

MAOI e.g.

Answer 81

Phenelzine, Moclobemide, Rasagiline

Question 82

MAOI MOA

Answer 82

Block monoamine oxidase enzyme so block breakdown of monoamine neurotransmitters.

Question 83

MAOI SE

Answer 83

Dietary restrictions due to risk of hypertensive crisis with tyramine.

Question 84

MOA typical antispchotics

Answer 84

D2 antagonists

Question 85

e.g. typical antipsychotics

Answer 85

Chlorpromazine, Haloperidol, Promazine, Flupentixol and Zuclopenthixol

Question 86

SE typical antipsychotics

Answer 86

Extrapyramidal SE parkinsonism ), acute dystonia , akathisia, tardive dyskinesia

Question 87

features parkinsonism

Answer 87

Tremor, rigidity and bradykinesia >1 weeks after admission.

Question 88

tx parkinsonism

Answer 88

Decrease dose or change to SGA, Procyclidine 5mg TDS

Question 89

featues acute dystonia

Answer 89

Usually occurs within 1 week of commencing or rapidly increased dose . Contraction of muscle group to maximal limit – Oculogyric spasm, Opisthotonos, Torticollis

Question 90

mx acute dystonia

Answer 90

Procyclidine IM/IV

Question 91

features akathisia

Answer 91

Restlessness with a drive to engage in motor activity (especially involving the LL and trunk). Occurs >1m after initiation

Question 92

mx akathisia

Answer 92

Lowest possible dose or change to SGA, Propranolol +/- cyproheptadine

Question 93

features tardive dyskinesia

Answer 93

Continuous slow writhing movements and sudden involuntary movements → typically oral-lingual region (chorea). Chewing, jaw pouting, grimaces or excessive blinking, Axial trunk twisting, Torticollis

Question 94

mx tardive dyskinesia

Answer 94

Tetrabenazine

Question 95

MOA atypical antipsychotics

Answer 95

5HT2A and D2 antagonists (dopamine, serotonin antagonists)

Question 96

e.g. 2nd gen antipsychotics

Answer 96

Amisulpride, Olanzapine, Quetiapine, Risperidone, Zotepine, Clozapine, Amisulpride

Question 97

SE SGA

Answer 97

lower risk of EPSE but more metabolic SE (weight gain, hyperglycaemia, dyslipidaemia, increased prolactin)

Question 98

third gen antispychotics e.g. and moa

Answer 98

Aripiprazole Dopamine partial agonists

Question 99

drug for tx resistaant schizophrenia

Answer 99

Clozapine - Blocks D1 and D4 receptors, lower affinity for D2 receptors, also block 5HT2A receptors

Question 100

SE clozapine

Answer 100

Constipation, agranulocytosis, reduces seizure threshold, If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly Smoking cessation can cause a rise in clozapine blood levels

Question 101

e.g. mood stabilisers

Answer 101

lithium, valproate, lamotrigine, carbamazapine

Question 102

SE lithium

Answer 102

Leucocytosis, Increased weight, Tremor (fine to coarse), Hydration decreases (dry mouth), Increased GI (N+V, diarrhoea/constipation, abdo pain),hypothyroidism, teratogenic, Cardiac, Oedema, Nephro/Neurotoxic

Question 103

lithium monitoring

Answer 103

Weekly serum levels until constant dose for 4w, then monthly for 6m then 3monthly. Aim for level 0.6-1 mmol/l 12h post dose Thyroid, calcium and liver at start and every 6m

Question 104

SE valproate

Answer 104

GI pain, drowsy, tremor, ataxia, sedation, hair loss, increased appetite, blood dyscrasias (low wcc), teratogenic

Question 105

SE lamotrigine

Answer 105

Headache, drowsy, nausea, diarrhoea, ataxia, tremor, blurred vision, skin rash, blood disorders, liver failure

Question 106

SE carbamazepine

Answer 106

Fatigue, nausea, blurred vision, ataxia, headache, drowsy. Blood/liver/skin disorder

Question 107

hypnotics

Answer 107

barbiturates, benzos. Risk resp depression

Question 108

anxiolytics

Answer 108

antidepressants, buspirone, benzos, pregabalin, hydroxyzine

Question 109

stimulants

Answer 109

used to tx ADHD (methylphenidate), or illicit (cocaine, amphetamines)

Question 110

what is ECT

Answer 110

electric current through brain causing surge of electrical activity, usually 6-12 session s(2/wk)

Question 111

SE ECT

Answer 111

memory loss (short term retrograde amnesia – usually completely resolves), confusion, headaches, clumsiness

Question 112

indications ECT

Answer 112

Indications: rapid improval for severe sx e.g. prolonged/sever mania, severe depression, catatonia

Question 113

biopsychosocial formulation

Answer 113

biological, psychological and social factors for predisposing, precipitating, prolonging, and protective

Question 114

CBT

Answer 114

hot cross bun model (thoughts, emotions, behaviour, bodily sensations). Depression, GAD, phobias, OCD, PTSD, bulimia

Question 115

most cardioprotective SSRI

Answer 115

sertraline

Question 116

dependence syndrome

Answer 116

characteristic: desire (often strong, sometimes overpowering) to take a substance

Question 117

diagnosing dependence syndrome

Answer 117

3 or more of the following: Craving (strong desire or sense of compulsion to take the substance), Difficulty in controlling substance use (onset, termination, level of use), Withdrawal, Tolerance, Progressive neglect of alternative pleasures or interests, Persisting use despite clear evidence of harmful consequences

Question 118

alcohol misuse screening

Answer 118

CAGE and TWEAK

Question 119

features alcohol withdrawal

Answer 119

Pulse↑, BP↓, Tremor, Fits, Visual or tactile hallucinations (e.g., insects crawling under skin) – Lilliputian hallucinations Symptoms 6-12h, tremors 36h, delirium tremens 72h

Question 120

mx alcohol withdrawal

Answer 120

Chlordiazepoxide, also thiamine to prevent Wernicke’s

Question 121

medication used in alcohol addiction

Answer 121

Disulfiram → increases sensitivity to alcohol (unpleasant symptoms after drinking) , Acamprosate → reduces cravings (prevents alcohol relapse, Diazepam → anxiolytic but can also be used in reducing regime in drug detox, Naltrexone → reduces pleasurable effects of alcohol

Question 122

medication used in opioid addiction

Answer 122

Methadone → opioid agonist – replacement to wean off, Buprenorphine → mixed opioid antagonist/agonist – sublingual methadone alternative (less sedating), Naltrexone → opioid antagonist for relapse prevention (blocks euphoria)

Question 123

wernickes encephalopathy

Answer 123

Thiamine (vitamin B1) deficiency, usually related to alcohol use

Question 124

triad wernickes encephalopathy

Answer 124

Confusion , Wide-based gait ataxia, Ophthalmoplegia

Question 125

mx wernickes

Answer 125

High dose IV/IM Thiamine

Question 126

korsakoffs

Answer 126

Hypothalamic damage and cerebral atrophy due to thiamine deficiency

Question 127

features korsakofs

Answer 127

Inability to acquire new memories, Confabulation (invented memory, owing to retrograde amnesia) May be irreversible

Question 128

features delirium tremens

Answer 128

Ataxia, nystagmus, confusion, tremors

Question 129

mx delirium tremens

Answer 129

May need to treat hypoglyaemia, pabrinex (thiamine), lorazepam +/- antipsychotics

Question 130

RF suicide

Answer 130

Older, male, widow, divorced, unemployed,poor MH

Question 131

RF self harm

Answer 131

witnessed before, neglect, abuse, bullying, low self esteem, substance misuse

Question 132

assessing a suicide attempt

Answer 132

Before: RF (MH, alcohol), degree of planning Attempt: prep, objective and subjective assessment of seriousness, how did they access the health service, did they intend to die Future: how do they feel about not succeeding, regret, what has changed, would they try again, what would stop them trying again

Question 133

features lithium toxicityy

Answer 133

Coarse tremor, Diarrhoea, vomiting, anorexia, muscle weakness, lethargy, dizziness, ataxia, lack of coordination, tinnitus, blurred vision, hyperreflexia

Question 134

triggers lithium toxicity

Answer 134

Metronidazole, Renal failure, Bendroflumethiazide (diuretics), ACE-i/ARB, Dehydration

Question 135

mx lithium toxiciyt

Answer 135

Stop lithium, rehydrate, consider haemodialysis

Question 136

mx opioid OD

Answer 136

naloxone

Question 137

mx paracetamol OD

Answer 137

Acetylcysteine (infusion over 1 hour)

Question 138

mx benzo OD

Answer 138

Flumazenil (reverse respiratory depression)

Question 139

mx TCA OD

Answer 139

Bicarbonates (prevent cardiovascular complications)

Question 140

CAUSE OF NEUROLEPTIC MALIGNANT syndrome

Answer 140

antipsychotics

Question 141

presentation neuroleptic malignant syndrome

Answer 141

Slow onset, Hyperthermia, Muscle rigidity, Autonomic instability, Altered mental status, Elevated CK + Leucocytosis

Question 142

mx neuroleptic malignant syndrome

Answer 142

Stop causative agent (or restart anti-parkinsonism agents), IV Benzodiazepine,Treat rhabdomyolysis , Sometimes bromocriptine and amantadine are used as muscle relaxants

Question 143

sause serotonin syndrome

Answer 143

initiation or dose increase of a serotonergic agent (SSRIs, Amphetamines, MAOIs, TCAs , Lithium, Overdose, Drug interactions)

Question 144

presentation serotonin syndrome

Answer 144

Rapid onset and progression, Confusion, Agitiaion, Myoclonus, Ridigity, Tremours, Hyperreflexia, Autonomic hyperactivity (Tachycardia, Hyperthermia)

Question 145

mx serotonin syndrome

Answer 145

Remove offending agent, FLUIDS, Control agitation with benzodiazepine (e.g., lorazepam), Rhabdomyolysis – alkalinisation of urine using NaHCO3, Serotonin receptor antagonists e.g., cyproheptadine

Question 146

core sx depression

Answer 146

must be present every for over 2 weeks: Continuous low mood, Anhedonia, Fatigue

Question 147

RF depression

Answer 147

Family history , Death or loss, Conflict, Abuse – past physical, sexual or emotional, Life events, Other illnesses, Medications , Substance abuse , Social isolation

Question 148

mx depression

Answer 148

Mild: Low-intensity psychological interventions (sleep hygiene, anxiety Mx, problem-solving techniques) Moderate: Antidepressant and High-intensity psychological intervention Severe: antidepressants, need rapid assessment by specialist

Question 149

GAD

Answer 149

Anxiety that is generalized and persistent but not restricted to, or even strongly predominating in, any particular environmental circumstances

Question 150

presentation GAD

Answer 150

Excessive anxiety across different situations: Agitation/irritability, Poor concentration, Disturbed sleep, Muscle tension, Hyperventilation

Question 151

mx GAD

Answer 151

Self-help (Regular exercise, Meditation Therapies: CBT and relaxation, Behavioural therapy Medication: SSRI (Sertraline) then another SSRI or SNRI (venlafaxine or duloxetine)

Question 152

OCD

Answer 152

Obsessive thoughts + compulsive acts that the person finds distressing

Question 153

mx ocd

Answer 153

CBT, Exposure and Response Prevention (ERP), SSRIs (e.g., fluoxetine) or Clomipramine (TCA)

Question 154

agoraphobia

Answer 154

cluster of phobias: fear of crowds, travel (usually trains or buses) or events away from home

Question 155

social phobia

Answer 155

where we might be minutely observed (e.g., small dinner parties), characterised by a fear of scrutiny by other people

Question 156

simple phoboia

Answer 156

numerous phobias restricted to specific situations E.g., dentists (odontophobia), spiders (arachnophobia), clowns (coulrophobia)

Question 157

mx phobias

Answer 157

CBT +/- SSRI, TCA, pregabalin, clonazepam

Question 158

panic disorders

Answer 158

Recurrent attacks of severe anxiety (panic), which are not restricted to any particular situation or set of circumstances and are therefore unpredictable

Question 159

mx panic disorders

Answer 159

Psychoeducation, CBT, SSRIs (escitalopram and sertraline)

Question 160

presentation PTSD

Answer 160

Hyperarousal (leading to poor sleep, irritability, angry outbursts), Avoidance of reminders of event, Re-living (flashbacks), Dull/numbed emotions. Symptoms still present 4 weeks after the event

Question 161

mx ptsd

Answer 161

Trauma focused CBT and Eye movement desensitisation and reprocessing (EMDR). Medication 2nd line - Venlafaxine or SSRIs (paroxetine

Question 162

acute stress rxn

Answer 162

Occurs within the 4 weeks after a traumatic event

Question 163

mx acute stress rxn

Answer 163

Trauma-focused cognitive-behavioural therapy

Question 164

hypomania

Answer 164

less severe states; many of the characteristics of mania, without psychotic symptoms, impairment in daily functioning, or need for inpatient treatment

Question 165

bipolar affective disorder

Answer 165

depression alternates with mania

Question 166

cyclothymia

Answer 166

cyclical mood swings with subclinical features (hypomania and minor depression)

Question 167

bipolar I

Answer 167

one or more manic episodes with or without a history of depressive episodes

Question 168

bipolar II

Answer 168

one or more depressive episodes with at least one hypomanic episode

Question 169

sx hypomania

Answer 169

4+ days and doesn’t affect functioning. Elevated mood (can be euphoric/dysphoric/angry), Increased energy, Increased talkativeness , Poor concentration, Mild reckless behaviour e.g., overspending, Sociability/ overfamiliarity, Increased libido/ Sexual disinhibition, Increased confidence, Decreased need sleep, Change in appetite

Question 170

sx mania

Answer 170

7+ days and affect functioning. Extreme elation – uncontrollable, Over activity, Pressure of speech, Impaired judgement, Extreme risk-taking behaviour e.g., spending spree, Social disinhibition, Inflated self-esteem, grandiosity, With psychotic symptoms, Mood congruent/ incongruent

Question 171

mx bipolar disorers

Answer 171

Acute mania: Any SGA or Valproate semisodium , Referral to CMHT Prophylaxis: Mood stabilisers: Lithium carbonate (Valproate or Carbamazepine – 2nd line). Antipsychotics (haloperidol, olanzapine, quetiapine or risperidone) and antidepressants (fluoxetine)

Question 172

RF schizophrenia

Answer 172

Early use of cannabis, living in cities, migrant groups such as Asians and African-Caribbean’s

Question 173

paranoid schizophrenia

Answer 173

commonest subtype, Paranoid delusions, auditory hallucinations and perceptual disturbances

Question 174

hebephrenic schizophrenia

Answer 174

Fluctuating affect prominent with fleeting fragmented delusions and hallucinations

Question 175

first rank sx schizophrenia

Answer 175

Thought alienation (Thought insertion, Thought withdrawal, Thought broadcast), Passivity phenomena (or delusions of control) , 3rd person auditory hallucinations, Delusional perception

Question 176

2nd rank sx schizophrenia

Answer 176

Delusions, 2nd person auditory hallucinations, Hallucinations in any other modality (somatic, visual, tactile), Thought disorder, Catatonic behaviour ,

Question 177

positive sx schizophrenia

Answer 177

: An excess or distortion of normal functioning, Caused by overactivity of receptors in the mesolimbic pathway Hallucinations, Delusions, Thought alienation, Passivity phenomena, Lack of insight, Disturbance in mood

Question 178

negative sx schizophrenia

Answer 178

Decrease or loss of functioning, Caused by underactivity of receptors in the mesocortical pathway Blunting of affect , Poverty of speech , Amotivation, Poverty of thought, Poor non-verbal communication, Clear deterioration in functioning, Self-neglect, Lack of insight

Question 179

diagnosis schizophrenia

Answer 179

symptoms >6 months and symptoms are present much of the time for at least 1 month, and there is marker impairment in work or home functioning At least one very clear first rank symptom or At least two secondary symptoms

Question 180

mx schizophrenia

Answer 180

antipsychotics, CBT, support

Question 181

schizoaffective

Answer 181

Patient experiences both symptoms of a mood disorder (mania or depression) and schizophrenia at the same time (within days) and of the same intensity without another medical disorder or substance misuse cause

Question 182

mx schizoaffective disorders

Answer 182

antipsychotic and mood stabiliser

Question 183

schizophreniform

Answer 183

Disorders that fail to meet threshold for schizophrenia (usually duration of psychosis) but have some symptoms of schizophrenia and deterioration inf functioning

Question 184

mx schizophreniform disorders

Answer 184

antipsycotics

Question 185

cluser A personality disorder

Answer 185

odd/eccentric paranoid, schizoid

Question 186

cluster b personality disorder

Answer 186

dramatic/emotional antisocial emotionally unstable histrionic narcisstic

Question 187

luster c personality disorder

Answer 187

anxious/avoidant anankastic anxious dependent

Question 188

paranoid persoanlity disorder

Answer 188

Suspicious, preoccupied with conspiratorial explanations, distrusts others, holds grudges

Question 189

schizoid persoanlity disorder

Answer 189

Emotionally ‘cold’, lacks interest in others, rich fantasy world, excessive introspection

Question 190

antisocial personalityt disorder

Answer 190

Aggressive, easily frustrated, callous lack of concern for others, irresponsible, impulsive, unable to maintain relationships, criminal activity, lack of guilt, conduct disorder (<18yrs)

Question 191

emotionally unstable - borderline type

Answer 191

Feelings of ‘emptiness’, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self-harm, impulsivity, pseudo hallucinations

Question 192

emotionally unstable - impulsive type

Answer 192

Inability to control anger or plan, unpredictable affect and behaviour

Question 193

histrionic personality disorder

Answer 193

Over-dramatise, self-centred, shallow affect, liable mood, seeks attention and excitement, manipulative behaviour, seductive

Question 194

narcisstic personality disorder

Answer 194

High self-importance, lacks empathy, takes advantage, grandiose, needs admirations

Question 195

anankastic persoanlity disorder

Answer 195

Worries and doubts, orderliness and control, perfectionism, sensitive to criticism, rigidity, indecisiveness, pedantry, judgemental

Question 196

anxious personality disorer

Answer 196

Extremely anxious and tense, self-conscious, insecure, fearful of negative evaluation by others, timid, desires to be liked

Question 197

dependent personality disorder

Answer 197

Passive, clingy, submissive, excess need for care, feels helpless when not in relationship, feels hopeless and incompetent

Question 198

hypochondriasis

Answer 198

Disorder where people fear that minor symptoms may be due to a serious disease

Question 199

conversion disorder

Answer 199

Condition where a person has symptoms which suggest a serious disease of the brain or nerves

Question 200

FACTITIOUS DISORDER (MUNCHAUSEN SYNDROME

Answer 200

Patient will intentionally (deliberately) feign symptoms

Question 201

MALINGERING DISORDER

Answer 201

Fabricating or exaggerating the symptoms (not psychiatric diagnosis) for personal gain

Question 202

SOMATISATION DISORDER (BRIQUET’S SYNDROME)?

Answer 202

Chronic, multiple, medically unexplained, difficult to treat (but unfeigned) symptoms, affecting any body part, psychological cause

Question 203

MX SOMATISATION DISORDER?

Answer 203

Support, Treat any other mental health problem Cognitive behavioural therapy

Question 204

mx adhd

Answer 204

Methylphenidate (Ritalin) – important to monitor their growth whilst they’re taking this  Psychotherapy

Question 205

features autism

Answer 205

Impaired social interaction, Speech and language disorder, Imposition of routines – ritualistic and repetitive behaviour Poor eye contact, Failure to develop relationships, Abnormal playing/communications , Restricted interests or activities – i.e. they will want to do the same few activities over and over again , Abnormal gazing, Motor tics

Question 206

learning disability

Answer 206

A reduced intellectual ability and difficulty with everyday activities – e.g. household tasks, socialising – which affects someone for their whole life

Question 207

fragile x syndrome features

Answer 207

X-linked dominant Large head and ears, poor eye contact, abnormal speech, hypersensitivity to touch/visual stimuli, hand flapping, associated with autism Carriers often have social interaction difficulties, ADHD, anxiety, early menopause

Question 208

mild learning disability

Answer 208

IQ 50-69 speech normal difficulties at school mostlt fully independent

Question 209

oderate learnign disability

Answer 209

IQ 35-49 simple to no speech, reasonable comprehension limited achievement at school mostly independent

Question 210

severe learnign disability

Answer 210

IQ 20-34 simple to no speech, reasonable comprehension limited achievemnt at school lifelong supervision

Question 211

profound learning disability

Answer 211

IQ<20 non verbal, underdtands basic commads no abilty at school completely dependent

Question 212

TCA OD mx

Answer 212

if arrhythmias/ECG changes e.g. wide QRS : sodium bicarb, if does not respond after 2 doses need lidocaine if hypotension: fluid bolus if low sats: oxygen if seizures: midazolam

Question 214

what systems does iron overdose affect

Answer 214

directly corrosive to GI tract leading to met acidosis with increased anion gap hepatotoxic cardiotoxic

Question 215

features iron overdose

Answer 215

reduced/loss consciousness convulsions GI haemorrhage shock haemolysis

Question 216

what level is iron ingestion toxic

Answer 216

likely over 20mg/kg severe >75mg/kg

Question 217

management severe iron overdose

Answer 217

DONT WAIT FOR BLOODS desferrioxamine 15mg/kg/hr IV infusion ECG +/- bowel irrigation, tx seizures

Question 218

mx mild iron overdose

Answer 218

WAIT FOR BLOOD RESULTS TO TX FBC, U&E, LFTs, coag, BM, serum iron ABG

Question 219

what can ibuprofen OD cause

Answer 219

unlikely as low toxicity met acidosis and AKI

Question 220

mx cocaine OD

Answer 220

benzos +/- antipsychotics/diphenhydramine CCBs-diltiazem labetalol

Question 221

mx benzo OD

Answer 221

supportive +/- flumazenil

Question 222

mx OD hallucinogens (LSD, magic mushrooms)

Answer 222

activated charcol benzos/antipsychotics

Question 223

Therapeutic levels lithium

Answer 223

0.4 - 1

Question 224

Blood results neuroleptix malignant syndrome vs serotonin syndrome

Answer 224

NMS: Increased CK, WCC, LFTS low iron Serotonin syndrome: normal or mildly raised CK or WCC

Question 225

RF acute dystonic rxn and akathisia

Answer 225

M Young Cocaine LD

Question 226

RF drug induced parkinsonism, tardive dyskinesia

Answer 226

F Old LBD dementia

Question 227

Legal provisions for detaining someone against wishes

Answer 227

Mental capacity act Mental health act

Question 228

Can someone be physically restrained from leaving

Answer 228

Only if lacks capacity or detained under mental health act

Question 229

When does mental health act take precedence over mental capacity act

Answer 229

Treatment of a mental disorder in hospital

Question 230

Can you give medical treatment under mental health act

Answer 230

No Only under mental capacity act