Psych

Question 1

How long after their last drink may someone develop seizures

Answer 1

36 hours

Question 2

How long after their last drink may someone develop delirium tremens

Answer 2

72 hours

Question 3

How does SSRI discontinuation syndrome present?

Answer 3

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI symptoms- pain, cramping, diarrhoea, vomiting
paraesthesia

Question 4

How should SSRIs be stopped and why?

Answer 4

gradually reduced over 4 weeks (not necessary with fluoxetine)- can cause SSRI discontinuation syndrome

Question 5

What SSRI is most likely to cause long QT syndrome

Answer 5

citalopram

Question 6

RF for bipolar disorder

Answer 6

adverse childhood experiences
exposure to viruses in utero
cannabis and cocaine use
recent childbirth
family history (first degree relatives have a 5x greater risk than the general population)

Question 7

what is bipolar

Answer 7

A disorder characterised by recurrent episodes of depression and mania/hypomania

Question 8

What is a manic episode?

Answer 8

excessively elevated mood and energy which significantly impacts normal functions.
Lasts at least one week and causes marked impairment in social or occupational functioning, or includes psychotic features such as delusions or hallucinations

Question 9

what features may be preset in a manic episode?

Answer 9

abnormally elevated mood
increased energy
decreased sleep
grandiosity
disinhibition and sexually inappropriate behaviour
flight of ideas
pressure speech
increased libido
psychosis
irritability

Question 10

what is a hypomanic episode

Answer 10

an episode characterised by milder symptoms of mania without a significant impact on function
Only needs to last 4 days and does not include psychotic features

Question 11

based on DSM-5 what is bipolar type 1

Answer 11

depression and at least one episode of mania

Question 12

based on DSM 5 what is bipolar type II

Answer 12

at least one episode of major depression and one of hypomania

Question 13

what is cyclothymia

Answer 13

mild symptoms of hypomania and low mood- not enough to cause significant disruption to functioning

Question 14

1st line treatment of an acute manic episode

Answer 14

antipsychotic medications - onlanzapine, quetiapine, risperidone

Question 15

second line management of a manic episode

Answer 15

lithium or sodium valporate

Question 16

management of a depressive episode in bipolar

Answer 16

olanzapine plus fluoxetine

Question 17

Long term management of bipolar

Answer 17

lithium - mood stabilised
alternate- sodium valporate

Question 18

what is a potential complication of lithium therapy in bipolar

Answer 18

lithium toxicity

Question 19

what is the therapeutic range of lithium

Answer 19

0.4 to 1 mmol/l

Question 20

at what concentration of lithium can toxicity occur

Answer 20

1.5

Question 21

How does lithium toxicity present?

Answer 21

coarse tremor
hyperreflexia
acute confusion
polyuria
seizure coma

Question 22

what may precipitate lithium toxicity

Answer 22

dehydration
drugs- diuretics, NSAIDs, ACEi
renal failure

Question 23

how does tardive dyskinesia present?

Answer 23

chewing, blinking, jaw pouting, lip smacking

Question 24

how does schizotypal personality disorder present?

Answer 24

‘magical thinking’ and odd beliefs
ideas of reference
unusual perceptual disturbances
odd eccentric behaviour
lack of close friends
odd speech but not incoherent

Question 25

what are clang associations

Answer 25

ideas related only by rhyme or being similar sounding

Question 26

what is tangentiality

Answer 26

wandering from one topic to the next without returning

Question 27

what is circumstantiality

Answer 27

the inability to answer a question without giving an excessive, unnecessary detail They will eventually circle back to the point which differs from tangentiality

Question 28

what are neologisms

Answer 28

new word formations that might be formed by combing two words

Question 29

what is word salad

Answer 29

completely incoherent speech where real words are strung together in a nonsense sentence

Question 30

what is knights move thinking

Answer 30

a severe type of loosening of associations where there are unexpected and illogical leaps from one idea to the next

Question 31

what is flight of ideas

Answer 31

a feature of mania where there are leaps from one topic to another but with discernible links between them

Question 32

what is echolalia

Answer 32

repetition of someone elses speech

Question 33

what differs between hypochondria and somatisation disorder

Answer 33

somatisation is where a person is concerned by persistent unexplained symptoms whereas hypochondrial disorder the patient is concerned with a specific diagnosis such as cancer

Question 34

what are long term complications of lithium use

Answer 34

hyperparathroidism and hypercalcaemia - bones stones groans and psychic moans

Question 35

what physiological abnormalities can occur in anorexia

Answer 35

hypokalaemia low FSH, LH, oestrogen and testosterone raised cortisol raised testosterone impaired glucose tolerance hypercholesterolaemia hypercarotinaemia low T3

Question 36

what medication is preferred to chlordiazepoxide in alcoholics with severe liver cirrhosis

Answer 36

lorazepam

Question 37

why can chlordiazepoxide cause problems in liver cirrhosis

Answer 37

chlordiazepoxide undergoes hepatic oxidation by the cytochrome P450 system which is impaired with cirrhosis

Question 38

what is the strongest risk factor for suicide

Answer 38

a previous suicide attempt

Question 39

what type of antipsychotics can lead to glucose dysregulation and diabetes

Answer 39

atypical antipsychotics (clozapine, olanzapine, risperidoe)

Question 40

How long do symptoms of PTSD need to be present for diagnosis

Answer 40

4 weeks

Question 41

first line antidepressant in children

Answer 41

fluoxetine

Question 42

describe a schizoid personality disorder

Answer 42

- few activities if any provide pleasure - emotional coldness, flattened affect - apparent indifference to praise or criticism - little interest in sexual experiences - lack of close friends or desire for relationships

Question 43

first line treatment of PTSD

Answer 43

trauma focused CBT or eye movement desensitisation and reprocessing therapy (EMDR)

Question 44

what is conversion disorder

Answer 44

functional neurological disorder- the patient presents with neurological symptoms such as paralysis, blindness or seizures without an explained cause

Question 45

which antipsychotic has the most tolerable side effect prophile

Answer 45

aripiprazole

Question 46

describe paranoid personality disorder

Answer 46

hypersensitivity and an unforgiving attitude when insulted unwarranted tendency to question the loyalty of close friends reluctance to confide preoccupation with conspirational beliefs and hidden meaning

Question 47

first line drug treatment for PTSD

Answer 47

venlafaxine

Question 48

what medication for alcohol dependence acts as a deterrent by causing patients to vomit on ingestion of alcohol

Answer 48

disulfiram

Question 49

what medication for alcohol dependence acts as an anti-craving medication

Answer 49

acamprosate

Question 50

which medication for opioid dependence can be used instead of methadone as a tablet under the tongue

Answer 50

buprenorphine

Question 51

a PHQ score above what suggests severe depression

Answer 51

greater than or equal to 16

Question 52

what may be shown on the ABG of someone with bulimia nervosa

Answer 52

metabolic alkalosis

Question 53

what may be shown of the ECG of someone with bulimia

Answer 53

first degree heart block tall P waves flattened T waves occurs due to hypokalaemia

Question 54

what medication can be used to treat acute dystonia secondary to antipsychotic use

Answer 54

procyclidine

Question 55

are pseudohallicinations part of the normal grieving process

Answer 55

yes

Question 56

how does serotonin discontinuation syndrome present?

Answer 56

diarrhoea vomiting abdominal pain sweating restlessness inability to sleep

Question 57

what are the key features of PTSD

Answer 57

re-experiencing = flashbacks, nightmares, repetitive and distressing intrusive imagaes avoidance= avoiding people and situation resembling the associated event hyperarousal = hypervigiliance for threat, exaggerated startled response, sleep problems, irritability, difficulty concentrating emotional numbing= lack of ability to experience feelings

Question 58

what prescribed medication can cause a sudden onset of psychosis

Answer 58

steroids

Question 59

what lifestyle change could cause clozapine blood levels to rise

Answer 59

smoking cessation

Question 60

what antipsychotic can cause seizures

Answer 60

clozpien

Question 61

what is thought withdrawal

Answer 61

a belief that someone is removing thoughts

Question 62

how long does a period of depression need to occur for for it to be classified as a depressive episode

Answer 62

2 weeks

Question 63

how does catatonia present?

Answer 63

stopping of voluntary movement or staying still in an unusual position

Question 64

second line options for anxiety

Answer 64

different SSRIs- paroxetine, escitalopram SNRIs- venlafaxine, duloxetine

Question 65

how does tardive dyskinesia present

Answer 65

lip smacking, difficulty swallowing, excessive blinkingh

Question 66

how can you differentiate between knights move and flight of ideas

Answer 66

there is discernible links between ideas in flight of ideas- there are not in knights move

Question 67

what is the mechanism of duloxetine

Answer 67

serotonin and noradrenaline reuptake inhibitor

Question 68

over how long should an SSRI be stopped?

Answer 68

over 4 weeks

Question 69

when should lithium levels be checked

Answer 69

7 days after a dose change- 12 hours after last dose

Question 70

what antidepressant might be prescribe to have the additional effect of increasing appetite

Answer 70

mitrazapine

Question 71

how does the dose of SSRIs differ in treating OCD and in treating depression

Answer 71

usually a higher dose is needed in OCD

Question 72

how long do SSRIs need to be taken to see a benefit in OCD

Answer 72

12 weeks

Question 73

what is the risk of taking SSRIs in the third trimester

Answer 73

persistent pulmonary hypertension of the newborn

Question 74

in patients under 25 how long after starting SSRIs should they be reviewed

Answer 74

1 week

Question 75

which type of antipsychotics can cause acute dystonia

Answer 75

typical antipsyhotics

Question 76

what is the first line treatment of borderline personality disorder

Answer 76

dialectical behavioural therapy

Question 77

differentials for generalised anxiety disorder

Answer 77

aged 35-54 being divorced or separated living alone being a lone parent

Question 78

can sumatriptans be taken with SSRIs

Answer 78

no - risk of serotonin syndrome

Question 79

first line drug treatment of panic disorder?

Answer 79

SSRI

Question 80

if clozapine is stopped for more than 48 hours how does it need to be restarted

Answer 80

it needs to restarted slowly and retitrated up to the correct dose

Question 81

SE of zopiclone in elderly

Answer 81

increased risk of falls

Question 82

first line management of OCD if functional impairment is mild

Answer 82

CBT including exposure and response therapy