psych

Question 1

what is delusion of guilt?

Answer 1

Also referred to as delusions of sin or worthlessness, this delusion is characterised by the belief that one deserves to be punished. Usually, the ‘sin’ is an innocent error out of proportion to the guilt felt. It is typically associated with severe depression

Question 2

what is delusion of thought possession?

Answer 2

These are false beliefs around the ownership of your thoughts. They can be subdivided into insertion, withdrawal, and broad-casting. They are classically seen in schizophrenia. This patient is not displaying any signs of thought possession

Question 3

what are delusions of grandeur?

Answer 3

This is characterised by exaggerated beliefs about one’s self-worth, power, or identity - for example, believing one is a king or queen. It is classically associated with mania. This patient is not displaying any signs of delusions of grandeur

Question 4

what are delusions of persecution?

Answer 4

This is the most common type of delusion, also known as paranoid delusions. Patients believe they are being followed, spied on, or conspired against. This is classically seen in schizophrenia. This patient is not displaying any signs of paranoid delusions

Question 5

what is cotard’s syndrome?

Answer 5

A rare syndrome seen in severe depression - patient’s believe that they are dead, decaying, or do not really exist (also known as ‘walking corpse syndrome’). This patient is not displaying any signs of Cotard’s syndrome

Question 6

what is derailment?

Answer 6

Derailment is a type of formal thought disorder where the speech consists of a series of unrelated or remotely related ideas.

Question 7

what is tangentiality?

Answer 7

Tangentiality is a type of formal thought disorder where the person diverts from the original train of thought to other topics but never returns to the original topic. There are still some associations between the sentences, but they are diverted from the original topic of discussion. This is mainly seen in patients with schizophrenia.

Question 8

what is word salad?

Answer 8

Word salad is a formal thought disorder where the speech is a mixture of random words and phrases that is confused and lacks meaning. It may not be possible to understand the sentence at all. This may occur in patients with schizophrenia.

Question 9

what is perseveration?

Answer 9

a person with perseveration may answer the first question correctly but continues to give the same answers to subsequent different questions. This is seen in several conditions, including psychosis, dementia, and organic brain diseases.

Question 10

what is circumstantiality?

Answer 10

Circumstantiality is a formal thought disorder where the speech consists of many unnecessary and insignificant details as well as digressions, but will still return to the original point. This may occur in patients with psychosis or obsessional disorders.

Question 11

how do you test cognition?

Answer 11

10-point cognitive screener (10-CS)
6-item cognitive impairment test (6CIT)
6-item screener
Memory Impairment Screen (MIS)
Mini-Cog
Test Your Memory (TYM).

Question 12

what is risk of chlorphenamine in elderly?

Answer 12

A first generation H1 antagonist, it also has anticholinergic activity. It is able to cross the blood brain barrier and can lead to anti-depressant/anxiety effects. In the elderly however, there is a high risk of inducing acute delirium or other anti-cholinergic actions such as dry mouth and urinary retention

Question 13

what indicated risk of going on to complete suicide?

Answer 13

Question 14

wha indicated better prognosis in schizophrenia?

Answer 14

higher IQ/education level, sudden onset, presence of a precipitating factor, a strong support network, and predominance of positive symptoms

Question 15

what are symptoms of methadone overdose?

Answer 15

decreased respiratory rate, decreased heart rate, drowsiness and constricted pupils

Question 16

what is capgras syndrome?

Answer 16

In Capgras syndrome, patients believe that someone familiar to them (eg. a friend or relative) has been replaced by an exact clone.

Question 17

features of schizoid personality disorder?

Answer 17

the absence of close friends, minimal contact with other people, including family, insensitivity to social norms and flattened affect.

Question 18

what is a common cardiac complication of anorexia?

Answer 18

mitral valve prolapse with a pan systolic murmur and click which is a very common finding in anorexia and is caused by loss of cardiac muscle with the mitral valve remaining the same size

Question 19

what indicates poor prognosis in schizophrenia?

Answer 19

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 20

what is the MOA of atomoxetine?
what is it used for?

Answer 20

Atomoxetine is a norepinephrine reuptake inhibitor

ADHD

Question 21

what is the MOA of methylphenidate?
what is it used for?

Answer 21

Norepinephrine and dopamine reuptake inhibitor

adhd

Question 22

what is the tuberoinfundibulnar pathway?

Answer 22

a dopaminergic pathway emanating from the hypothalamus to the median eminence

Question 23

what does inhibition of the tuberoinfundibulnar pathway cause?

Answer 23

Inhibition of the tuberoinfundibular pathway by antipsychotics causes hyperprolactinaemia

Question 24

what is the nigrostriatal pathway involved in?

Answer 24

pathophysiology of Parkinson’s disease

Question 25

what is the mesolimbic pathway?

Answer 25

thought to be overactive in schizophrenia which causes a patient's positive symptoms such as hallucinations

Question 26

what is the mesocortiyal pathway?

Answer 26

thought to be abnormal in schizophrenia, which causes the negative symptoms e.g. avolition.

Question 27

what are SSRI discontinuation symptoms?

Answer 27

Question 28

which SSRI has higher incidence of discontinuation symptoms?

Answer 28

paroxetine

Question 29

how does haloperidol work?

Answer 29

dopamine D2 receptor antagonist, blocking dopaminergic transmission in the mesolimbic pathways

Question 30

what is true about brief psychotic disorder?

Answer 30

Question 31

how does zopiclone work?

Answer 31

a non-benzodiazepine which stimulates the α-subunit of the GABA receptor to exert its effects On the receptor, zopiclone binds to a different distinct site than benzodiazepines but has similar effects

Question 32

what is zopiclone used for?

Answer 32

It is used for insomnia and anxiety and prolonged use should be avoided due to addiction and tolerance.

Question 33

what ion flows through the GABA receptor?

Answer 33

chloride

Question 34

what is the strongest risk factor for completion of sucicde?

Answer 34

A previous suicide attempt is one of the strongest risk factors for future suicide completion

Question 35

what are reflex hallucinations?

Answer 35

when a normal sensory stimulus, in one modality, precipitates a hallucination in another e.g. the voices are only heard when the lights turn out.

Question 36

what are autoscopic hallucinations?

Answer 36

a visual hallucination, which describes the experience of seeing oneself in external space

Question 37

what are first person auditory hallucinations?

Answer 37

(audible thoughts) are where a person hears their own thoughts aloud.

Question 38

what are elementary hallucinations?

Answer 38

simple, unstructured sounds e.g. buzzing or whistling.

Question 39

what are haptic/tactile hallucinations?

Answer 39

the feeling of the skin being touched, pricked or pinched

Question 40

What should be monitored at initiation and dose titration of venlafaxine?

Answer 40

BP

Question 41

What should be monitored prior to starting citalopram in this patient?

Answer 41

ECG due to possible QT prolongation, and/or ventricular arrhythmias including torsade de pointes

Question 42

What would you perform first to identify the cause of confusion in a patient's taking sertraline?

Answer 42

For people at high risk, measure the serum sodium level before starting treatment, 2-4 weeks after starting treatment and every 3 months thereafter.

Question 43

short term s/e of ECT?

Answer 43

cardiac arrhythmias

Question 44

who does the mental health act apply to?

Answer 44

individuals over 16 years of age with serious mental health disorders, which threaten their health or safety or the safety of others, to facilitate assessment and treatment of their condition irrespective of their consent where it is necessary to prevent them from harming themselves or others

Question 45

what is the criteria for the mental health act?

Answer 45

They must have a mental disorder There must be a risk to their health/safety or the safety of others There must be a treatment (however this can include nursing care, not just drugs)

Question 46

what does assessment under the mental health act require?

Answer 46

Question 47

what does MHA section 2 do?

Answer 47

Question 48

what does MHA section 3 do?

Answer 48

Question 49

what does MHA section 4 do?

Answer 49

Question 50

what does MHA section 5(2) do?

Answer 50

Holding power which enables a doctor to legally detain a voluntary patient in the hospital for a period of 72 hours.

Question 51

what does MHA section 5(4) do?

Answer 51

Section 5(4) is comparable to a Section 5(2) but is enacted by registered nurses and has a duration of 6 hours.

Question 52

what does MHA section 17a do?

Answer 52

Allows for a Supervised Community Treatment (also known as a Community Treatment Order).

Question 53

what does MHA section 135 do?

Answer 53

Court order enabling the police to enter a property to escort a person to a Place of Safety (either the police station or, more commonly, an Accident and Emergency Department (A&E)).

Question 54

what does MHA section 136 do?

Answer 54

Provides police officers the authority to take an individual, who seems to be suffering from a mental disorder and is in a public place, to a Place of Safety.

Question 55

5 principles of the mental capacity act?

Answer 55

Question 56

when is the mental capacity act used?

Answer 56

The Mental Capacity Act (MCA) is used when a patient lacks capacity. It allows doctors (or less commonly, those with Lasting Power of Attorney) to make decisions in the best interests of their patient.

Question 57

how do you assess capacity? part 1

Answer 57

Is there an impairment of, or disturbance in, the functioning of the mind or brain? If yes, then step 2) For a person to lack capacity they must show an 'impairment of, or disturbance in, the functioning of the mind or brain' AND they are unable to undertake any of the following: Understand relevant information Retain the relevant information Weigh up the relevant information Communicate a decision If they are unable to do one of these things then they do not have capacity.

Question 58

do you do if someone does not have capacity?

Answer 58

Question 59

what is deprivation of liberty>

Answer 59

Used where it is necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm. It safeguards for those who lack capacity and do not want to be somewhere and are not free to leave.