psych

Question 1

how long for GAD to be diagnosed

Answer 1

6 months

Question 2

GAD questionnaire and severity scores

Answer 2

GAD-7

5-9 = mild
10-14= moderate
15 or more= severe

Question 3

long term management of GAD

Answer 3

Step 1: assess, educate + active monitoring

Step 2: low intensity psychological intervention e.g. guided self help or self help groups

Step 3: higher intensity CBD or meds
1st= SSRI (sertraline preferred)
2nd= another SSRI or SNRI
3rd= consider pregablin

somatic symptoms= BB

Step 4: refer to specialist

Question 4

short term mangement GAD

Answer 4

can give benzodiazepines (GABA agonists) but do not give for over 4 weeks

lorazepam= short acting
diazepam= long acting

Question 5

reversal agent for benzodiazepines?

Answer 5

flumazonil

Question 6

SE benzodiazepines

Answer 6

drowsiness
confusion
ataxia

Question 7

signs of benzodiazepine withdrawal

Answer 7

anxiety
insomnia
depression

Question 8

management of delirium tremons?

Answer 8

1st= lorazepam (short acting benzo)

Question 9

management of acute alcohol withdrawal

Answer 9

1st= long acting benzo (chlorodiazeperoxide or diazepam)

if hepatic impairement lorzepam is preferred

Other:
carbamazepine

Question 10

social phobia vs agorophobia

Answer 10

Social phobia: social situations

Agoraphobia: situations in public, crowds, can’t leave easily
(panic attacks common)

Question 11

antipsychotic best SE profile

Answer 11

Aripiprazole

Question 12

effect of smoking and clozapine

Answer 12

smoking increases the levels of clozapine in the body so if a patient starts smoking increased levels of the drug may be harmful

Question 13

A pateint is being started on anti-psychotics and wants to avoid weight gain and T2DM risk – which should be avoided

Answer 13

Olanzapine
-associated with the most weight gain and highest T2DM risk

Question 14

what is adjustmant disorder?

Answer 14

-abnormal distress greater than would be expected in response to a stressor
-reaction must begin within the month of the stressor
-less severe response than PTSD
-CANNOT LAST >6 MONTHS (if it does its something else)

Question 15

PTSD vs acute stress disorder

Answer 15

PTSD >4 weeks
acute stress disorder <4 weeks

Question 16

abnormal greif reaction

Answer 16

-lost a family member or friend
-response is severe and lasts >6 months

Question 17

guidelines for switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Answer 17

direct switch is possible

Question 18

Switching from fluoxetine to another SSRI

Answer 18

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low dose of the alternative SSRI

Question 19

Switching from an SSRI to a tricyclic antidepressant (TCA)

Answer 19

cross-tapering is recommended (the current drug dose is reduced slowly, whilst the dose of the new drug is increased slowly)

• an exception is fluoxetine which should be withdrawn, the leave a gap of 4-7 days prior to TCAs being started at a low dose

Question 20

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

Answer 20

direct switch is possible (caution if paroxetine used)

Question 21

what antihypertensive med should be avoided with lithium + why

Answer 21

thiazides e.g. bendroflumethiazde

increases levels of lithium, increasing risk of toxicity

also can both cause hypokalaemia

Question 22

can you take lithium in pregnancy

Answer 22

nope, taper down before getting pregnant

-risks Ebsteins anomaly

Question 23

dose of paracetamol required to be hepatotoxic?

Answer 23

> 150mg/ Kg

Question 24

when should serum paracetamol concentration be measured in a paracetamol overdose

Answer 24

4 hours or more post ingestion

Question 25

when to give activated charcoal in paracetamol overdose

Answer 25

if presenting an hour or less from ingestion

Question 26

when should n- acetylcysteine be given for paracetamol overdose?

Answer 26

-if there was a staggered overdose (all tablets weren't taken within an hour) -unsure of the time from ingestion ->8 hours since ingestion and ingested dose is >150mg/ kg -plasma paracetamol concentraiton is >100 when measured (at 4 hours)

Question 27

when can someone be discharge for paracetamol overdose?

Answer 27

if paracetamol level <75mg/ kg (typically less than 12 tablets) and no signs of hepatic impairement