Psych

Question 1

According to ICD-10, list four diagnostic features of EUPD.

Answer 1

Any four of the following (½ mark each):
● Impulsivity
● Unstable affect
● Fear of abandonment
● Chronic emptiness
● Self-harm
● Unstable relationships

Question 2

Give three ways to differentiate EUPD from bipolar affective disorder. (1½
marks)

Answer 2

EUPD: mood changes are reactive (½ mark)
Bipolar: mood episodes last days to weeks (½ mark)
Psychosis is more common in bipolar (½ mark)

Question 3

What are the six key elements of a psychosocial risk assessment after
self-harm? (1½ marks)

Answer 3

Any three of the following (½ mark each):
● History of attempts
● Was it spontaneous or planned
● Intent (e.g. did they mean to actually end their life)
● Protective factors
● Triggers
● Access to means

Question 4

Name two evidence-based psychotherapies for EUPD and their core focus. (2
marks)

Answer 4

DBT (½ mark); emotional regulation (½ mark)
MBT (½ mark); mentalisation of self/others (½ mark)

Question 5

Describe one challenge and one effective communication technique when
managing patients with EUPD. (2 marks)

Answer 5

Challenge: boundary-testing, splitting (½ mark)
Technique: consistent responses, validation, active listening (½ mark)

Question 6

List two non-drug strategies to prevent or reduce delirium. (2 marks)

Answer 6

Any 2 of the following (1 mark each):
● Orientation cues
● Sensory aids
● Consistent staffing
● Sleep hygiene
● Hydration

Question 7

What are the four components of the 4AT assessment tool. (2 marks)

Answer 7

Alertness
● AMT4
● Attention
● Acute change/fluctuation

Question 8

List four clinical features that distinguish delirium from dementia. (2 marks)

Answer 8

• Acute/sudden onset
  ● Fluctuating course
  ● Impaired attention
  ● Hallucinations
  ● Disorientation

Question 9

Describe two key components of relapse prevention in bipolar disorder. (2 marks

Answer 9

Any 2 of the following (1 mark each):
● Maintenance mood stabilisers
● Psychoeducation
● Early warning signs plan

Question 10

List four features that differentiate mania from hypomania. (2 marks)

Answer 10

Severity
● Functional impairment
● Psychotic features
● Hospitalisation required

Question 11

Define a manic episode using ICD-10. (2 marks)

Answer 11

Elevated mood (½ mark)
≥3 symptoms: grandiosity, distractibility, increased activity, decreased sleep (½ mark)
≥1 week duration (½ mark)
Impairment to life/daily functioning (½ mark)

Question 12

Name two psychosocial interventions in long-term schizophrenia care and
describe their purpose. (2 marks)

Answer 12

Any 2 of the following:
● Cognitive behavioural therapy (CBT) (½ mark); to challenge delusions (½ mark)
● Family therapy (½ mark); to reduce relapse (½ mark)
● Supported environment (½ mark); social function (½ mark)

Question 13

Name one laboratory feature of neuroleptic malignant syndrome (½ mark)
e. How is it managed? (1½ marks)

Answer 13

Raised creatinine kinase (½ mark)

Stopping antipsychotic (½ mark), IV fluids (½ mark), Dantrolene or bromocriptine (½ mark)

Question 14

Outline the ICD-10 criteria for diagnosing schizophrenia. (2 marks)

Answer 14

≥1 first-rank and ≥2 other symptoms (1 mark)
For ≥1 month (1 mark)

Question 15

Side effects of clozapine

Answer 15

Seizures
Constipation
Agranulocytosis
Myocarditis

Question 16

List four clinical features that suggest biological (somatic) depression. (2 marks)

Answer 16

Any four (½ mark each):
● Early morning wakening
● Diurnal variation
● Weight loss
● Loss of libido
● Psychomotor retardation

Question 17

Define a mild depressive episode (ICD10)

Answer 17

At least 2 core symptoms, plus

At least 2 additional symptoms, for a total of 4–5 symptoms

Symptoms present most of the day, nearly every day, for at least 2 weeks

Some difficulty in carrying out ordinary activities, but still manageable

Question 18

Define a moderate depressive episode using ICD-10 criteria. (2 mark)

Answer 18

≥2 core and ≥3 other symptoms, total of 6 (1 mark)
Duration ≥2 weeks (1 mark)
Clear functional impairment, but not usually complete inability to function.

Question 19

Define severe depressive episode (ICD10)

Answer 19

All 3 core symptoms, plus

At least 5 additional symptoms, for a total of 8 or more symptoms

Symptoms present most of the day, nearly every day, for at least 2 weeks

Severe functional impairment

May or may not include psychotic symptoms (e.g., delusions, hallucinations)

Question 20

Cognitive sx of depression

Answer 20

• Low self esteem
• Guilt/self-blame
• Hopelessness
• Hypochondriacal thoughts
• Poor concentration/attention
• Suicidal thoughts
• Pseudodementia -
  
  • Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia

Question 21

What are some red flag signs to indicate higher risk of suicide

Answer 21

Note left behind
Planned attempt of suicide
Attempts to avoid discovery
Help not sought after an attempt
Violent method
Final acts – sorting out finances, writing a will

Question 22

ECT indications

Answer 22

E: Euphoria (Long manic episode)

C: Catatonia

T: Tearful (severe depression)

Question 23

What are some poor prognostic factors of schizophrenia

Answer 23

Strong family history
- Gradual onset
- Decrease in IQ
- Premorbid history of social withdrawal
- No obvious precipitant

Question 24

What are the side effects of atypical antipsychotic

Answer 24

Impaired glucose tolerance
- Weight gain
- Hypercholesterolaemia
- Sedation
- Increased prolactin – sexual dysfunction, breast enlargement, galactorrhoea

Question 25

Lithium side effects

Answer 25

Leucocytosis Insipidus Tremor (fine) Hypothyroid Inc weight U Metallic taste NOTE: women of child bearing age should take contraception if commenced on lith which is generally avoided in preg as risk of cardiac malformations

Question 26

Lithium toxicity s/e

Answer 26

In toxicity (‘TOXIC’): Tremor (coarse), Oliguric renal failure AtaXia, Increased reflexes, Convulsions/Coma/Consciousness ↓. NOTE: Normal therapeutic levels of lithium are 0.4–1.0 mmol/L. Toxic levels are >1.5 mmol/L (lithium has a narrow therapeutic window)

Question 27

How do you manage lithium s/e

Answer 27

**IV fluids are crucial to enhance lithium excretion, and urine alkalisation can further increase its elimination. More aggressive treatments, such as haemodialysis, may be required depending on the severity of the toxicity.** If lithium > 3 mmol/L or when conservative measures have failed then give haemodialysis as just omitting lithium will not be enough

Question 28

What are risk factors for anorexia nervosa

Answer 28

Female Perfectionism personality - Preoccupation with slimness - Occupational pressure to be slim – running - Bullying at school revolving around weight - Premorbid anxiety or depressive disorder - Criticism regarding eating, body shape or weight

Question 29

Sx of PTSD

Answer 29

Reliving the situation - - - Avoidance Hyperarousal Emotional numbing

Question 30

Mx of PTSD

Answer 30

Trauma focused CBT - EMDR – Eye movement desensitisation and reprocessing therapy