Psych 2017

Question 1

DIagnosis of depression

Answer 1

2 major
+2 for mild
+3-4 moderate
+5 severe

Question 2

What is CBT

Answer 2

A type of talking therapy that aims at changing the processes underpinning the thoughts and behaviours related to a patient’s symptoms.
Can be carried out 1-to-1 with a mental health individual, in group sessions, or utilizing online platforms.

Question 3

What is IPT

Answer 3

Addresses issues regarding communication behaviours between people, under the belief that some depression symptoms arise due to difficult interpersonal interactions.

Question 4

WHAT IS behavioural activation therapy ?

Answer 4

Aims at making small changes to ones lifestyle in order to alleviate depressive symptoms, by identifying ‘depression loops’.

Question 5

SSRI eg, side effects

Answer 5

Sertraline
Citalopram
Fluoxetine

Nausea and indigestion,
Worsening of sexual dysfunction, suicidal thoughts in younger people, serotonin syndrome.

Question 6

SNRI eg Side effects

Answer 6

Venlafaxine
Duloxetine
Venlafaxine can raise BP and is CI in heart disease.
Similar to SSRIs.

Question 7

TCA eg side effects

Answer 7

Amitriptyline
Dosulepin
Dry mouth, tachycardia, constipation, sleepiness and weight gain.

Question 8

MAOI eg side effects

Answer 8

Phenelzine
Moclobemide
Can cause v. v. high BP if taken with tyramine (aged cheese, cured meats, broad beans).

Question 9

Atypical antidepressants eg side effects

Answer 9

Mirtazepine
Drowsy and weight gain.

Question 10

Sx and managment of serotonin syndrome

Answer 10

Symptoms include:
Cognitive: headaches, agitation, hallucinations, coma
Autonomic: sweating, shivering, tachycardia, hypertension, nausea, diarrhoea.
Somatic: myoclonus, hyperreflexia (clonus), tremor.

Treatment is by means of removing the causative agent and providing supportive care (cooling measures, fluids, benzodiazepine). If symptoms persist once stimulus removed, consider cyproheptadine – a serotonin antagonist.

Question 11

1st rank sx of schitz ? Diagnosis?

Answer 11

Auditory hallucinations of a specific type:
Third person hallucinations, thought echo, commentary voices
Thought disorder:
thought insertion, thought withdrawal, thought broadcasting
Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings are imposed on the individual or influenced by others
Delusional perceptions

Diagnosis = one 1st rank or two 2nd rank symptoms acutely for 1 month, with evidence of disturbance of functioning for 6 months.

Question 12

Diagnosis of GAD?

Answer 12

The patient must have a 6-month Hx of tension, worry and anxiety about everyday issues.

4 of the following Sx must be present:
Autonomic Sx: palpitations, sweating, trembling, dry mouth
Chest/Abdomen Sx: breathing difficulty, choking sensation, chest pain/discomfort, nausea
Brain/Mind Sx: dizzy, unsteady, derealisation, depersonalization, fear of losing control or passing out, fear of dying
Tension Sx: muscle tension, aches, restlessness, globus hystericus
General Sx: tingling/numbness, hot flushes
C) The criteria for panic disorder, hypochondriasis and OCD are not fulfilled:
D) No physical medical condition or medication could be responsible for these symptoms

Question 13

Karen was telling her colleague – Deborah – about her new diagnosis of GAD, and Deborah thinks she has it also. She hasn’t come to work for the past few weeks after she was robbed at knife point while leaving her home 25 days ago. She is too scared to leave the house via the front door as she experiences vivid memories of the incident, which is often replayed in her dreams. Her husband has noted that she is very irritable and that she startles quickly.
DIAGNOSIS?

Answer 13

Acute stress reaction = <1month

Question 14

Acute stress reaction and ptsd diagnosis / management ?

Answer 14

Diagnosis:
Exposure to a stressful event
Persistent remembering or reliving the event – flashbacks/vivid dreams
Distress when exposed to reminders of event
Avoiding stimuli related to event
<1 month = ASR, chronic = PTSD

Treatment:
ASR: watchful waiting. ?narrative exposure therapy?
PTSD within 3 months: Trauma focussed CBT, medicate for sleep disturbance
PTSD after 3 months: CBT, Eye movement desensitization and reprocessing, drugs: mirtazapine, phenelzine

Question 15

What is cyclothymia ?

Answer 15

rapid cycling between short periods of mania and depression

Question 16

MHA section 2, 3, 4, 5,

Answer 16

Section 4 is used to admit a patient when only one doctor can be found - this doctor may be the GP (72 hr detention)

Section 2 – Requires 2 doctors (one section 12 approved) and AMP to make recommendation. Allows for assessment up to 28 days.

Section 3 – As above. For patients under section 2 or who are known to the service. Allows for 6 months of treatment and can be renewed.

Section 5 (2) – For patients in hospital (informal admission) gives doctors 72hrs holding power. (Section 5(4) for nurses)

Question 17

During her admission Casey’s mood stabilises and you discuss options for controlling the fluctuations long term. You agree to start lithium therapy.
What investigation is NOT required prior to starting lithium?
ECG
TFTs
LFTs
U&Es
Calcium

Answer 17

LFTs

Before starting lithium the following should be done:
Measure weight, blood pressure and pulse.
Ensure renal function is normal - lithium is primarily excreted by the kidney. Measure serum creatinine AND eGFR
Check FBC, U&E, creatinine, TFT, calcium.(Plasma lithium levels are increased by sodium)
Check there is no goitre; take blood for thyroid autoantibodies where there is a family history of thyroid disorders.
Consider baseline parathyroid hormone and magnesium.
Perform baseline ECG.

Question 18

6 months later Casey presents to the emergency department with slurred speech, coarse tremor, vomiting and hyper-reflexia on examination. You suspect chronic lithium toxicity.
What do you suspect her lithium levels will be?
0.5 to 1.0 mmol
1.1 to 1.5 mmol
1.6 to 2.0 mmol
2.1 to 2.5 mmol
Greater than 2.5 mmol

Answer 18

2.1-2.5

1.6 to 2.0 mmol – Mild toxicity
Nausea, diarrhoea, poor concentration, severe FINE tremor

2.1 to 2.5 mmol – Moderate toxicity
Slurred speech, disorientation, visual disturbance, nystagmus, vomiting, COARSE tremor, hyper-reflexia, FLAT/INVERTED T-WAVES ON ECG

Greater than 2.5 mmol – Severe toxicity
Above + muscle twitches, chorea, parkinsonism, incontinence, oliguria, renal failure, seizures, confusion, coma, death.

Question 19

MX of lithium toxicity

Answer 19

Stop lithium 
Supportive
IV fluids to maintain hydration 
Careful monitoring and correction of electrolyte disturbance
Anti-emetics 
Manage seizures 

Acute toxicitiy e.g. overdose
Bowel irrigation
Consider haemodialysis