PSYCH

Question 1

ECT

Answer 1

Useful for patients with severe depression refractory to medicine or those with psychotic symptoms.

Only CI is increased intracranial pressure

Question 2

ECT S/E

Answer 2

Headache
Nausea
Short term memory impairment
Cardiac arrhythmia

Question 3

Causes of unexplained symptoms

Answer 3

Somatisation disorder
Hypochondriac disorder
Conversion disorder
Dissociative disorder
Munchausens syndrome
Malingering

Question 4

Malingering

Answer 4

Fraud claims or exaggeration of symptoms with the intention of financial or other gain

Question 5

Munchausens syndrome

Answer 5

Intentional production of physical or psychological symptoms

Question 6

Dissociative disorder

Answer 6

Separating off cetain memories from normal consciousness
Involves psychiatric symptoms
Most severe form is dissociate identity disorder

Question 7

Conversion disorder

Answer 7

Loss of motor or sensory function
Doesn’t consciously feign symptoms or seek material gain
May be indifferent to their apparent disorder

Question 8

Hypochondriac disorder

Answer 8

Persistent belief in the presence of an underlying disease

Refuse to accept reassurance or neg test results

Question 9

Somatisation disorder

Answer 9

Multiple physical symptoms present for at least 2 years

Question 10

Body dysmorphic disorder

Answer 10

Condition where patients have a significantly distorted body image

Question 11

SSRI + NSAID

Answer 11

GIVE PPI

Question 12

First choice SSRI in patient with a CVS history

Answer 12

Sertraline

Question 13

S/E SSRI

Answer 13

GI symtoms
Increased risk of GI bleeding
Increased risk of more severe anxiety/ depression initially

Question 14

QT prolongation

Answer 14

Escitaopram and citalopram should not be used if present

Question 15

SSRI discontinuation syndrome

Answer 15

Unsteadiness
Sweating
GI symptoms
Parenthesia

Question 16

Clozapine

Answer 16

NOT FIRST LINE- must try at least 2 other drugs first
Used in treatment of drug resistant schizophrenia 
Very effective but serious side effects
Weight gain
Excessive salivation
Agranulocytosis 
Neutropenia
Myocarditis 
Arrhythmia

Question 17

Schizophrenia mgmt

Answer 17

Oral atypical antipsychotics
CBT to be offered to all patients
Close attention to CVS risk factor modification

Question 18

Alcohol withdrawal mechanism

Answer 18

Chronic alcohol consumption enhances GABA mediated inhibition in the CNS and inhibit NMDA type glutamate receptors
Alcohol withdrawal is thought to be lead to the opposite- decreased inhibitory GABA and increased NMDA glutamate transmission

Question 19

Features of alcohol withdrawal

Answer 19

Start at 6012 hours; tremor, sweating, tachycardia and anxiety
Peak incidence of seizures at 26hours
DT is peaked at 48-72hours ; coarse tremor, confusion, delusion and auditory and visual hallucinations, fever and tachycardia

Question 20

Mmgmt of alcohol withdrawal

Answer 20

First line- benzodiazepines,

Carbamazepine

Question 21

Schizophrenia epidemiology

Answer 21

Monozygotic twin has it - 50%
Parent has it - 10-15%
Sibling - 10%
No relatives- 1%

Question 22

Schizophrenia features

Answer 22

Auditory hallucinations; two or more voices discussing the patient in the third person
Though echo
Voices commenting on the patients behaviour

Though disorder
Insertion
Withdrawal
Broadcasting

Passivity phenomena
Body sensations being controlled by external influence

Delusional perceptions

Impaired insight 
Blunting of affect
Decreased speech 
Neologism 
Catatonic

Question 23

Negative symptoms

Answer 23

Incongruity
Ahedonia
Alogia
Avolition

Question 24

SSRI of choice in children and adolescents

Answer 24

Fluoxetine

Question 25

Anorexia features

Answer 25

Most things low G’s and C’s raised Growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

Question 26

Anorexia nervousness features

Answer 26

Reduced BMI Bradycardia Hypotension Enlarged salivary glands

Question 27

Physiological abnormalities in AN

Answer 27

``` Hypokalemia Low FSH, lH, Estrogen and testosterone Raised cortisol and GH Impaired glucose tolerance Low T3 ```

Question 28

Grief reaction - abnormal

Answer 28

More likely to occur in women If death was sudden or unexpected Delayed Grief- 2 weeks after death Prolonged grief - hard to define

Question 29

SAD

Answer 29

Depression that occurs around the winter months Should be treated the same way as depression Don’t give a sleeping tablet - this can make them worse Evidence for light therapy is limited- should not be routinely recommended

Question 30

PTSD

Answer 30

Can develop in people of any age following a traumatic event Symptoms must be present for over a month

Question 31

Anti psychotics - extrapyramidal s/e

Answer 31

Parkinsonism Acute dystopia Aka this is Tardive dyskinesia In elderly - increased with of stroke and venous thromboembolism

Question 32

Anti psychotics - other side effects

Answer 32

Anti mus- dry mouth, blurred vision, urinary rentention, constipation Sedation Weight gain Resided prolactin- galactorrrhoea impaired glucose tolerance Neuroleptic malignant syndrome- pyrexia, muscle stiffness Prolong QT interval

Question 33

Atypical antipsychotics

Answer 33

First line in patients with schizophrenia S/e eight gain,