Psych

Question 1

4 categories of Antipsychotic SEs

Answer 1

Tardive dysknesia:
- choreoathetoid movements + pouting of jaw

Acute dystonia:

• torticollic
• oculogyric crisis

Extrapyramidal:
- Parkinsonism

Akathesia: restlessness

Question 2

3 major clusters of symptoms for PTSD

Answer 2

Intrusive recollections
Hyperarousal
Avoidance

Question 3

First line Rx for PTSD

Answer 3

If mild and <4/52: watch and wait

Otherwise, EMDR
can consider antidepressant if refractory to EMDR

Question 4

What is Section 7

Answer 4

Application for Guardianship

ie. enables care in community where cannot be provided without the use of compulsory powers

Guardian usually a social worker, who can require a person to live in specific place, attend specific places for treatments, grant access to authorised persons

Question 5

MMSE score suggestive of dementia

Answer 5

<24/30

Question 6

Scoring system for anxiety/GAD

Answer 6

Hamilton Anxiety Scale

Question 7

When to monitor for SEs and efficacy of drugs in GAD?

Answer 7

2, 4, 6, 12 weeks

Question 8

Anorexia features

Answer 8

Distorted body image
Weight maintained below 15% of normal
(BMI <17.5)

Question 9

Social phobia features

Answer 9

Intense, persistent fear of being negatively evaluated by others resulting in avoidance of social situations

Question 10

Somatisation definition

Answer 10

2 year Hx multiple various physical symptoms for which no cause found. Refusal to accept reassurance

Has a family tendency

Question 11

Hypochondriasis definition

Answer 11

Persistent belief that one has underlying illness (eg. cancer) underlying their symptoms

No familial tendency

Question 12

What is echopraxia/echokinesis?

Answer 12

Feature of schizo

Involuntary imitation of another’s actions

Question 13

What is Ambitendency?

Answer 13

Co-existence of mixed feelings

Question 14

Lithium blood monitoring

Answer 14

Aim 04-1.2

Monitor level 12h post dose:
On days 4-7 after commencing
Then once weekly for 4 weeks
Then monthly

Question 15

Depo antipsychotic options (atypical and typical)

Answer 15

Atypical: Risperidone
Typical: Haloperidol

Question 16

88yo presents with daughter with forgetfulness and confusion. MMSE 24/30. Recently started on Mirtazapine for low mood.

Dx and Rx?

Answer 16

Depressive peudodementia

Improves with treatment of low mood

Question 17

Lithium toxicity features

Answer 17

Tremor
Dysarthria
Renal impairment
Nystagmus
Ataxia
Convulsions

Question 18

Side effect of SSRI that can cause confusion/drowsiness

Answer 18

Hyponatraemia/SIADH

Question 19

Switching from SSRI to Venlafaxine

Answer 19

Withdraw SSRI, commence low dose venlafaxine

EXCEPTION: Fluoxetine has long half-life
IE. leave 4-7 day gap between stopping Fluoxetine and commencing Venlafaxine

Question 20

Relative and absolute contraindications to ECT

Answer 20

Relative: infarction stroke/MI

Absolute: Recent subdural/subarach

Question 21

OCD Treatment

Answer 21

Exposure and Response Treatment

Question 22

Avoidant personality disorder and Rx

Answer 22

Very shy, feel inadequate, hypersensitive to rejection. Paralysed by this into social isolation.

Rx: psychotherapy (basis of PD Rx)

Question 23

Bipolar I vs Bipolar II

Answer 23

I: presents with mania ~severe and function impaired

II: involves hypomania ie. not involving hospital admission and can continue functioning

Question 24

Indication for Venlafaxine in depression

Answer 24

If low risk suicide + 2 SSRIs already not worked -> SNRI eg. Venlafaxine, prior to considering ECT

Question 25

Temporal lobe SOL can cause which Sx?

Answer 25

Personality change | Cognitive deficit

Question 26

What is fugue?

Answer 26

Severe end of dissociate spectrum: | - forgets whole personal history and may take on a new persona

Question 27

Antidepressant discontinuation syndrome: Features? Which antidepressants more likely?

Answer 27

Symptoms 2-3 days after stopping: - GI disturbance - vivid dreams - nightmares - insomnia - headaches/sweat/lethargy ~Short acting antidepressants eg. Venlafaxine, Duloxetine

Question 28

Anxiety and depression are a feature of withdrawal from many illicit drugs - but which features are more specific to cocaine withdrawal?

Answer 28

paranoia | fornication

Question 29

Systemic therapy use

Answer 29

Couples therapy | Dysfunctional family therapy

Question 30

Patient's dad died. Since then, getting into trouble, rude, argumentative, moody Rx?

Answer 30

Interpersonal psychotherapy ~interpersonal relationships

Question 31

Ways of testing frontal lobe function

Answer 31

Verbal fluency (ask patient to recall as many words starting with a letter in 1min) Estimating Clock drawing test Response inhibition/motor preservation (ask patient to tap twice when you tap once and vice versa) Abstract thinking (link between pairs eg. cat and dog)

Question 32

Which ages is ECT not recommended for?

Answer 32

Ages 5-11

Question 33

Appropriate therapy for possibly autistic child?

Answer 33

Social skills support training

Question 34

Depression is most common in which dementia

Answer 34

Vascular dementia > Alzheimers

Question 35

Patient now abstinent from alcohol, going on a business trip, wants help to remain abstinent on trip

Answer 35

Disulfiram