psych high yield

Question 1

first line treatment alcohol withdrawal

Answer 1

chlordiazepoxide or diazepam

Question 2

alcohol withdrawal but with liver cirrhosis

Answer 2

lorazepam

Question 3

bipolar type 1

Answer 3

mania

Question 4

elderly patient with new sudden onset psychosis, what should u do?

Answer 4

CT head
- could be an organic cause

Question 5

which is the best antipsychotic for negative symptoms in schizophrenia

Answer 5

clozapine

Question 6

atypical/send gen antipsychotics

Answer 6

• quetiapine
• aripiprazole
• clozapine
• olanzapine
• risperidone

Question 7

SSRI discontinuation symptoms

Answer 7

• dizziness
• electric shock sensations
• anxiety
• GI upset
• sleep disturbances
• restlessness
• sweating

Question 8

SSRI + NSAID

Answer 8

co prescribe PPI

Question 9

SSRI + warfarin/heparin?

Answer 9

NOOO
prescribe mirtazepine instead

Question 10

conversion disorder

Answer 10

loss of motor or sensory function after a period of stress

Question 11

somatisation disorder

Answer 11

multiple symptoms for at least 2 years

Question 12

Mx PTSD

Answer 12

• CBT or EMDR
• if drug therapy: SSRI or venlafaxine
• severe: risperidone

Question 13

how long do symptoms have to persist for a PTSD diagnosis

Answer 13

more than one month

Question 14

examples of typical antipsychotics

Answer 14

haloperidol
chlorpromazine

Question 15

extra pyramidal side effects

Answer 15

• parkisonism
• acute dystonia (torticollis, oculogyric crisis)
• akathisia (severe restlessness)
• tardive dyskinesia (abnormal involuntary movement - chewing and pouting of jaw)

Question 16

Mx acute dystonia

Answer 16

procyclidine

Question 17

other SE’s of typical antipsychotics

Answer 17

• antimuscarinic
• weight gain
• raised prolactin
• imparied glucose tolerance
• neuroleptic malignant syndrome
• prolonged QT interval

Question 18

presentation of neuroleptic malignant syndrome

Answer 18

pyrexia
muscle stiffness

Question 19

what needs to be monitored when starting an SNRI like venlafaxine

Answer 19

blood pressure
- SNRIs are known to increase BP

Question 20

features of mania or severe depression in bipolar, what do u do?

Answer 20

urgent referral to community mental health team

Question 21

management for acute stress disorder

Answer 21

• trauma based CBT first line
• benzodiazepines sometimes

Question 22

symptoms of serotonin syndrome

Answer 22

• hyperreflexia
• tremors
• hyperthermia
• agitation
• autonomic instability

Question 23

when switching to MAOI from SSRI, what should be done to prevent serotonin syndrome

Answer 23

2 week washout period

Question 24

clozapine side effects

Answer 24

• weight gain
• excessive salivation
• agranulocytosis
• neutropenia
• myocarditis
• arrythmias

Question 25

when should clozapine be initiated

Answer 25

lack of improvement following use of at least 2 antipyschotics for 6-8 weeks with at least one being from the atypical class

Question 26

what's an obsession in OCD

Answer 26

an intrusive, unpleasant and unwanted thought

Question 27

what meds with SSRI's can cause serotonin syndrome

Answer 27

- SNRIs - **MAOIs (phenelzine, moclobemide, selegiline)** - tricyclic antidepressants (clomipramine, imipramine, amitriptyline) - opioids - triptans - lithium - st johns wort - mirtazapine

Question 28

management of panic disorder

Answer 28

CBT or drug treatment - SSRIs first line - if CI or no response after 12 weeks then imipramine or clomipramine

Question 29

Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Answer 29

direct switch is possible

Question 30

swtiching from fluoxetine to another SSRI

Answer 30

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 31

switching from SSRI to a tricyclic

Answer 31

cross tapering recommended

Question 32

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

Answer 32

direct switch

Question 33

swtiching from fluoxetine to venlafaxine

Answer 33

withdraw and then start venlafaxine at a low dose 4–7 days later

Question 34

mirtazapine SE

Answer 34

WEIGHT GAIN - like huge weight gain

Question 35

treatment for tardive dyskinesia

Answer 35

Tetrabenazine

Question 36

when do people get tardive dyskinesia compared to acute dystonia

Answer 36

TArdive dyskinesia - TAking antipsychotics for a while acute dSTonia - STarting antipsychotics

Question 37

patient on an antipsychotic for a while - get thirst, polyuria and tiredness

Answer 37

impaired glucose tolerance! - check fasting glucose levels

Question 38

anorexia features, what is low and what is high

Answer 38

most things low G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

Question 39

medications that prolong QT

Answer 39

METHCATS Methadone Erythromycin Terfenadine Haloperidol Citalopram/Choloquine Amiodarone Tricyclics Sotalol

Question 40

what psych drug can cause hyperparathyroidism

Answer 40

lithium

Question 41

how often should lithium levels be checked until established

Answer 41

weekly - same after every dose change

Question 42

post dose change - when check lithium levels

Answer 42

a week later, then weekly til established

Question 43

once established, how often should lithium levels be checked

Answer 43

every 3 months

Question 44

schizoid

Answer 44

like an incel - no interest in anyone, no emotion

Question 45

schizotypal

Answer 45

a bit odd, like no pals but have magical beliefs