Psych- Mood disorders and schizophrenia

Question 1

What are the 3 cardinal symptoms of depression?

Answer 1

1. Depressed mood
2. Low energy/ fatigue
3. Loss of interest/ anhedonia

Question 2

Depression is 2 times higher in which gender?

Answer 2

Women

Question 3

Give 4 examples of somatic (biological) symptoms of depression.

Answer 3

1. Anhedonia
2. Early wakening
3. Loss of libido
4. Poor appetite/ weight loss
5. Depression worse in mornings
6. Psychomotor retardation/agitation
7. Lack of emotional reactivity to normal pleasurable surroundings

Question 4

What are the associated symptoms of depression?

Answer 4

1. Guilt
2. Low self esteem
3. Self harm/ suicide ideas
4. Changes in appetite
5. Pessimistic life views
6. Disturbed sleep
7. Reduced concentration
8. Changes in psychomotor activity

Question 5

________ is 2 or more years of constant depressed mood, where any normal mood rarely lasts longer than 2 weeks.

Answer 5

Dysthymia

Question 6

Mild depression has __ cardinal symptoms and __ other symptoms.

Answer 6

2 cardinal symptoms

2 other symptoms

Question 7

Moderate depression has __ cardinal symptoms and __ other symptoms.

Answer 7

2 cardinal symptoms

3 other symptoms

Question 8

What are the NICE guidelines for managing depression?

Answer 8

1. Recognise and diagnose
2. Treat mild depression in primary care
3. Treat moderate- severe depression in primary care
4. Treatment by specialist mental health services
5. Inpatient treatment for resistant/ life threatening depression

Question 9

What are the 1st, 2nd and 3rd line treatments for depression?

Answer 9

1st line- SSRIs eg. Sertraline
2nd line- Switch SSRI, or SNRI or Mirtazapine
3rd line- SNRI or Mirtazapine or TCA

Question 10

Bipolar disorder is defined as 2 plus episodes of ________/___________ or alternating with depression

Answer 10

Mania/ hypomania

Question 11

In bipolar disorder, which usually lasts longer- depression or mania?

Answer 11

Depression

Question 12

_______ is 7 plus days of sustained elevated/ irritable mood with 3 plus symptoms (spending sprees, increased libido, decreased need for sleep, increased talkativeness, etc)

Answer 12

Mania

Question 13

Which is more commonly associated with psychosis; mania or hypomania?

Answer 13

Mania

Question 14

What symptoms are typical of mania/ hypomania?

Answer 14

Increased libido
Increased talkativeness, sociability and activity
Decreased need for sleep
Spending sprees
Wreckless behaviour
Distractability

Question 15

What are the potential SEs of lithium?

Answer 15

Weight gain
Hypothyroidism/ goitre
Renal impairment
Teratogenicity
Tremor

Question 16

What are the features of lithium toxicity?

Answer 16

Ataxia
Slurred speech
Tremor
UMN signs
Seizures
Diarrhoea and vomit

Question 17

If a patient has delusions of grandeur and

auditory hallucinations are they more likely to be having mania or hypomania?

Answer 17

Mania

Question 18

What is the NICE stepped care approach to treating anxiety?

Answer 18

1. Recognise and diagnose
2. Treat in primary care
3. Review and consider other treatment
4. Refer to secondary care
5. Secondary care treatment

Question 19

What psychological treatments are available for anxiety?

Answer 19

CBT
Psychoeducation
Mindfullness

Question 20

What psychological treatments are available for PTSD?

Answer 20

CBT trauma focused

EMDR (eye movement desensitization and reprocessing)

Question 21

What pharmacological therapies are used for anxiety?

Answer 21

1. SSRIs- Sertraline, Citalopram, Fluoxetine
2. SNRIs- Venlafaxine, Duloxetine
3. TCA/ Pregabalin

Question 22

Which class of drugs should NOT usually be used for anxiety?

Answer 22

Benzodiazepines

Question 23

Give at least 5 examples of differential diagnoses for anxiety.

Answer 23

1. Psych- Depression, Panic disorder, PTSD, phobia, psychosis
2. Hypoglycaemia
3. Thyrotoxicosis
4. Excess caffeine
5. Acute drug/ alcohol withdrawal
6. Parathyroid disease
7. Phaeochromocytoma
8. Cardiac disease
9. Medication induced anxiety: St Johns wort, Salbutamol, Theophyline, Antidepressants, corticosteroids

Question 24

What is agoraphobia?

Answer 24

Fear and avoidance of places from which escape may be difficult/ fear of travelling alone

Question 25

What is social phobia?

Answer 25

Fear of social situations where exposed to unfamiliar people/ possible scrutiny

Question 26

An _________ is a persistent thought/ urge that is unwanted and causes distress

Answer 26

Obsession

Question 27

A _________ is repetitive behaviour that the person feels a drive to perform

Answer 27

Compulsion

Question 28

What class of drugs does Clomipramine belong to?

Answer 28

TCAs

Question 29

In anorexia nervosa patients have a BMI below what?

Answer 29

<17.5

Question 30

What are the differential diagnoses for anorexia?

Answer 30

``` Bulimia Schizophrenia Diabetes Addison's Malabsorption Malignancy ```

Question 31

What are the differential diagnoses for bulimia?

Answer 31

Anorexia Klein Levin syndrome (sleep disorder) Kluver Bucy

Question 32

What metabolic disorder can occur as a consequence of bulimia?

Answer 32

Metabolic alkalosis due to hypokalaemia

Question 33

What are the potential complications of anorexia?

Answer 33

``` Oesteoporosis Cardiac- bradycardia, hypotension, dizzyness, irregular HR, valve issues Dry/ yellow skin Hair loss Amenorrhoea and fertility issues Anaemia ```

Question 34

What are the potential complications of bulimia?

Answer 34

``` Osteoporosis Dry skin and brittle nails Amenorrhoea/ oligomenorrhoea Dental issues- bad breath, Mallory Weis tears Hypokalaemia ```

Question 35

What electrolyte disturbance occurs in refeeding syndrome?

Answer 35

Hypophosphataemia Hypomagnesia

Question 36

In refeeding syndrome, what happens to insulin secretion?

Answer 36

It increases after refeeding due to high blood sugar

Question 37

What are the differential diagnoses for dementia?

Answer 37

``` Pseudodementia Depression Delirium Space occupying lesion Drug use ```

Question 38

Give 3 differences between delirium and dementia.

Answer 38

Delirium- acute, clouded consciousness, fluctuating mental state, reversal of sleep wake cycle, visual hallucinations common Dementia- gradual onset, clear consciousness, no reversal of sleep-wake cycle, hallucinations uncommon

Question 39

Give at least 5 causes of delirium

Answer 39

``` Infection Dehydration Constipation Hypoxia Metabolic disturbances (Low sodium or calcium) Acute blood loss Sepsis Malignancy Hypothyroidism Hypoglycaemia Severe asthma attack Alcohol poisoning Alcohol withdrawal Medications: antihypertensives, opiates, insulin, glicazides, methotrexate, NSAIDs ```

Question 40

Which type of dementia typically has a younger age of onset, and involves personality changes and obsessional behaviours?

Answer 40

Fronto-temporal

Question 41

Which type of dementia involves motor changes and hallucinations, with fluctuating cognition?

Answer 41

Lewy body dementia

Question 42

Which type of dementia has knife blade changes on CT scans?

Answer 42

Fronto-temporal

Question 43

________ is an NMDA antagonist that targets excess glutamate and can be used in Alzheimer's or Lewy body dementia.

Answer 43

Memantine

Question 44

Which class of drugs should be avoided in Lewy body dementia?

Answer 44

Typical antipsychotics