Psychiatry

Question 1

First line medical treatment for depression

Answer 1

SSRIs = sertraline or citalopram
Can take 2-4 weeks before benefit
If not working, try a different SSRI

Question 2

How long should antidepressants be taken for?

Answer 2

First episode = at least 6 months after full recovery without reducing the dose
More than one episode = continue for 1-2 years after full recovery without reducing the dose

Question 3

Treatment for severe life threatening depresssion, particularly if psychotic symptoms present

Answer 3

Electroconvulsive therapy

Question 4

Classifications of bipolar disorder

Answer 4

Bipolar 1 = have had a full manic episode meeting full criteria, may have had bouts of hypomanic and depressive episodes too.

Bipolar 2 (more common) = current or past hypomanic episode but never met full criteria. Also past of depressive episodes

Question 5

How to treat an acute manic episode

Answer 5

If currently taking anti-depressants stop them

If currently taking lithium, valproate or a mood stabiliser as prophylaxis then check levels and maybe increase dose

If not on antipsychotics, offer haloperidol, respiridone or “-apines”

Question 6

How to treat acute bipolar depression

Answer 6

Dont prescribe antidepressant without an antimanic drug
Avoid antidepressants in though with a recent hypo/mani episode or a history of rapid cycling

SSRIs usually fluoxetine

Question 7

Maintenance therapy for bipolar disorder

Answer 7

Lithium is gold standard

Lamotrigine or valproate

Question 8

Side effects of lithium

Answer 8

Dry mouth, strange taste, polydipsia and polyuria, tremor, hypothyroidism, renal problems, weight gain
Toxic effects: Vomiting, diarrhoea, ataxia, drowsiness, convulsions, coma

Requires a lot of monitoring

Question 9

Mode of action of SSRIs and side effects

Answer 9

Selectively inhibits reuptake of serotonin (5-HT) from the synaptic cleft

SA = nausea, vomiting, anxiety, transient increase in self-harm particularly in young people, vivid dreams, sexual dysfunction, hyponatraemia

E.g. sertraline, citalopram, fluoxetine, paroxetine

Question 10

MOA of tri-cyclic antidressants and side effects and examples

Answer 10

Block the uptake of monoamines serotonin and noradrenaline into presynaptic terminals

SA = anticholinergic effect as drugs block muscarinic receptors; blurred vision, dry mouth, contipation, urinary retention, arrhythmias

E.g. amitriptyline, imipramine, dosulepsin

Question 11

Managment for anorexia nervosa

Answer 11

1st line is family-based therapy for children and young people
Also CBT
Never use just medications

Question 12

What is Russels sign in bullimia nervosa?

Answer 12

Calluses on the back of hands due to self-induces vomiting

Question 13

Management of bullimia nervosa

Answer 13

Individual or group CBT

High dose fluoxetine can reduce cravings for food

Question 14

Describe 1st and 2nd generation antipsychotics

Answer 14

1st gen = haloperidol, chloropromazine
2nd gen = clozapine, risperidone, olanzapine

1st gen cause more extra-pyramidal side effects (can prescribe with an anti-cholinergic to help e.g. procyclicine)

2nd gen cause more weight gain, central obesity, type 2 diabetes

Usually start with 2nd gen and titrate up
Clozapine is best but not 1st line as can cause agranulocytosis (only use for resistant cases)

Question 15

Management of general anxiety disorder (GAD)

Answer 15

CBT
SSRIs, SNRIs, pregabalin

Benzodiazepines should be avoided as it is a chronic condition

Question 16

Management of panic disorder

Answer 16

CBT
SSRIs if long-standing or CBT not helping
Tricyclics
Benzodiazepines only for short-term use

Question 17

Management of agoraphobia

Answer 17

CBT and exposure therapy
SSRIs if needed
Benzidiazepines for short-term only

Question 18

Mode of action of benzodiazepines

Answer 18

Bind to GABAa receptors which causes a positive allosteric effect and makes GABA more likely to bind and the effect of GABA greater

GABA is the main inhibitory neurotransmitter in the brain and reduces the action of neurons in the amygdala (emotions and fear response) and in the cortico-striatal-thalamic-cortical circuit (worry, anxiety)

Question 19

Type 1 and Type 2 trauma

Answer 19

Type 1: single event, sudden and unexpected

Type 2: repetitive, 3x high PTSD risk vs type 1

Question 20

Broca’s area

Answer 20

Part of frontal cortex responsible for production of speech

Deactivated when remembering trauma

Question 21

Wernicke’s area

Answer 21

Area in left temporal lobe responsible for comprehension of speech

Question 22

How can you treat a drug poisoning or overdose within 1 hr?

Answer 22

Activated charcoal

Decreases gut absorption of some substances

Question 23

Over 1hr since a paracetamol overdose, how to treat

Answer 23

N-acetyl cystine

Question 24

Treatment for benzodiazepine overdose

Answer 24

IV flumazenil

Question 25

Treatment for overdose of tricyclic antidepressants

Answer 25

Sodium bicarbonate

Question 26

What is Wernickes Encephalopathy

Answer 26

thiamine deficiency that results in cytotoxic oedema in mamillary bodies Symptoms: ocular dysfunction, ataxic gait and acute confusion Treat with thiamine replacement

Question 27

What is Korsakoffs syndrome?

Answer 27

Chronic thiamine deficiency where there is cerebral atrphy due to Wernickes encephalopathy Presentation: Anterograde and retrograde amnesia, patient makes things up where there is a lapse in memory, lack of insight Chance of recovery is low, need abstinence and nutrition

Question 28

Episodic memory

Answer 28

Memory of your experiences

Question 29

Semantic memory

Answer 29

Memory of facts - dont know where you learnt it but you know it

Question 30

Procedural memory

Answer 30

Acquired memory through repeated tasks

Question 31

Pharmocological treatment for moderate and severe ADHD

Answer 31

1st line - stimulants e.g. methyphenidate, dexamfetamine 2nd - SNRI e.g. atomoxetine 3rd - alpha agonists e.g. clinidine 4th - antidepressants, antipsychotics e.g. risperidone, imipramine

Question 32

What would a PET scan of someone suffering from schizophrenia show?

Answer 32

Hypoactivity of prefrontal lobes | Enlarged cerebral ventricles

Question 33

Definition of hallucination

Answer 33

A perception which occurs without an external stimulus that is experienced as if its really there. Can be any sense Is not subject to conscious manipulation

Question 34

Definition of ideas of reference

Answer 34

Normal events being ascribed significant meaning | Thinking news is about them or talking to them, seeing meaning in gestures

Question 35

Definition of delusions

Answer 35

A fixed, falsely held belief held with unshakeable conviction Impervious to logical argument and unusual for the social, cultural, educational background of the patient It is culturally defined Primary - just appear in consciousness Secondary - often attempts to explain hallucinations or depression etc.

Question 36

Definition of thought disorder

Answer 36

Weird associations, rhyming, punning, making up their own words

Question 37

Types of thought interference

Answer 37

Thought insertion = Belief that thoughts are being put inside your head Thought withdrawal = belief that someone is taking thoughts out of your head Thought broadcasting = belief that thoughts can be heard by everyone else Thought blocking = get halfway through a thought then it dries up and they can’t think anything for a while

Question 38

Definition of passivity

Answer 38

Belief that someone else is moving their arm or making them feel their emotions or urges

Question 39

What sections can hold patients for what time frame?

Answer 39

72hrs = section 5, cannot be extended 28 days = section 2, cannot be extended 6 months = section 3, can be extended for another 6 months and then for a year