Psychiatry

Question 1

What is SICK FM

Answer 1

Symptoms of anxiety:
Sleep disturbance
Irritable
Concentration poor or mind goes blank
Keyed up or restless/on edge
Fatigued easily
Muscle tension

Question 2

Contraindications for psychostimulants

Answer 2

Glaucoma, untreated hypertsh, mod htn, cardio dz, mania/psychosis

Question 3

Early warning signs of autism at any age

Answer 3

Parental concerns
Developmental regression
Loss of social behahaviour and communication

Question 4

Early warning signs of autism at age 6-12 months

Answer 4

Decreased smiles
Limited eye contact
Limited sharing of sounds
Limited facial expressions
Decreased babbling, gestures, response to name

Question 5

Early warning signs of autism at age 9-12 months

Answer 5

Repetitve behaviours
Unusual play

Question 6

Early warning signs of autism atvage 15-24 months

Answer 6

Diminished, atypical or no spontaneous or meaningful 2 word phrases

Question 7

Diagnostic criteria for autism

Answer 7

Persistent deficit in social communication and social interaction across multiple contacts as manifested by the following:
- deficits in social-emotional reciprocity
- deficits and non-verbal communication
- deficit in relationships

Restricted repetitive patterns has manifested by at least two of the following:
- stereotyped repetitive motor movements
- insistence on sameeness, inflexible adherence to routine or retualised patterns
- highly restricted fixated interest
- hyper or hypo reactivity to sensory input

Question 8

Bipolar 1 vs Bipolar 2

Answer 8

Bipolar 1: One or more manic or mixed episode. Depressive episode not required. Manic episode lasts at least one week, most of the day, most days of the week. Cause functional impairment, not related to substance use or medical condition.

Bipolar 2: One or more major depressive episode and one or more hypomanic episode lasts 4 or more days but <7 days.

Question 9

Cyclothymic disorder

Answer 9

Several hypo, manic and depressive episodes that do not meet criteria for two or more years, not without symptoms for more than two

Question 10

What is the monitoring for lithium?

Answer 10

12 hour trough levels, five days after dose change
Cr, TSH, calcium every 3-6 months

Question 11

What is the monitoring for divalproex?

Answer 11

12 hour trough levels
CBC, LFTs every 3-6 months

Question 12

What is the monitoring for atypical antipsychotics?

Answer 12

Monitor BP, FBG lipids every 12 months

Question 13

Acute management of mania?

Answer 13

Monotherapy: lithium, quetiapine

Combination: Quetiapine + Li/DVP

Question 14

Four categories relating to conduct disorder

Answer 14

Aggression to people and animals
Destruction of property
Deceitfulness and theft
Serious violations of rules

Question 15

Treatment for conduct disorder

Answer 15

** Psychotherapy

Question 16

SIGECAPS for depression

Answer 16

Depressed mood most of the day
Sleep - insomnia or hypersomnia
Interest - diminished in almost all activities most the day
Guilt
Energy low
Concentration low
Appetite - increased or decreased
Psychomotor agitation or retardation
Suicidal ideation

Question 17

What antidepressants require a two week washout period

Answer 17

MAOIs

Question 18

Best antidepressants for elderly

Answer 18

Duloxetine, sertraline, Mirtazapine

Question 19

Antidepressants for perimenopausal

Answer 19

Desvenlafaxine

Question 20

Symptoms of discontinuation syndrome

Answer 20

Flu like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal

Question 21

What antidepressants are most commonly associated with discontinuation syndrome?

Answer 21

Paroxetine
Venlafaxine

Question 22

What antidepressants are the least commonly associated with discontinuation syndrome?

Answer 22

Fluoxetine
Vortioxetine

Question 23

Symptoms and signs of serotonin syndrome

Answer 23

Mild:
Nervousness, insomnia, tremor, nausea, and diarrhoea, big pupils

Moderate:
Hyperreflexia, sweating, agitation, and restlessness, inducible clonus, side to side eye movements

Severe:
Fever higher than 38.5, confusion and delirium, sustained clonus, and rigidity, rhabdomyolysis, death

Question 24

Highest risk meds for serotonin syndrome

Answer 24

MAOI
ex. Selegiline

Question 25

Treatment for serotonin syndrome

Answer 25

Discontinue maths, restart lowest dose or alternative, ER and cyprohepatadine

Question 26

Definition of obsessions and compulsions

Answer 26

Obsessions: recurrent unwanted and intrusive thoughts, images or urges that cause marked anxiety. Compulsions: repetitive behaviours for mental acts that are performed to reduce the anxiety generated by the obsessions

Question 27

Schizoid personality disorder

Answer 27

DISTANT Detached/Flat affect Indifferent to criticism/ praise Sexual experiences of little interest Tasks done soilitarily Absence of close friends Neither desire nor enjoys relationships Takes pleasure in few activities

Question 28

Schizotypal personalitiy disorder

Answer 28

ME PECULIAR Magic thinking or odd beliefs Experiences unusual perceptions Paranoid ideation Eccentric behaviour or appearance Constricted or inappropriate affect Usual thinking and speech Lacks close friends Ideas of reference Anxiety in social situations R/O pyschosis

Question 29

Antisocial personality disorder?

Answer 29

CORRUPT Conforming to law lacking Obligations ignored Recklessness disregard for safety Remorseless Underhanded Planning insufficient - impulsive Temper issues **Prior diagnosis of conduct disorder

Question 30

Bordline personality disorder?

Answer 30

AM SUICIDE Abandonment Mood instability Suicidal Unstable/intense relationships Impulsivity/irritability - spending Control of anger Identity disturbance Dissociative Emptiness Tx: Dialectical behavioural therapy

Question 31

Histrionic personality disorder?

Answer 31

ACTRESSS Appearance focused Center of attention Theatrical Relationships considered more intimate then they are Easily influenced Seductive behaviours Shallow emotions Speech - vague

Question 32

Narcissistic personality disorder?

Answer 32

SPEEECIAL Special - believe they are unique Preoccupied with fantasies Envious Entitlement Excess admiration required Conceited Interpersonal exploitation Arrogance Lacks empathy

Question 33

Avoidant personality disorder?

Answer 33

AVOIDER Avoids social type of work Views self is inept or an appealing Occupied with fear of rejection or criticism Inhibited in new interpersonal relationships Don't get involved when uncertain of being liked Embarassement prevents new activities Restraint within intimate relationships

Question 34

Dependant personality disorder?

Answer 34

RELIANCE Reassurance required Expressing disagreement difficult Life responsibilities, assumed by others Initiating projects difficult Alone Nuturance Companionship Exaggerated fears of being left to care for self

Question 35

Obsessive compulsive personality disorder?

Answer 35

OBSESSOR Obsessed over details Both miserly with self and others Shows perfectionism that interferes with task completion Excessively devoted to work Super consciousness Supervision required for delegated tasks Object hoarder Rigidity

Question 36

Schizophrenia diagnosis

Answer 36

2 or more of the following symptoms present for most of a month, at least one symptom must be in the first three: - delusions - hallucinations - disordered, thinking speech - grossly, disorganised or catatonic behaviour - negative symptoms, for example, diminished, emotional expression - mark, social occupational or self care dysfunction - continuous signs of disturbance for six or more months with over one month of symptoms

Question 37

What is Wernicke encephalopathy caused by

Answer 37

Low thiamine

Question 38

What does delirium tremens happened?

Answer 38

3 to 5 days after last drink

Question 39

When do alcohol withdrawal seizures happen

Answer 39

24 to 72 hours after last drink

Question 40

Treatment for alcohol withdrawal inpatient

Answer 40

Benzodiazepines Diazepam 10 mg QID then decrease by 10 mg a day \ Lorazepam 2 mg Q4H for two days and 1 mg Q4H for two days

Question 41

Treatment for alcohol withdrawal as an outpatient

Answer 41

Diazepam 5 mg QID + 5 mg Q4H PRN (max 2) the decrease by 5 mg per day

Question 42

Medical options for alcohol dependence

Answer 42

Naltrexone. Contraindicated in liver, failure and ongoing opioid use, Monitor LFTs. Can also trial gabapentin