Psychiatry

Question 1

Patient presents with first time short history of psychosis investigation?

Answer 1

Urinary Toxicology
- drug intoxication important to rule out

Question 2

First line medication in schizophrenia?

Answer 2

risperidone- 2nd gen antipsychotic
-less likely to cause extra pyramidal side effect s

Question 3

How do 2nd generation antipsychotics work?

Answer 3

transiently inhibit D2 and 5HT-3 receptors
-less likely to cause extrapyramidal side effects

Question 4

Why do 1st gen antipsychotics cause extrapyramidal side effects?

Answer 4

through inhibition of D2 receptors- causes decrease dopamine activity via nigrostriatal pathway (responsible for movement and sensory stimulus)

Question 5

Clozapine side effect

Answer 5

agranulocytosis!

Question 6

Indication for clozapine use?

Answer 6

treatment resistant schizophrenia
-patient who has been treated with 2 antipsychotics already

Question 7

Most likely finding on blood tests when suspected re-feeding syndrome

Answer 7

hypokalaemia, hypophosphatemia and hypomagnesaemia

Question 8

Pharmacological management of anorexia nervosa with mild-moderate depression

Answer 8

Mirtazapine- causes weight gain
is a tetracyclic antidepressant

Question 9

what is conduct disorder?

Answer 9

similar to antisocial disorder but in <18 y/o
often presents with aggression towards peers and animals

Question 10

definition of acute stress disorder

Answer 10

acute stress reaction in 4 weeks after traumatic event
features:
intrusive thoughts
dissociation
avoidance
negative mood

Question 11

after how many weeks can PTSD be diagnosed

Answer 11

4 weeks

Question 12

side effects of atypical antipsychotics e.g. olanzapine

Answer 12

metabolic effects
impaired glucose tolerance
weight gain
raised prolactin
agranulocytosis

Question 13

what is somatisation disorder?

Answer 13

multiple physical SYMPTOMS present for at least 2 years

patient refuses to accept reassurance or negative test results

Question 14

what is hypochondriasis?

Answer 14

persistent belief in underlying serious DISEASE e.g. cancer

Question 15

what is malingering

Answer 15

fraudulent stimulation or exaggeration with the intention of financial or other gain

Question 16

how often should lithium monitoring be performed

Answer 16

weekly after initiation and after each dose change until levels stable
once stable- check every 3 months

Question 17

symptoms of SSRI discontinuation syndrome

Answer 17

dizziness, electric shock and anxiety

Question 18

what is the medical management of delirium tremens/alcohol withdrawal?

Answer 18

oral chlordiazepoxide or diazepam

Question 19

SSRI side effects

Answer 19

GI => most common
hyponatraemia
GI bleeding -> PPI should be prescribed if patient also using NASIDs

Question 20

how long after remission of symptoms of depression should antidepressants be continued for?

Answer 20

at least 6 months - to reduce the risk of relapse

Question 21

what is the SSRI of choice in children and adolescents?

Answer 21

fluoxetine
(fluoxeTEEN)

Question 22

diagnosis of schizoaffective disorder is based off of what?

Answer 22

presence of an affective disorder - mania or depression and
evidence of schizophrenia (psychotic features)q

Question 23

what is emergency detention certificate?

Answer 23

detention of patient for 72 hours
DOES NOT authorise treatment
- any medical professional

Question 24

what is short term detention certificate?

Answer 24

detention and initiation of treatment for 28 days
- initiated by psychiatrist and MHO

Question 25

what is compulsory treatment order?

Answer 25

6 months for inpatient or community treatment
- MHO application to mental health tribunal

Question 26

patient presenting with anorexia nervosa

Answer 26

make sure to do capillary blood glucose

Question 27

lithium side effects

Answer 27

LITHIuM
Leucocytosis
Insipidus
Tremor (fine)
Hypothyroidism
Increased Weight
Metallic taste

Question 28

inpatient of a few days seeing bugs and feeling them crawling

Answer 28

delirium tremens

Question 29

ECG change associated with Haloperidol use

Answer 29

prolongation of QT interval
(hallo doll, i’ve travelled a long way to see you QT)

Question 30

management of acute bipolar episode

Answer 30

STOP SSRI
mania with agitation- IM neuroepileptic or benzodiazepine
mania without agitation- haloperidol/ olanzapine / risperidone

Question 31

what is alcohol withdrawal a result from

Answer 31

decreased inhibitory GABA and increased NMDA glutamate transmission

Question 32

triad for korsakoff’s syndrome

Answer 32

anterograde amnesia
retrograde amnesia
confabulation

Question 33

electrolyte abnormalities seen in bulimia nervosa

Answer 33

metabolic alkalosis, hypokalaemia and hypochloraemia

Question 34

what drug should be used instead of SSRI if patient on warfarin

Answer 34

mirtazapine

Question 35

what medication is contraindication to prescribing SSRIs

Answer 35

any ‘triptans’

Question 36

side effects of mirtazapine

Answer 36

increase sleep and appetite

Question 37

action of alcohol on pathways

Answer 37

potentiates inhibitory GABA and inhibits excitatory glutamate

Question 38

withdrawal of alcohol

Answer 38

= excitatory
-restlessness, tremor, anxiety, seizures
delirium tremens =EMERGENCY

Question 39

management of alcohol withdrawal

Answer 39

alcohol withdrawal = excitatory - so treaet with inhibitory e.g. benzodiazepines (diazepam)
+ pabrinex (thiamine)

Question 40

symptoms of opioid toxicity

Answer 40

pin point pupils
respiratory depression
unconsciousness

Question 41

how does cholinesterase inhibitors work in alzheimer’s

Answer 41

e.g. rivaastigmine, donezapil
alzheimer’s = reduction in ACh => decrease in transmission of learning memory and muscle movements
cholinesterase inhibitors => decrease reuptake of ACh => more ACh => more transmissions