PSYCHIATRY

Question 1

BIPOLAR DISORDER

Answer 1

• MANIA OR HYPOMANIA AND DEPRESSION is called BPD
• Only elevated mood : Hypomania
• Elevated mood + depression : BPD
• Elevated mood + psychotic symptoms ( delusion or halucination ) : Mania
  T/t : GP setting - refer to psychiatry
  Psychiatry setting - Lithium - first line

Question 2

Anorexia Nervosa

Answer 2

Management :
1) Immediate referral to medicine unit
any BMI with features of medical complications ( Hypotension ( <90/60 mmHg ) , Bradycardia , Hypoglycemia , Electrolyte imbalance

2) Immediate referral to Psychiatric unit
if there are any signs of suicidal tendancies

3) Eating disorder unit
if there are only signs of eating disorder

Question 3

BULLIMIA NERVOSA

Answer 3

Managment : CBT and SSRI

Question 4

RUMINATION SYNDROME

Answer 4

Regurgitation
t/t : Diaphragmatic breathing

Question 5

ADHD

Answer 5

Disorder of executive functioning

below symptoms in more than 2 settings

Hyperactivity + impulsitivity + Attention disorder

t/t : Methylphenidate

Question 6

Autism Spectrum Disorder

Answer 6

Language difficulty + Anti social + repetitive behaviour
t/t : multidisciplinary approach

Question 7

MANIA

Answer 7

Elevated mood ( sleeplessness, overspending etc ) with delusion / hallucinations +
Hypomania - Milder version of mania without delusions or hallucinations

t/t of mania : Lithium - first line
2nd line - psychotherapy

Question 8

CLINCHERS FOR Bipolar disorder

Answer 8

1) Only elevated mood : Hypomania
2) Elevated mood + depression : BPD
3) Elevated mood + Psychotic symptoms ( delusions/ hallucinations) : Mania

Question 9

T/T for mania , hypomania or BPD

Answer 9

Psychiatry setting or if not mentioned : Lithium
GP setting : refer to psy

Question 10

Lithium toxicity

Answer 10

Tremor, nausea , vomititng, hyperreflexia, seizures , coma , polyuria , polydipsia
In pregnancy : Ebstein anomaly
t.t:
mild to moderate : IV FLUIDS and stop the drugs ASAP
Severe toxicity : Haemodialysis

Question 11

Investigations for lithium toxicity

Answer 11

BEFORE STARTING : TFT AND ECGs
AFTER STARTING : after 12 hours - lithium levels check
then after 1 week , then 3 montly
check RFT , TSH - 6 monthly

Question 12

Depression Management

Answer 12

mild to moderate - CBT , Psychotherapy
More severe : CBT + SSRI

SSRI vs CBT : SSRI first line &raquo_space;»CBT

Question 13

Antidepressants of choice

Answer 13

Sertaline - safest for MI and bleeding and with patient on aspirin

Patient on warfarin - Mirtazapine

For young teenagers : Fluoxetine
For breast feeding : Sertaline

Question 14

Timing of SSRI

Answer 14

2-4 weeks - improvement expected , full efect 6 weeks
tried for at least 6 months - if not effective , change to another antidepressant

Question 15

DEPRESSION IN ADOLESCENTS

Answer 15

FIRST LINE - PSYCHOTHERAPY
SECOND LINE - FLUOXETINE

Question 16

DELUSION

Answer 16

1. EKBOMS SYNDROME
   infested by parasites

2.Delusion of reference

3.Delusional perception

4.Folie a deux : same delusional belief and hallucinations shared by 2 ppl

5.OTHELLO Syndrome: unfaithful partner

6.Erotomania : Delusional belief that a person of higher social status falls in love with him/her

7.Capgras syndrome : Fixed belief that someone they know has been replaced by an imposter

8.Fregoli delusion : Delusional belief that diff ppl are in fact a single person who changes apperance

Question 17

HALLUCINATION

Answer 17

No stimulus present
Auditory hallucinations:
1) 1 st person : “I am walking “
2) 2nd person :”You are walking”
3) 3 rd person :” He is walking “

Question 18

SCHIZOPHRENIA

Answer 18

More than 2 of the following symptoms to be present for at least 1 month to be termed as SCHIZOPHRENIA

1) Dellusion
2) Hallucination
3) Disorganised speech
4) Disorganized behaviour
5) Negative symptoms : FLAT AFFECT , SOCIAL WITHDRAWAL

Question 19

Management of schizophrenia

Answer 19

1) Atypical antipsychotics: Risperidone , olanzapine

Question 20

Subtypes of Schizophrenia

Answer 20

Paranoid : fearful schizophrenia

Hebephrenic : Disorganized speech or silly responses and foolish or bizzare behaviour, delusions and hallucinations.

Catatonic: Reduction in moving, rigid posture , not talking , sluggish response

Simple : schizophrenia without delusion or hallucinations

Question 21

SCHIZOAFFECTIVE DISORDER

Answer 21

Psychotic symptoms ( delusion and hallucination ) + Mood disorders ( mania or depression)

How to differentiate between BPD and Schizoaffective disorder ?

In BPD : Psychotic symptoms present only during mania

In schizoaffective disorder : Psychotic symptoms occur irrespective of mood ie occurs both during high mood ( mania ) and depression

Question 22

Acute Psychosis

Answer 22

IM lorazepam ( safest)- when medical condition is not known
IM Haloperidol - not safe in parkinsons patient

Question 23

INCONGRUENCE AFFECT

Answer 23

Inappropriate expressions in unsuitable conditions( like smiling and laughing in father s death ) seen usually in schizophrenic disorder

Question 24

PANIC ATTACK

Answer 24

C/F :tremors , palpitations , SOBs
Respiratory alkalosis
No triggers required
out of blue

Question 25

DIAGNOSIS OF PANIC ATTACK

Answer 25

> 1 Panic attack for > 1 month with more than 1 of the following 1) Persistent concern of additional attacks 2) Worrying about consequences of attack 3) Behavioural changes

Question 26

T/T of Panic attack

Answer 26

**Immediate management** 1)Rebreathing into mask - first line 2) IM/IV lorazepam **Long term management** CBT SSRI Prophylactic : Propanalol , diazepam

Question 27

Generalized anxiety disorder

Answer 27

Triggers+ Anxiety and worry for more than 6 months they worry about wide range of things / events / activities not anything specific , random anxiety like that of mothers T/T: CBT , SSRI

Question 28

Social anxiety disorder

Answer 28

Trigger : Afraid of social embarssement or being judged Same features as panic attack like tremors , palpitation, shortness of breath , Numbness t/t: CBT , SSRI

Question 29

OCD

Answer 29

T/T: 1) CBT - exposure and response prevention 2) SSRIs

Question 30

PTSD

Answer 30

Presentation : 1) Reexperiencing of events - flashbacks of events 2) Avoidance of memory/ events associated with trauma 3) Hyperarousal - nightmares T/T: 1) Trauma focussed CBT 2) Eye movement desensitation and reprocessing 3) SSRIs

Question 31

Acute stressor reaction vs Adjustment disorder vs PTSD

Answer 31

Acute stressor and PTSD same in all features expect duration Acute stressor : sudden onset and symptoms last for less than 4 weeks PTSD : Last for more than 1 month Adjustment disorder : Like grief for loss of someone

Question 32

Dissociative Disorder

Answer 32

Dissociative amnesia: inability to recall , related to truma Dissociative Identity Disorder : multiple personality disorder Depersonlisation : derealisation disorder

Question 33

PHOBIA

Answer 33

**Agoraphobia** * Fear of travelling to open spaces * Occurs as a complication of PSTD * usually due to trauma related T/t: GRADED EXPOSURE TO REDUCE FEAR RESPONSE

Question 34

SUICIDE RISK FACTORS

Answer 34

3 biggest risk factors : 1) H/O suicide attempt 2) H/O self harm 3) Divorce others : Recurrent depression, alcohol . agoraphobia , h/o suicidal attempt Protective factors: 1) A Strong faith 2) married 3) children

Question 35

Completed suicide

Answer 35

R/F: 1) Efforts to avoid discovery 2) leaving a suicide note 3) Violent methods

Question 36

Admission for depression

Answer 36

TO GP : 1) Low suicidal risk patients 2) No active suicidal ideation 3) Good social support PSY OPD OR ADMISSION 1) High suicidal risk patients 2) Active suicidal ideation 3) Socially isolaled patient

Question 37

Developmental disorders

Answer 37

Tourettes syndrome : repetitive tics ( motor - eye twitching or blinking and vocal tics - thorat clearing and retts syndrome : hand wringing

Question 38

ANTI PSYCHOTICS S/E

Answer 38

HALOPERIDOL , RISPERIDONE, CLOZAPINE Neuroleptic malignant syndrome 1) Hyperthermia 2) Muscular rigidity 3) autonomic instability A/C DYSTONIA : Muscle spasm neck stiffness AKATHESIA : RESTLESSNESS TARDIVE DYSKINESIA : LIP SMACKING , TONGUE PROTUSION

Question 39

OTHER S/E

Answer 39

Hyperprolactinoma due to risperidone Olanzapine and clozapine - GDM in pregnancy

Question 40

T/T OF ANTIPSYCHOTICS S/E

Answer 40

Procyclidine

Question 41

Personality disorder

Answer 41

Borderline personality disorder * Unstable personal relationship * Mood swings * Marked impulsitivity * Self harm * Dramatic and attention seekers Antisocial personality disorder Criminal acts Impulsiveness Aggresiveness Recklessness and irresponsibility lack of remorse

Question 42

DELIRIUM TREMENS

Answer 42

Symptoms of alcohol withdrwal like tremors , sweating , palpitations etc AND psychotic symptoms like hallucinations and delusions