Psychiatry

Question 1

What is neuroleptic malignant syndrome?

Answer 1

Complication of antipsychotics- rare

Fever
Altered mental status
Autonomic dysfunction (rigidity)

Question 2

What is akathesia?

Answer 2

Complication of antipsychotics
Characterised by restlessness, fidgeting, pacing around

Question 3

What is oculogyric crisis?

Answer 3

Oculogyric crisis -> prolonged involuntary upward deviation of the eyes,
Type of acute dystonia.

Acute dystonias are extrapyramidal side effects that can occur within hours to days after initiating or increasing the dose of antipsychotic medication like chlorpromazine.

They are characterized by sustained, often painful muscle contractions leading to abnormal postures or movements.

Question 4

What is the risk of prescribing antipsychotics in elderly patients?

Answer 4

increased risk of stroke
increased risk of venous thromboembolism

Question 5

What drugs should be avoided with SSRI?

Answer 5

NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor

warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine

aspirin

triptans - increased risk of serotonin syndrome

monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

Question 6

What is Fregoli delusion?

Answer 6

Fregoli delusion is a rare misidentification syndrome where the individual believes that different people are, in fact, the same person in disguise.

Question 7

What is Cotard’s syndrome?

Answer 7

Cotard’s syndrome is the fixed, false belief that the person themselves is dying or dead.

Question 8

What is Capgras delusion?

Answer 8

Capgras delusion is the fixed, false belief that a close relative or partner has been replaced by an impostor

Question 9

What is Othello syndrome?

Answer 9

Othello syndrome, otherwise known as delusional jealousy, or pathological jealousy, is a form of delusional disorder in which an individual believes their partner is unfaithful, despite the absence of proof. It usually affects males and can result in stalking behaviour or even homicide

Question 10

What is De Clerambault’s syndrome?

Answer 10

De Clerambault’s syndrome, otherwise known as erotomania, is a delusional disorder in which the patient has a specific, fixed, false belief that someone else is in love with them.

In exams, the patient is usually a woman and the person they are fixated upon is usually of a higher social status, despite only a brief or non-existent acquaintance. This is not normally any unusual behaviour or hallucinations accompanying the delusion

Question 11

Stepwise treatment for alcohol withdrawal?

Answer 11

First-line: benzo (chloradiazepoxide or diazepam)- lorazepam if liver cirrhosis/ failure

Maintenance:
-Chloradiazepoxide
-Fluids
-Anti-emetics
-Pabrinex (replenish vitamins)

Question 12

Causes of delirium?
DELIRIUMS

Answer 12

D: Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E: Eyes, ears and emotional disturbances
L: Low Output state (Myocardial Infarction, Acute Respiratory Distress Syndrome, Pulmonary Embolism, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease)
I: Infection
R: Retention (of urine or stool)
I: Ictal (related to seizure activity)
U: Under-hydration/Under-nutrition
M: Metabolic disorders (Electrolyte imbalance, thyroid disorders, Wernicke’s encephalopathy)
(S): Subdural hematoma, Sleep deprivation

Question 13

Schizotypal vs Schizoid PD?

Answer 13

Schizotypal- characterised by bizarre or magical thinking and distorted perceptions. They are perceived as odd or eccentric, and therefore, can have difficulty interacting socially.

Schizoid- tend to lack interest in others. They may have few friends and prefer solitary activities to those performed in a group.

Question 14

Anti-depressant which helps increase appetite?

Answer 14

Mirtazapine

Question 15

Management of acute dystonia?

Answer 15

acute dystonia (sustained muscle contraction (oculogyric crisis)
-may be managed with procyclidine

Question 16

What SSRI is best prescribed in children?

Answer 16

Fluoxetine is the SSRI of choice in children and adolescents

Question 17

Common SE of atypical antipsychotics?

Answer 17

Weight gain
Agranulocytosis
hyperprolactinaemia

Question 18

Hypomania characteristics?

Answer 18

Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms

Question 19

Treatment for personality disorders?

Answer 19

dialectical behaviour therapy (DBT)

Question 20

What is somatisation disorder?

Answer 20

Somatisation disorder:
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results

Question 21

what atypical antipsychotics lowers seizure threshold?

Answer 21

Clozapine

Question 22

Side effect of SSRI discontinuation?

Answer 22

GI upset -> diarrhoea

Question 23

Drug therapy for persistent PTSD?

Answer 23

If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI

Question 24

What food group to avoid when taking MOAIs?

Answer 24

Cheese

When tyramine containing foods (e.g. cheese) are taken alongside monoamine oxidase inhibitors a hypertensive crisis can occur

Question 25

What antidepressant can be used post MI?

Answer 25

Sertraline- SSRI

Question 26

SE of SSRIs?

Answer 26

GI upset-> most common GI bleeds-> co-prescribe PPI Hyponatraemia Citalopram-> CI in congenital long QT syndrome

Question 27

Treatment for acute stress disorder?

Answer 27

trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line benzodiazepines sometimes used for acute symptoms e.g. agitation, sleep disturbance