Psychiatry

Question 1

What disorders are SNRIs commonly used to treat?

Answer 1

• Major depressive disorders
• Generalised anxiety disorder
• Social anxiety disorder
• Panic disorder
• Menopausal symptoms

Question 2

What is the mechanism of action of duloxetine?

Answer 2

Serotonin and Noradrenalin Reuptake Inhibitor

Question 3

Management of generalised anxiety disorders?

Answer 3

Sertraline

Question 4

Features of depression in the elderly?

Answer 4

Insomnia and fatigue, anxiety and agitation

Question 5

Mx of depression in young people?

Answer 5

Fluoxetine

Question 6

Cause of Charles-Bonnet syndrome?

Answer 6

Age related macular degeneration

Question 7

What is De Clerambault syndrome aka erotomania?

Answer 7

A belief that someone is in love with the patient

Question 8

What is Ekbom syndrome?

Answer 8

Delusional parasitosis

Question 9

What is Othello syndrome?

Answer 9

Belief that the partner is cheating

Question 10

Most suitable SSRI post-MI?

Answer 10

Sertraline

Question 11

What SSRI is suitable in people who take Heparin/Warfarin?

Answer 11

Mirtazepine (Sertraline is contraindicated due to risk of bleeding)

Question 12

What causes serotonin syndrome?

Answer 12

Sertraline + triptans
Sertraline + MAOI
Sertraline + MDMA

Question 13

What precautions to take with SSRIs?

Answer 13

• Continue for 6 months after resolution of symptoms
• Taper dose over 4 weeks
• Paroxetine has the highest chance of discontinuation symptoms
• GI symtoms are frequent (diarrhea) - hyponatremia is also recognised

Question 14

Features of conversion disorder?

Answer 14

Motor or sensory loss due to stress
Psychogenic aphonia is a form of conversion disorder

Question 15

What is Cotard syndrome?

Answer 15

Belief that one is dead - associated with severe depression (Marion Cotillard death scene)

Question 16

What is somatisation disorder?

Answer 16

Unexplained symptoms occuring for more than 2 years - Patient refuses to believe normality of tests

Question 17

What precautions to take with citalopram?

Answer 17

Do not use in patients with long-QT syndrome or in combination with other medication that cause QT prolongation
(maximum dose is 40mg in adults, and 20mg in >65yo and hepatic impairment)

Question 18

What is the next line in the management of PTSD if CBT and EMDR failed?

Answer 18

SNRI (Venlafaxine) or SSRI

Question 19

What is Korsakoff syndrome?

Answer 19

It’s a complication of Wernicke’s encephalopathy. Features include: CAS (confusion, ataxia, squint) + anterograde amnesia, retrograde amnesia, and confabulation (making up of stories)

Question 20

What is Capgras syndrome?

Answer 20

The belief that a person has been replaced by an identical impostor

Question 21

Features of severe depression?

Answer 21

Presents as pseudo-dementia but the memory loss is global (long term)

Question 22

Factors suggesting depression over dementia?

Answer 22

• Short history, rapid onset
• Biological symptoms e.g. weight loss, sleep disturbance
• Patient worried about poor memory,
  reluctant to take tests, disappointed with results
• Mini-mental test score: variable
• Global memory loss (dementia characteristically causes recent memory loss)

Question 23

What is the main risk of antipsychotics in the elderly specifically?

Answer 23

Increased risk of sroke and VTE

Question 24

What is the strongest risk factor for developing schizophrenia?

Answer 24

History of schizophrenia in a first-degree relative (50% if monozygotic twin - 10-15% if parent - 10% if sibling)
- Other risk factors include : Black carribean ehtinicty - migration - urban environment - cannabis use

Question 25

What are the mechanisms of action of Tri Cyclic antidepressants?

Answer 25

- Serotonin (5-HT): inhibition of reuptake of serotonin causes its concentration in the synaptic cleft, enhancing serotonegic neurotransmission - Noradrenaline (NA): same mechanism, results in noradrenergic neurotransmission. - Side-effects are due to other effects -antagonism of histamine receptors => drowsiness -antagonism of muscarinic receptors=>dry mouth, blurred vision, constipation, urinary retention -antagonism of adrenergic receptors=>postural hypotension -lengthening of QT interval

Question 26

What is the safest TCA in overdose?

Answer 26

Lofepramine

Question 27

What are the most dangerous TCA in overdose?

Answer 27

Amitriptyline and dosulepin (dothiepin)

Question 28

What are the sedative and less sedative TCA?

Answer 28

More sedative: Amitriptyline - dosulepin - clomipramine - trazodone Less sedative: Lofepramine - imipramine - nortriptyline

Question 29

Mx of oculogyric crisis?

Answer 29

Procyclidine

Question 30

How to monitor lithium therapy?

Answer 30

- When checking levels, do so 12 hours post-dose - After starting lithium or changing dose, levels should be checked weekly until stabilised - Once stabilised, check levels every three months - Thyroid and renal functions should be checked every 6 months - Provide patients with leaflet, alert card and record book

Question 31

What is the Mx of bothersome sleep paralysis?

Answer 31

Clonazepam

Question 32

Mx of bulimia nervosa?

Answer 32

High dose fluoxetine

Question 33

Mechanism of action of Haloperidol?

Answer 33

Dopamine D2 receptor antagonist - blocks dopaminergic transmission in the mesolimbic pathways

Question 34

How to do withdrawal of benzodiazepine?

Answer 34

Switch to diazepam and wean off over 2 months