Psychiatry

Question 1

What are some common side effects of ECT?

Answer 1

Reversible memory loss - retrograde>anterograde
Tension headache
Nausea
Transient muscle pain

Question 2

What are some less common side effects of ECT?

Answer 2

Skin burns

Prolonged seizure

Question 3

What features in a psychiatric history would correlate with increased risk of harm?

Answer 3

Previous self harm/harm.
Suicide attempts - more serious if planned, precautions taken to avoid discovered, help sought after, note left.
Recent actions.
Recent major stress.

Question 4

What features in a mental state would correlate with increased risk of harm?

Answer 4

Suicidal or violent thoughts
Significant mood disturbance.
Psychotic symptoms.

Question 5

How can you formulate a risk assessment?

Answer 5

What are the risks?
How probable?
How intermediate and long lasting?
What can be done to reduce risk and what may affect probability?

Question 6

When would a psychodynamic psychotherapy be used?

Answer 6

Anxiety disorders.
Weekly for up to years.
Focuses on changing current behaviours and feeling by analysing past experiences.

Question 7

Interpersonal therapy.

Answer 7

Depressive disorders.
Weekly up to 4 months.
Focuses on understanding problematic interpersonal relationships.
Enable better control over mood and behaviour.

Question 8

CBT.

Answer 8

OCD, phobia, anxiety.
6 weeks to 6 months.
Aims to change distorted, harmful, irrational or ineffective beliefs. Teach skills and strategies.

Question 9

Motivational interviewing.

Answer 9

Substance abuse, depressive disorders.

2-4 sessions.

Question 10

What are the risk factors for completed suicide?

Answer 10

Male, unemployed, isolated, mental or psysical illness, drugs, alcohol.
Current mental state.
Planned, final acts, secrecy.

Question 11

What is ‘impaired control’ in substance dependancy?

Answer 11

Using in larger or longer amounts than intended.
Repeated failed attempts to cut down.
Desire to obtain and use.

Question 12

What is ‘social impairment’ in substance dependancy?

Answer 12

Problems fufilling at work, school or social obligations

Reduced social and recreational activities

Question 13

What is ‘risky use’ in substance dependancy?

Answer 13

Use in physically hazardous situations - driving a car

Use despite knowledge of physical problem - alcohol and cirrhosis

Question 14

What is ‘pharmacological factors’ in substance dependancy?

Answer 14

Drug tolerance - need to increase dose to achieve affect

Withdrawl - substance dependant collection of symptoms that appear after cessation of prolonged drug use

Question 15

What is the main active component of cannabis?

Answer 15

THC

Question 16

What are the clinical features of cannabis?

Answer 16

Intoxication
Anxiety or panic
Red eyes
Munchies  
Dry mouth
Tachycaria and increase BP

Question 17

What are the clinical features of cannabis withdrawl?

Answer 17

Unstable mood
Depression
Agression
Sweating
Headache

Question 18

What is benzodiazepine rebound phenomena?

Answer 18

Re-emergence of symptoms absent or prev controlled after med stopped for a few days

Question 19

What is the clinical features of benzodiazepine overdose?

Answer 19

ANS
Sweating
N,V and anorexia 
HTN 
Tremors 
Seizure

Question 20

What is the management for benzo dependance?

Answer 20

Psychotherapy
Dose tapering
Seizure prophylaxis - carbamazepine

Question 21

How does cocaine work?

Answer 21

Increases dopamine in the synaptic cleft

Inhibits Na channels - LA action

Question 22

What is the treatment for nicotine addiction?

Answer 22

Councelling and support
Nicotine replacement therapy
Vareniciline - reduces potitive symptoms and prevents withdrawl
Bupropion - reduces cravings and withdrawl symptpms

Question 23

How does caffeine work?

Answer 23

Increased cAMP.

Question 24

What is ADHD?

Answer 24

Characterised by inattention, hyperactivity, and impulsivity.
Interferes with social and academic functioning.
Last for at least 6 months.
Occurs before the age of 7.
Present in multiple settings.

Question 25

What is the pathology in ADHD?

Answer 25

Decreased dopamine.

Question 26

What are the risk factors for ADHD?

Answer 26

Genetic predisposition. Prematurity. Exposure to alcohol inutero.

Question 27

What are the symptoms of ADHD?

Answer 27

``` Short attention span. Hyperactivity. Constant failure in school. Inability to sit through cartoons. Disobediance. ```

Question 28

What is the management of ADHD?

Answer 28

Behavioural - First line for preschool and adjuncts for school age. Socio-education measures. Parent training. Methylphenidate - Ritalin. Increases dopamine. First line >6 year

Question 29

What is the effects of Ritalin?

Answer 29

Increased mental performance. Improved concentration. Congnition. Fine motor skills.

Question 30

What are the main side effects of Ritalin?

Answer 30

Sympathic effects - dry mouth, sweating. Epileptogenic potential. Decreased growth rate (reversible if stopped). Titrate slowly.

Question 31

What drug is second line therapy?

Answer 31

Atomoxetine.

Question 32

What is ASD?

Answer 32

Neurodevelopment disorder. Evident before 2-3 yers of age. Spectrum ranges from Kanners - Aspergers.

Question 33

What are the risk factors for ASD development?

Answer 33

Geneticcs Toxin exposure Prenatal infections

Question 34

What are the core features of ASD?

Answer 34

Persistent impairment in social and communication. | Restricted, sterotypical patterns of behaviour.

Question 35

What are some additional features of ASD?

Answer 35

Intellectual impairment Language impairment. Motor abnormalities. Epilepsy Pica Retts Syndrome.

Question 36

Childhood autism/Kanners Syndrome.

Answer 36

``` Impaired language. Impaired intelligence. No eye contact with parents. Reduced emotional response. Repetitive movements. Distrubed by small changed in surroundings. ```

Question 37

Aspergers Syndrome.

Answer 37

Normal language and cognitive development. Normal or high IQ. Exceptional skills/interests in specific areas. Reduced ability to empathise.

Question 38

Retts Syndrome.

Answer 38

Normal development until 7-24 months then onset. Loss of motor, cognitive and language competancies. Hand wringing.

Question 39

Hellers Dementia.

Answer 39

Childhood dintingerative disorders. | Normal development then loss of acquired skills within several months.

Question 40

What is the management of ASD?

Answer 40

``` Behaviour and educational management Competance training Structures Set limits Medical treatment for co-morbidities. ```

Question 41

What are the indicators of poor prognosis in ASD?

Answer 41

Severe core symptoms. Low IQ. Poor or absent language skills. Late initiation of treatment.

Question 42

PSTD.

Answer 42

``` Symptoms which last >1 month following >1 traumatic event. Intrusive thoughts. Distressing dreams Flashbacks. Physiological reactions Avoiding memories/reminders Negative mood Detatchment Impact on fucntioning ```

Question 43

What is the management for PTSD?

Answer 43

CBT - exposure ot trauma focuses, eye movement | SSRI, SNRI

Question 44

What is word salad?

Answer 44

Incoherant thinking expressed as a sequence of words without logical connections.

Question 45

What is neologisms?

Answer 45

The creation of new words with idiosyncratic meaning

Question 46

What is echolalia?

Answer 46

Repition of speech

Question 47

What is clang association?

Answer 47

Use of words based on rhyme patterns rather than meaning

Question 48

What is circumstantial speech?

Answer 48

Non linear thought expressed as a long winded manner of explanation, before expressing the central idea

Question 49

What is thought blocking?

Answer 49

An objective observation of abrupt ending in a thought process, sudden interuption in speech

Question 50

What are first rank symptoms?

Answer 50

Thought insertion or withdrawl Delusions of control Delusional perceptions 3rd person auditory hallucinations