1
Q
True or False: First-generation (typical) antipsychotics like haloperidol are primarily associated with a high risk of metabolic syndrome, while second-generation (atypical) antipsychotics have a higher risk of extrapyramidal symptoms (EPS).
A
False
The opposite is true. First-generation antipsychotics have a high risk of extrapyramidal symptoms (EPS). Second-generation antipsychotics are associated with a higher risk of metabolic syndrome (weight gain, diabetes, etc.).
2
Q
A 25-year-old patient with a history of bipolar disorder presents to the emergency department with coarse tremor, confusion, and ataxia. They recently had a stomach bug with vomiting and diarrhea. Which of their regular medications is most likely responsible for these symptoms?
A) Lamotrigine
B) Olanzapine
C) Lithium
D) Valproic Acid
A
Answer: C) Lithium.
Explanation: This is a classic presentation of lithium toxicity. Lithium has a narrow therapeutic index, and its levels can become dangerously high with dehydration (e.g., from vomiting/diarrhea), leading to neurological symptoms like tremor, confusion, and ataxia.
NOTE –> Lithium is gold standard for bipolar disorders
3
Q
True or False: Benzodiazepines, such as lorazepam, work by increasing the amount of serotonin in the synaptic cleft.
A
False
Benzodiazepines are positive allosteric modulators of the GABAₐ receptor. They enhance the effect of the inhibitory neurotransmitter GABA, leading to sedation and anxiety reduction. They do not primarily act on the serotonin system.
4
Q
A patient being treated for depression is starting a new medication. You advise them that they must avoid tyramine-rich foods like aged cheese and red wine to prevent a potentially life-threatening complication. Which class of antidepressant is this patient most likely taking?
A) SSRI (Selective Serotonin Reuptake Inhibitor)
B) SNRI (Serotonin-Norepinephrine Reuptake Inhibitor)
C) TCA (Tricyclic Antidepressant)
D) MAOI (Monoamine Oxidase Inhibitor)
A
Answer: D) MAOI (Monoamine Oxidase Inhibitor).
Explanation: MAOIs prevent the breakdown of tyramine. Ingesting tyramine-rich foods while on an MAOI can lead to a surge of norepinephrine, causing a hypertensive crisis.
5
Q
True or False: A patient taking a high dose of an SSRI for OCD who also takes St. John’s Wort is at an increased risk for Neuroleptic Malignant Syndrome (NMS).
A
False.
Explanation: The combination of two serotonergic agents (SSRI and St. John’s Wort) puts the patient at risk for Serotonin Syndrome, not Neuroleptic Malignant Syndrome (NMS). NMS is a reaction to antipsychotic (neuroleptic) medications.
6
Q
A physician is choosing a mood stabilizer for a female patient of childbearing age with bipolar disorder. The patient is concerned about potential side effects. Which of the following medications carries a significant risk of causing Stevens-Johnson Syndrome (SJS) and requires a slow dose titration to minimize this risk?
A) Lithium
B) Valproic Acid
C) Lamotrigine
D) Carbamazepine
A
Answer: C) Lamotrigine.
Explanation: Lamotrigine is associated with a risk of the life-threatening rash Stevens-Johnson Syndrome, particularly if the dose is increased too quickly at the start of treatment.
7
Q
List the 4 classes of antidepressants and give examples of each.
A
SSRI –> fluoxetine / sertraline
SNRI –> duloxetine / venlafaxine
TCA –> amitriptyline / nortriptyline
MAOIs –> phenelzine
8
Q
SE of SSRI?
A
GI distress and SS
9
Q
SE of SNRI?
A
GI distress and SS and increase in BP
10
Q
SE of TCA?
A
-anticholinergic SE: dry mouth, constipation, urinary retention, confusion
- cardiovascular: Major cause of death in TCA overdose
- orthostatic hypotension
11
Q
SE of MAOIs?
A
Risk of hypertensive crisis when combined with thyamine rich foods (aged cheese/wine). Risk of SS when combined with SSRI
12
Q
True or False: All antidepressants have an FDA Black Box Warning regarding an increased risk of suicidal thoughts and behaviors in patients up to age 24.
A
True. This is the FDA’s most serious type of warning, and it applies as a class-wide warning to all antidepressant medications for this specific age group.
13
Q
True or False: Fluoxetine is exempt from the FDA’s Black Box Warning about increased suicidality in young adults.
A
False. The warning applies to all antidepressants, including fluoxetine.
14
Q
True or False: First-generation antipsychotics treat both positive and negative symptoms of psychosis.
A
False.
The chart states that first-generation antipsychotics “Treat positive symptoms,” while second-generation agents “Treat positive and negative symptoms.”
15
Q
True or False: A major concern with second-generation antipsychotics is a high risk of metabolic syndrome.
A
True.
“high risk of metabolic syndrome (weight gain, dyslipidemia, diabetes)” for second-generation agents.
16
Q
True or False: Clozapine requires special monitoring due to its high risk of Extrapyramidal Symptoms (EPS)
A
False.
While EPS is a risk with antipsychotics, the chart specifically notes that Clozapine requires monitoring for agranulocytosis.
17
Q
True or False: Both first and second-generation antipsychotics act as dopamine D₂ receptor antagonists.
A
True.
The chart shows that first-generation drugs are “Potent Dopamine D₂ receptor antagonists,” and second-generation drugs are “Dopamine D₂ and Serotonin 5-HT₂ₐ antagonists.” Both classes share the D₂ antagonism mechanism.
18
Q
Between what ages is schizophrenia typically diagnosed?
A
Ages 15-35
19
Q
True or false: Schizophrenia is more common in men than women
A
False
It affects men and women equally and is usually diagnosed between the ages of 15 and 35. However, the age of onset tends to be slightly earlier in men (18-25) and later in women (25-35).
20
Q
True or False: Schizophrenia is more commonly diagnosed in rural areas and among non-migrant populations.
A
False
there is a higher incidence in urban areas and among migrants.
21
Q
True or False: According to the statement, lower socioeconomic status is a confirmed cause of schizophrenia.
A
False.
The text explicitly suggests that the higher incidence in lower socioeconomic classes may be a consequence of the illness (e.g., the illness leads to job loss and downward social drift), rather than a cause.
22
Q
True or False: Events that occur before or during birth, such as viral infections in utero or hypoxic brain injury, are not considered risk factors for schizophrenia.
A
False
The text explicitly states that people who experienced these events “are at greater risk of developing schizophrenia.”
23
Q
True or False: According to the text, imaging has shown that people with schizophrenia tend to have smaller brain ventricles and an increase in grey matter.
A
False.
The text states the opposite: brain imaging has shown enlarged ventricles and small amounts of grey matter loss.
24
Q
True or False: The text identifies smoking cannabis during the period of brain development as a significant risk factor for schizophrenia.
A
True.
The text clearly lists “who smoke cannabis while their brain is still developing” as being at a higher risk.
25
True or False: An excess of dopamine is believed to cause the negative symptoms of schizophrenia, while a lack of dopamine causes the positive symptoms.
False
The text states the opposite: an excess of dopamine is linked to positive symptoms, and less dopamine activity is thought to cause negative symptoms.
26
True or False: Dopamine antagonists are more effective at treating the positive symptoms of schizophrenia than the negative symptoms.
True.
The text explains that since antagonists block dopamine (which is in excess for positive symptoms), they are more successful at treating those than the negative symptoms, where dopamine activity is already low.
27
True or False: Dopamine is the only neurotransmitter implicated in schizophrenia.
False.
The text explicitly mentions that there is also an increase in serotonin activity and a decrease in glutamate activity involved in schizophrenia.
28
True or False: Medications and drugs that increase dopamine levels in the brain, such as levodopa or cocaine, can lead to psychosis.
True.
The text provides examples of this, stating that overtreating with levodopa or using drugs like amphetamines and cocaine increases dopamine and can lead to psychosis.
29
True or False: The onset of schizophrenia is typically abrupt, with no prior warning signs, and is most common in individuals over the age of 40.
False.
John's case illustrates a classic presentation: the onset is in young adulthood (he is 20) and is preceded by a prodromal phase of declining function and emerging negative symptoms before the acute psychotic episode.
30
True or False: In a patient like John, who presents with both positive symptoms (delusions) and significant negative symptoms (avolition, alogia), a second-generation (atypical) antipsychotic is the preferred first-line treatment
True.
As discussed and shown in the medication chart, second-generation antipsychotics are more effective at treating the full spectrum of both positive and negative symptoms, making them the preferred choice in this scenario.
31
True or False: A diagnosis of schizophrenia, according to the ICD-10 criteria provided, can be made based on the presence of a single first-rank symptom, such as a persecutory delusion.
True.
The diagnostic chart clearly states that the presence of "One of these..." first-rank symptoms (like persecutory delusions or third-person hallucinations) for a month or more is sufficient for a diagnosis.
32
True or False: A CT scan of the brain is a mandatory, routine baseline investigation for every young patient presenting with a classic first episode of psychosis
False
A brain CT is not routine for a classic presentation. It is reserved for cases with atypical features, such as a late age of onset or the presence of neurological signs, to rule out an organic cause.
33
True or False: Inpatient hospital admission is required for psychosis because community care is not an effective treatment option for psychosis.
False.
Community care is the preferred standard for psychosis. Admission was required for John specifically due to safety concerns, namely the immediate risk of self-harm (the rope) and severe self-neglect, which made him unsafe to manage at home.
34
A 20-year-old man, John, is brought for assessment after his parents report five weeks of social withdrawal and a five-day history of staying in his room, neglecting himself, and talking as if someone else is present. He believes his mother is trying to poison his food. During examination, he is mute and suspicious.
What is the most likely diagnosis?
A) Major Depressive Disorder with psychotic features
B) Substance-induced psychotic disorder
C) Borderline Personality Disorder
D) Schizophrenia
E) Bipolar I Disorder
Answer: D) Schizophrenia
Justification: The patient’s age, clear prodromal phase of declining function, and classic presentation with both positive (persecutory delusions, hallucinations) and negative (avolition, alogia) symptoms are all hallmark features of schizophrenia.
35
A young patient is diagnosed with schizophrenia. He exhibits both prominent auditory hallucinations and a significant lack of motivation and emotional expression. You decide to start an antipsychotic medication.
Which of the following medications is most appropriate as a first-line treatment for this patient?
A) Haloperidol
B) Fluoxetine
C) Olanzapine
D) Diazepam
E) Lithium
Answer: C) Olanzapine
Justification: Olanzapine is a second-generation (atypical) antipsychotic. This class is preferred because it effectively treats both the positive and negative symptoms of schizophrenia. Haloperidol (first-generation) primarily treats positive symptoms, while the others are not first-line antipsychotics.
36
According to Schneider's criteria for diagnosing schizophrenia, some symptoms are given more diagnostic weight than others.
Which of the following is considered a Schneider's first-rank symptom?
A) Poverty of speech
B) Blunted affect
C) Third-person auditory hallucinations
D) Vague, circumstantial speech
E) Social withdrawal
Answer: C) Third-person auditory hallucinations
Justification: As per the provided ICD-10 chart, third-person auditory hallucinations (voices discussing the patient or giving a running commentary) are a first-rank symptom. The other options are examples of negative symptoms or thought disorders, which are considered second-rank.
37
A patient is admitted to the psychiatric ward with a first episode of psychosis. The clinical team is considering the need for brain imaging.
In which of the following scenarios would a CT scan of the brain be most strongly indicated?
A) The patient is 22 years old with a 6-week history of social withdrawal.
B) The patient has a family history of schizophrenia.
C) The patient is 45 years old and presents with a new-onset seizure.
D) The patient has prominent negative symptoms.
E) The patient admits to recent cannabis use.
Answer: C) The patient is 45 years old and presents with a new-onset seizure.
Justification: An atypical age of onset (over 40) and the presence of neurological signs (like a seizure) are major red flags for an organic cause of psychosis (e.g., a brain tumour), making a CT scan essential.
38
True or False: Clozapine is typically prescribed as a first-line medication for a patient newly diagnosed with schizophrenia.
Answer: False.
Clozapine is reserved for treatment-resistant psychosis, meaning it is used only after the illness has not responded to trials of at least two other antipsychotic drugs.
39
True or False: Patients taking Clozapine must undergo regular blood monitoring because of a significant risk of developing agranulocytosis.
Answer: True.
The risk of agranulocytosis (a severe drop in white blood cells) is the primary reason for mandatory and frequent blood tests (CBC) for anyone prescribed Clozapine.
40
True or False: Clozapine is classified as a first-generation (typical) antipsychotic.
Answer: False.
Clozapine is a second-generation (atypical) antipsychotic, known for its unique efficacy in treatment-resistant cases.
41
True or False: Having a first-degree relative with psychosis is not considered a risk factor for an individual being at risk of psychosis.
False.
The second bullet point explicitly states that if a person "has a first-degree relative with psychosis, they may be at risk of psychosis."
41
True or False: An acute psychotic illness can be preceded by a prodromal period characterized by symptoms like anxiety and depression.
True.
The first bullet point states, "Acute psychotic illness may be preceded by a prodromal period during which patients exhibit symptoms such as anxiety, depression and ideas of reference (feelings of being watched)."
42
True or False: Individuals who are considered "at risk of psychosis" should be immediately prescribed antipsychotic medication.
False.
The third bullet point clearly states, "People at risk may be offered CBT and treatment of comorbid conditions, but not antipsychotic medication."
43
True or False: A patient experiencing a catatonic stupor is unconscious and will have no memory of the events that occurred during the episode.
False.
Justification: Despite appearing unresponsive, individuals in a catatonic state are often fully conscious and aware of their surroundings. They can frequently recall events that happened during the episode after they recover.
44
True or False: The first-line pharmacological treatment for catatonic stupor is an antipsychotic medication like Haloperidol to target the underlying psychosis.
False.
Justification: Antipsychotics can worsen catatonia and risk Neuroleptic Malignant Syndrome (NMS). The first-line treatment is a high-dose benzodiazepine, such as lorazepam.
45
A 22-year-old man with a history of schizophrenia is brought to the emergency department. He is found to be immobile, mute, and holding an awkward posture. A doctor lifts the patient's arm above his head, and upon letting go, the arm remains in that position. What is this classic clinical sign called?
A) Negativism
B) Akathisia
C) Dystonia
D) Waxy Flexibility
E) Tardive Dyskinesia
Answer: D) Waxy Flexibility
Justification: Waxy flexibility is the specific term for the maintenance of a posture into which a patient's limbs are moved by an examiner, a hallmark sign of catatonia.
46
A patient is admitted to the psychiatric ward in a state of catatonic stupor. She has not responded to initial attempts to engage her. What is the most appropriate initial pharmacological intervention?
A) Start a selective serotonin reuptake inhibitor (SSRI)
B) Administer an intravenous dose of Lorazepam
C) Administer an intramuscular dose of Haloperidol
D) Arrange for urgent Electroconvulsive Therapy (ECT)
E) Start a mood stabilizer like Lithium
B) Administer an intravenous dose of Lorazepam
Justification: The "Lorazepam Challenge" is both a diagnostic test and the first-line treatment for catatonia. ECT is a highly effective second-line treatment, while Haloperidol is contraindicated.
47
What is the most common symptom of depression?
Pervasive lowering of mood
although this is NOT essential for a diagnosis to be made.
48
For a depression diagnosis, pervasive lowering of mood must be present.
False
This is NOT an essential for diagnosis. Any 2 of these core symptoms must be present everyday for atleast 2 weeks:
1. low mood
2. anhedonia
3. decreased energy
49
T or F: In depression, monoamine neurotransmitter avalibility is increased in the synaptic cleft
False
Monoamine neurotransmitter availability in the synaptic cleft is reduced in depressed patients, and antideprassants increase monoamine availability.
50
List the 3 core diagnostic symptoms of depression.
Only 2 must be present for 2 weeks at least:
1. low mood
2. anhedoinia
3. decreased energy (or increased fatiguability)
51
T or F: Depression associated with psychostic features is always classified as severe
True
52
T or F: Depression can be either unipolar or bipolar
True
53
List Beck's Triad and the other depressive thoughts
Beck's triad:
1. the seld (low self esteem)
2. the world
3. the future
Other:
- suicide or self-harm
- guilt and worthlessness
54
T or F: Depressive thoughts and anxiety never co-exist
False
Depressive symptoms can be masked by severe anxiety. alcohol, hypochondrial preoccupations or irritability.
55
What other psychiatric conditions can mask depression?
Depressive symptoms can be masked by severe anxiety. alcohol, hypochondrial preoccupations or irritability.
56
T or F: Depression is often also comorbid with anxiety disorders, eating disorder, personality disorders, and substance misuese
True
57
T or F: Most depressive illnesses require psychiatric referral
False
Most can be managed in primary care, although many are undetected.
Psychiartic referral is indicated if suicide risk is high or of the depression is severe, unresponsive to inital treatment, bipolar, or recurrent.
58
What is an anti-depressant that is best to treat patients with cardiac problems?
Sertraline as it has cardioprotective features
59
A 7-year-old child's parents and teachers report that he is constantly fidgeting, blurts out answers in class, and has difficulty waiting for his turn in games. These symptoms have been present since he started school. Which core domain of ADHD is most prominent in this description?
A.
Hyperactivity-Impulsivity
B.
Social Anxiety
C.
Inattention
D.
Oppositional Defiance
Hyperactivity-Impulsivity
The behaviors described, such as fidgeting, blurting out answers, and difficulty waiting, are classic examples of hyperactivity and impulsivity.
60
A 9-year-old boy is diagnosed with ADHD. He struggles with both inattention and hyperactivity. His parents are concerned about medication side effects and want to try other options first. What is the most appropriate first-line non-pharmacological treatment for this child?
A.
Prescribing a non-stimulant medication immediately
B.
Behavioral therapy and parent training
C.
Individual psychotherapy for the child
D.
Dietary restrictions, such as eliminating sugar
Behavioral therapy and parent training
This is the gold-standard first-line non-medication treatment. It teaches parents and children effective strategies for managing behavior and improving functioning.
61
For a formal diagnosis of ADHD in a child, symptoms must be present in how many settings?
At least two settings (e.g., home and school)
62
A 10-year-old with ADHD has tried two different stimulant medications but cannot tolerate the side effects, which include severe appetite loss and insomnia. What is the most appropriate next class of medication to consider?
A non-stimulant medication (e.g., Atomoxetine)
When stimulants are ineffective or not tolerated, non-stimulants like Atomoxetine or alpha-2 agonists are the recommended next step.
63
What other conditions does ADHD frequently coexist with?
- conduct disorder
- anxiety and/or depression
- language delay
- sepcific reading retardation
- antisocial behaviour
- clumsiness
64
What are the questions that shoukd be asked when suspecting ADHD and to whom should they be asked to?
I would interview the child, their parents, and teachers. I would ask about general behaviour and emotional difficulties (sleep, appetite, mood, elimination, relationships, antisocial behaviour), daily routines (including hobbies), family structure and interactions and seperations, and academic preformance and behaviour. I would explore ADHD-specific symptoms:
Inattention – distractibility, forgetting tasks, losing items, poor concentration, daydreaming.
Hyperactivity – fidgeting, inability to sit still, excessive movement, talking excessively.
Impulsivity – interrupting, difficulty waiting turn, acting without thinking.
I would ask about functional impairment across home and school, developmental history, medical conditions, and screen for comorbidities such as ASD, learning disorders, anxiety, and ODD.
65
T or F: ADHD can only be diagnosed in childhood
False
It can be diagnosed at any age
66
T or F: Symptoms of ADHD are always present by the age of 7, and occur only at home.
False
Symptoms of ADHD are always present by the age of 7, but must occur in atleast 2 settings (eg. home and school).
67
List the core symptoms of ADHD.
1. Short attention span
2. Impulsivity
3. Overactivity
4. Distractability
Must be present for atleast 6 months
68
List the treatment options for ADHD.
1. Parent teaching and education programmes this includes: a positive approach, stuctured approach, clear boundaries, plenty of physical activity, a healthy diet (certain foods may exacerbate the symptoms)
2. Classroom behavioural interventions by trained teachers
3. Methylphenidate in school age children and sometimes atomoxetine
4. Lisdexamfetamine is 1st line for adults
5. Atomexitine is 2nd line after two stimlulants are ineffective
69
A patient with a chronic inflammatory condition is started on long-term, high-dose steroid therapy. Several weeks later, they present with low mood, crying spells, and a loss of interest in their usual activities.
According to the diagram, what is the most likely psychiatric consequence of their medication?
A) Metabolic syndrome
B) Adjustment disorder
C) Psychosis
D) Depression
Answer: D) Depression
Justification: The diagram explicitly links medication like steroids to the development of depression, and occasionally psychosis. While a chronic illness can cause an adjustment disorder, the question specifies a consequence of the medication itself.
70
True or False: According to the diagram, mental illness can lead to the development or worsening of physical illness.
True.
Justification: The diagram shows an arrow leading from "Mental illness" back to "Physical illness" with examples such as decreased self-care, decreased adherence to medication, and refusal to eat and drink, all of which can cause or exacerbate physical health problems.
71
A patient with schizophrenia is being treated with a second-generation (atypical) antipsychotic.
Which physical health consequence is a well-known side effect of this class of medication, as shown in the diagram?
A) Stroke
B) Depression
C) Metabolic syndrome
D) Brain injury
Metabolic syndrome
Justification: The diagram specifically lists atypical antipsychotics as a medication that can lead to metabolic syndrome, a key physical health concern in this patient population.
72
T or F: Dementia is never apparent during hospitalisation of a patient
False
Demintia may first become apparent during hospitalilisation as patients reveal their inability to learn to cope in a novel environment and without family support
73
An elderly patient with a severe physical illness reports lethargy, poor sleep, and a reduced appetite. You are trying to determine if they also have Major Depressive Disorder.
According to the text, which of the following symptoms would be most helpful in distinguishing depression from the symptoms of their physical illness?
A) Lethargy
B) Poor sleep
C) Reduced appetite
D) Pervasive feelings of guilt and hopelessness
D) Pervasive feelings of guilt and hopelessness
Justification: The text explicitly states that physical symptoms like lethargy and poor sleep can be difficult to distinguish from those of depression. It recommends focusing on emotional features such as anhedonia, guilt, and hopelessness to make the diagnosis.
74
True or False: According to the text, Electroconvulsive Therapy (ECT) can be a life-saving treatment for a physically ill person with severe depression, especially if their food and fluid intake is poor.
True.
Justification: The text states, "Electroconvulsive therapy (ECT) can be life-saving in severe or psychotic depressive illness in physically ill people...where physical health is further threatened by poor food and fluid intake."
75
True or False: The text suggests that patients with a pre-existing psychiatric illness can have their psychiatric management paused if they require urgent medical or surgical treatment.
False.
Justification: The text indicates the opposite, stating that such patients "will need continued psychiatric management with careful monitoring of their mental state under stressful circumstances."
76
True or False: Mrs. Attard's history of recurrent self-harm, unstable relationships, and impulsivity are most indicative of a primary psychotic disorder like schizophrenia.
False.
Justification: These symptoms are the hallmark features of Borderline Personality Disorder (BPD)
77
T or F: when a patient with a known psychiatric illness is admitted to a surgical ward, it is best to pause their psychiatric management to focus on the medical issue.
False.
Justification: Liaison psychiatry emphasizes the importance of continued psychiatric management and close cooperation between medical and psychiatric teams to manage the overlap of physical and mental health needs.
78
T or F: Patients presenting with behavioural disturbance frequently have delirium or dementia
True
Patients presenting with behavioural disturbance — such as agitation, aggression, confusion, wandering, or disinhibition — often have an underlying organic cause, most commonly delirium or dementia.
This must be excluded, or its inderlying cause identified and treated as a matter of urgency
79
True or False: Somatisation disorder is diagnosed when a patient has multiple physical symptoms for a few weeks that can be explained by a clear organic illness.
False.
Justification: The text states the disorder is characterized by at least two years of multiple physical symptoms with no physical explanation. Somatisation is when emotional distress or internal conflict is unconsciously converted into physical symptoms through abnormal brain–body communication.
80
explaining how somatic symptoms can arise, a person with health anxieties misinterprets a normal bodily sensation as an illness.
What happens next in this cycle?
A) The physical symptom immediately disappears.
B) The person seeks reassurance, which resolves the anxiety.
C) Increased anxiety makes the physical symptoms worse.
D) The person develops a different, unrelated health anxiety.
C) Increased anxiety makes the physical symptoms worse.
Justification: The diagram shows a clear cyclical process where misinterpretation leads to anxiety, and the "increased anxiety makes symptoms worse," which then feeds back into the initial health anxiety.
81
True or False: The text suggests that the first step in treating somatisation disorder is to begin psychological therapy immediately.
False.
Justification: The text explicitly states that "Treatment should begin by ruling out all organic illnesses." This is the essential first step before considering a psychiatric diagnosis.
82
Somatisation disorder can result in multiple operations
True
This occurs despite the absence of organic disoder
83
What are the most commmon physical symptom of somatisation disorder?
GI and skin complaints
84
T or F: Somatisation is much more common in women
True
85
T or F: Somatisation disoder usually starts after age 40
False
Usually starts before the age of 30.
86
True or False: Hypochondriacal disorder is a delusional preoccupation with having a serious illness.
False.
Justification: The text explicitly states that it is a "non-delusional" preoccupation with the possibility of serious illness.
87
True or False: Dysmorphophobia is an excessive preoccupation with an imagined or barely noticeable defect in one's physical appearance.
True.
Justification: The text defines dysmorphophobia in this exact way, giving the example of a person being preoccupied with the size of their nose.
88
True or False: Cognitive Behavioural Therapy (CBT) is considered a primary treatment for somatoform disorders.
True
89
True or False: SSRIs can be a helpful medication for treating the symptoms of dysmorphophobia.
True
90
A 25-year-old woman is brought to the emergency department after being found wandering in a different city, with no memory of her name or how she got there. Her wallet is missing, but a friend eventually identifies her and reports that she had been under extreme stress after losing her job.
What is the most likely diagnosis?
A) Dissociative amnesia
B) Dissociative fugue
C) Dissociative motor deficit
D) Ganser's syndrome
B) Dissociative fugue
Justification: This condition combines dissociative amnesia with a seemingly purposeful but unplanned journey away from home, which perfectly describes the patient's presentation.
91
A young man presents to his doctor with a sudden onset of blindness in his left eye. A full neurological and ophthalmological work-up, including an MRI of the brain and optic nerve, reveals no underlying physical or neurological cause for his vision loss. His symptoms began the day after a highly stressful and traumatic event.
Which of the following best describes his condition?
A) Dissociative convulsions
B) Dissociative amnesia
C) Dissociative motor and sensory deficits
D) Ganser's syndrome
C) Dissociative motor and sensory deficits
Justification: This category includes unexplained sensory deficits such as numbness or blindness. The sudden onset following a stressor with no organic cause is classic for a dissociative (conversion) disorder.
92
A patient in a psychiatric hospital begins to have seizure-like episodes involving thrashing movements and side-to-side head shaking. The episodes last for 15 minutes, and he does not lose bladder control. He is able to warn staff just before an episode begins. A video-EEG monitoring shows no abnormal electrical activity in the brain during the spells.
What is the most likely diagnosis?
A) Dissociative fugue
B) Dissociative convulsions (non-epileptic seizures)
C) Dissociative amnesia
D) Ganser's syndrome
B) Dissociative convulsions (non-epileptic seizures)
Justification: The long duration, specific type of movements, preserved awareness (ability to warn others), and lack of epileptic brain activity are all hallmark features of dissociative convulsions, also known as Psychogenic Non-Epileptic Seizures (PNES).
93
True or False: For a diagnosis of schizophrenia, the presence of negative symptoms like blunted affect is considered a Schneider's first-rank symptom.
False
According to the ICD-10 chart, negative symptoms are second-rank symptoms. First-rank symptoms include specific delusions and third-person hallucinations.
94
True or False: The first-line pharmacological treatment for a patient in catatonic stupor is a low-dose antipsychotic.
False
Antipsychotics are CI. Treatment is with ECT and lorezepam
95
List the signs of substance dependence.
CANT STOP: -
Complusion/strong desire to use substance
Aware of harm
Neglect of other activities
Tolerance to substance
Stopping causes withdrawal symptoms
Stereotyped pattern of drinking
Time preoccupied with substance
Out of control use
Persistent, futile wish to cut down
96
What are the questions used to detect alcohol misuse?
CAGE Questionnare: -
C --> have you tried to cut down drinking?
A --> have people annoyed you by critizing your drinking?
G --> have you felt guilt about drinking?
E --> have you needed an eye-opener (early morning drink) to steady yout nerves or get rid of a hangover?
| CAGE is not a diagnostic tool. If one is positive then ask more question
97
Benzodiazepines (lorazepam) should never be used on treatment of withdrawl symptoms
False
Benzodiazepines and/or antipsychotics (haloperidol or olanzipie) can be used
98
Write down the 8 step management of alcohol misuse.
Abstience is the goal of treatmenr of dependance, although sometimes it's controlled drinking:
- Take a good hx and include motivational interviewing skills.
- Collateral history
- Physcial exam, particularly liver disease and peripheral neuropathy- take blood testsesp LFTs and coagulation screen
1) acute detoxification --> in hospital if risk of delerium tremens, withdrawal seziures, or person is a child or vulnerable (eg. cognitiviely impaired or lacking support)
2) Rehydration, correction of electrolyte imbalance, and oral or parenteral thiamine
3) Benzodiazepine (lorezepam/diazepam) - start with a high dose and tailor down sithin the week (imp patients stop benzos within a week) and/or antipsychotics (resperidone)
4) Psychological therapies whether indvidually or in groups (this includes AA and rehab if severe)
5) Self-help groups
6) Medications like Naltrexone help maintain abstience after detoxification. Consider SSRIs if patient is depressed
7) Prevention measures
8) Include the famiy in the treatment (eg. family therapy)
99
A 54-year-old man with a long history of heavy alcohol consumption is brought to the hospital with confusion, ataxia (unsteady gait), and ophthalmoplegia (paralysis of eye muscles). What is the most critical initial treatment to prevent the progression of his condition to a permanent, irreversible state?
A) Intravenous lorazepam
B) Intravenous thiamine
C) Intravenous glucose
D) Oral naltrexone
Answer: B) Intravenous thiamine.
Explanation: This patient presents with the classic triad of Wernicke's encephalopathy, an acute neurological emergency caused by thiamine (Vitamin B1) deficiency. It is crucial to administer IV thiamine before giving any glucose. Giving glucose first can worsen the condition by depleting the body's remaining thiamine stores, potentially precipitating the irreversible memory disorder known as Korsakoff syndrome.
100
True or False: Delirium tremens, the most severe form of alcohol withdrawal, typically begins within the first 12 hours after the last drink.
False.
Explanation: Delirium tremens (DTs) is a delayed complication of alcohol withdrawal. It typically occurs 48-96 hours (2-4 days) after the last drink. It is characterized by severe confusion, hallucinations (often visual or tactile), agitation, fever, tachycardia, and hypertension. Early withdrawal symptoms like anxiety and tremors occur sooner.
101
Which of the following laboratory findings would be most specific for chronic alcohol-induced liver disease?
A) An AST:ALT ratio greater than 2:1
B) Elevated total bilirubin
C) Low serum albumin
D) Prolonged prothrombin time (PT)
Answer: A) An AST:ALT ratio greater than 2:1.
Explanation: While all the other options can indicate liver damage, an AST to ALT ratio of >2:1 is highly suggestive of alcoholic liver disease. This is because alcohol directly damages mitochondria, leading to a preferential release of the mitochondrial enzyme AST.
102
True or False: Chronic alcohol misuse leads to macrocytic anemia primarily due to iron deficiency from gastrointestinal bleeding.
Answer: False.
Explanation: While GI bleeding can cause iron deficiency anemia (which is microcytic), the macrocytic anemia commonly seen in alcohol misuse is typically due to folate (Vitamin B9) and/or Vitamin B12 deficiency from poor nutrition and impaired absorption. Alcohol also has a direct toxic effect on bone marrow that can contribute to larger red blood cells.
103
Macrocytosis without anemiaand raised GGT, ALT and AST, or CDT indicate recent harmful use
True
104
A pediatrician is examining a newborn whose mother had a history of heavy alcohol consumption during pregnancy. The infant has a low birth weight, a small head circumference, and distinct facial features including a smooth philtrum, a thin upper lip, and small palpebral fissures. Which of the following conditions is the most likely diagnosis?
A) Down Syndrome (Trisomy 21)
B) Neonatal Abstinence Syndrome (NAS)
C) Fetal Alcohol Syndrome (FAS)
D) Congenital Hypothyroidism
Answer: C) Fetal Alcohol Syndrome (FAS).
Explanation: This question describes the classic and specific diagnostic features of Fetal Alcohol Syndrome. The triad of (1) growth deficits (low birth weight, microcephaly), (2) a specific pattern of facial abnormalities (smooth philtrum, thin vermillion border of the upper lip, small palpebral fissures), and (3) central nervous system dysfunction (which may present later as developmental delays or intellectual disability) is pathognomonic for FAS. While the other conditions can present with some overlapping features, the constellation of facial dysmorphology is unique to FAS.
105
List the symptoms of Wernicke's encephalopathy.
1. acute confusion
2. opthalmoplegia
3. nystagmus
4. ataxia
106
What is Korsakoff's psychosis and what are its symptoms?
Korsakoff's psychosis is a chronic, often irreversible neuropsychiatric syndrome caused by a severe thiamine (vitamin B1) deficiency. It is the long-term consequence of untreated Wernicke's encephalopathy and is most commonly seen in patients with chronic alcohol use disorder.
Its symptoms are:
1. Profound short-term memory loss
2. Confabulation
106
List the symptoms of fotal alcohol syndrome.
1. Decreased muscle tone
2. Poor coordination
3. Developmental delay
4. Heart defects
5. Facial abnormalities
107
When does the early withdrawal symptoms of opioid use occur and what are they?
Occur after 24-48 hours:
1. Yawning
2. Sweating
3. Flu-like symptoms
4. Craving
108
When does the late withdrawal symptoms of opioid use occur and what are they?
After 7-10 days:
1. Pupil dilation (mydriasis)
2. Abdominal cramps
3. Agitation
4. Restlessness
5. Piloerection (goosebumps)
6. Diarrhoea
7. Tachycarida
109
How long does the opioid detoxification treatment last?
4-12 weeks
110
What is the first line medical treatment for opioid detoxification?
Methadone (opoiod agonist) and buprenorphine (opioid partial agonist)
111
T or F: Lofexdine is sometimes used for short detoxification treatments or where abuse is uncertain.
True
112
In maintenance therapy, methadone or buprenorphine is prescribed at a dose lower than required to prevent withdrawal symptoms
False
In maintenance therapy, methadone or buprenorphine is prescribed at a dose HIGHER than required to prevent withdrawal symptoms
113
T or F: Naltrexone is an opioid agonist.
False
It is an opioid antagonist
114
Naltrexone blocks the euphoric effects and is occasionally used to prevent relapse
True
115
What medication is used to treat opioid overdose?
Naloxone
116
True or False: Methadone is listed as a management option for both detox and maintenance of opiate dependence.
True.
The table indicates under the "Management" row for Opiates: "Methadone or buprenorphine, for detox or maintenance."
117
True or False: An overdose on heroin is characterized by pupil dilation (mydriasis) and respiratory stimulation.
False.
The table lists the negative effects of an opiate overdose as "miosis [pupil constriction], respiratory depression, death."
118
True or False: Cocaine and amphetamines are classified as stimulants that can be snorted or taken intravenously.
True.
The table includes cocaine and amphetamines under "Stimulants" and lists the "Taken" route as "Snorted, iv."
119
True or False: According to the table, psychosis is a potential negative effect experienced during the euphoric high of stimulant use.
True
120
True or False: The primary form of dependence associated with hallucinogens like MDMA and LSD is physical dependence.
Answer: False.
The table states under the "Dependence" row for Hallucinogens that "Psychological dependence [is] common."
121
True or in False: Flashbacks and psychosis are listed as potential negative effects of both hallucinogens and cannabis.
True.
Under "Negative effect," the table lists "flashbacks/psychosis" for LSD (a hallucinogen) and "Flashbacks, transient psychosis" for cannabis.
122
True or False: The management for opiate dependence and hallucinogen use is the same, involving residential community programs.
False.
The table shows different management strategies. Opiate management includes "Residential or community" programs along with medications like methadone, while hallucinogen management is listed as "Usually community psychological therapy."
123
What is lithium used for?
1. Prophylaxis in recurrent affective disorder (unipolar and bipolar)
2. Acute treatment of mania
3. Augmentation of antidepressants in resistant depression
4. Schizoaffective illness
5. The control of aggresion
124
What should be monitored when taking lithium and how often?
Monitoring should include:
- Thyroid function
- Renal function
Mointored prior to starting lithium and every 6 months while taking
125
TFTs and renal monitoring should only be done while on lithium and not before taking it
False
Should be done prior to starting lithium and while taking it every 6 months
126
What are the CIs to lithium?
Lithium should be avoided in renal, cardiac, thyroid, and Addison's disease
127
T or F: Dehydration and diuretics have no effect on lithium use
False
Can lead to lithium toxicity
128
Lithium, lamotrigine, and valproic acid are teratogenic
True
They should be avoided during pregnancy (especially 1st trimester) and lactation
129
What drug can cause Stevens Johnson Syndrome?
Lamotrigine
130
Other than lithium, name other drugs for prophylaxis in bipolar disorder?
Valproic acid and carbemazepine
131
T or F: Men are more likely to misuse over the counter medication than women
False
Women are more likely to abuse them than men
132
True or False: Chronic opiates use stimulates the hypothalamus to increase its production of Gonadotropin-Releasing Hormone (GnRH).
Answer: False.
Explanation: Opiates suppress the hypothalamus, leading to a decrease in the release of GnRH.
133
True or False: The reduction in GnRH caused by opiate use leads to lower levels of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) from the pituitary gland.
True.
Explanation: GnRH is the signal for the pituitary to release LH and FSH. When GnRH is suppressed, LH and FSH levels fall accordingly.
134
True or False: Amenorrhea (the absence of menstruation) is a potential consequence of chronic opiate use in women.
True.
Explanation: By disrupting the entire hormonal axis (GnRH, LH, FSH), opiates can stop the menstrual cycle, leading to amenorrhea or oligomenorrhea (infrequent periods).
135
True or False: Opiates directly increase estrogen production in the ovaries, which is the primary cause of infertility.
False.
Explanation: Opiates lead to lower estrogen levels because they suppress the hormones (LH and FSH) that are needed to stimulate the ovaries to produce estrogen and ovulate.
136
True or False: The failure to ovulate, known as anovulation, is a direct result of opiates suppressing LH and FSH.
True.
Explanation: LH and FSH are essential for stimulating the ovaries to mature and release an egg. When their levels are low due to opiate use, anovulation occurs, making conception impossible.
137
With stabilisation of methadone and no heroin, ovulation returns and so does menustuation
True
138
Involving the partner in treatment of opoid addict is unncecessary
False
Include the partner
139
The dose of methadone given is not important
False
Correct dose must be given at all times
140
In pregnant women, methadone is CI
False
Must increase dose of methadone in pregnant women, and NOT decrease it before the 12th weeks and after the 31st weeks of gestation
141
Unlike methadone, buprenorphine can NOT be prescribed during pregnancy
False
It is safe
142
Never should a pregnant woman be encouraged to stop taking her methadone
True
As this would cause her to miscarry
143
Anxiety disorders are frequently comorbid with other disorders.
True
These include depression, substance misuse, or another anxiety disorder
144
Benzodiazepines abuse can worsen or cause anxiety and panic attacks
True
It paradoxical because benzodiazepines are used to treat panic attacks in emergency, and the abuse of it can worsen or cause anxiety and panic attacks
145
In what pathology is panic attacks 10x more common?
COPD likely because breathlessness precipitates symptoms of panic
146
What is agoraphobia?
It is fear and avoidance of places or situations from which escape maybe difficuly or in which help may not be available in the event of having a panic attack. It is often comorbid with panic disorder.
147
Explain the cognitive model of panic attacks.
Panic attacks occur when catastrophic misinterpretations of ambigupous physical sensation (SoB/tachycardia) increase arousal, creating a positive feedback loop that results in panic
148
What is the mainstyau treatment for agoraphobia?
CBT is the mainstay and SSRIs can be useful
149
Questions to be asked for schizophrenia.
- I would interview the patient, and where possible, obtain collateral history from family members. I would ask about the presenting symptoms and explore +ve psychotic symptoms: auditory hallucinations (do you hear voices who other can't? what do they say?), somatic passivity (can someone control what you do or say?), thoughts insertion/withdrawal (are your thoughts interfered with or controlled? are they known to others?), thoughts broadcasting, persecutory delusions (do you have enemies? is someone out to get you?), ideas of refrence (message specific you?), delusional perceptions?. I would assess for -ve symptoms: alogia, affective flattening, anhedonia, aovilition. I would enquire about functional decline (social engagement, occupation, academic, self-care). I would explore premorbid personality.
- I would assess mood symtpom to exclude affective disorders, screen for substance misuse, and assess risk of harm to self or others.
- A full psychiatric history would include past psychiatric illness, medical history, medication use, history of psychosis, and MMSE with particular attention to insight and cognition.
150
Formal psychiatric assessment risk.
Ask these questions to the close members and to the patient:
- Risk to self --> Do you think of harming yourself? Do you feel hopelessness or desire to end your life?
- Risk to others --> Do you think of hurting the poeple that are trying to get to you? Has he been aggresice or violent to anyone in home?
- Self-neglect --> Do you eat? How many meals> Do you drink water? Do you care about your own personal hygiene?
151
Psychiatric personal and social history.
Family hx
premorbid functioing
social hx
152
Management of borderline personality disorder.
admit to hospiral if risk of suicde, harm to self and/or others.
1. Requires active work to engage the patient and foster a theraputic relationship and explin recovery is possible and attainable
2. Set structure, consistency, and clear boundaries (ie. agreement of accepatable and unacceptable behaviour) and MDT and multi-agency work
3. Treatment for comorbid psychiatric illness adn substance misuse is a priority
4. Drugs are sometimes used (eg. mood stabilizers (lithium) for impulsivity), and consider short-term sedative medication like lorezrepam for crisis management
5. Adopted CBT and DBT and mentalisation based treatment
153
What type of pregnant women is significant depression more common in?
1. Past psychiatric illness
2. Conflicting feelings about the preganancy
3. History of sexual abuse as a child
4. US showing fetal abnormalities
154
How is the severity of depression assessed?
1. Number of symptoms present
2. Severity of symptoms present
3. Degree of associated distress
4. Interfernce with daily activity
155
What antidepressants have the lowest passage to milk?
1. Sertaline
2. Paroxetine
3. Fluvoxamine
156
Risk assessment of the perinatal period?
157
Management of postpartum depression?
158
List the 5 types of psychcotic disorders.
1. Schizophrenia
2. Schizoaffective disorder
3. Psychotic depression
4. Delusional disorder
5. Bipolar affective disorder
159
What is bipolar disorder?
Characterized by recurrent episodes of depression and mania or hypomania. The symtpoms often start at a younger age (<25y/o) and has a high suicide rate.
160
What is the median duration of mania and depression?
Mania --> 4 months
Depression --> 6 months
161
What is the difference between bipolar disorder I and bipolar disorder II
- Bipolar disorder I --> at least one episode of mania
- Bipolar disorder II --> at least one episode of major depression and at least one episode of hypomania
162
List the DDx for bipolar disorder.
1. substance abuse (particularly cocaine and amphetamines)
2. Mood abnormalities secondary to endocrine disturbance (idiopathic Cushing's or steroid-induced psychoses) or epilepsy
3. Schizophrenia
4. Schizoaffective disoder
6. Personality disorders --> may mimic some features of the mood or behavioural disturbance of mania or hypomania
163
Define what is the mental health act?
It provides a legal framework for keeping patients in hospital against their wish for assessment and treatment of a mental health disorder. This is called being detained or sectioned under the Mental Health Act.
164
T/F: In a voluntary admitted patient, discharge maybe prevented
True
This can be prevented for up to 4 hours by the nurse
165
What 3 criteria that must be met to detain a person under the mental health act?
1. Severe mental health disorder
2. Risk of physical harm to self or to others
3. Deterioration of condition in community or prevent the administration of treatment that can NOT be given in community
166
What is MHA Section 2?
Section 2 involves compulsory admission for assessment following a Mental Health Act assessment, with a maximum period of 28 days.
It cannot be renewed. It ends in either discharge or further detention under Section 3.
167
What is MHA Section 3?
Section 3 involves compulsory admission for treatment. The maximum period is six months, after which the Responsible Clinician can arrange to renew it for further treatment.
Detention under Section 3 requires a Mental Health Act assessment. Patients that are well-known to mental health services may be detained under Section 3 straight from the community. Alternatively, patients may be detained under Section 3 following assessment under Section 2.
168
What is the Conveyance Order?
Persons on IATO, Extension of IATO , Continuing Detention Order, and CTO who either does not comply with the care plan, can not be located and are deem to deteriorate if kept in a community setting maybe brought to hospital against their will, by police assistance.
169
T/F: Capacity is decision-dependent, but not time-dependent.
False
It is time and descision dependent.
170
T/F: If a patient makes an irrational or strange descision, this means they lack capacity
False
171
T/F: Patient has capacity until proven otherwise
True
172
What is the first step in assessing capacity?
1. does patient have impairment and/or disturbance of brain function?
- If NO, then the patient has capacity
- If YES, does this mean they are unable to make a descision as a result?
173
How to manage an acute episode of mania? (bipolar disoder)
1. Antipsychotics (eg. olanzapine, quetiapine, risperdione, or haleperidol)
2. Lithium or sodium valporate
3. Antidepressants are stopped or tapered down (taper if risk of withdrawals eg. paroxetine, venlafaxine)
174
How to manage acute depressive episode? (bipolar disorder)
1. Olanzapine + Fluoxetine
2. Antipsychotics (eg. olanzapien or quetiapine)
3. Lamotragine
175
Long-term management of bipolar disoder?
176
Lithium SE?
1. Fine tremor
2. Weight gain
3. Chronic kidney disease
4. Hypothyroidism and goitre (it inhibits the production of thyroid hormones)
5. Hyperparathyroidism and hypercalcaemia
6. Nephrogenic diabetes insipidus
177
What is Cyclothymia?
Mild symptoms of hypomania and low mood. Not severe enough to signficantly impair their function
178
What is the psycho and social treatment for bipolar disorder?
Psychological treatment of bipolar disorder includes psychoeducation, CBT, interpersonal and social rhythm therapy, and family-focused therapy, with emphasis on relapse prevention and early warning sign recognition.
Social treatment includes community-based support, occupational and vocational assistance, structured daily routines, addressing substance misuse, family support, and ensuring safety and practical stability.
179
What are personality disorders (PDs)?
PDs are enduring, pervasive patterns of maladaptive thoughts, emotions, and behaviours that deviate markedly from what is considered normal within a particular culture. These patterns are inflexible, stable over time, and lead to significant distress or impairment in relationships, social functioning, and QoL.
PDs typically begin in adolescence or early adulthood and often arise from a combination of genetic vulnerability and adverse early-life experiences such as trauma or neglect.
180
List the categories of PDs.
1. Cluster A --> Suspicious (odd/eccentric)
2. Cluster B --> Emotional or impulsive (dramatic/flamboyent)
3. Cluster C --> Anxious
181
Which two PDs are more likely to present to emergency or psychiatric services?
Borderline (and to lesser extentet) Anti-Social
182
Management of antisocial PD?
183
List the most common conditions of secual function in men and women.
Men --> ED and/or ejaculation dysfuntion
Women: -
1. Low sexual intrest
2. Vaginusmus (inability to allow penetration)
3. Dyspareunia (pain on intercourse)
4. Lack of sexual enjoyment and organic dysfunction
184
Define obessions and compulsions.
Obsessions --> Unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore.
Compulsions --> Repetitive actions the person feels they must do, generating anxiety if they are NOT done. Often, these compulsions are a way for the person to handle their obsessions
Obessions and compulsions are present daily and are NOT something the person will enjoy or do willingly. They impact other areas of life such as their social life or other intrests.
185
DSM-5 Clinical Features of OCD (diagnsotic criteria).
186
Management of OCD?
- Mild OCD maybe treated with education and self-help resources
More significant OCD may require: -
1. CBT and exposure and responses prevention (ERP)
2. SSRI
3. Clomipramine --> Serotonergic TCA (strongest serotonin reuptake inhibitor among TCAs) bcz OCD responds best to strong serotonergic agents, and clomipramine is one of the most potent SRIs available.
187
What is Anakastic Personality Disorder?
- Also called "obsessive compulsive personality disoder"
Characteristic features include:
1. rigidity of thinking
2. perfectionism that may interfere with with completing tasks
3. moralistic preocupation with rules
4. excessive cleanliness and orderliness
5. objectively high standards that are seldom achieved
6. tendency to hoard
7. emotional coldness
188
Define anorexia nervosa.
The person feels they are overweight despite evidence of normal or low body weight. It involves obsessively restricting calorie intake to lose weight. Often, the person exercises excessively and may use diet pills or laxatives to limit the absorption of food.
189
List the diagnostic features of anorexia nervosa.
1. morbid fear of fatness
2. delibrate weight loss
3. distorted body image
4. BMI <17.5
5. amenorrhoea
6. loss of sexual interest and potency in men; in prepubertal boys development will be arrested
190
Management of anorexia nervosa?
- exclude other diagnoses and monitor mental health
- involve specialist services and MDT
- Management is centred around changing behaviour and addressing environmental factors:
1) self-help resources
2) psychological therapies - family interventions (1st line for adolescents) and for adults: CBT, IPT, focal psychodynamic therapy
3) Addressing other psychological factors such as depression, anxiety, and relationships (coesxistant depression should improve with weight gain, even without antidepressants)
4) Severe cases may require compulsory admission, where structured and symptom focused regime is provided, for observed refeeding (NG-tube maybe used) and monitoring for refeeding syndrome
191
Define bulimia nervosa.
People with bulima nervosa often have a normal body weight. Their body weight tends to fluctuate. The condition involves binge eating, followed by purging by inducing vomiting or taking laxatives to prevent thr calories from being absorbeb.
192
Diagnostic criteria for bulima nervosa.
1. morbid fear of fatness
2. craving for food and binge-eating (of large amounts in a short (eg. >2000 kcal in a session)
3. recurrent behaviours to prevent weight gain (eg. self-induced vomiting; misuse of laxatives, diuretics, enemas; omitting insulin if diabetic, fasting or excessive exercise)
4. preoccupation with body weight and shape
5. episodes are NOT exclusively during episodes of anorexia nervosa
193
Management of bulima nervosa?
1. Medical stabilization
2. Psychotherapy (usually CBT or IPT) to establish a regular eating programme, re-establish control of diet and address underlying abnormal cognitions
3. Antidepressants are effective - fluoxetine (60mg) but less effective than CBT
194
What is binge eating disorder?
Episodes where the personn excessively overeats, often as an expression of underylying psychological distress. The person typically feels a loss of control. Tends to be overweight.
195
Management of binge eating disorder?
- CBT, exercise and educational programmes.
- Anti-obesity medications such as orlistat are of short-term benefit.
- Surgery (eg. gastric banding or bypass surgery) is indicated in severe cases.
196
What are the 3 recognized diagnoses of autistic spectrum disorder (ASD)?
1. autistic disorder --> neurodevelopmental disorder chararacterized by impairments in social interactions and commiunication, along with restricted, repetitive behaviours, with inset before age 3. Often associated with language delay and intellectual disability.
2. asperger's syndrome --> display normal intelligence and ability to function but difficulty in reading emotions and responding to others
3. pervasive developmental disorder --> characterzied by some features, but NOT severe meeting full criteria for ASD
197
List the features, 3 of which are essential to make a diagnosis of ASD.
1. deficits in social communication, including verbal and non-verbal language and reduced eye contact
2. impaired social-emotional reciprocity
3. difficulties developing and maintaing relationships
4. restricted and repetitive behaviours, including resistance to change, rigid routine, stereotyped movements
5. restricted or highly focused intrests
6. onset in early childhood and associated functional impairment
198
At what age is the onset of ASD?
Onset is before the age of 3y/o and can even occur in the first few months
199
Management of ASD?
- Treatment is with specialist, intensive behavioral treatments (>25hours a week). These typically include:
1. breakdown skills into small tasks (like communitcation and cognitive skills), then teach those tasks in ahighly structured way
2. reward and reinforce positive behaviour
3. discourage and redirect inappropriate behaviour
- Family support and cousnelling are crucial
- It is important to note that ASD is a life-long condition and is not cured. Management depends on severity. Patients with mild impairments maybe highly functioning and NOT require formal support. An MDT can help support patients and carers with greater impairments (CAMHS, psychologists, paeds, SLT, dieticians, social workers)
200
Why is making a specific psychiatric diagnosis in patients with learning disability difficult?
1. Coexisting language deficits
2. Symptoms being attributed to the person's LD
201
T/F: Psychiatric disorders are more prevelant in people with learning disability and most people with LD have psychiatric conditions conditions.
False
They are more prevelant in poeple with LD but most do NOT have them
202
List the exact psychiatric conditions that are more prevelant with LD.
1. behavoiural disturbance --> more common with increasing severity LD (eg. purposeless or self-injurious behavoiur, aggresion or inappropriate sexual behaviout such as masturbation in public)
2. depression
3. anxiety (OCD and phobias)
4. dissociative sypmtoms (amnesia, episodes of unconsciousness, etc.)
5. schizophrenia
6. mania
203
What does it mean when you say: capacity is descion-specific?
Means that a person can make some decisions but not others
204
To have capacity, a patient must demonstrate the ability to...?
1. Understand --> the decision that needs to be made
2. Retain --> the information long enough to make the descision
3. Weigh up --> the options and the implications of choosing each option
4. Communicate --> their descision
205
Communicating with people with learning disabilities.
1. Ask if they use a communication aid - they might have a communication passport that describes how they communicate
2. Listen carefully
3. Look at the person when he or she is talking
4. If you cannot understand, try to make the person feel at ease by saying "sometimes it is difficult for me to understand. Could you say it again please"
5. Don't pretend to understand when you do not.
6. Ask the person if it is okay to ask a carer/support worker for help with communication.
206
List the different SEs of typical and atypical anti-psychotics.
- Typical (eg. Haloperidol) --> EPS: dystonia, akathisia, Parkinsonism. Risk of Tardive Dyskinesia (long-term)
- Atypical (eg. Olanzapine, Clozapine) --> Metabolic syndrome and agranulocytosis for clozapine
207
How long should antidepressants be continued after remission of symptoms? Why?
- At least 6 months after full remission
- This reduces the risk of relapse
- NICE: review after 2 weeks (or 1 week if <25 yrs or ↑ suicide risk)
- Continue treatment for ≥6 months after a good response
208
List the general types of psychosis.
1. schizophrenia
2. schizoaffective disorder
3. bipolar affective disorder
4. psychotic depression
5. post-partum psychosis
However, other ddx are important to keep in mind like --> substance use disorder and psychosis due to a medical condition
209
When does bipolar affective disorder typically appear?
Typically develops during the late adolesence and early adulthood, however it can arise for the first time during the perinatal period or re-occur
210
T/F: Women with bipolar disorder who cease their medication in pregnancy have twice the risk of relapse than those who maintain their medication
True
211
Questions to ask to detect mania.
Direct questions:
- Have you had periods of increased energy lasting atleast 4 days
- Were they accompanied by elevated or grandiose mood, low need for sleep, rapid speech, racing thoughts, or unusal creativity and productivity?
Indirect questions:
- Did other peopel teel you that you were too active, needed to slow down, or talking too fast?
- Have you ever been on medications for anxiety or to control your mood? If so what type?
212
T/F: Women with bipolar disorder, schizophrenia, or schizoaffective disorder should be referred to the perinatal mental health team antenatally, even if they are currently well.
True
213
T/F: Severe mental illnesses such as bipolar disorder and schizophrenia do not increase the risk of severe postpartum episodes.
False
214
T/F: Women with a first-degree relative who has bipolar disorder, schizophrenia, or puerperal psychosis should also be referred to perinatal services, even if they only show mild symptoms.
True
215
T/F: Only women who are currently symptomatic need perinatal psychiatric referral; asymptomatic women with a history of severe mental illness do not require referral.
False
216
T/F: A family history of severe mental illness does not affect the risk of postpartum psychiatric episodes.
False
217
In what psychiatric illness is post-partum psychosis mostly seen in?
Bipolar disorder --> most often seen in patient that have been or will be diagnosed with bipolar disorder
218
T/F: Patients with post-partum psychosis do not typically make a full recovery.
False
They typically make a full recovery
219
Describe the clinical features of post-partum psychosis and vriefly outline its treatment.
220
T/F: Some personality traits can worsen outcomes from physical illnesses.
True
221
Individuals with Type D personalities tend to have better recovery after myocardial infarction.
False
Type D --> worse recovery from MI
222
Type D personality is characterised by pessimism, worry, and social inhibition.
True
223
What is the mainstay treatment of somatsisation disorder and what should we focus on during the treatment?
Mainstay treatment is CBT together with a focus on psychosocial and NOT physical symptoms
224
T/F: In dissociative disorders, symptoms are often physical and usually neurological in nature.
True
Almost always neurological and occur in the absence of pathology and have a clear relationshp with stressful events or disturbed relationships
225
T/F: Dissociative disorder symptoms occur despite the presence of clear neurological pathology.
False
226
T/F: Dissociative symptoms commonly have a clear relationship with stressful events or disturbed relationships.
True
227
T/F: Dissociative disorders present with physical symptoms that are unrelated to psychological stress.
False
have a clear relationshp with stressful events or disturbed relationships
228
T/F: Chronic pain may responf to psychological therapy and antidepressants
Ture
Even in the absence of clear-cut depression
229
Define somatisation disorder.
Characterized by atleast two yeats of multiple physical symmptoms with no physical explanation; patients persistently refuse to accept the advice of the doctors that there is no physical explanation, and their social and family functioning is imapired as a result of the illness.
230
Define hypochondriacal disorder.
Non-delusional preoccupation with the possibility of serious illness such as cancer, heart disease, HIV or aids, despite medical reassurance
231
Define factitious disorder.
Deliberate feign or actually induce illness in themselves often to gain future from other os tangivle benefit
232
List the features/signs suggesting an organic problem.
FLAVOUR:
- F --> fluctuating symptoms
- L --> localised (specific) cognitive deficits
- A --> associated neurological signs
- V --> vague or transient paranoid delusions
- O --> olfactory or visual hallucinations
- U --> untypical symptoms of a functional disorder
- R --> record of cognitive disorder before psychiatric symptoms
233
What is the difference between schizophrenia and schizoaffective disorder?
Schizophrenia --> is a severe, long-term mental health disorder characterised by psychosis.
Schizoaffective disorder --> combines the symptoms of schizophrenia with bipolar disorder. Patients have psychosis and symptoms of depression and mania.
234
What is the ICD-10 criteria for acute stress reaction?
acute stress reactions require rapid onset
(within minutes or hours) of extreme responses to sudden and severe stressful events.
235
T/F: Acute stress reaction can develop into PTSD
True
236
What symptoms of acute stress reaction predict increase risk of PTSD?
Dissociative symptoms like wandering aimlessly and nightmares and reduced sleep.
237
List the 5 main categories of acute stress reaction symptoms
1. Intrusive symptoms --> re-experiencing the traumatic event (flashback, memories, nightmares)
2. Negative mood --> inability to experience postitive emotions
3. Dissociative symptoms --> altered sense of surroundings eg. wandering aimlessly
4. Avoidance symptoms --> avoidance of thought or memories of event
5. Arousal symptoms --> exaggerated startle response, insomnia, hyper vigilance
238
When is the onset of a ute stress reaction and what is the maximum amount of time that the symptoms last?
Symptom onset is usually immediatly (minutes to hours) and max is 1 month of lasting symptoms (this is the minimum of PTSD).
239
Post-traumatic stress disorder (PTSD) describes a constellation of symptoms and experiences that an individual develops after exposure to a traumatic event or multiple events. These include:
240
Bereavement requires death of a loved one
True
241
Upcoming surgery can precipitate adjustment disorder
True
242
All emotional reactions before surgery are pathological
False
243
Adjustment disorder occurs in response to identifiable stressors
True
244
Define GAD.
Excessive worry about a number of different events associated with heightened tension. Symptoms should be persistent, occuring most days for atleast 6 months, and NOT caused by substance use or another condition.
245
What symptoms is GAD usually associated with?
1. subjective apprehension (fears, worries)
2. increased vigillance
3. feeling restless and on edge
4. sleep difficulties (insomnia, fatigue on walking)
5. motor tension (tremore, hyperactive deep reflexes)
6. autonomic hyperactivity (eg. tachycardia)
246
DDx for GAD?
1. withdrawal from drugs or alcohol
2. excessive caffeine consumption
3. depression
4. psychotic disorder
5. organic causes
247
What is meant by the term “ego-syntonic” in personality disorders?
Ego-syntonic means that the individual perceives their behaviour and personality traits as acceptable or appropriate, and therefore does not usually experience distress about them. As a result, patients with personality disorders often lack insight and are less likely to seek treatment.
248
Describe borderline personality disorder and list features.
It is characterized by features of fluctuating strong emotions and difficulties with identitiy and maintaining healthy relationships. Patients often display:
1. marked impulsivity
2. fear of abandonment
3. recurrent self-harm or suicidal behaviour
4. unstable interpersonal relationships
249
How can Borderline Personality Disorder be distinguished from Bipolar Disorder?
In borderline personality disorder, mood changes are brief, rapid, and triggered by interpersonal stress, whereas in bipolar disorder, mood episodes are distinct, sustained, and episodic, lasting days to weeks. Borderline personality disorder is also associated with identity disturbance and fear of abandonment, which are not core features of bipolar disorder.
250
Describe the key features of Antisocial (Dissocial) Personality Disorder.
Characterized by features of reckless and harmful behaviour with a lack of concern of their cosequnces on themselves or other. These people fail to conform with social norms and are associated with criminal misconduct.
1. decitfulness and impuslivity
2. repeated unlawful or aggresive behaviour
3. lack of remorse or guilt
4. disregarud for the rights of others
251
Outline the essential features of Avoidant Personality Disorder.
Charactized by severe anxitey about rejection or disapproval and avoidance of social situations or relationships.
1. social inhibition
2. feelings of inadequacy
3. hypersensitivity to criticism
4. desires relationships but avoids them due to fear
252
Outline the essential features of Schizoid Personality Disorder.
Features of lack of intrest or desire to form relationships with others and feelings that there is no benefit to them.
1. prefers solitary activity
2. indifference to praise or criticism
3. restricted emotional expression
4. detachment from social relationships
253
Differentiate Avoidant Personality Disorder from Schizoid Personality Disorder.
Individuals with avoidant personality disorder desire social relationships but avoid them due to fear of rejection, whereas individuals with schizoid personality disorder show indifference to social relationships and prefer solitude. Avoidant personality disorder belongs to Cluster C, while schizoid personality disorder is part of Cluster A.
254
Outline the main features of Obsessive–Compulsive (Anankastic) Personality Disorder.
Features of unrelastic expectations on how things should be done by themselves and other and catstrophising about what will happen if these expectations are not met.
1. excessive conscientiousness
2. preoccupation with rules
3. perfectionism interfering with task completion
4. rigid and controlling, lack flexibility
255
Outline the main features of Paranoid Personality Disorder.
Characterzied by features of diffuclty in trusting others or revealing personal information to others.
1. pervasive distrust and suspiciousness
2. bears grudges and hypersensitive to criticism
3. reluctance to confide in others
4. interprets neutal remarks as threatening
NO delusions.
256
Outline the main features of Schizotypal Personality Disorder.
Characterized by features of unusual thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.
1. odd beliefs or magical thinking
2. ideas of refrence
3. social anxiety with paranoid fears, not low self esteem
4. unusual preceptual experiences
257
Outline the main features of Narcissistic Personality Disorder.
Feelings that they are special and need other s to recognize this, or else they get upset. They put themselves first.
1. grandiose sense of self-importance
2. lack of empathy
3. need for admiration
4. exploitative interpersonal relationships
257
Outline the main features of Histrionic Personality Disorder.
Need to be the centre of attention and preforming for others to maintain that attention
1. attention seeking behaviour
2. shallow, rapidly changing emotions
3. inappropriately seductive behaviour
4. highly suggestible.
258
Outline the main features of Dependent Personality Disorder.
Heavy reliance on others to make decisions and take responsibility for their lives, taking very passive approach.
1. excessive need to be taken care of
2. difficulty making descisions without reassurance
3. fear of seperation
4. submissive and clinging behaviour
259
T/F: Discontinuation syndrome implies addiction
False
Antidepressants are NOT addictive
260
T/F: Paroxetine commonly causes discontinuation syndrome
True.
The most common antidepressants that cause discontinuation syndrome are:
1. Paroxetine
2. Venaflaxine
This is because it has a very short half-life. Unlike fluoxetine which has a long half-life.
261
T/F: Fluoxetine is least likely to cause discontinuation syndrome
True
Because it has a long half life
262
T/F: SSRIs impair platelet aggregation
True
SSRIs act as antiplatelets aswell. Thus when combined with NSAIDs, which damage the muscosal layer, we must give PPIs aswell to prtoect from GI bleeding.
263
MD4 Semster 1
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