Psychiatric Services

Question 1

What is prevention psychiatry?

Answer 1

Reduction of mental disorders/behavioral problems by identifying risk/protective factors and applying evidence-based interventions.

Question 2

What is primary prevention?

Answer 2

Preventing illness before it occurs
(e.g. vaccines, diet).

Question 3

What is secondary prevention?

Answer 3

Early identification and treatment to shorten duration (e.g. screening, EITs).

Question 4

What is tertiary prevention?

Answer 4

Reducing disability from established illness (e.g. rehab, relapse prevention).

Question 5

What is Geoffrey Rose’s ‘prevention paradox’?

Answer 5

Population-wide interventions reduce overall disease burden but offer small benefit to each individual.

Question 6

Types of preventative interventions (IOM 1994)?

Answer 6

Universal (entire population), Selective (high-risk subgroups), Indicated (individuals with subthreshold Sx of early illness).

Question 7

What are major risk factors for psychiatric disorders?

Answer 7

Biological, psychological/psychosocial, social/environmental.

Question 8

Who first induced therapeutic seizures for psychosis?

Answer 8

Ladislas von Meduna (1934, camphor-in-oil).

Question 9

Indications for ECT?

Answer 9

1st line: severe depression, psychosis, high suicide risk, catatonia, pregnancy + severe depression

2nd line: TRD, severe mania, TR schizophrenia/catatonia

Question 10

Absolute contraindications for ECT?

Answer 10

None.

Question 11

Common ECT side effects?

Answer 11

Short-term memory loss, retrograde/anterograde amnesia, headache, nausea, confusion.

Question 12

ECT effectiveness and relapse?

Answer 12

60-80% remission in severe depression, relapse >80% without maintenance.

Question 13

Maintenance ECT indications?

Answer 13

Early relapse despite drugs, intolerance to meds, patient preference, prior good response.

Question 14

Electrode placement for ECT?

Answer 14

Bilateral: both temples, 4cm above midpoint between eye and ear

Unilateral: nondominant hemisphere, frontal-parietal

Question 15

Which drugs increase seizure threshold?

Answer 15

Benzos, barbs, anticonvulsants.

Question 16

Which drugs decrease seizure threshold?

Answer 16

Antipsychotics, antidepressants, lithium.

Question 17

How does rTMS work?

Answer 17

Magnetic pulses stimulate cortical neurons without inducing generalised seizures.

Question 18

Indications for rTMS?

Answer 18

TRD, left DLPFC common target, outpatient, no anaesthesia needed

Question 19

rTMS side effects?

Answer 19

Site discomfort, transient headache, rare seizure (motor cortex stimulation).

Question 20

When is psychosurgery indicated?

Answer 20

Severe mood disorder or OCD resistant to all other evidence based treatments, informed consent required

Question 21

Adverse effects of modern stereotactic psychosurgery?

Answer 21

Headache, nausea, brief confusion; long-term effects rare.

Question 22

Common psychosurgical procedures?

Answer 22

Subcaudate tractotomy, anterior cingulotomy, limbic leucotomy, anterior capsulotomy.

Question 23

DBS mechanism and indications?

Answer 23

Electrodes stimulate brain regions via pacemaker, used in Parkinson’s disease, OCD, TRD, Tourette’s.

Question 24

DBS complications?

Answer 24

Infection, haemorrhage, seizures, neuropsychiatric effects, hardware issues

Question 25

Vagus nerve stimulation (VNS) indications?

Answer 25

TRD, partial-onset epilepsy; mechanism affects serotonin, norepinephrine, GABA and glutamate

Question 26

What is ICM?

Answer 26

Intensive Case Management for long-term care of severely mentally ill; small caseload <20, high intensity

Question 27

What is a CMHT?

Answer 27

Community Mental Health Team: multidisciplinary care, promotes continuity and engagement

Question 28

What is a CPA?

Answer 28

Care Programme Approach: structured aftercare plan with Care Coordinator, multiagency integration, enhanced for high-risk patients

Question 29

What is the purpose of EIP teams?

Answer 29

Early Intervention in Psychosis teams reduce duration of untreated psychosis, promote recovery, reduce morbidity/mortality, psychosocial damage

Question 30

Key elements of rehab in psychiatry?

Answer 30

Recovery-orientated, vocational skills, transitional/sheltered employment, peer support, holistic and strengths-based

Question 31

Difference between compliance, adherence, and concordance?

Answer 31

Compliance = passive following of instructions Adherence = outcome-focussed spectrum of behaviors Concordance = negotiated agreement respects patient preferences

Question 32

Most common human rights violations in mental illness?

Answer 32

Discrimination, exclusion, abuse (physical, sexual, emotional), restricted access to services/stigma

Question 33

Key ECHR rights relevant to psychiatry?

Answer 33

Right to life (Art 2), prohibition of torture (Art 3), liberty (Art 5), fair hearing (Art 6), private/family life (Art 8), non-discrimination (Art 14)

Question 34

What are the requirements for valid consent?

Answer 34

Information, competence, understanding, decision-making autonomy, communication.

Question 35

What is Gillick competence?

Answer 35

A child <16 yo may consent if competent; refusal can be overridden by parents/court if not competent.

Question 36

What are the exceptions to consent?

Answer 36

Implied consent in emergencies, statutory requirements, risk to self/others.

Question 37

What are MacArthur Treatment Competence Study 4 capacities for decision-making?

Answer 37

Choice, Understanding, Appreciation, Reasoning.

Question 38

Diagnostic requirement for PMDD?

Answer 38

≥5 Sx (≥1 mood core) in luteal phase x2 cycles.

Question 39

1st line Tx for PMDD?

Answer 39

SSRI (fluoxetine or sertraline).

Question 40

Dosing options for PMDD?

Answer 40

Continuous, luteal-phase only, or symptom-onset

Question 41

1st line antidepressant in depression in CHD?

Answer 41

SSRI (sertraline).

Question 42

Which antidepressants should be avoided in depression in CHD?

Answer 42

TCAs (↑MI risk)

Question 43

Hyperthyroidism causes which psychiatric Sx?

Answer 43

Anxiety and hypomania

Question 44

Hypothyroidism causes which psychiatric Sx?

Answer 44

Depression

Question 45

Myxoedema coma may present with which psychiatric Sx?

Answer 45

Psychosis

Question 46

Which bloods should always be checked in depression?

Answer 46

TFTs.