Psychiatry

Question 1

Acute stress disorder presentation and Mx

Answer 1

Presentation: Like PTSD but occurs in first 4 weeks

Mx: Trauma focused CBT, Benzo’s can be used for acute stymptoms like agitation or sleep disturbance

Question 2

Charles Bonnet syndrome presentation

Answer 2

Visual or auditory hallucinations
Visual impairment (age related macular degeneration)
Usually have insight

Question 3

Depression Screening

Answer 3

HAD
0-7 normal
8-10 borderline
11+ case

PHQ 9
< 16 on the PHQ-9: less severe depression
≥ 16 on the PHQ-9: severe depression

Question 4

Depression Mx

Answer 4

Reviewed after 2 weeks
If they are <25yo or high suicide risk review after 1 week
Continue on treatment for at least 6 months after remission
SSRI dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine)

Question 5

ECT contraindications

Answer 5

Raised ICP

Question 6

ECT short term SE

Answer 6

Headache
Nausea
Short term memory impairment
Memory loss of events prior to ECT
Cardiac arrhythmia

Question 7

ECT long term SE

Answer 7

Impaired memory

Question 8

Agrophobia

Answer 8

Fear of open spaces but also includes related aspects, e.g. the presence of crowds or the difficulty of escaping to a safe place

Question 9

GAD DD

Answer 9

Hyperthyrodism
Cardiac disease
Medication induced e.g. salbutamol, steroids

Question 10

GAD Mx

Answer 10

SSRI - first sertraline
Then offer alternative of SNRI like duloxetine or venlafaxine
If can’t tolerate SSRI or SNRI then pregabalin

Question 11

Personality disorders different types

Answer 11

Cluster A - Old or eccentric
Paranoid (hypersensitive, unforgiving when insulted)
Schizoid (indifferecne to praise and critism, preference to be alone)
Schizotypal (lack close friends)

Cluster B - Dramatic, emotional or erratic
Antisocial (Lack of remorse)
Boderline (EUPD)
Histrionic (Inappropriate sexual seductiveness)
Narcissistic

Cluster C - Anxious and fearful
Obsessive (rigid about etiquettes or morality, ethics or values)
Avoidant (Preoccupied with ideas that they are being critised or rejected in social circumstances)
Dependent (Difficulty making everyday decisions without excessive reassurance from others)

Question 12

PTSD Mx

Answer 12

Trauma focused CBT
EMDR
Drugs should not be used as first line
Venlafaxine
SSRI e.g. sertraline
Risperidone in severe cases

Question 13

Types of bipolar and how to differentiate

Answer 13

Type I disorder: mania (lasts >7 days) and depression (most common)
Type II disorder: hypomania (lasts >4 days)and depression

In mania you get psychotic symptoms

Question 14

Capgras syndrome

Answer 14

Delusion that a friend or partner has been replaced by an identical-looking impostor

Question 15

Bipolar Mx

Answer 15

Mood stabiliser
Mx mania by stopping antidepressants and prescribe antipsychotic e.g. olanzapine or haloperidol

Question 16

Othello’s syndrome

Answer 16

Thinks partner is cheating on them with no proof

Question 17

De Clerambault syndrome

Answer 17

Single women beliving famous person is in love with them

Question 18

Cotard syndrome

Answer 18

Believes that they (or is some cases just a part of their body) is either dead or non-existent

Question 19

Somatisation

Answer 19

Symptoms

Question 20

Hypochondriasis (illness anxiety disorder)

Answer 20

Cancer

Question 21

Functional neurological disorder (conversion disorder)

Answer 21

Loss of motor or sensory function

Question 22

Dissociative disorder

Answer 22

Separating certain memories from normal conscious

Question 23

Factious disorder

Answer 23

AKA munchausen’ syndrome
Intentional production of physical or psychological symptoms

Question 24

Malingering

Answer 24

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 25

Alcoholic hallucinosis

Answer 25

Psychiatric disorder considered separate from alcohol withdrawal, Wernicke's/Korsakoff's Defined as * a psychosis of less than 6 months duration * auditory hallucinations, often of persecutory or derogatory nature * occurs in clear consciousness

Question 26

Alcohol withdrawral presentation

Answer 26

Symptoms start at 6-12 hours (tremor, sweating, tachycardia, anxiety) Peak incidence of seizures at 36 hours Peak incidence of delirium tremens at 48-72 hours (coarse tremor, confusion, delsions, hallucinations, fever)

Question 27

Alcohol withdrawal Mx

Answer 27

Hx of complex withdrawrals e.g. seizures or tremens should be admitted to hospital for monitoring until withdrawrals have stabilised Long acting benxo e.g. chlorodizepoxide or diazpam

Question 28

Drugs that can be used to help with alcoholism

Answer 28

Disulfram = unpleasant symptoms Acamprosate = reduced cravings

Question 29

Karskoff's presentation

Answer 29

Untreated Wernicke's encephalopathy Presentation Anterograde amnesia: inability to acquire new memories Retrograde amnesia Confabulation

Question 30

Wernickes encephalopathy presentation

Answer 30

Oculomotor dysfunction e.g. nystagmus Gait ataxia Encephalopathy: confusion, disorientation Peripheral sensory neuropathy

Question 31

DVLA: - Active suicidal thoughts

Answer 31

Active suicidal thoughts - Must not drive and inform DVLA