Psychy quick

Question 1

If SSRI isnt working ?

Answer 1

Try another SSRI or SNRI for GAD

Question 2

TCAs side effects

Answer 2

Overflow incontinence
Drowsy, dry mouth, blurred vision, constipation, urinary retention. lengthened QT

Question 3

Serotonin syndrome

Answer 3

MAOIs, SSRIs
ST johns wort and tramadol
Ecstasy and amphetamines

Hypreflexia, hyperthermia, myoclonus, sweating

Confusion

—> IV fluids and benzodiazepines

Question 4

NMS

Answer 4

Hours- days
Pyrexia, muscle rigidity, HTN, tachycardia , tachypnoea, Normal pupils

Raised CK, AKI and leukocytosis

IV fluids, stop antipsychotic, dantrolene

Question 5

Alcohol withdrawal

Answer 5

Decreased GABA and increased NMDA

0-12 hours - tremor
36 hours - seizures
72 hours - delirium tremens (hallucinations)

Give chlordiazepoxide OR in liver cirrhosis needs to be lorazepam

Question 6

Serotonin discontinuation symptoms

Answer 6

Increased mood change, restlessness, difficulty sleeping, unsteadiness, sweating, GI symptoms e.g. pain, cramping, diarrhoea, vomiting, paraesthesia

Question 7

Antipsychotics caution side effects in elderly

Answer 7

Increased risk of stroke and VTE

Question 8

What happens if clozapine doses are missed for 48 hours

Answer 8

Restart dose again slowly

Question 9

Schizophrenia first rank symptoms

Answer 9

Thought insertion and withdrawal and broastcarsting

Delusional

Hallucination
Body being controlled by outside influence

Question 10

T1 vs T2

Answer 10

t2 - hypomania

Question 11

SSRI in 3rd trimester

Answer 11

Pulmonary HTN risk in newborn

Question 12

Oculogyric crisis

Answer 12

Dystonic reaction
Give IM procyclidine

Question 13

Tetrabenzine

Answer 13

Tardive dyskinesia antidote

Question 14

Anorexia

Answer 14

G and Cs raised
GH, Glucose, salivary glands, cortisol, cholesterol, carrotinaemia

Question 15

Personality disorders clusters

Answer 15

A - Weird eg paranoid, schizoid, schizotypal

B - Emotional or impulsive e.g. antisocial, borderline, narcissistic

C- Anxious (wobbly), Obsessive compulsive, avoidant, dependent

Question 16

Personality disorders treatment

Answer 16

DBT

Question 17

Depression treatment

Answer 17

Guided self help first line if not sever e

If over 16- give them CBT and SSRI

Question 18

Anorexia treatment

Answer 18

CBT- ED for adults

Anorexia family therapy for children

Question 19

Histrionic

Answer 19

Attention seeking

Question 20

Section 2, section 3, section 4, section 5(2), section 5(4)

Answer 20

2- 28 days
3- 6 months
4- 72 hours

5 (2)- 72 hours
5 (4) - 6 hours ( nurse)

Question 21

135 and 136

Answer 21

135- court order for police to break in

136- take the to a place of safety

Question 22

Bulimia

Answer 22

Hypocholeramic, hypokalaemia alkalosis

1x a week for 3 weeks

Bulimia self help
if ineffective after 4 weeks —-> CBT ED

Question 23

MAOIs hypertensive reactions

Answer 23

With tyramine containing foods e..g cheese, marmite and broad beans

Question 24

Somatisation

Answer 24

Multiple physical symptoms present for 2 years
Patient refuses to accept reassurance or negative test results

Question 25

Hypochondriasis

Answer 25

Persistent blief in underlying illness e..g cancer

Question 26

FND

Answer 26

Motor or sensory functional loss

Question 27

Wernickes

Answer 27

Thiamine deficiency, most commonly alcoholics Opthalmoplegia, gait ataxia, encephalopathy, peripheral sensory neuropathy Low red cell transkelotase, MRI URGENT REPLACEMENT AND THIAMINE Korsakoffs - amnesia, confabulation

Question 28

Gynaecomastia

Answer 28

Kallmans, kleinefleters, testicular cancer - semioma secreting HCG, hyperthyroid Spiro, digoxin, goserelin, oestrogens Anabolic steroids

Question 29

Gallactorrhea

Answer 29

Prolactinoma, pregnancy, oestrogens, PCOS, metoclopramide

Question 30

Typical antipsychotics

Answer 30

E.g. haloperidol and chlopromaraine. Dopamine d2, positive symtoms fo schizophrenia EXTRAPYRAMIDAL - acute dystonia- abnormal tone - akathisia - psychomotor restlessness - Parkinsonism - tremor and rigid - Tardive dyskinésie - abormal movements Can get prolonged QT and TDP

Question 31

Atypical antipsychotics

Answer 31

Act on variety of receptors e.g. D2, d3, 5Ht e.g. Clozapine, risperidone, olazapine Positive and negative symptoms of schizo WEIGHT GAIN and metabolic syndrome Raised prolactin- galactorrhea, impaired glucose tolerance, NMS Reduced seizure tolerance

Question 32

Mitrazapine

Answer 32

Sedation and increased appetite

Question 33

Acute stress

Answer 33

4 weeks Trauma based CBT

Question 34

OCD

Answer 34

ERP therapy Y-BOCS scale Can do CBT/ SSRI - if SSRI doesnt wrok --? clomipramine

Question 35

PTSD

Answer 35

More than 1 month re experiencing, hyperarousal, emotional numbing, avoidance EMDR - venlafaxine, SSRI

Question 36

ECT

Answer 36

Severe repression, refractory to medications, catatonia, psychotic Raised ICP is contraindicated

Question 37

Acute manic episode

Answer 37

Olazapine, quetiapine, haloperidol Stop antidepressants

Question 38

Lithium, when to check and side effects?

Answer 38

Check levels 12 hours after dose Weekly until stable Thyroid and renal function every 6 months Side effects: - N and V, diarrhoea, weight gain, hypothyroid, hypercalcaemia, IIH, fine tremor

Question 39

Lithium toxicity

Answer 39

precipitated by: - dehydration, renal failure, acei, NSAIDs, thiazide Coarse tremor, polyuria, seizures, hyperreflexia ----> IV fluids haemodialysis

Question 40

BAD - if symptoms of hypomania? - if symptoms of mania? depression? mania?

Answer 40

Hypo- routine referral to community team hyper - CMHT urgently depression - fluoxetine mania- olazapine/ haloperidol