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PSYCHIATRY: QUESTIONS AND ANSWERS

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Q.WHAT ARE THE KEY FEATURES OF THE PSYCHIATRIC FUNCTIONAL INQUIRY?

  1. Mood
  2. Anxiety
  3. Psychosis
  4. Suicide / Homicide
  5. Organic

Q. WHAT MUST YOU INCLUDE IN PAST PSYCHIATRIC HISTORY?

  • Previous psychiatric diagnoses
  • Contact with psychiatrists
  • Treatments
  • Hospitalizations
  • Suicide Attempts

Q. WHAT ARE THE 5 AXES OF DIAGNOSIS?

  • I – DSM-IV Disorders
  • II – Personality Disorders + Mental Retardation
  • III – General Medical Conditions
  • IV – Psycho-social Issues
  • V – Global Assessment of Function (GAF)

Q. WHAT ARE THE FEATURES OF THE MMSE?

  1. Orientation, memory
  2. Attention & concentration
  3. Language
  4. Spatial ability

Q. WHAT ARE THE KEY FEATURES OF THE MSE?

  • Appearance
  • Behavior
  • Conversation
  • Mood
  • Affect
  • Thought Process (TP)
  • Thought Content (TC)
  • Perception
  • Cognition
  • Insight
  • Judgment

Q. HOW IS MMSE INTERPRETED?

  • <24/30 abnormal
  • 20-24 mild cognitive dysfunction
  • 10-19 moderate
  • <10 severe

Q. WHAT IS PSYCHOSIS?

  • It is the significant impairment in reality testing characterized by:

a) Delusions or hallucinations without insight into their pathological nature

b) Disorganized behavior

Q. WHAT ARE THE COMMON DIFFERENTIAL DX FOR PSYCHOSIS?

  • General Medical Condition
  • Affective disorder
  • Drug/EtOH intoxication/withdrawal
  • Personality disorder
  • Psychotic disorder (e.g. Schizophrenia)

Q. HOW LONG MUST PERSON HAVE PSYCHOTIC SYMPTOMS TO BE DIAGNOSED WITH SCHIZOPHRENIA?

  • 1 month

Q. WHAT ARE THE SUB TYPES OF SCHIZOPHRENIA?

  • Paranoid
  • Catatonic
  • Disorganized
  • Undifferentiated

Q. WHAT ARE THE NEGATIVE SYMPTOMS OF SCHIZOPHRENIA?

  • Affect flattening
  • Alogia
  • Avolition

Q. WHAT IS NECESSARY FOR THE DIAGNOSIS OF SCHIZOAFFECTIVE DISORDER?

  • At least 2 weeks of psychotic features without prominent mood symptoms.

Q. WHAT ARE THE MAJOR MOOD DISORDERS?

  • Depression
  • Bipolar I & II

Q. WHAT MUST BE INCLUDED IN THE MEDICAL WORKUP OF MOOD DISORDERS?

  • Physical Examination
  • CBE, TSH, electrolytes
  • Urinalysis, urine drug screen

Q. WHAT ARE THE RISK FACTORS FOR DEPRESSION?

  • Female
  • Age 25-50
  • Family History of depression
  • EtOH abuse
  • Early childhood losses
  • Recent stressors
  • Social isolation

Q. WHAT ARE THE ANXIETY DISORDERS?

  • Panic disorder +/- agoraphobia
  • Generalized Anxiety Disorder
  • Simple phobia
  • Social Phobia
  • Obsessive Compulsive Disorder
  • Post-Traumatic Stress Disorder

Q. WHAT ARE THE IMPORTANT MEDICAL DIFFERENTIAL DX OF ANXIETY?

  • Hyperthyroidism
  • Pheochromocytoma
  • Hypoglycaemia (DM)
  • Arrhythmia
  • Asthma
  • Drug / EtOH intoxication/withdrawal
  • Myocardial Infarction

Q. HOW LONG DOES IT TAKE FOR A PANIC ATTACK TO PEAK?

  • 10 minutes

Q. HOW DOES ONE DISTINGUISH OCD FROM OC PERSONALITY DISORDER?

  • OCD is ego-dystonic

Q. WHAT ARE THE 3 C’S OF SUBSTANCE DEPENDENCE?

  1. Compulsive use
  2. (loss of) Control
  3. Consequences of use

Q. WHAT IS THE CIWA-A PROTOCOL?

  • A scoring system to monitor the management of AWS. Includes assessment of:
  • Nausea / vomiting
  • Tactile, auditory & visual disturbances
  • Tremor
  • Agitation, sweats, anxiety
  • Headache
  • Orientation

Q. WHICH MEDICATION IS COMMONLY USED TO TREAT ETOH WITHDRAWAL?

  • Benzodiazepine (e.g. Diazepam)

Q. WHICH VITAMIN IS COMMONLY ADMINISTERED IN THE MANAGEMENT OF ETOH WITHDRAWAL?

  • Thiamine (Vitamin B1)

Q. WHAT IS THE TREATMENT FOR TOXIC REACTION TO OPIOIDS / OPIOID OD?

  • ABC’s
  • IV glucose
  • Naloxone
  • Intubation + Mechanical Ventilation

Q. WHAT ARE SOME DRUGS OF ABUSE THAT ARE SCREENED FOR?

  • MDMA (“Ecstasy” “E”)
  • GHB
  • Ketamine
  • Methamphetamine
  • THC

Q. WHAT IS IMPORTANT IN THE ASSESSMENT OF SUICIDALITY?

  • Suicidal ideation
  • Intent / Plan
  • Past attempts
  • Lethality of past attempts

Q. WHAT ARE KEY FEATURES OF ANOREXIA NERVOSA?

  • Refusal to maintain body weight at or above minimally normal weight for age
  • Intense fear of gaining weight
  • Disturbance in perception of one’s body weight
  • Absence of >/= 3 menstrual cycles

Q. WHAT ARE THE KEY FEATURES OF BULIMIA NERVOSA?

  • Recurrent episodes of binge eating and inappropriate compensatory behaviour (i.e. purging)

Q. WHAT ARE THREE COMPONENTS OF AUTISM?

  1. Impaired social interaction
  2. Delay in communication skill development
  3. Restricted and repetitive behaviours

Q. WHAT ARE THE SIDE EFFECTS OF “TYPICAL” ANTIPSYCHOTICS?

  • Sedation
  • Cardiovascular
  • Anticholinergic & Antiadrenergic
  • Movement disorders
  • Neuroleptic Malignant Syndrome (NMS)
  • Extrapyramidal side effects

Q. WHAT ARE THE FEATURES OF NEUROLEPTIC MALIGNANT SYNDROME?

  • Fever
  • Autonomic changes
  • Rigidity of muscles
  • Mental status changes

Q. WHAT ARE THE FOUR TYPES OF EXTRAPYRAMIDAL SIDE EFFECTS?

  1. Dystonia
  2. Akathisia
  3. Pseudoparkinsonism
  4. Dyskinesia

Q. HOW MIGHT TARDIVE DYSKINESIA PRESENT?

  • Involuntary:
  • Grimacing, Tongue Protrusion, Lip Smacking, Rapid Eye Movement

Q. WHAT NEEDS TO BE DONE FOR A PATIENT ON CLOZAPINE?

  • Weekly blood counts for 1 month, then every two weeks after.
  • Why? Risk of agranulocytosis.

Q. WHAT ARE THE SYMPTOMS OF SEROTONIN SYNDROME?

  • Nausea, diarrhoea, palpitations, chills, restlessness, confusion, and lethargy.
  • CAN PROGRESS TO:
  • Myoclonus, hyperthermia, rigor & hypertonicity.

Q. WHAT ARE THE SIDE EFFECTS OF LITHIUM?

  • Leukocytosis
  • I (diabetes) Insipidus
  • Tremor, Teratogenicity
  • Hypothyroidism
  • Increased weight
  • U(vomiting & nausea)
  • Misc. (ECG changes, acne)

Q. WHICH BENZODIAZEPINES ARE APPROPRIATE FOR THE GERIATRIC POPULATION & WHY?

  • Lorazepam
  • Oxazepam & Temazepam

They ar appropriate because they are not metabolized in the liver.

Q. WHAT DO YOU UNDERSTAND BY THE TERM “MAJOR DEPRESSION”?

  • 5/9 for 2/52
  • Behaviour change (psychomotor retardation / agitation)
  • Appetite (decreased / increased)
  • Depressed mood – persistent & pervasive
  • Concentration difficulties
  • Ruminations
  • Interest/pleasure (loss of) anhedonia
  • Sleep disturbance
  • Energy (loss of)
  • Suicidal Ideation

Q. WHAT DO YOU UNDERSTAND BY THE TERM “MELANCHOLIC DEPRESSION”?

  • Anhedonia
  • Retarded or agitated
  • Anorexia
  • Non-reactive Mood
  • Guilty ruminations
  • Diurnal mood variation
  • Distinct quality of mood

Q. WHAT DO YOU UNDERSTAND BY THE TERM “DYSTHYMIC DISORDER”?

  • Most days for 2 years depressed mood for most of the day.
  • Never absent for >2/12

Q. WHAT DO YOU UNDERSTAND BY THE TERM “DOUBLE DEPRESSION”?

  • People with dysthymic disorder who occasionally lapse into a MDE, then when MDE resolves return to chronic dysthymic state

Q. WHAT DO YOU UNDERSTAND BY THE TERM “BIPOLAR MOOD DISORDER”?

  • BPAD I – 1 or more manic / mixed episodes with or w/o MDE.
  • BPAD II – at least 1 MDE and at least 1 hypomanic episode, no past manic / mixed episodes.

Q. WHAT DO YOU UNDERSTAND BY THE TERM “BIPOLAR SPECTRUM DISORDER”?

  • Does not meet DSM-IV criteria for BPAD I or II but exhibit cyclothymia (cyclical changes in mood).

Q. WHAT DO YOU UNDERSTAND BY THE TERM “SCHIZOAFFECTIVE DISORDER”?

  • Psychotic symptoms for the majority of 1/12
  • AND at least 1 MDE, manic / mixed episode
  • MUST have had psychotic symptoms present for at least 2 weeks w/o prominent mood Sx

Q. WHAT DO YOU UNDERSTAND BY THE TERM “MANIA”?

  • >1/52 abnormally elevated, expansive or irritated mood
  • Distractibility
  • Indiscretion
  • Grandiosity
  • Flight of Ideas
  • Activity Increased
  • Sleep (decreased need for)
  • Talkativeness (pressured speech)

Q. WHAT DO YOU UNDERSTAND BY THE TERM “HYPOMANIA”?

  • As mania BUT is NOT severe enough to cause a marked impairment in social or occupational functioning

Q. WHAT DO YOU UNDERSTAND BY THE TERM “PSYCHOTIC DEPRESSION”?

  • One of the most SEVERE forms of depression in which person experiences psychotic symptoms (usually paranoid / mood-congruent delusions & hallucinations)

Q. WHAT DO YOU UNDERSTAND BY THE TERM “MOOD CONGRUENT DELUSIONS”?

  • Delusional content is consistent with mood.
  • e.g. Depressed “world is ending”
  • Manic “possess magical talents or abilities”

Q. WHAT ARE THE RISK FACTORS FOR SUICIDE?

  • Sex male
  • Age 15-24, 75-84
  • Depression (45-70% of all attempts)
  • Previous attempts
  • Ethanol abuse
  • Relationship issues
  • Social support lacking
  • Organized plan
  • No spouse
  • Sickness
  • Psychosis with demand hallucinations
  • Hopelessness a better indicator of suicide than mood

Q. WHAT ARE THE SYMPTOMS ASSOCIATED WITH SUICIDE?

  • Hopelessness
  • Anhedonia
  • Severe anxiety, panic attacks
  • Sleep disturbances
  • Impaired concentration
  • Psychomotor agitation

Q. HOW DO YOU ASSESS SUICIDAL INTENT?

  • Risk factors
  • Onset
  • Precipitating, aggravating, relieving factors
  • Frequency of thoughts
  • How much control of thoughts
  • What keeps them alive

Q. HOW DO YOU ASSESS SUICIDAL LETHALITY?

  • Access to means e.g. firearms, hanging, gases, drugs
  • Funeral plans
  • Practiced suicide
  • Changed life-insurance / will
  • Given away possessions

Q. HOW DO YOU MANAGE THE SUICIDAL PATIENT?

  • <3 RF consider sending home with family.
  • >3 RF hospitalize
  • 1. Make the patient feel safe
  • 2. OACIS, case notes & collateral Hx to determine previous Mental Illness.
  • 3. If attempt has been made, attend to medical consequences
  • 4. Define stressors
  • 5. Arrange inpatient treatment +/- detainment
  • 6. Suicide is a Sx of mental illness, treat underlying illness & Sx will resolve.

Q. NAME 4 CURRENT ANTIPSYCHOTIC MEDICATIONS + COMMONLY USED DOSAGES.

  1. Risperidone (2-8mg)
  2. Quietapine (300-900mg)
  3. Olanzapine (10-20mg)
  4. Clozapine (200-600mg)

Q. NAME 3 COMMON LONG LASTING ANTIPSYCHOTIC DEPOT INJECTIONS + COMMONLY USED DOSAGES.

  • Haloperidol decanoate (25-300mg 4 wkly)
  • Risperidone (25-50mg 2 weekly)
  • Zuclopenthixol decanoate (200-400mg 4 weekly)

Q. MENTION THE IMMEDIATE ACTING DEPOT INJECTION + DOSAGES.

  • Zuclopenthixol acetate (acuphase) (50-150mg) every 2-3 days max. 4 doses

Q. NAME COMMON SIDE-EFFECTS OF ANTIPSYCHOTIC MEDICATION.

  • Weight gain (esp. atypical)
  • Sedation
  • Hypertension
  • Extrapyramidal effects (e.g. akathisia, dystonia, tardive diskinesia)
  • Elevation of the hormone prolactin (rediced libido, disturbance of menstrual cycle, galactorrhoea)

Q. NAME A TRICYCLIC ANTIDEPRESSANT MEDICATION + DOSAGE.

  • Amitriptyline (Endep) 100-200mg

Q. NAME 4 SSRIS + COMMON DOSAGES.

  1. Fluoxetine (20-60mg)
  2. Paroxetine (20-40mg)
  3. Sertraline (50-200mg)
  4. Escitalopram (10-20mg)

Q. NAME A REVERSIBLE MAOI + COMMON DOSAGES.

  • Moclobemide (300-900mg)

Q. NAME A SNRI + USUAL DOSAGE RANGE.

  • Venlafaxine (75-375mg)

Q. NAME 3 MOOD STABILIZERS + USUAL DOSAGE RANGE.

  1. Lithium carbonate (500-1500mg)
  2. Sodium valproate (500- 2000mg)
  3. Carbamazepine (400-1200mg)

Q. NAME 5 COMMONLY USED BENZODIAZEPINES + USUAL DOSAGE RANGE.

  1. Clonazepam (0.5-6mg)
  2. Diazepam (2-25mg)
  3. Lorazepam (1-6mg)
  4. Oxazepam (7.5-90mg)
  5. Temazepam (10-20mg)

Q. NAME AN ANTI-CHOLINERGIC MEDICATION + DOSAGE.

  • Benztropine (0.5-6mg)

Q. DEFINE “PERSONALITY DISORDER”

  • An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture.
  • Manifested in two or more of; cognition, affect, interpersonal functioning, impulse control
  • Inflexible and pervasive across a range of situations.
  • Causes distress & impaired occupational and social functioning.
  • >18 y.o. for diagnosis
  • Associated with many complications mental illness, violence, substance abuse etc.

Q. WHAT IS DELIRIUM?

  • Acute confusional state with global dysfunction of CNS with underlying GMC.
  • Consciousness is disturbed
  • Cognition is disturbed
  • Develops quickly hours – days

Q. WHAT ARE THE CAUSES OF DELIRIUM?

  • Infectious (encephalitis, meningitis, pneumonia, UTI)
  • Withdrawal (drug / EtOH)
  • Acute metabolic disorder
  • Trauma (head)
  • CNS pathology
  • Hypoxia
  • Deficiencies (B12, folate, thiamine)
  • Endocrinopathy
  • Acute vascular (shock, vasculitis)
  • Toxins, substance abuse, MEDICATION
  • Heavy metal (Pb, Hg etc.)

Q. WHAT IS PSEUDODEMENTIA?

  • Cognitive deficits accompanying depression or other psych illness. Usually resolve with Rx, but risk of progressing to real dementia esp. w/o Rx

Q. WHAT MEDICATIONS CAN BE USED AS AN ADJUNCT THERAPY IN ALCOHOL DEPENDENCE?

  • Disulfiram – Inhibits metabolism of EtOH in liver -> excess acetaldehyde
  • Naltrexone – mu opioid antagonist reduces pleasure effect of alcohol
  • Acamprosate – Modulation of glutamate & GABA NT system

Q. WHAT DO YOU UNDERSTAND BY THE TERMS TRANSFERENCE & COUNTER-TRANSFERENCE?

  • Transference: Phenomenon where a patient’s perceptions, feelings, behaviour towards the therapist are subconsciously influenced by their past relationships & experiences.
  • Counter-transference: Phenomenon where the therapists perceptions, feelings and behaviours towards the patient are influenced by previous experiences with patients (in response to patient’s transference)

Q. HOW CAN TRANSFERENCE AND COUNTER-TRANSFERENCE AFFECT CLINICAL PRACTICE?

  • Can undermine therapeutic process
  • Cloud clinical judgment
  • Therapist must remain non-judgmental and assume an empathetic & professional stance.

Q. WHAT IS CBT?

  • Combines cognitive and behaviour therapies to teach the patient to weaken connections between thinking patterns, habitual behaviours and mood and anxiety problems.

 

 

 

 

 

 

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