Q.WHAT ARE THE KEY FEATURES OF THE PSYCHIATRIC FUNCTIONAL INQUIRY?
- Mood
- Anxiety
- Psychosis
- Suicide / Homicide
- 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?
- Orientation, memory
- Attention & concentration
- Language
- 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?
- Compulsive use
- (loss of) Control
- 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?
- Impaired social interaction
- Delay in communication skill development
- 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?
- Dystonia
- Akathisia
- Pseudoparkinsonism
- 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.
- Risperidone (2-8mg)
- Quietapine (300-900mg)
- Olanzapine (10-20mg)
- 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.
- Fluoxetine (20-60mg)
- Paroxetine (20-40mg)
- Sertraline (50-200mg)
- 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.
- Lithium carbonate (500-1500mg)
- Sodium valproate (500- 2000mg)
- Carbamazepine (400-1200mg)
Q. NAME 5 COMMONLY USED BENZODIAZEPINES + USUAL DOSAGE RANGE.
- Clonazepam (0.5-6mg)
- Diazepam (2-25mg)
- Lorazepam (1-6mg)
- Oxazepam (7.5-90mg)
- 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.
