Psychiatry Viva Questions

Front 1

What are the key features of the psychiatric functional inquiry?

Back 1

Mood
Anxiety
Psychosis
Suicide / Homicide
Organic

Front 2

What must you include in past psychiatric Hx?

Back 2

Previous psychiatric diagnoses
Contact with psychiatrists
Treatments
Hospitalisations
Suicide Attempts

Front 3

What are the 5 axes of diagnosis?

Back 3

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

Front 4

What are the features of the MMSE?

Back 4

Orientation, memory, attention & concentration, language, spatial ability

Front 5

How is MMSE interpreted?

Back 5

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

Front 6

What is psychosis?

Back 6

Significant impairment in reality testing. Evidence:
a) Delusions or hallucinations without insight into their pathological nature
b) Disorganised behaviour

Front 7

What are the common Ddx for psychosis?

Back 7

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

Front 8

How long must person have psychotic symptoms to be diagnosed with Schizophrenia?

Back 8

1 month

Front 9

What are the subtypes of Schizophrenia?

Back 9

Paranoid
Catatonic
Disorganised
Undifferentiated

Front 10

What are the key features of the MSE?

Back 10

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

Front 11

What are the negative symptoms of schizophrenia?

Back 11

Affect flattening
Alogia
Avolition

Front 12

What is necessary for the diagnosis of schizoaffective disorder?

Back 12

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

Front 13

What are the major mood disorders?

Back 13

Depression
Bipolar I & II

Front 14

What must be included in the medical workup of mood disorders?

Back 14

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

Front 15

What are the risk factors for depression?

Back 15

Female
Age 25-50
FHx depression
EtOH abuse
Early childhood losses
Recent stressors
Social isolation

Front 16

What are the anxiety disorders?

Back 16

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

Front 17

Important medical Ddx of anxiety?

Back 17

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

Front 18

How long does it take for a panic attack to peak?

Back 18

10 minutes

Front 19

How does one distinguish OCD from OC Personality Disorder?

Back 19

OCD is ego-dystonic

Front 20

What are the 3 C's of substance dependence?

Back 20

Compulsive use
(loss of) Control
Consequences of use

Front 21

What is the CIWA-A protocol?

Back 21

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

Front 22

Which medication is commonly used to treat EtOH withdrawal?

Back 22

Benzodiazepine (e.g. Diazepam)

Front 23

Which vitamin is commonly administered in the management of EtOH withdrawal?

Back 23

Thiamine (Vitamin B1)

Front 24

What is the treatment for toxic reaction to opioids / opioid OD?

Back 24

ABC's
IV glucose
Naloxone
Intubation + Mechanical Ventilation

Front 25

What are some drugs of abuse that are screened for?

Back 25

MDMA ("Ecstasy" "E")
GHB
Ketamine
Methamphetamine
THC

Front 26

What is important in the assessment of suicidality?

Back 26

Suicidal ideation
Intent / Plan
Past attempts
Lethality of past attempts

Front 27

What are key features of anorexia nervosa?

Back 27

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

Front 28

What are the key features of bulimia nervosa?

Back 28

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

Front 29

What are three components of autism?

Back 29

Impaired social interaction
Delay in communication skill development
Restricted and repetitive behaviours

Front 30

What are the side effects of "typical" antipsychotics?

Back 30

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

Front 31

What are the features of Neuroleptic Malignant Syndrome?

Back 31

Fever
Autonomic changes
Rigidity of muscles
Mental status changes

Front 32

What are the four types of Extrapyramidal side effects?

Back 32

Dystonia
Akathisia
Pseudoparkinsonism
Dyskinesia

Front 33

How might tardive dyskinesia present?

Back 33

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

Front 34

What needs to be done for a patient on clozapine?

Back 34

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

Front 35

What are the symptoms of Serotonin Syndrome?

Back 35

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

Front 36

What are the side effects of Lithium?

Back 36

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

Front 37

Which benzodiazepines are appropriate for the geriatric population & why?

Back 37

Lorazepam, Oxazepam & Temazepam because they are not metabolised in the liver.

Front 38

What do you understand by the term "Major Depression"?

Back 38

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

Front 39

What do you understand by the term "Melancholic Depression"?

Back 39

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

Front 40

What do you understand by the term "Dysthymic Disorder"?

Back 40

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

Front 41

What do you understand by the term "Double Depression"?

Back 41

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

Front 42

What do you understand by the term "Bipolar Mood Disorder"?

Back 42

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.

Front 43

What do you understand by the term "Bipolar Spectrum Disorder"?

Back 43

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

Front 44

What do you understand by the term "Schizoaffective Disorder"?

Back 44

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

Front 45

What do you understand by the term "Mania"?

Back 45

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

Front 46

What do you understand by the term "Hypomania"?

Back 46

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

Front 47

What do you understand by the term "Psychotic Depression"?

Back 47

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

Front 48

What do you understand by the term "Mood Congruent Delusions"?

Back 48

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

Front 49

What are the risk factors for suicide?

Back 49

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

Front 50

What are the symptoms associated with suicide?

Back 50

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

Front 51

How do you assess suicidal intent?

Back 51

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

Front 52

How do you assess suicidal lethality?

Back 52

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

Front 53

How do you manage the suicidal patient?

Back 53

<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.

Front 54

Name 4 current antipsychotic medications + commonly used dosages.

Back 54

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

Front 55

Name 3 common long lasting antipsychotic depot injections + commonly used dosages.

Back 55

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

Front 56

Immediate acting depot injection + dosages.

Back 56

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

Front 57

Common side-effects of antipsychotic medication.

Back 57

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)

Front 58

Name a tricyclic antidepressant medication + dosage.

Back 58

Amitriptyline (Endep) 100-200mg

Front 59

Name 4 SSRIs + common dosages.

Back 59

Fluoxetine (20-60mg)
Paroxetine (20-40mg)
Sertraline (50-200mg)
Escitalopram (10-20mg)

Front 60

Name a reversible MAOi + common dosages.

Back 60

Moclobemide (300-900mg)

Front 61

Name a SNRI + usual dosage range.

Back 61

Venlafaxine (75-375mg)

Front 62

Name 3 mood stabilisers + usual dosage range.

Back 62

Lithium carbonate (500-1500mg)
Sodium valproate (500- 2000mg)
Carbamazepine (400-1200mg)

Front 63

Name 5 commonly used benzodiazepines + usual dosage range.

Back 63

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

Front 64

Name an anti cholinergic medication + dosage.

Back 64

Benztropine (0.5-6mg)

Front 65

Define "personality disorder"

Back 65

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.

Front 66

What is delirium?

Back 66

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

Front 67

What are the causes of delirium?

Back 67

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.)

Front 68

What is pseudodementia?

Back 68

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

Front 69

What medications can be used as an adjunct therapy in alcohol dependence?

Back 69

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

Front 70

What do you understand by the terms transference & counter-transference?

Back 70

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)

Front 71

How can transference and counter-transference affect clinical practice?

Back 71

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

Front 72

What is CBT?

Back 72

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