Psychiatry Module 3

A 65-year-old female with a history of ischaemic heart disease is noted to be depressed following a recent myocardial infarction. What would be the most appropriate antidepressant to start?

Sertraline

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Paroxetine

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Imipramine

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Flupentixol

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Venlafaxine

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A 35-year-old man with a history of schizophrenia is brought to the Emergency Department by worried friends due to drowsiness. On examination he is generally rigid. A diagnosis of neuroleptic malignant syndrome is suspected.

Each one of the following is a feature of neuroleptic malignant syndrome, except:

Usually occurs after prolonged treatment

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Renal failure

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Pyrexia

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Elevated creatine kinase

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Tachycardia

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A 64-year-old woman presents as she is feeling down and sleeping poorly. After speaking to the patient and using a validated symptom measure you decide she has moderate depression. She has a past history of cerebrovascular disease and currently takes aspirin, ramipril and simvastatin.

What is the most appropriate course of action?

Start citalopram and lansoprazole concurrently.

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Stop aspirin and start citalopram

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Start venlafaxine

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Switch aspirin to clopidogrel, then start citalopram

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Start citalopram

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Which one of the following intervention is most likely to be beneficial in a patient with schizophrenia?

Cognitive behavioural therapy

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Counselling

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Supportive psychotherapy

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Social skills training

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Adherence therapy

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A 69-year-old man is diagnosed as having Parkinson’s disease. Which one of the following psychiatric problems is most likely to occur in this patient?

Depression

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Tics

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Psychosis

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Mania

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Dementia

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A 25-year-old woman with a history of depression is brought to your clinic for evaluation. She has a busy job in a corporate office, is unmarried, and has a history of self-harm, including arm cutting.

Based on this scenario, which of the following factors suggests an increased risk of suicide in this patient?

History of arm cutting

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Being 25-years-old

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Being married

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Female sex

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Having a busy job

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A 31-year-old woman who gave birth two weeks ago presents for review with her husband. He is worried by her mood as she now seems depressed and is interacting poorly with the baby. He describes her mood three days ago being much different, when she was talking in a rapid and incoherent fashion about the future.

The mother denies any hallucinations but states that her child has been brought into a ‘very bad world’.

What is the most appropriate management?

Arrange an urgent admission

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Start fluoxetine

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Provide reassurance and arrange a routine review by a clinical psychiatrist next week.

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Offer cognitive behavioural therapy

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Start lithium

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A 36-year-old patient presents with nausea, headaches and palpitations. He has had multiple previous admissions with such symptoms over the past 2 years, each time no organic cause was found.

What type of disorder does this patient represent?

Somatisation disorder

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Munchausen's syndrome

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Hypochondrial disorder

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Conversion disorder

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Dissociative disorder

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The risk of developing schizophrenia if one monozygotic twin is affected is approximately:

50%

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10%

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20%

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75%

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>95%

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A 43-year-old man with a history of schizophrenia is taken off chlorpromazine due to troublesome parkinsonian symptoms.

Which of the following atypical antipsychotic is the least suitable alternative for him?

Clozapine

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Quetiapine

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Amisulpride

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Olanzapine

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Risperidone

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Which one of the following statements regarding cognitive behavioural therapy is incorrect?

Patients may get around 35-40 hours in total

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May be useful in the management of generalised anxiety disorder

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Can be used for patients already taking antidepressants

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Usually consists of one to two hour sessions once per week

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Should be completed within 6 months

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A patient reports feeling unwell after suddenly stopping paroxetine.

Which one of the following symptoms is most consistent with selective serotonin reuptake inhibitor discontinuation syndrome?

Diarrhoea

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Postural hypotension

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Myoclonic jerks

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Hallucinations

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Seizures

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A 42-year-old woman presents for review. Her husband reports that she has had an argument with their son which resulted in him leaving home. Since this happened she has not been able to speak. Clinical examination of her throat and chest is unremarkable.

Which one of the following terms best describes this presentation?

Psychogenic aphonia

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Aprosodia

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Schizophasia

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Expressive aphasia

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Akinetic mutism

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Which one of the following is least recognised as a potential adverse effect of electroconvulsive therapy?

Epilepsy

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Nausea

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Cardiac arrhythmias

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Short term memory impairment

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Headache

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A 24-year-old man is brought to the Emergency Department by his brother who is concerned about his odd behaviour. Over the past two weeks he has started to tell his brother that he can hear people talking about him on the radio. He denies any auditory hallucinations. During the consultation he scores 10/10 on the mini-mental state examination.

When asked to explain the meaning of the statement ‘people in glass houses shouldn’t throw stones’ he replies ‘you may break the glass’.

What is this an example of?

Concrete thinking

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Depression

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Autistic thinking

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Delusional disorder

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Acute mania

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A 16-year-old girl is brought for review by her father. She is talented violinist and is due to start music college in a few weeks time. Her parents are concerned she has had a stroke as she is reporting weakness on her right side. Neurological examination is inconsistent and you suspect a non-organic cause for her symptoms.

Despite reassurance about the normal examination findings the girl remains unable to move her right arm.

What is the most appropriate term for this behaviour?

Conversion disorder

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Hypochondrial disorder

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Munchausen's syndrome

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Somatisation disorder

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Munchausen's-by-proxy syndrome

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Which one of the following selective serotonin reuptake inhibitors has the highest incidence of discontinuation symptoms?

Paroxetine

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Citalopram

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Escitalopram

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Fluoxetine

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Sertraline

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You review a 55-year-old woman who has become dependant on temazepam, which was initially prescribed as a hypnotic.

She is keen to end her addiction to temazepam and asks for help. Her current dose is 20mg on.

What is the most appropriate strategy?

Switch to the equivalent diazepam dose then slowly withdraw over the next 2 months

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Switch to the equivalent zopiclone dose then slowly withdraw over the next 2 weeks

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Switch to the equivalent diazepam dose then slowly withdraw over the next 2 weeks

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Switch to the equivalent zopiclone dose then slowly withdraw over the next 2 months

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Switch to the equivalent chlordiazepoxide dose then slowly withdraw over the next 2 months

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A 34-year-old ex-soldier with a history of post-traumatic stress disorder returns for review. He has had a course of eye movement desensitisation and reprocessing therapy which was not helpful and is reluctant to try cognitive behavioural therapy.

Of the options listed, which medication may be useful in such patients?

Mirtazapine

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Fluoxetine

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Citalopram

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Topiramate

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Bupropion

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Which of the following types of tricyclic antidepressant is considered the safest in overdosage?

Lofepramine

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Nortriptyline

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Imipramine

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Dosulepin

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Clomipramine

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A 46-year-old man is seen by an occupation health doctor due to longterm sickness leave. He states chronic lower back pain prevents him from working but examination findings are inconsistent and the doctor suspects a non-organic cause of his symptoms. This is an example of a:

Malingering

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Conversion disorder

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Munchausen's syndrome

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Hypochondrial disorder

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Somatisation disorder

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You are considering prescribing a selective serotonin reuptake inhibitor for a patient with depression. Which class of drug is most likely to interact with a selective serotonin reuptake inhibitor?

Triptan

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Beta-blocker

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Thiazolidinediones

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Tetracycline

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Statin

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Which class of drug have the Medicines and Healthcare products Regulatory Agency warned may be associated with an increased risk of venous thromboembolism in elderly patients?

Atypical antipsychotics

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Tricyclic antidepressants

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5HT3 antagonists

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Third generation cephalosporins

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Benzodiazepines

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A patient presents three days after suddenly stopping diazepam after having taken it for over two years. He feels generally unwell.

Which one of the following features would suggest a diagnosis other than benzodiazepine withdrawal syndrome?

Hypothermia

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Loss of appetite

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Tinnitus

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Perceptual disturbances

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Perspiration

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A 45 year old man with a history of depression comes to your clinic for advise regarding his anti-depressant, citalopram 20mg daily, which he has been taking for the last 3 years.

He is feeling very well in himself now and therefore is asking if he could stop the medication.

What would your advise be?

Do not stop as their is a high risk of relapse.

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Stop for 6 months then resume at the same dose.

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Stop for 12 months then resume at half a dose.

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Reduce citalopram to 10mg daily for 3 months then stop.

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Stop cilatopram but later switch to sertraline after 6 months of stopping.

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In a recent study comparing the efficacy of subanesthetic intravenous ketamine to electroconvulsive therapy (ECT) in adults with treatment-resistant major depression without psychosis, which of the following statements best summarizes the findings?

Ketamine demonstrated noninferiority to ECT with a notable difference in response rates favoring ketamine.

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Ketamine was significantly inferior to ECT in reducing depressive symptoms.

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ECT was found to be superior to ketamine in all secondary outcomes, including quality of life and memory function.

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Both ketamine and ECT showed similar adverse effects, including musculoskeletal pain and dissociation.

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The primary outcome measure was the improvement in patient-reported quality of life, where ECT outperformed ketamine.

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Aripiprazole is a second generation anti-psychotic that is approved for the treatment of which condition?

Schizophrenia

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Behavioural problems in autism spectrum disorder

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Dementia related psychosis

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Tourette's syndrome

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Major depressive disorder

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Psychiatry Module 3

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