1. psych
Tom dalton, ct1

2. PART 1: meds

3. PART 1: meds Which of the following is an SSRI: Vortioxetine
Duloxetine
Paroxetine
Mirtazapine
Pictures of baby animals
SSRI
Sertraline, Fluoxetine, Citalopram, Escitalopram, Paroxetine
SNRI
Duloxetine, Venlafaxine
TCA
Clomipramine, Amitriptyline, Imipramine
NaSSA
Mirtazapine
NDRI
Bupropion

4. PART 1: meds
Which of the following medications is likely to be most well-tolerated:
Venlafaxine
Selegiline
Olanzapine
Sertraline
Pictures of baby animals
- [SSRI], hypotension, ++withdrawal effects
- CHEESE
- Sedation, metabolic, (EPSEs)
- [SSRI]
- None
SSRI SIDE EFFECTS
Early: GI symptoms, sleep disturbance, anxiety
Ongoing: Sexual dysfunction

5. PART 1: meds Which of the following is not an atypical antipsychotic:
Clozapine
Paliperidone
Clopixol
Zuclopenthixol
Amisulpride
TYPICAL
Haloperidol, Chlorpromazine, Zuclopenthixol,
(old ones ending in “-azine”)
ATYPICAL
Clozapine, Olanzapine, Risperidone, Aripiprazole, Quetipine, Amisulpride,

6. PART 1: meds Which of the following is not an EPSE: Oculogyric crisis
Intention tremor
Bradykinesia
Pacing up and down the ward
Tardive dyskinesia
EXTRAPYRAMIDAL SIDE-EFFECTS
- Acute Dystonia
- Parkinsonism/Akinesia
- Akathisia
- Tardive dyskinesia

7. PART 1: meds
What is the most suitable treatment for oculogyric crisis?
Procyclidine 5mg IM
Procyclidine 10mg PO
Midazolam 5mg IV
Manage the airway
A nice cup of tea
ACUTE DYSTONIA
Antimuscarinic (ie. Procyclidine 5-10mg) PO or IM/IV depending on swallowing
Benzodiazepines not often used
Have a cup of tea afterwards
Procyclidine 5-10mg may be given regularly or PRN up to TDS for recurrent EPSEs

8. PART 1: meds
Your patient has just been started on a mYsTERy pSYcHoTROpic mEDiCAtioN.
They present with agitated delirium, hyperthermia, rigidity, shivering and myoclonus.
What’s the most likely diagnosis?
Influenza
Serotonin Syndrome
Neuroleptic Malignant Syndrome
Ignore it they’re just a mad person lol
SEROTONIN SYNDROME
Presentation:
Mental status change
Myoclonus, hyperreflexia, rigidity
D&V
Autonomic instability
Diaphoresis
Tachycardia
Hyperthermia
Hypertension

9. PART 1: meds Which of the following is not a symptom of NMS:
Palpitations
High fever
Muscle rigidity
CK >1000
Confusion
NEUROLEPTIC MALIGNANT SYNDROME
Presentation:
Mental status change (?catatonia)
Muscular Rigidity
Hyperthermia (commonly >40°C)
Autonomic instability
Tachycardia
Labile BP
Tachypnoea
Ix Findings:
Leucocytosis
High CK
AKI + other electrolyte abnormalities

10. PART 1: meds
You accidentally gave someone too much diazepam and they are snoring. What do?
Support the airway and wait for it to wear off
Support the airway and prescribe flumazenil
Monitor pulse oximetry
Drop a few mg yourself and have a lovely afternoon

11. PART 1: meds
Someone just accidentally consumed too much blow and have arrived in A&E shortly afterwards. What do?
Naloxone 400mg IV, supportive management and monitor closely
Activated charcoal
Supportive management and consider benzodiazepines
Supportive management and fomepizole, or ethanol
Pop to the bathroom and check UrbanDictionary
- Opioids
<4h after PO OD
- Methanol

12. PART 1: meds
Match the medication to the vaguely sensible starting dose:
Fluoxetine
Lithium Carbonate
Sertraline
Olanzapine
Super Saiyan Level
>9000 units
20mg
5mg
400mg
50mg

13. PART 1: meds
I would not be too concerned if my patient’s lithium level was:
0.1
0.5
1.5 4 40
Too damn high

14. PART 1: meds
You have just started your patient on Lithium. Which of the following statements is a filthy lie?
Levels should be taken 12 hours after the dose
Aim for a serum-lithium concentration of 0.8–1 mmol/litre for acute episodes of mania
Routine serum-lithium monitoring should be performed daily for the first week after initiation and after each dose change until concentrations are stable
When doses are stable, and in the absence of significant intercurrent illness, levels should be taken every 3 months
This is the best damn psychiatry quiz I have ever experienced
Monitor BMI, serum electrolytes, eGFR, and thyroid function at baseline and every 6 months during treatment

15. PART 2: some other things
Which of the following is the most useful part of the AMT-10 for diagnosing delirium:
Months of the year backwards
Orientation (time/place/person)
Short-term memory test
Who is the current prime-minister
To know the Kings of England and to quote the fights historical, from Marathon to Waterloo in order categorical

16. PART 2: some other things
A gentleman on AMU has UTI on BG of MCI and now has delirium. He is taking ramipril, oxybutynin, sinemet and sodium valproate. Overnight he thinks there are spiders everywhere and starts trying climb the furniture. What do?
Stop his oxybutynin
Grab‘n’Stab (lorazepam 2mg IM under restraint)
Give haloperidol 5mg PO
Guided relaxation exercises
Help him kill the spiders oh lawd they're everywhere

17. PART 2: some other things
Said gentleman later wakes up and tries to leave the ward, mumbling incoherently about spiders. What do?
Send him on his merry way
Fill out a Section 5(2)
Cuff him to a chair and tell him he does not have to say anything but it may harm his defence if he does not mention when questioned something he later relies on in court
Make a recommendation for Section 2
Fill out DoLS

18. PART 2: some other things
MCA:
Presumption of capacity
Does the person have an impairment or disturbance of the functioning of their mind or brain?
Does the impairment or disturbance of their mind or brain mean that the person is unable to make a particular decision? (understand, retain, weigh up, communicate)

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