Which one of the following intervention is most likely to be beneficial in a patient with schizophrenia?
Correct Answer E:
Schizophrenia: management:
NICE published guidelines on the management of schizophrenia in 2009.
Key points:
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?
Correct Answer E: Whilst dementia is common in patients with Parkinson's disease depression is known to exist in around 40%
Parkinson's disease: features: Parkinson's disease is a progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra.. This results in a classic triad of features: bradykinesia, tremor and rigidity. The symptoms of Parkinson's disease are characteristically asymmetrical.
Bradykinesia:
Tremor:
Rigidity:
Other characteristic features:
Drug-induced parkinsonism has slightly different features to Parkinson's disease:
A patient with a history of depression presents for review.
Which one of the following suggests an increased risk of suicide?
Correct Answer B: Whilst arm cutting may sometimes be characterised as attention-seeking or 'releasing the pain' studies show that any history of deliberate self harm significantly increases the risk of suicide.
Employment is a protective factor.
Suicide:
Factors associated with risk of suicide following an episode of deliberate self harm:
These are in addition to standard risk factors for suicide:
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?
Correct Answer E: The mother may be suffering from puerperal psychosis and needs urgent admission to allow psychiatric evaluation.
Post-partum mental health problems:
Post-partum mental health problems range from the 'baby-blues' to puerperal psychosis:
*Paroxetine is recommended by SIGN because of the low milk/plasma ratio
**Fluoxetine is best avoided due to a long half-life
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 kind of disorder is this likely to represent?
Correct Answer C:
Unexplained symptoms: There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:
Somatization disorder:
Hypochondrial disorder:
Conversion disorder:
Dissociative disorder:
Munchausen's syndrome:
Malingering:
Click to expand