The risk of developing schizophrenia if one monozygotic twin is affected is approximately:
Correct Answer C:
Schizophrenia: epidemiology:
Risk of developing schizophrenia:
A 43-year-old man with a history of schizophrenia is taken off chlorpromazine due to troublesome parkinsonian symptoms.
Which one of the following atypical antipsychotic is it least suitable for him to be commenced on as the next step?
Correct Answer E: Clozapine is no longer used first-line due to the risk of agranulocytosis.
Atypical antipsychotics:
Atypical antipsychotics should now be used first-line in patients with schizophrenia, according to 2005 NICE guidelines. The main advantage of the atypical agents is a significant reduction in extrapyramidal side-effects.
Adverse effects of atypical antipsychotics:
The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:
Examples of atypical antipsychotics:
Clozapine, one of the first atypical agents to be developed, carries a significant risk of agranulocytosis and full blood count monitoring is therefore essential during treatment. For this reason clozapine should only be used in patients resistant to other antipsychotic medication.
Adverse effects of clozapine:
Which one of the following statements regarding cognitive behavioural therapy is incorrect?
Correct Answer E:
Cognitive behavioural therapy:
Main points:
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?
Correct Answer B: Selective serotonin reuptake inhibitor discontinuation syndrome can present with a wide variety of symptoms including diarrhoea, vomiting and abdominal pain.
Depression: selective serotonin reuptake inhibitors:
Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression:
Adverse effects:
Interactions:
Following the initiation of antidepressant therapy patients should normally be reviewed by a doctor after 2 weeks.
For patients under the age of 30 years or at increased risk of suicide they should be reviewed after 1 week. If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse.
When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.
Discontinuation symptoms:
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?
Correct Answer E: Psychogenic aphonia is considered to be a form of conversion disorder. Please see the link for more details.
Aphonia:
Aphonia describes the inability to speak. Causes include:
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