Liaison Psychiatry

Frage	Antworten
antidepressant with best evidence for use in post stroke depression is	Nortriptyline Patients with cardiovascular disease should be given nortriptyline only under close supervision because of the tendency of the drug to produce tachycardia and to prolong the conduction time (QT)
MADRS	Montgomery Asberg depression rating scale (MADRS) is a 10 items version, which is most sensitive to change when measuring the severity of depression.
Modafinil	Modafinil activates glutamatergic circuits while inhibiting GABAergic neurotransmission. increases the release of monoamines specifically the catecholamines, norepinephrine and dopamine from the synaptic terminals. Activates neurons containing orexins
common side effect of modafinil	Side effects are headache, appetite suppression, nervousness, and sleep disturbance.
Breastfeeding, Bipolar Relapse	Use Sodium Valproate
psychotherapy has established evidence in HIV associated depression	Interpersonal therapy
prevalence of comorbid depression in those with coronary heart disease is	20%
suicide rates in patients with Huntington's disease?	4 times higher than general population This increased risk is also seen in unaffected individuals in the same family. One must be careful not to offer insensitive or uninformed genetic counselling to the family.
Amnesia is the most common residual deficit following recovery from	Herpes simplex encephalitis
Symptoms in Ganser Syndrome	Ganser's syndrome is a rare syndrome characterized by approximate answers, clouded consciousness, pseudo-hallucinations and hysterical conversion symptoms.
A patient known to have bipolar disorder with mixed affective state is in the first trimester of her pregnancy	Olanzapine
medications could be used to treat pathological crying?	Citalopram
What would be the most appropriate drug for a depressed lady who is pregnant?	Fluoxetine
Features which are common in pseudoseizures	biting the tip of the tongue, seizures lasting more than 2 minutes, seizures having a gradual onset, a fluctuating course of disease severity, the eyes being closed during a seizure, and side to side head movements.
Idiopathic progressive calcium deposition in the basal ganglia	Fahr's disease
organic aetiology for anxiety include	onset of symptoms after the age of 35 years, lack of anticipatory anxiety, lack of avoidance behavior, and lack of personal or family history of anxiety disorders and poor response to short term anxiolytics
percentage of women with postpartum psychosis will go on to develop schizophrenia later in their lifetime?	16%
mptoms do you see more often in the later rather than the early stages of HIV dementia?	Paraparesis
Most common psychiatric symptom in Cushing's syndrome is	Depression
MRI finding is characteristically seen in Huntington's disease?	Caudate atrophy
Which drug used in the treatment of multiple sclerosis is associated with depression.	Beta and alpha interferons
Effective treatment for post-stroke depression based on the best available evidence?	Fluoxetine
included under dissociative disorders?	Trance and possession' disorders are placed under the general rubric of dissociative disorder (ICD-10) implying a psychological causation of symptoms.
case fatality rate in patients with herpes simplex encephalitis?	70%
Features of Non-epileptic seizures	The following factors in the history may support a diagnosis of non-epileptic seizures. (Dilley and Fleminger, 2006) 1. A psychiatric history 2. Regaining alertness and orientation rapidly 3. Ability to recall events clearly 4. The presence of social stressors.
MRI shows hypointensity of striatum in patients	Fahr's disease
Frequency of Baby Blues	3/4 of new mothers will experience a short-lived period of tearfulness and emotional lability starting two or three days after birth and lasting one to two days.
Doctor-shopping is an entity associated with	Somatisation disorder multiple, atypical, and inconsistent medically unexplained symptoms in a patient under the age of 40. There is excessive use of medical service and alternative therapies. Chronic cases will have had large numbers of diagnostic procedures and surgical or medical treatments.
What percentage of patients will die by completed suicide in the 12 months after an initial parasuicidal act?	0.01
What percentage of patients will die by completed suicide in the 24 months after an initial parasuicidal act?	1%
Peak incidence of head injury	15 - 24 years
co-morbid psychiatric condition associated with hypochondriasis	88% of patients with hypochondriasis had one or more concurrent psychiatric disorders, the most common being generalized anxiety disorder (71%)
Which lobe of the brain is commonly affected in patients with herpes simplex encephalitis?	Temporal
Older Medications in epileptic patients with depression	Moclobemide SSRIs are considered to be a good choice too in epileptic patients. Most TCAs are epileptogenic and ideally should be avoided completely. Amitriptyline, Dothiepin, Clomipramine and Bupropion should be avoided. Use mirtazapine, Venlafaxine, Reboxetine and duloxetine with care in epileptic subjects.
Cause of Herpes Encephalitis	HSV 1 (HSV 2 in neonates)
male: female ratio of hypothyroidism is	1:6
A woman who has had Herpes encephalitis develops severe carbohydrate craving, weight gain and inappropriate sexuality	Kluver-Bucy syndrome
weak inhibitor of cytochrome P450 enzyme system?	Citalopram
potent inhibitors of hepatic CYP enzyme systems (CYP2D6, CYP3A4).	Fluoxetine and Paroxetine
risk factor associated with depression in Parkinson's disease?	Female sex, younger onset, prominent right-sided signs, bradykinesia and gait disturbance, rapid disease progression, poorer cognitive status and activities of daily living.
prevalence of postpartum blues	50% of all pregnancies
PMS	Severe PMS affects 3-8% women in reproductive age Comorbidity with mood disorder is seen in 30-70% peak 2 days before start of menses and last for few days to 2 weeks.
Depressive relapse when d/c medication during pregnancy	he relapse rate was 26% for women who maintained their medication throughout their pregnancy, compared to 68% in women who discontinued medication.
Guilt	ssociated with depression, not premenstrual dysphoria.
antidepressant with favourable evidence for use in postpartum breastfeeding mother	Sertraline
Give ____ When taking S.valproate or Carbamazepine during pregnancy and after delivery	Prophylactic folic acid (5 mg daily, from at least a month before conception) should be used. Prophylactic Vitamin K should be given mother and neonate after delivery when valproate or carbamazepine is used.
relapse rate of depression in those who had a past history	50%
factors is most relevant if a pregnant woman is considered for ECT?	Barbiturates and atropine used for inducing anaesthetic state can reduce beat-to-beat variability in the foetal heart rate, and atropine can cause foetal tachycardia. Uterine smooth muscle does not routinely contract during a seizure so premature labour is almost unheard of. During pregnancy, prolonged gastric emptying time increases the risk of gastric regurgitation and aspiration pneumonitis
risk of developing spina bifida in the children of women treated with carbamazepine	0.5-1%
sedative would be safe during breast feeding?	Zolpidem
Benzodiazepines use during the first trimeste	0.6% risk of an oral cleft, CNS and urinary tract malformation. Neonatal toxicity (withdrawal symptoms), respiratory depression, muscular hypotonia (floppy baby syndrome) are also reported.
Breast Feeding and SSRI	SSRIs (Fluoxetine, sertraline, paroxetine and citalopram) and tricyclic antidepressants (except Doxepin) are safe. Sertraline is the first line of treatment across the globe.
Which of the following neurocognitive functions is most affected in children exposed to valproate during pregnancy?	Verbal IQ
SSRI and PMS	Advantages of intermittent SSRI dosing in PMT include a reduced withdrawal rate due to side effects and being more effective than continuous dosing
Disadvantages of intermittent dosing of SSRI in PMS	Less effective for somatic than for mood symptoms
bsolute spontaneous risk of Ebstein's Anomaly	1 in 20,000
Female patient 1st time pregnancy with a history of BPAD not taking treatment	A five-fold increased chance of a relapse into depression is seen in bipolar patients after delivery

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