Mental health

1. Mental health

2. Which is not a criterion for substance abuse • Recurrent use when physically hazardous • Tolerance • Continued use despite persistent/recurrent social or interpersonal problems • Recurrent substance-related legal problems

3. Match the correct drug and mechanism of action • Alcohol • Barbiturates • Benzodiazepines • Amphetamines • Cocaine • Nicotine • LSD • Codeine • Marijuana • Enhance GABA effects • Acts on serotonin receptors • Possibly dec Ca2+ channels • Potentiate GABA • Stimulate cannabinoid receptors • Stimulate opioid receptors • Inhibit DA, NA and 5-HT transporters • Stimulates nicotine receptors • Release of DA, NA and 5-HT

4. Which is generally not a recommended treatment option for drug overdose? • Haemodialysis • Administer antidote • Emesis • Activated charcoal

5. What is the MOA of paracetamol toxicity? • Conjugation with glucuronide • Reaction with the scavenger glutathione • Conjugation with sulphate • Hydroxylation and rearrangement to NAPBQI

6. Which is a protective factor for suicide? • Intelligence • Male gender • Lack of spouse • Ethanol intake

7. What are some considerations when communicating with patients in a mental health setting? • Ensure privacy • Introduce yourself to patient (and carer) • Sit down, be willing to listen and do not hurry • Body language (comfortable distance, use eye contact but do not over-do it) • Generally do not touch the patient • Ask open ended questions where possible to facilitate discussion • Tolerate silences • Repetition • Identify the patient’s emotions • Allow the patient to maintain their dignity (engage them in planning) • Respect cultural/religious practices

8. What are the important points in a mental status examination • Appearance and behaviour (eye contact and rapport; personal hygiene; facial expressions; motor behaviour; autonomic arousal) • Speech (form, volume, content) • Mood (affective expression, appropriateness, ?suicidal ideation) • Thought and perception (stream of thought, form, thought content, perceptions, delusions, hallucinations) • Cognition (orientation, concentration, registration, memory recall) • Insight

9. If a patient does not open their eyes, makes incomprehensible sounds and shows decerebrate extension to painful stimuli, what is their GCS score? • Eyes  1/4 • Verbal  2/5 • Motor  2/6 • Total: 5/15

10. Which is NOT a goal of CBT? • Enhance the patient’s problem solving capacities • To relieve the role of GPs in the mental health setting • To modify patients’ perspectives about themselves • To assist in the regulation of distressing affective states

11. If a patient has recently been diagnosed with emphysema and is concerned that their smoking could be contributing to the problem, which stage of behavioural change are they at? • Pre-contemplation • Contemplation • Preparation • Action • Maintenance • Relapse

12. Match the term and definition • Mood • Affect • Euthymia • Anhedonia • Alexithymia • Normal mood • Inability to sense and describe mood states • Superficial and immediate emotional state • Pervasive emotional state • Inability to experience pleasure

13. Match the disorder and description • Major depressive disorder • Dysthymic disorder • Bipolar disorder • Cyclothymic disorder • Adjustment disorder with depressed mood • Mood disorder not otherwise specified • Depression alternating with manic/hypomanic episodes • Minor depression/ mixed depression and anxiety • Pervasively depressed mood + impaired functioning • Chronic low-grade dysphoria • Feeling down in response to a loss or setback • Sudden and rapid alteration between depressive and manic/hypomanic states

14. Which of the following meets the criteria for a major depressive disorder • Insomnia + anhedonia + high self-esteem + fatigue + reduced concentration • Anhedonia + dysphoria + insomnia + hallucinations • Insomnia + weight gain + anhedonia + reduced concentration + fatigue • Anhedonia + diurnal mood variation + low self-esteem + suicidal thoughts

15. Which is a first-line antidepressant? • Sertraline • Mirtazapine • Phenelzine • Amitriptyline

16. Which is NOT a hypothesised pathological process leading to schizophrenia? • Excess dopamine • Decreased serotonin • Glutamate deficiency • Elevated acetylcholine

17. Match the anti-depressant and MOA • MAOI • SSRI • SNaRI • TCA • NaSSAs • Inhibit serotonin and noradrenaline reuptake • Inhibit monoamine oxidase • Inhibit presynaptic a2, 5-HT2 and 5-HT3 receptors • Inhibit serotonin reuptake • Older drugs which inhibit reuptake of NA and 5-HT

18. Which is not a possible treatment for bipolar disorder • Sodium valproate • Risperidone • Psychotherapy • Increased sleep • Electroconvulsive therapy

19. Which is not part of the diagnostic criteria for schizophrenia? • Concurrent episodes of major depressive disorder • Presence of psychotic symptoms for at least a month • Presence of significantly impaired psychosocial function • At least six months duration of continuous signs of illness

20. Rehabilitation for people with schizophrenia includes • Pre-vocational programs • Vocational programs • Housing • Social and recreational support • All of the above

21. Which drug has the greatest extra-pyramidal side effects? • Chlorpromazine • Haloperidol • Clozapine • Risperidone

22. Which anti-psychotic is associated with seizures as an adverse effect? • Chlorpromazine • Haloperidol • Clozapine • Risperidone

23. Are doctors legally required to notify the police of domestic violence? • Yes  doctors are obligated to advise police of crimes, non-accidental injuries using weapons and application of heat or partial strangulation/asphyxiation • This includes wilful injury, property damage, intimidation, harassment and indecent behaviour • But otherwise MUST maintain confidentiality