Psychiatry is the branch of medicine that deals with the diagnosis, treatment, and prevention of mental illness and emotional disorders. It is a fascinating and constantly evolving field that covers a wide range of topics, from mood disorders and anxiety to schizophrenia and personality disorders. As a medical student, studying psychiatry will give you a deep understanding of the mind and how it can be affected by illness and environmental factors.
If you’re a medical student looking to build your knowledge and skills in psychiatry, why not try our free multiple choice questions? Our questions cover a range of topics, and are designed to help you assess your understanding of this important field. Challenge yourself, reinforce your knowledge – and prepare for your exams for free!
To fulfil the ICD 10 classification for a definite diagnosis of anorexia nervosa you MUST have which of the following:
BMI < 17.5 or body weight never gained
Self induced weight loss
Female
Body image distortion
Widespread endocrine disorder
Self induced vomiting
Prepubertal onset
Free from other psychiatric illnesses
There are 5 main principles to the ICD 10 for Anorexia Nervosa below:
BMI <17.5 or body weight maintained at <15% expected (i.e. weight never gained)
Self induced weight loss
Body image distortion: i.e. fear of being fat becomes an intrusive overvalued idea
Widespread endocrine disorder. Male: sexual. Female: Amenorrhoea. Via HPA axis.
Prepubertal onset. Female: delay in sequence of pubertal events. Male: failuyre of testicular development
As such the following are not needed:
You do not need to be female
You do not need to lose weight per se, you may simply never gain it (e.g. during puberty).
You do not need to have self induced vomiting (think bulimia).
You do not need to be be free from other psychiatric illnesses (depression & obsessional behavior often coexist).
Remember complications including osteoporosis etc. Woman may still have periods if they are taking the OCP/ HRT.
Bulimia
For a definite diagnosis of bulimia nervosa under the ICD 10, which of the following are ALWAYS required?
Preoccupation and craving for food
Female
History of depression/anorexia
Self induced vomiting
Counteracting of the “fattening” effects via one of a numebr of methods e.g. starvation, laxative abuse, vomiting, dietary suppressants
Morbid fear of fatness
Thin in appearance
ICD 10 Criteria Needed for a Definite Diagnosis of Bulimia
Preoccupation and craving for food.
Counteracting of the “fattening” effects via one of a number of methods e.g. starvation, laxative abuse, vomiting, dietary suppressants.
Morbid fear of fatness.
I.e. you do not need to be either female, thin, have a history of depression/anorexia, or vomit to have the diagnosis, you must simply use one of a number of weight loss techniques, have a fear of fatness and have a preoccupation for food.
Remember diabetic patients with bulimia may deliberately omit their insulin in an attempt to lose weight.
By the same principles remember one of the presenting features of type I diabetes is weight loss.
First Rank Symptoms
Which of the following are Schneiders “first rank” symptoms of schizophrenia?
Consistently fearful emotions
Auditory Hallucinations
External Control of Affect
External control of motor actions
Thought of harming others
Thought withdrawal
Thought Insertion
Thought Broadcasting
Delusional perception
These have now been superseded by the ICD10 (International Classification of Diseases from the W.H.O.)
Schneider’s First Rank Symptoms:
Auditory Hallucinations (3rd person, commenrary, arguing)
External Control of Affect
External control of motor actions
Thought withdrawal (thought being taken out of your head)
Thought Insertion (thought being put into someones head
Thought Broadcasting (also called thought broadcast)
Delusional perception (see something and then see it as having personal significance)
Note that thought of harming others is NOT a first rank symptom but… it is if someone is inserting thoughts into a persons head telling them to do something.
Definitions
What are the definitions/meaning of each of these terms?
Nihilistic delusion
Pareidloia
Anhedonia
Grandiose delusion
Hypnagocic
Capgras delusion
Ideas of Reference
Paranoia
Phobia
See the following table…
Term
Meaning
Nihilistic delusion
Also termed Cotard’s delusion: the patient may complain that they do not need to eat. They may deny the existence of a part of their body
Pareidloia
Linking random images to something of significance: e.g. seeing the pope in your alphabet soup
Anhedonia
The lack of enjoyment in previously enjoyable tasks: a hallmark of depression
Grandiose delusion
Grandiose delusions often relate to feelings of power, wealth or genius. A delusion of grandeur
Hypnagocic¨C12C
Transition between sleep and wakefulnesses¨C13C
Capgras delusion¨C14C
Fear that a person (e.g. spouse) has been replaced by an impostor¨C15C
Ideas of Reference¨C16C
Linking irrelevant events to things of significance to that personE.g. linking the weather forecast to what mark you’ll get in your exam¨C17C
Paranoia¨C18C
Fear that an individual intends to do you harm¨C19C
Phobia¨C20C
Irrational fear that an individual will cause you harm¨C21C
Matching drugs
Match the drugs with their relevant classes
Drugs
Haloperidol
Chlorpromazine
Midazolam
Fluoxetine
Donepizil
Clozapine
Venlafaxine
Dosulepin (Dothiepin)
Lithium
Classes
TCS
Lithium salt
SNRI
ACh Inhibitor
Atypical Antipsychotic
SSRI
Benzodiazepine
Butrophenone
Phenothiazine
Name
Class
Main Indication
Notes
Haloperidol
Butrophenone
Psychosis
Dystonia/extrapyramidal SE
Chlorpromazine
Phenothiazine
Psychosis
Midazolam
Benzodiazepine
Sedation
Fluoxetine
SSRI
Antidepressant
OCD
Safer in OD compared to TCA’s
Donepizil
ACh Inhibitor
Dementia
Nice guidelines apply: i.e. MMSE & limited use
Clozapine
Atypical Antipsychotic
Schizophernia
neutropaenia
Venlafaxine
SNRI
Resistant/ Sever depression
Dosulepin (Dothiepin)
TCS
Depression
Cardiotoxic in OD
Lithium
Lithium salt
Mania
Toxicity (see later questions)
TCA’s like dosulepin are fatal in overdose. This is their clear distinguishing aspect to SSRI’s
Personality Disorders
Diagnose the personality disorder types for each of these cases below:
Withdrawal from affectional and social constructs into a a solitary existence characterised by fantasy and introspection. Limited expression of feelings and emotions.
Unpredictable, sometimes aggressive or explosive impulsive outbursts of emotion without consideration of the consequences of the action.
Priorities of perfectionism, conscientiousness and self doubt. (OCD is an exception to this diagnosis).
Transference of responsibility onto others and a reliance on others for making major or minor decisions in life.
Sensitivity, suspiciousness and the tendency to misconstrue innocuous actions as being hostile or disparaging. Includes suspiciousness regarding spouse (e.g. paranoia regarding infidelity).
Amoral/antisocial/psychopathic/sociopathic behaviours. Features include disregard for social obligations and unconcern for the feelings of others. Behave well outside social normality. Tendency towards aggression and violence.
Exaggerated emotions, need for appreciation, infantile like behaviour.
Denial of existence or relationship of body parts.
Types of personality disorder include:
Type
Features
Schizoid Personality Disorder
Withdrawal from affectional and social constructs into a a solitary existence characterised by fantasy and introspection. Limited expression of feelings and emotions.
Emotionally unstable personality disorder
Unpredictible sometimes aggressive or explosive impulsive outbursts of emotion without consideration of the consequences of the action. The 2 main types are personality disorder: impulsive and personality disorder: borderline, the latter of the 2 being characterised by unstable relationships, self destructive behaviour and suicidal gestures and attempts.
Anankastic personality disorder
Priorities of perfectionism, conscientiousness and self doubt. OCD is an exception to this diagnosis however an anankastic personality disorder has tenancies towards OCD.
Dependent personality disorder
Transference of responsibility onto others and a reliance on others for making major or minor decisions in life
Paranoid personality disorder
Sensitivity, suspiciousness and the tendency to misconstrue innocuous actions as being hostile or disparaging. Includes suspiciousness regarding spouse (e.g. paranoia regarding infidelity)
Dissocial personality disorder
Comprises amoral/antisocial/ psychopathic /sociopathic behaviours. Features include disregard fro social obligations and unconcern for the feelings of others. Behave well outside social normality. Tendencey towards aggression and violence. Questionable if this is truly treatable
Histrionic personality disorder
Exaggerated emotions, need for appreciation, infantile like behaviour.
Narcicisstic type
Denial of existence or relationship of body parts. Patients may deny that an arm belongs to them. They may feel that they do not need to be fed, or not bother to eat as their intestines have rotted away. Rare. Can be treated with ECT.
Clozapine
A 34 year old schizophrenic is treated with clozapine.
He presents with a fever and a sore throat. He also has a bad headache. He is shuffling around nervously in the clinic and keep s on repetitively throwing his head backwards and laughing.
What is the most concerning diagnosis from the following?
Neutropenia
Steven Johnsons syndrome
Acute Dystonia
Neuroleptic Malignant syndrome
None of the answers listed here
Neutropenia
Whenever you see clozapine (clozaril TM) think of examiners love for its important side effect agranulocytosis (neutropenia). Therefore patients presenting with symptoms compatible with infection should have an urgent FBC (full blood count). Acute dystonia includes things like oculogyric crisis…
Cab driver scenario 1
A cab driver feels guilty that his friend was seriously injured at work in a car accident. He feels it was his fault and that he shouldn’t have finished his shift and gone home to leave his friend. He believes that his laziness is directly responsible and has caused the accident.
He has now given up work and is unemployed. His wife is distraught.
There is no evidence that his actions were in any way related to the accident relating to his friend. You have a long discussion talking about the fact he is not in any way to blame. He refuses to accept the concepts you introduce.
Which of the following terms relate to his thoughts/ideas?
Hallucination
Formal Thought disorder
Illusion
Obsession
Delusion
Mood disorder
Overvalued Idea
None of the listed answers here
He’s delusional. It has the hallmarks:
fixed held belief
absence of events linking him to the accident
evidence to the contrary
not usual in the context of his social/ religious / cultural beliefs
Cab driver scenario 2
A cab driver feels guilty that his best friend was injured in a car accident. The cab driver was late for work and as a result his friend stayed late on his shift, fell asleep and crashed.
He has quit his job and his wife was distraught. He accepts that he is not directly to blame but “cannot live with himself”.
Which of the following terms relate to his thoughts/ideas?
Delusion
Hallucination
Formal Thought disorder
Illusion
Obsession
Mood disorder
Overvalued Idea
None of the listed answers here
Mood disorder
Delusion: no, he accepts he’s not to blame.
What is he suffering from?
Guilt. This is part of the mood disorders (remember depression, elation, irritablity , emotional lability).
Cab driver scenario 3
A cab driver that feels he is at risk of dying in a car accident every day he drives on the M6. His best friend was seriously injured in a similar accident 3 weeks ago.
As such he has started driving a different way to work in the morning.
Which of the following terms relate to his thoughts/ideas?
Delusion
Hallucination
Formal Thought disorder
Illusion
Obsession
Mood disorder
Overvalued Idea
None of the listed answers here
Overvalued Idea
Diagnosis required
A 92 year old man has left his shopping on the bus.
The bus driver has brought him to A&E as he cannot remember: Where he lives or what his phone number is.
On your arrival he appears quite bright and is drinking a cup of coffee. He greets you with a booming voice “hello matron”.
What is his most likely diagnosis?
Dementia
Psychosis
Thought disorder
Delirium
Stroke
Dementia
From the info you have no evidence of a fluctuating level of consciousness that would signify delirium and maybe point to another inter currant illness e.g. infection.
You have no evidence of any previous cognitive performance.
He is 92. Therefore the most likely diagnosis is dementia (although any could be true).
Hand washing
A 45 year old woman washes her hands 62 times a day because she feel they get dirty very easily.
She tells you she gets a “compulsion” to wash her hands. She does not attempt to resist the desire. She does feel satisfied after her “ritual” is finished.
This is typical for obsessive compulsive disorder.
True
False
FALSE
OCD patients characteristically try to exclude the thoughts from their mind and resist them.
What is the most likely nature of her thoughts?
Delusion
Hallucination
Formal Thought disorder
Illusion
Obsession
Mood disorder
Overvalued Idea
None of the listed answers here
Overvalued idea
You can understand why people wash their hands regularly but she is taking things to a higher level. The fact she doesn’t resist her thoughts makes OCD less likely.
Palpitations
A patient has taken an overdose of fluoxetine. They are 6 hours post overdose and have symptoms of palpitations. An ECG is performed during the symptoms.
The ECG shows the following:
Rate 97 PR interval 0.10 seconds QRS complex: normal width T waves No acute t wave changes QTc interval= 0.34 seconds No other notable features
What is the most likely explanation for the palpitations?
Prolonged QT interval
Fast Atrial Fibrillation
Supraventricular tachycardia
None of the answers listed here
None of the answers listed here
The QTc is the corrected QT interval for rate. the upper limit is 0.42 seconds.
Therefore the QT is normal.
It cant be fast AF or SVT: she is having symptoms and the ECG shows sinus rhythm.
The symptoms most likely reflect anxiety and side effects of the overdose.
Paraphrenia
Paraphrenia describes:
Paradnoid schizophrenia
Paranoia
Paranoia and schizophrenia in adolescents
Paranoia and schizophrenia in the elderly
None of the answers listed here
Paranoia and schizophrenia in the elderly
Paraphrenia is a form of paranoid schizophrenia seen in the elderly – associated with Alzheimers.
Hallucination
A man describes hearing voices. He tells you they do not sound like “real” voices and they do not seem to come from anywhere in particular, but the voices are telling him to sell his house.
It does concern him significantly and he tells you he’s quit his job because of the anxiety surrounding it. He thinks hes gone mad.
Is this a true hallucination?
Yes
No
No
It lacks 2 of the essential qualities:
A source: e.g. inside my head, behind my ear
And the voice "quality": does it seem like a real voice.
If it lacks these things its a pseudohallucination.
QT
Which of the following medications is most likely to prolong the QT interval?
Fluoxetine
Donepezil
Haloperidol
Diazepam
Paroxetine
Haloperidol
The QT interval is prolonged by atypical anti psychotics. This is of particular relevance to patients taking other drugs that prolong the QT interval like:
Terbinafine (anti fungal)
Amiodarone
Trichotillomania
Trichotillomania is:
Pulling out ones own hair and eating it
Irrational fear of hair loss
A distorted body image
Pulling out hair in response to a delusion
None of the answers listed here
None of the answers listed here
Trichotillomania is noticeable hair loss following a patients inability to resist the urge to pull their own hair out. This is different to a patient pulling their hair out as reponse to a delusion (e.g. the hair is growing into their own head and clogging up their brain). This is a delusion.
OCD drug
Regarding the following statement:
“There is no effective drug treatment for use in OCD licenced in the United Kingdom.”
True
False
FALSE
SSRI inhiibitors e.g. fluoxetine and citalopram are indicated for OCD. They are generally used at a slightly higher dose than for depression.
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