Surprise ME
Which psychiatric syndrome is associated with the highest risk of suicide?
Bipolar disorder
Definition of negative symptoms
1. Affective flattening
2. Alogia
3. Avolition
4. Anhedonia
5. Asociality
Duration for MDD
≥5 symptoms for ≥2 weeks, with depressed mood or anhedonia.
Diagnostic features of GAD
Excessive worry ≥6 mo + ≥3 of restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance.
Acetylcholine (cholinesterase inhibitor).
Define personality disorder
Enduring, inflexible maladaptive traits causing distress/impairment across situations.
What is the most common side effect of ECT?
Headache
Duration required for schizophrenia diagnosis?
≥1 month active symptoms + ≥6 months total disturbance
Difference between mania and hypomania
Mania ≥1 week, marked impairment or psychosis; Hypomania ≥4 days, no marked impairment.
Define panic disorder
Recurrent unexpected panic attacks + ≥1 month of persistent concern or maladaptive behavioural change.
Three core features of delirium
Acute onset, fluctuating attention, cognitive/perceptual disturbance.
Define splitting and its management
Seeing others as “all good” or “all bad”; manage with team consistency and boundaries.
What is the future risk of an untreated child with ADHD?
Future substance use and antisocial traits
The difference between schizoaffective and schizophrenia
Schizoaffective: mood + ≥2 weeks psychosis without mood; Schizophrenia: psychosis dominates whole course.
Serotonin syndrome triad
Neuromuscular: clonus/hyperreflexia; Autonomic: fever, diaphoresis; Mental: agitation/confusion.
CBT with Exposure and Response Prevention (ERP).
Difference between Dementia with Lewy Bodies (DLB) and Parkinson's Dementia
DLB: dementia first; PDD: Parkinson’s ≥1 year before dementia. Both have visual hallucinations + parkinsonism.
Core skills in DBT
Mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.
Which vitamin is given first in refeeding or alcoholism?
Thiamine
Typical presentation of autoimmune encephalitis
Acute psychosis, agitation, catatonia, seizures, dyskinesias, autonomic instability (anti-NMDA).
Lithium start + monitoring
Start 250–400 mg daily; target 0.6–1.0 mmol/L; monitor levels (5d post-change), renal, thyroid, calcium q6–12mo.
What is the difference between PTSD and acute stress disorder?
ASD: 3 days–1 month post-trauma; PTSD: >1 month, possibly delayed onset.
Treatment approach for ADHD?
Psychoeducation + behavioural structure + stimulants (methylphenidate/amphetamine)
Describe refeeding syndrome
Electrolyte shifts (↓PO₄⁻, ↓K⁺, ↓Mg²⁺) after nutrition restart → insulin causes intracellular shift. Risk of arrhythmia, delirium, death.
Which dementia type benefits most from ACh-inhibitors?
Alzheimer's
Indications and monitoring for clozapine
After ≥2 failed antipsychotics. Monitor FBC (agranulocytosis), ECG (myocarditis/QTc), metabolic profile.
Sodium valproate side effects + monitoring
Weight gain, tremor, hair loss, hepatotoxicity, thrombocytopenia, teratogenicity; monitor LFT, FBC, weight. Avoid in pregnancy.
Hyperthyroidism, hypoglycaemia, phaeochromocytoma, arrhythmia, COPD/asthma.
FBC, UEC, LFT, TFT, B12, folate, glucose, ECG, MRI brain, MoCA/MMSE, exclude delirium/depression.
Medical admission criteria in anorexia
HR <40–50 bpm, BP <90/60, T <35.5°C, K⁺/PO₄⁻/Mg²⁺ low, BMI <14, QTc >470–500ms, or syncope.