Clinical Procedures and Protocols Flashcards

A patient on long-term lithium therapy develops polyuria and polydipsia. Which investigation should be prioritised?

Answer: Urine osmolality after water deprivation

Lithium can cause nephrogenic diabetes insipidus, and a water deprivation test with measurement of urine osmolality confirms the diagnosis.

Which of the following is a contraindication to the use of ECT?

Answer: Raised intracranial pressure

Raised intracranial pressure is a major contraindication to ECT because the procedure increases cerebral blood flow and intracranial pressure transiently.

A 28-year-old with schizophrenia is prescribed depot antipsychotic medication. What is the primary clinical advantage of depot over oral medication in this context?

Answer: Improved adherence

Depot antipsychotics bypass first-pass metabolism and covert non-adherence, making them the preferred option for patients with a history of poor oral adherence.

Under Section 136 of the Mental Health Act 1983, where can a police officer remove a person believed to have a mental disorder?

Answer: From a public place only

Section 136 applies only to public places; following the 2017 amendment, police can no longer use Section 136 to remove someone from a private dwelling.

When assessing a patient using the Mini-Mental State Examination (MMSE), which cognitive domain is assessed by asking the patient to copy intersecting pentagons?

Answer: Visuospatial ability

The intersecting pentagons drawing task in the MMSE assesses visuospatial construction ability.

A psychiatrist suspects neuroleptic malignant syndrome (NMS) in a patient on haloperidol. Which triad of findings is most consistent with NMS?

Answer: Hyperthermia, muscle rigidity, and altered consciousness

NMS classically presents with hyperthermia, 'lead-pipe' muscle rigidity, altered consciousness, and autonomic instability.

During psychiatric assessment of a patient from a different cultural background, which principle is most important to maintain diagnostic validity?

Answer: Using a professional interpreter and cultural formulation approach

Using a professional interpreter and a cultural formulation approach (as outlined in DSM-5) helps ensure accurate diagnosis by contextualising symptoms within the patient's cultural framework.