Get Through Workplace Based Assessments in Psychiatry, Second edition

200 Pages·2008·0.714 MB·\200

by  Sree Murthy (Author)

Get Through
Workplace Based Assessments in Psychiatry
This book is dedicated to:
My beloved wife Dr Mythili Varadan
My beloved sister Mrs Sri Vidhya Rajasekharan
and
To my respected teachers of psychiatry:
Dr Raja Ram Mohan
Dr Priscilla Read
Dr Rhinedd Toms.
Get Through
Workplace Based
Assessments in Psychiatry
Second Edition
Sree Prathap Mohana Murthy MB BS MRCPsych
Hertfordshire Partnership NHS Trust
©2008 Royal Society of Medicine Ltd
Published by the Royal Society of Medicine Press Ltd
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stated here should be sent to the publishers at the UK address printed on this page.
The right of Sree Prathap Mohana Murthy to be identified as author of this work has been
asserted by him in accordance with the Copyright, Designs and Patents Act, 1988.
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ISBN: 978-1-85315-896-4
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Contents
C
o
n
t
e
n
Preface viii t
s
How to use this book ix
1. Introduction to workplace based assessments (WPBAs) 1
Assessment of clinical expertise (ACE) 2
Mini-assessed clinical encounter (mini-ACE) 2
Case-based discussion (CbD) 3
Case presentation (CP) 4
Direct observation of procedural skills (DOPS) 4
2. History taking and mental state examination 6
How to take a history 6
3. Physical examination 16
Aims of routine physical examination 16
General examination 16
Specific system examinations 17
4. Diagnosis and differential diagnoses 19
Diagnosis 19
Differential diagnosis 30
5. Aetiological formulation 36
Commonly identified aetiological factors 37
Schizophrenia 37
Depression 38
Mania 39
Anorexia nervosa 39
Alcoholism 40
Post-traumatic stress disorder 40
Alzheimer’s dementia 40
Vascular dementia 40
6. Investigations 42
Physical investigations 42
Psychological investigations 43
Social investigations 43
7. Management plan 45
Immediate/short-term management 45
Long-term management 47
Schizophrenia 49
Depression 62
v
Bipolar affective disorder 71
C
o Alcohol misuse and dependence 75
n
t Opioid misuse and dependence 82
e
nt Old age (psychosis, depression and dementia) 86
s
Obsessive–compulsive disorder 96
Anxiety disorder and phobias 99
Post-traumatic stress disorder 103
Eating disorders –anorexia, and bulimia nervosa 105
Borderline personality disorder 109
8. Prognosis 112
Schizophrenia 112
Schizoaffective disorder 113
Mood disorders 113
Drug and alcohol misuse 114
Obsessive–compulsive disorder 115
Eating disorders 115
Alzheimer’s dementia 116
9. Tasks for mini assessed clinical encounters (mini-ACEs) 117
Eliciting symptoms of depression and suicidality 117
Eliciting manic/hypomanic symptoms 118
Eliciting history of hallucinations 120
Eliciting details of delusions and abnormal experiences 123
Assessing first rank symptoms of schizophrenia 125
Eliciting alcohol history 128
Assessing complications of alcohol misuse and assessing
motivation 130
Eliciting illicit drug history 131
Eliciting history of anxiety symptoms, panic attacks and phobias 133
Eliciting details of obsessive–compulsive symptoms 135
Eliciting post-traumatic stress disorder history 136
Eliciting eating disorder history 138
Assessing insight 140
Eliciting history of premorbid personality 140
Dementia – history taking (collateral information) 142
Mini mental state examination 145
Detailed cognitive examination 146
Frontal lobe function testing 150
Suicide risk assessment 152
Violence-risk assessment 156
10. Direct observation of procedural skills (DOPS) 159
Electroconvulsive therapy administration 159
vi
Cardiopulmonary resuscitation (basic life support) 162
C
Extrapyramidal side effects – physical examination 163 o
n
t
11. Sub-specialities 165 e
n
t
Child psychiatry 165 s
Learning disability 173
12. Specialist populations 179
Drug prescribing for specialist populations 179
Drugs list 184
References and further reading 187
vii
Preface
P
r
e
f
a
c
e This is one of the first books to be published for helping trainees to perform
different workplace based assessments (WPBAs) in psychiatry since this
course’s implementation by the Royal College of Psychiatrists in August 2007.
This book was initially written to help the candidates to present their long
cases in a structured and professional way, however, with the introduction of
WPBAs in psychiatry, this book has been revised and is suitable for guid-
ance on how to perform well in all kinds of assessments such as assessed
clinical encounters (ACEs), mini-ACEs, case presentations (CPs), case-based
discussion (CbD) and direct observation of procedural skills (DOPS).
Get ThroughWorkplace Based Assessments in Psychiatry should be help-
ful for all the trainees involved in WPBAs in psychiatry – it will not only
prepare you to succeed in your WPBAs, but should also help you to face the
clinical situations confidently and effectively.
Regards,
Sree Prathap Mohana Murthy
viii
How to use this book
H
o
w
t
o
The chapters on eliciting history, mental state examination and physical u
examination (Chs 2 & 3) could be used for ACEs, mini-ACEs, CbD and CPs se
in psychiatry. The chapters on differential diagnosis, aetiological formula- th
is
tion, management options and prognosis (Chs 4, 5, 7 & 8) could be used b
o
again for ACEs, CPs and CbD on different areas of psychiatry. o
k
I have chosen the individual tasks for mini-ACEs from different areas of
psychiatry, which could be applied to a wide variety of settings. I have also
included some tasks for DOPS in psychiatry.
General management options are also discussed (with evidence and key
points) for all the common psychiatric conditions seen in our routine practice,
including subspecialties such as old age psychiatry, child and adolescent psy-
chiatry and learning disability.
You can quickly revise the management plans before presenting the case
to the assessor, and you may find it helpful to establish a confident discussion
with the assessors as part of your assessment.
The answers that I have given should only be used as a rough guide, and
reference to standard textbooks is also recommended.
In short, this book could be used as a ‘pocket revision guide’ for all trainees
in psychiatry involved in WPBAs, which constitutes a significant part of their
current training.
I sincerely hope that this book serves its purpose! Good luck.
SPMM
ix