Consultation tips Flashcards
How would you try control a consultation if a patient has anxiety?
reassure and normalise their symptoms
How would you try control a consultation if a patient is manic?
try focusing them on the purpose of the interview, explain that you are interrupting to re-direct them and will come back to what they are saying later.
How would you try control a consultation if a patient is confused (delirium or dementia)?
try to orientate the patient to time and place
How would you try control a consultation if a patient is psychotic?
be empathetic and non-judgemental and acknowledge non-verbal cues (e.g. responses to hallucinations)
How might you build a good rapport with a patient?
signposting (sorry to ask you this...) normalising (some people can feel this way, do you?) acknowledge embarrassment (i know this is a sensitive topic)
What are you assessing in a Mental state examination?
ASEPTIC appearance and behaviour speech emotion (mood) and affect perception thoughts insight cognition
visual hallucinations would indicate what kind of illness?
an organic brain disease or substance misuse
second person auditory hallucinations - particularly derogatory ones - are seen in which conditions?
schizophrenia, severe depression with psychosis, mania with psychosis
third person auditory hallucinations - esp. running commentary - is typical of?
schizophrenia
3rd person auditory hallucinations are NOT seen in any other psychotic conditions
List the risk factors for depressive disorder.
FF, AA, PP, SS female, family history Alcohol, adverse events Past depression, physical co-morbidities (low) social support, (low) socioeconomic status
the main symptoms of depression…DEAD SWAMP
Depressed mood
Energy loss
Anhedonia
Death thoughts
Sleep disturbance Worthlessness or guilt Appetite or weight loss Mentation (concentration) reduced Psychomotor retardation
What is Beck’s triad?
represents 3 types of negative thoughts;
negative views about oneself, the work and the future.
What must you always screen for in a depressed patient?
mania - a patient presenting with classical depressive symptoms may be bipolar if they have had previous manic/hypomanic episodes.
A patient has severe symptoms after the loss of a loved one. What pitfall do you need to avoid in an OSCE?
diagnosing them with PTSD;
bereavement is a unique traumatic stress which is NORMAL human behaviour; it should not extent over 6 months - if it does, abnormal bereavement or adjustment disorder should be considered.
Describe a classical patient who presents with anorexia nervosa.
significantly underweight likely have endocrine abnormalities no strong cravings for food not binge eating may have compensatory weight loss behaviours (not purging)
