Key Points Flashcards
Forensics
Before / During / After Event
Evolution of history
Previous Forensic History
Substances
Social - living situation
Occupation - eg child safeguarding / access to records
Risk TO OTHERS - Victim / Stalking / Confrontation / Weapons
Eating Disorders
Eating and food -
Compensatory behaviours eg. Vomiting, Exercise, medications
Calories - if counting, what target
Physical health - amenorrhea, CP, weakness, falls, fractures
Family history
Family expressed emotion
Personality type - perfectionism
Substances - dangerous subtype in AN
Medications
CAMHS
Compare different environments
Social - who do you live with, school
What’s the home environment like
Obstetric History
Developmental Milestones
Family History
Adverse childhood events
Substance use - don’t forget its possible in kids
Risk - FROM OTHERS - vulnerability, abuse, parental physical abuse TO OTHERS - lashing out / outbursts
Safeguarding - do we need to contact them
Speak with school
Involve multiple sources - collaterals from school / family members ect
Perinatal
Past obstetric history
Past psychiatric history
Family history
Medications - Quetiapine / Sertraline (safest)
Social - support network / other children at home
Wider teams - Involve obstetrics / Paeds / MBU
Risk - to baby (bonding, neglect and harm)
Aim is to provide info - not to convince them
Addiction
Timeline of use
Route of administration - oral / inject / snork / smoke
Context
Tolerance
Withdrawal - key to remember
Impact on daily life
Polysubstance use
Social History
Physical health
How is it being financed - eg. work or stealing ect.
Sexual history - consider in the right context
Risk - financial, physical health (needle sharing, BBV, direct from drug), FROM others (vulnerability) , TO others (disinhibition, aggression)
Old Age
Physical health
Medications
Functional ability
Social
Sensory difficulties
Risk - neglect / wandering / fires
Services - Carers, support networks, care home or nursing home
Learning Disabilities
How long have you known X? - Relationship to patient, timeline of interaction
What support are they requiring
Social support - family involved, what other support
Function - Socially, communication
Routines - what does a day look like / week look like? What do they like doing? Are they still doing it?
Changes - Relationships, routine, visitors, friendships
Cognitive changes
Physical health - constipation, seizures, pain, changes in medications, UTI
Past psychiatric - dementia, neurodevelopmental
Risk - FROM OTHERS - Abuse (staff or residents), vulnerability (bruising, incontinence, directed to a member of staff). TO OTHERS - agitation, aggression. TO SELF
Psychotherapy
What is it? - ‘type of talking therapy with a trained psychologist’
How does it work?
What does it involve (logistics) - Session numbers, length of session, length of therapy, 1:1, Group, Telephone ect.
What happens in the therapy?
Specifics to the therapy
Linking it back to the persons difficulties
Pre-treatment
Suitability
Confidentiality
We have a duty of confidentiality however that is not absolute. Time where we would break this confidentiality would be in cases where there was a significant risk of harm to yourself or to others.
Explain Stations
What is it
Why this medication
How does it work
Before - Initiation, screenings, baseline measurements
During - Monitoring, side effects
After (Long term) - Long term health complications eg: metabolic syndrome, thyroid ect…
Highlight any concerning features eg: Lithium Toxicity / Clozapine bowel obstruction or cardiac issues
Management Stations
Explanation / History - confirm what they know / confirm the diagnosis if needed
Biopsychosocial Model:
Bio -
Medications - for the illness / for co-morbid illness
Physical health optimisation
Exercise
Diet
Investigations - eg review patient / speak to family / scans / bloods
Psycho -
Therapy - often CBT / Psychoeducation / Nursing interventions
Social -
Support - and support for relatives
Employment
Finances
Home adaptations
Intense services eg Crisis
Hospital or community management
Long Term strategies and considerations
Management of risk:
Generic Structure ending
At the end…
Past psychiatric - have you ever seen a psychiatrist before
Past medical - anything you see a GP/doctor about
Medication history
Family history
Social history
Smoking, alcohol, substances
Risk - Self (DSH/Suicide), others, from others, Protective factors (‘is there anyone or anything that would stop you from acting on these thoughts in the future’ - especially in DSH/Suicide stations)
Things for tomorrow
Explain + management:
NMS
Serotonin Syndrome
Delirium Tremens
Tardive Dyskinesia
Akathesia
ECT
rTMS
Medication:
Lithium
Clozapine
Depot
Perinatal:
Lithium
Valproate
Methadone
Psychotherapy:
DBT
Mindfulness
CBT + Specifics (minimisation / personalisation ect.)
IPT - 4 domains
Suitability
ERP
Systematic Desensitisation
Physical Exams:
EPSE
Cerebellar
