Liaison

Question 1

Conversion disorder (history)

Answer 1

HPC (onset, duration, ass Sx, previous events)
Stressors
La Belle Indifference (concern about Sx, relieved by Ix findings, family response)
Comorbidity (moos, sleep, appetite, enjoyment, energy, psychosis, risk)
Personal Hx (PPHx, FHx, PMHx, substance use)

Question 2

Conversion disorder (explanation)

Answer 2

Summarise findings
Explain diagnosis and cause
Explain medication (antidepressant if indicated)
Explain psychological Rx (CBT)
Concerns and leaflets

Question 3

Health anxiety (history)

Answer 3

HPC (onset, duration, exac/relieving factors, ass Sx, Ix, ICEs)
Impact on functioning (research, family response, relationships, work)
Personal history (PMHx, medications, recurrent childhood illness, family response, FHx)
Comorbidities (mood, sleep, appetite, enjoyment, concentration, psychosis, risk)

Question 4

Health anxiety (management)

Answer 4

Clarify diagnosis and understanding
Explain cause (family culture, stress, genetic risk)
Explain medication (antidepressant)
Explain psych Rx (CBT)
Questions and concerns

Question 5

Somatoform pain disorder (history)

Answer 5

HPC (onset, duration, previous Rx, ICEs)
Stressors (relationships, work, finances, medical)
Impact on functioning
Comorbidity (mood, sleep, appetite, concentration, enjoyment, psychosis, substances, risk)

Question 6

Traumatic brain injury (history)

Answer 6

HPC (onset, duration, progression, injury)
Personality change (premorbid, disinhibition, impulsive)
Behavioural change (irritable, verbal/physical aggression)
Judgement (attention, concentration, decision making, risk)
Memory (short-term, long-term, planning, orientation TPP, word-finding)
Functioning (washing, dressing, finances)
Comorbidity (mood, sleep, appetite, enjoyment, abnormal behaviour, substances, risk)

Question 7

Traumatic brain injury (examination)

Answer 7

Day/date/month/year
Animals in 1 min
Objects x3
Clock drawing
Objects recall
Similarities (banana/orange, table/chair, tulip/rose/daisy)
Programming (fist-edge-palm, x3 together then alone, 6 reps for 3 points)
Cognitive estimates (elephants in London)
Letter on the floor

Question 8

Post MI depression (history)

Answer 8

HPC (admission, progress, treatment, medications, follow-up)
Depressive Sx
Current stressors (relationships, work, financial)
Understanding (cardiac rehab, lifestyle changes)

Question 9

Post MI depression (d/w cons)

Answer 9

Summary of case
Prevalence (20%, 2-6x higher mortality)
Medical Rx (sertraline - SADHART trial, avoid venlafaxine & tricyclics)
Psychological Rx (CBT and lifestyle support)
Liaise with cardiology

Question 10

Antidepressant induced sexual dysfunction (history)

Answer 10

Clarify diagnosis, medication and onset S/Es
Current depressive Sx & risk
Explore sexual difficulties (interest, erection, orgasm, priapism, relationship in general)
Other causes (PMHx, medication)
Options (continue - timing of meds, sildenafil, drug holiday; switch meds; stop - relapse)
Other Treatment (CBT, couples therapy)

Question 11

Antidepressant induced sexual dysfunction (d/w wife)

Answer 11

Clarify diagnosis
Wife’s perception of Sx (mood, sleep, appetite, risk)
Explain depression vs side-effects
Management plan (continue - timing of meds, sildenafil, drug holiday; switch meds; stop - relapse)
Questions and concerns

Question 12

Post-concussion syndrome (history)

Answer 12

HPC (injury, LOC, amnesia, admission, Ix)
Ongoing neurology (weakness, headache, dizziness, tinnitus)
Psych Sx (mood, anxiety, irritability, sensitivity to noise)
Risk (falls, memory, self)
Brief memory Ax (3 items, WORLD, recall, fluency)