Psychiatric OSCE Station Flashcards
To begin…
To begin - Introduce yourself, consent, explore open questions
After open questions, SOCRATES (psych focus) then carry out a …
Risk assessment
.. before asking sensitive questions!
Signpost
Risk assessment (psych)
Self harm - ideation, behaviour
Suicide - ideation, behaviour
Harm to others - ideation, behaviour
How to ask about recreational drugs
Sometimes we find some people find certain things make it worse, eg smoking cannabis
Mania - how to ask
Sometimes we see people who feel/have felt unusually energetic, and can do lots of activities with little sleep - has this ever happened with you?
Elicit any organic pathology in psych such as…
Weight loss/physical symptoms
Infective symptoms
Past psychiatric history - what should you cover in psych?
Have you seen a psychiatrist before?
Have you been diagnosed with any mental health conditions in the past?
Any hospital admissions? Any sectioning?
Past medical history - what should you cover in psych?
Do you see the doctor for anything regularly?
Do you have any diagnosed medical/physical health conditions?
Have you had to stay in hospital for anything in the past?
Past drug history - what should you cover in psych?
Are you on any regular medications?
Allergies?
OTC meds?
Recreational drug use? - quantify it like smoking and alcohol
Personal history for psych?
Childhood
Education
Life story up to now
Family history in psych?
Any history of mental health conditions?
Any family history of medical/physical health conditions e.g. hypothyroidism
Forensic history for psych?
Any police involvement?
Social history in psych?
Smoking Alcohol Occupation Functionality Live at home with
ICEE - psych
Ideas
Concerns
Expectations
Effects on life
Do and don’t in psych
Do - signpost, empathise/acknowledgement, probe for details
Don’t - summarise back, lie, forget about physical symptoms
Mental state exam - appearance
Appearance - general appearance, weight/body habitus/features of disease/stigmata of physical disease
Mental state exam - behaviour
Rapport
Body language and eye contact
Psychiatric signs (abnormal movement, psychomotor)
Mental state exam - cognition
Memory, orientation, concentration
Mental state exam - speech
Speed Amount Tone Volume Rhythm
Mental state exam - mood and affect
Affect = weather (objective observed) Mood = climate
Mental state exam - insight
Understand condition, abnormal?
Mental state exam - judgement
What would they do in a fire ?
Mental state exam - thoughts
Form (flow, coherence, speed)
Content (delusions, harm)
Possession (broadcasting, withdrawal, insertion)
Mental state exam - perception
Hallucination Illusion Depersonalisation Derealisation Pseudo-hallucination
Psychosis pathophysiology
Schizophrenia, Bipolar
Organic - drug induced, electrolyte abnormality (hyponatraemia, hypomagnesaemia, hypo or hypercalcaemia) delirium
Clinical features of psychosis
Delusions Formal thought disorder Thought possession disorder Perception disorder Lack of insight
Psychosis treatment
Bio-psych-social
Antipsychotic - acute and long term (Clozapine only after 2 previous ones)
CBT, family therapy, psychoeducation
Risk assessment + social support groups
Mania - pathophysiology
BPAD
Organic - drug induced, electrolytes, delirium
Mania - clinical features
Hypomania, mania - functionality Increased energy + activities Less sleep Pressured speech Delusions
BPAD - type 1 = mania + depression
BPAD - type 2 = hypomania, less commonly diagnosed
BPAD - type 1 = mania + depression
BPAD - type 2 = …, less commonly diagnosed
Mania - treatment
Antipsychotic - acute
Mood stabilising - lithium, sodium valproate
CBT, IPT, family therapy, psychoeducation
Risk assessment, social support groups
Anxiety - pathophysiology
GAD, panic disorder, PTSD
Organic causes - drug induced, anything that can cause hyperventilation (e.g. asthma, PE, AF)
Anxiety - clinical features
Cardiac, palpitations and chest pain
Resp - hyperventilation
GI - nausea and vomiting
Derealisation and depersonalisation
Diagnosis of anxiety
ICD 10/11 criteria for GAD, panic disorder, OCD, PTSD, organic cause
Treatment of anxiety …
Antidepressants (e.g. SSRIs) Benzodiazepines (with caution)
CBT, psychodynamic therapy, EMDR
Risk assessment, social support groups
BBOXE - bedside, bloods, orifice, x ray and ECG (psych)
Full history, NEWS, relevant exam
Bloods - FBC, U+E, CRP, LFTS, bone profile, prolactin, TFTs
Relevant drug serum, potential lithium level
Orifice - urine dip, sputum
X-ray and ECG - CXR, AXR, specific x-ray, ECG
ECT can be used in
Catatonic schizophrenia or severe depression
Senior led
