Psychiatry In Primary Care

Question 1

Primary, secondary and tertiary prevention

Answer 1

Primary = preventative measures used to avoid disease or injury
- vaccinations, alcohol and tobacco prevention/cessation, etc.

Secondary = screening measures to detect or halt progress of a disease/injury
- ultrasound, xrays, physical exams, etc.

Tertiary prevention = treatment measures to reduce the complications of a disease or injury
- medications, medical interventions, etc.

Question 2

Collaborative care model

Answer 2

Team based health care that includes

• primary care physician
• psychiatric consultant
• behavioral health care manager
• patient

if a team has these pieces on board for psychiatric disorder patients, then management of the patient becomes easier and the outcomes becomes better

Question 3

Principles of collaborative care

Answer 3

Patient-centered collaboration

Population based care

Measurement-based treatment to target

Evidence based care

Accountable care

Question 4

Principles of Motivational interviewing

Answer 4

Express empathy/curiosity

Roll with resistance (allow the patient to be resistant to the idea)

Support self-efficacy

Develop discrepancy

Question 5

Broad steps to motivational interviewing

Answer 5

1) engage with patient
- build rapport
- explore sense making

2) focusing
- assess sense making and determine the premise

4) fixing

Question 6

“POARS” acronym

Answer 6

Used for engaging the patient and building rapport

• ask Permission
• Open-ended questions
• Affirm (positive comments and reinforce strength/effort and intent)
• Reflect (restate what patient says)
• Summarize

Question 7

How to address a factual premise by reframing

Answer 7

5 steps to “elicit/ask, provide and elicit/asl”

1) Reflect patient sense making without judgement
2) Open ended questions to clarify patient sense making
3) Permission to share info relevant to their factual premise
4) Open ended question about what was provided
5) Reflect/Summarize
* take a neutral trance and avoid medical jargon*

Question 8

Addressing a motivational premise

Answer 8

Must use the “DARN” questions

Desire = “what would you want/wish?”

Ability = “How can/could you?”

Reasons = “What are some reasons to?”

Need = “what needs to change/ how important is it?”

DONT expect to get a change in 1 visit, and also make sure to roll with resistance

Question 9

Planning SMART goal setting

Answer 9

Measures to remember when planning a goal set once you get to this stage of change with the patient

Specific

Measureable

Attainable

Relevant

Timely

make sure to plan for follow-up