PSYCHIATRY
GENERAL PSYCH PRINCIPALS
PromptObjectives of medical assessment for “medical clearance”
ResponseAssessment aimed at identifying significant illness requiring immediate non psychiatric care
?medical illness causing presentation
?concurrent illness requiring urgent treatment/management
?chronic medical condition requiring management
?Side effects of treatment requiring management
Clearance does not mean an organic cause has been completely excluded in all cased
Intent is to determine if safe to admit to MH facility
?medical illness causing presentation
?concurrent illness requiring urgent treatment/management
?chronic medical condition requiring management
?Side effects of treatment requiring management
Clearance does not mean an organic cause has been completely excluded in all cased
Intent is to determine if safe to admit to MH facility
PromptMedical clearance without bloods
ResponseAge 16-65
No acute physical health problems (Trauma, drugs, etc)
No altered LOC
No evidnce of physical cause - normal examination + vitals)
Similar prior psychiatric presentations
Not the first episode. First episode gets bloods
No acute physical health problems (Trauma, drugs, etc)
No altered LOC
No evidnce of physical cause - normal examination + vitals)
Similar prior psychiatric presentations
Not the first episode. First episode gets bloods
PromptPitfalls of “medical clearance”
ResponseHistory - difficult to get from patient, failure to seek collateral, limited by location of review
Exam - locations of patient, failure to do full examinatoin, no vitals or MMSE, no neuro exam
Patient cooperation
Acceptance of “medical clearance” over reliance on investigations, failure of ongoing review.
Missed medical diagnoses in psychiatric patients are reported in 45% of patients!
Exam - locations of patient, failure to do full examinatoin, no vitals or MMSE, no neuro exam
Patient cooperation
Acceptance of “medical clearance” over reliance on investigations, failure of ongoing review.
Missed medical diagnoses in psychiatric patients are reported in 45% of patients!
PromptMost useful features in differentiating organic vs psychiatric cause for symptoms
ResponseAbnormal vital signs including fevers
Age of first onset
D+A history
Features of delirium - Fluctuating symptoms, disorientation, visual hallucinations, decreased LOC
Neurologic features - seizures, memory loss, inattention, disorganised thinking.
Identifiable neurologic features.
Age of first onset
D+A history
Features of delirium - Fluctuating symptoms, disorientation, visual hallucinations, decreased LOC
Neurologic features - seizures, memory loss, inattention, disorganised thinking.
Identifiable neurologic features.
PromptKey components of psychiatric patient assessment
ResponseMental state inclduing assessment of acute psychosis/depression
Assessment of suicide risk
Alcohol/drug use and current level of intoxication
Physical injury
Underlying medical condition that may be exaccerbating behaviour
Exclude pregnancy (if female obviously)
Social history including safety of any children in the home
Assessment of suicide risk
Alcohol/drug use and current level of intoxication
Physical injury
Underlying medical condition that may be exaccerbating behaviour
Exclude pregnancy (if female obviously)
Social history including safety of any children in the home
PromptMental State Examination
ResponseASEPTIC
Appearance - Physical appearance, (cleanliness + grooming) manner of relating to clinicians/family/activity levels (Slow/agitated)
Affect Observed emotional state - type, range, reactivity, appropriateness
Speech - spontaneous, fluency, rate, volume, tone
Emotion
Perception (Delusions/hallucinations)
Thoughts - Content, stream, form
Ideas
Insight (+judgement) - insight into perception disorders, problem solving
Cognition: LOC, orientation, attention, memory, ability
Content
Appearance - Physical appearance, (cleanliness + grooming) manner of relating to clinicians/family/activity levels (Slow/agitated)
Affect Observed emotional state - type, range, reactivity, appropriateness
Speech - spontaneous, fluency, rate, volume, tone
Emotion
Perception (Delusions/hallucinations)
Thoughts - Content, stream, form
Ideas
Insight (+judgement) - insight into perception disorders, problem solving
Cognition: LOC, orientation, attention, memory, ability
Content