✍ Scribed by Dr Seshni Moodliar
No coin nor oath required. For personal study only.
Pass the CASC
For the MRCPsych
First Edition
By Dr Seshni Moodliar
Cambridgeshire and Peterborough Foundation NHS trust
Forewords by Dr Dinesh Sinha, Dr MS Thambirajah, Professor Fabrizio Schifano and Dr Asif Zia
Published by Dr Seshni Moodliar
Printed and bound in Poland by Kozak Druk for Seshni Moodliar
© copyright Dr Seshni Moodliar
The right of Seshni Moodliar to be identified as the author of this work has been asserted by her in accordance with the Copyright, Patents, Design and Patients Act 1998.
All rights reserved. Apart from any dealing for the purpose of private study, research, review or critism, as permitted by the UK Copyright, Designs and Patents Act 1998, no part of this publication may be reproduced, stored or transmitted in any form...
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Notice
Medical knowledge is constantly changing. Readers are advised to check the most current information on medication and treatment. Neither the publisher not the author assumes liability for any injury or damage to persons or property arising from this ...
ISBN 978-0-9569941-0-3
First published 2012
Designer: Illustrations and cover
Aleksandra Rykala
Distribution
For distribution by Seshni Moodliar
Contact:
www.easterpsychcourse.com or www.easternpsychcourse.co.uk
Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer."
-Charles Caleb Colton
“Put your confidence in us. Give us your faith and your blessing, and under providence all will be well. We shall not fail or falter; we shall not weaken or tire. Neither the sudden shock of battle nor the long-drawn trials of vigilance and exertion w...
“Give us the tools and we will finish the job.”
-W. Churchill 1941 to Roosevelt
This book is dedicated to my husband and children Shreeya, Aryan and Sitara.
To our families and friends in South Africa and United Kingdom
Our Gratitude and thanks to all those who contributed in compiling this book.
A special thanks to my dear friend Gosia Demetriou.
And last but not the least this book is dedicated to our patients, their families, carers and mental health professionals.
CONTENTS
Contributors 12
Forewords 14
Introduction 19
Past CASC exam stations- discussed with Dr Albert Michael 23
A) June 2008
B) November 2008
C) March 2009
D) October 2009
E) March 2010
F) October 2010
G) January 2011
H) June 2011
1. General Adult Psychiatry- 36
Dr Esam Hassan, Dr Animesh Tripathi
1.1 Depression-History-Dr Nisha Rani/ Dr Rajeeve Parkianathan
1.2 Depression- Diagnosis and management-Dr Nisha Rani
1.3 Overdose assess- Dr Esam Hassan
1.4 Deliberate Self harm-DSH- Dr Esam Hassan
1.5 Post Myocardial Infarct Depression -Assess social History and capacity-Dr Saravanan Balasubramanian/ Dr Swali Malanda
1.6 Post Myocardial Infarct Depression -Assess social History and capacity-Dr Saravanan Balasubramanian/ Dr Swali Malanda
1.7 Antidepressants-Sexual side effects-Dr Amit Jain/ Dr Ravi Prakash
1.8 Antidepressants-Sexual side effects-Dr Amit Jain/ Dr Ravi Prakash
1.9 Lithium- Dr Nicholas Stafford
1.10 Treatment resistant Depression- Dr Esam Hassan
1.11 Electro Convulsive Therapy (ECT) Dr Animesh Tripathi
1.12 Bereavement- Dr Animesh Tripathi
1.13 Breaking bad news-Dr Animesh Tripathi
1.14 Bipolar Affective disorder- Dr Sepehr Hafizi
1.15 Bipolar Affective disorder- Dr Nicholas Stafford/ Dr Sepehr Hafizi
1.16 Psychosis Assess-Delusions and first rank symptoms- Dr Esam Hassan
1.17 Psychosis Assess-Delusional disorder- Dr Esam Hassan
1.18 Hallucinations- Dr Esam Hassan
1.19 Schizophrenia- Dr Simon Edgar/ Dr Rajeeve Parkianathan
1.20 Clozapine Rehabilitation-Dr Kumar Gandamaneni
1.21 Clozapine Rehabilitation-Dr Kumar Gandamaneni
1.22 AOT Assertive outreach team -Dr Kumar Gandamaneni
1.23 AOT Assertive outreach team –Dr Kumar Gandamaneni
1.24 Depot Antipsychotic-Dr Esam Hassan
1.25 Neuroleptic Malignant Syndrome (NMS) - Dr Animesh Tripathi
1.26 Generalised Anxiety- Dr Animesh Tripathi
1.27 Panic attacks Assess- Dr Animesh Tripathi
1.28 Panic Attacks Discuss management with mother- Dr Animesh Tripathi/ Dr Rajeeve Parkianathan,
1.29 Conversion Disorder-Dr Jothi Naidoo/Dr Rajeeve Parkianathan
1.30 Conversion Disorder-Dr Jothi Naidoo
1.31 Social phobia-Dr Esam Hassan
1.32 Obsessive Compulsive Disorder-OCD- Dr Animesh Tripathi
1.33 Obsessive Compulsive Disorder-OCD- Dr Animesh Tripathi
1.34 Body dysmorphic disorder-Dr Esam Hassan
1.35 Post Traumatic Stress Disorder-PTSD-History- Dr Animesh Tripathi/ Dr Rajeeve Parkianathan,
1.36 Somatoform pain disorder- Dr Animesh Tripathi
1.37 Hypochondriasis-Dr Manaan Kar-Ray
1.38 Hypochondriasis-Dr Manaan Kar-Ray
1.39 Dissociative Motor Disorder- Dr Jothi Naidoo
1.40 Dissociative motor disorder- Dr Jothi Naidoo
1.41 Head injury
1.42 Head injury
1.43 Haematemesis- Dr Swali Malanda
1.44 Haematemesis- Dr Swali Malanda
1.45 Temporal Lobe Epilepsy (TLE) and Pseudo seizures -Dr Nauman Khalil
1.46 Borderline Personality Disorder (BPD)
2. Old Age Psychiatry Dr Ehab Hegazi- 227
2.1 Elderly Psychosis- Assess psychopathology and do cognitive examination-Dr Manjula Atmakur
2.2 Elderly Psychosis –Dr Manjula Atmakur
2.3 Behavioural and Psychological Symptoms of Dementia-Dr Mike Walker
2.4 BPSD-Collateral history-Dr Mike Walker
2.5 Wandering -risk assessment Dr Ashaye Kunle
2.6 Vascular Dementia-Dr Ehab Hegazi
2.7 Vascular Dementia-Dr Ehab Hegazi
2.8 Vascular Dementia-Dr Ehab Hegazi //Dr Rajeeve Parkianathan
2.9 Recurrent Depression-collateral history-Dr Manjula Atmakur/d/w Dr Tom Dening
2.10 Recurrent Depression-Lithium Augmentation-Dr Manjula Atmakur d/w Dr Tom Dening
2.11 Recurrent Depression-ECT-Dr Ehab Hegazi
2.12 Fronto Temporal Dementia
2.13 Frontal Lobe Tests
2.14 Lewy body Dementia - Dr Manjula Atmakur/ d/w Dr Tom Dening
2.15 Alzheimer’s Dementia history Dr Arun Jha
2.16 Alzheimer’s treatment Antidementia drugs Dr Arun Jha
2.17 Depression psychotic-Dr Ashaye Kunle
2.18 Elderly man- Indecent exposure -assess-Dr Raghavakurup Radhakrisknan
2.19 Elderly man- Indecent exposure -discuss management with wife- Dr Raghavakurup Radhakrisknan
2.20 Acute confusional state Delirium -Dr Champa Ballale
2.21 Acute confusional state Delirium -Dr Champa Balalle
3. Child and Adolescent Psychiatry Dr MS Thambirajah- 302
3.1 Early onset Psychosis-Assess- Dr MS Thambirajah
3.2 Early onset Psychosis-discuss with mother Dr MS Thambirajah
3.3 Early onset Psychosis-discuss with consultant Dr MS Thambirajah
3.4 Overdose-risk assessment (precipitator Rape)-Dr Ken Ma
3.5 Overdose-discuss management- Dr MS Thambirajah
3.6 Overdose-risk assessment (precipitator Bullying)- Dr Ken Ma
3.7 Overdose - discuss management-Dr Ken Ma/ Gosia Demetriou
3.8 ADHD (Attention Deficit Hyperactivity Disorder)-Collateral History Dr Ken Ma/ Dr Rajeeve Parkianathan
3.9 ADHD (Attention Deficit Hyperactivity Disorder)-Explain management to father- Dr Ken Ma
3.10 Autism -collateral history-Dr Meera Roy
3.11 Autism -Explain diagnosis and management
3.12 Enuresis -Dr MS Thambirajah
4. Learning Disability Psychiatry Dr Nauman Khalil/ Dr Nilofar Ahmed- 353
4.1 Challenging behaviour in Learning Disability-Dr Ashok Roy/ Dr Jay Thamizhirai
4.2 Downs’ Syndrome-Dementia vs. Depression-Dr Kamalaika Mukerji
4.3 Downs’ Syndrome-bruising-Dr Rajnish Attavar
4.4 Indecent exposure-Dr Asif Zia
4.5 Indecent exposure-Dr Asif Zia
4.6 Asperger’s Syndrome-Dr Paul Bradley/ Dr Rajeeve Parkianathan
4.7 Epilepsy-Dr Nauman Khalil
4.8 Arson-Dr Regi Alexander
5. Forensic Psychiatry Dr Piyal Sen, Dr MS Thambirajah- 387
5.1 Indecent exposure-risk assessment-Dr Ravi Prakash
5.2 Morbid Jealousy – Assess - Dr Ravi Prakash
5.3 Morbid Jealousy - Discuss with wife- Dr Ravi Prakash
5.4 Morbid Jealousy -Discuss with consultant
5.5 Morbid Jealousy - displacement
5.6 Arson-Dr Regi Alexander
5.7 Erotomania - Assess -Dr Denzil Mitchell
5.8 Erotomania - Discuss management with nurse-Dr Denzil Mitchell
5.9 Erotomania - Discuss management with consultant-Dr Denzil Mitchell/ Gosia Demetriou
5.10 Violence Risk Assessment
5.11 Paedophile
5.12 Assault on the ward
5.13 Assault on the ward
6. Addictions psychiatry Dr Zahoor Syed- 439
6.1 Opiate history -Dr Zahoor Syed
6.2 Delirium Tremens -Assess psychopathology-Dr Christos Koumistidis
6.3 Delirium Tremens - Discuss management with orthopaedic nurse-Dr Christos Koumistidis
6.4 Alcohol Dependence - Dr Zahoor Syed
6.5 Methadone in pregnancy - Professor Fabrizio Schifano
6.6 Methadone in pregnancy - Professor Fabrizio Schifano
6.7 Alcohol and Depression - Professor Fabrizio Schifano
6.8 Cannabis and Schizophrenia - Professor Fabrizio Schifano
7. Psychotherapy Dr Dinesh Sinha/ Dr Furhan Iqbal- 475
7.1 Footballer- Cognitive distortions-assess- Dr Dinesh Sinha
7.2 Footballer -Cognitive distortions- discuss -Dr Dinesh Sinha
7.3 Psychodynamic psychotherapy- Dr Dinesh Sinha
7.4 Psychoanalytical psychotherapy-Dr Dinesh Sinha
7.5 Cognitive behavioural therapy (CBT)- Dr Furhan Iqbal
7.6 Interpersonal psychotherapy (IPT)-Dr Franco Orsucci
7.7 Systematic desensitization-Dr Furhan Iqbal
7.8 Exposure and response prevention(ERP)-Dr Furhan Iqbal / Dr Franco Orsucci
7.9 Psychotherapy-transference- Dr Furhan Iqbal
7.10 Borderline Personality Disorder
7.11 Other Personality Disorders
7.12 Dialectical behavioural therapy (DBT)- Dr Furhan Iqbal
8. Eating Disorder Dr MS Thambirajah, Dr Rajini Rajeswaran- 524
8.1 Anorexia Nervosa - History taking -Dr Tony Jaffa
8.2 Anorexia Nervosa-Discuss with mother-Dr Tony Jaffa
8.3 Anorexia Nervosa - Discuss management with nurse on medical ward
8.4 Anorexia Nervosa-assess personal and family history
8.5 Anorexia Nervosa-discuss aetiological factors and psychological management with nurse
8.6 Refeeding syndrome-discuss management with nurse
8.7 Bulimia Nervosa- Assess for prognostic factors
9. Perinatal Psychiatry Dr Theresa Xeurub, Dr Jothi Naidoo, Dr Rajini Rajeswaran- 559
9.1 Puerperal illness-Postnatal Depression
9.2 Puerperal illness-Postnatal Depression- Gosia Demetriou
9.3 Puerperal Psychosis- Dr Humphrey Enow
9.4 Puerperal Psychosis- Gosia Demetriou
10. Examinations- 583
10.1 EPSES- Extra pyramidal side effects- Dr Ruqayyah Zafar
Cognitive examination
10.2 Akathisia- Dr Ruqayyah Zafar
10.3 Thyroid examination- Dr Chris Robak
10.4 Frontal Lobe tests
10.5 Mini mental State Examination
10.6 Fundoscopy-Dr Chris Robak Neurological examination
10.7 Alcohol Dependence Upper limbs
10.8 Alcohol Dependence-Cerebellar examination Lower limbs
10.9 Korsakoff syndrome
10.10 Respiratory examination
10.11 Cardiovascular examination
10.12 Examination of Cranial nerves
10.13 Examination of upper limb motor and sensory system
10.14 Physical Examinations
10.15 Opiate withdrawal history
10.16 Record a 12 Lead ECG
10.17 Interpretation of ECG
10.18 Interpretation of ECG
10.19 Management of Neuroleptic Malignant Syndrome NMS
10.20 Management of Serotonergic Syndrome
CONTRIBUTORS
Dr Nilofar Ahmed, MBBS, Staff Grade Learning Disability, Milton Keynes, UK
Dr Regi Alexander, MBBS, MRCPsych, Consultant Learning Disability Psychiatrist, MRCPsych, UK
Dr Manjula Atmakur MBBS, MRCPsych, ST5 in Old Age Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Rajnish Attavar MBBS, MRCPsych Consultant Learning disability Psychiatrist, Oxfordshire ,UK
Dr Champa Ballale, MBBS, MRCPsych, Consultant Old Age Psychiatrist, Kettering, UK
Dr Saravanan Balasubramanian MBBS DPM DNB MD Phd Consultant General Adult Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Paul Bradley, MBBS BSc MRCPsych, ST6 in Learning Disability Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Gosia Demetriou, Social Worker, Luton, UK
Dr Tom Dening MBBS, MRCPsych, Consultant Old age psychiatrist , Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Simon Edgar, MB ChB MRCPsych Consultant General Adult Psychiatrist and Clinical Director, Milton Keynes, UK
Dr Sepehr Hafizi,MBBS, MRCPsych, Consultant General Adult Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Essam Hassan, MBBS, MRCPsych, Consultant General Adult Psychiatrist, Milton Keynes, UK
Dr Ehab Hegazi, MBBS, MRCPsych, MSc Consultant Old Age Psychiatrists, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Furhan Iqbal MBBS, MRCPsych, Consultant Psychotherapist Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Tony Jaffa, MBBS, MRCPsych Consultant Child and Adolescent Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Amit Jain MBBS, MRCPsych Staff Grade Herefordshire
Dr Arun Jha, Consultant Old Age Psychiatrist, Hertfordshire, UK
Dr Manaan Kar-Ray MBBS, MRCPsych, MSc, MS Consultant General Adult Psychiatrist, Clinical director, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Nauman Khalil, MBBS, MRCPsych, Consultant Learning Disability Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Christos Koumistidis, MBBS, MSc, MRCPsych, PhD, Consultant Addictions Psychiatrist, Hertfordshire, UK
Dr Ashaye Kunle, MBBS, MRCPsych Consultant Old Age Psychiatrist, Hertfordshire, UK
Dr Ken Ma, MBBS, MRCPsych Consultant Child and Adolescent Psychiatrist, Coventry and Warwickshire, UK
Dr Nigel Lester, MBBS, MRCPsych Consultant Psychiatrist, Associate Clinical Director Camden and Islington NHS Foundation Trust
Dr Franco Orsucci MBBS, DPsych MD Consultant Psychiatrist in Rehabilitation & Recovery Cambridgeshire and Peterborough NHS Foundation Trust, UK ,(Visiting Professor, Research Department of Psychology and Linguistics, University College London)
Dr Denzil Mitchell, MBBS, MRCPsych Consultant General Adult Psychiatrist, Southampton, UK
Dr Swali Malanda BSc MB ChB MSc MA MRCPsych Consultant General Adult 33Psychiatrist, Milton Keynes, UK
Dr Jothi Naidoo, MBBS, MRCPsych ST5 in General Adult Psychiatry, Southampton, UK
Dr Rajeeve Parkianathan BSc MBBS MSc CT3 Psychiatry, Cambridge and Peterborough NHS Foundation Trust.
Dr Ravi Prakash, CT3 in General Adult Psychiatry, Peterborough and Cambridge, UK
Dr Raghavakurup Radhakrisknan DPM(NIMHANS), DNB(Psychiatry), MRCPsych Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Rajini Rajeswaran, MBBS, MRCPsych London, UK
Dr Nisha Rani MBBS, MRCPsych ST4 General Adult Psychiatry Cambridgeshire and Peterborough NHS Foundation Trust, UK
Ferdinand Rensburg, BOJ, London, UK
Dr Chris Robak, MBBS MRCGP, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Ashok Roy, MBBS, MRCPsych Consultant Learning Disability Psychiatrist, Birmingham, UK
Dr Meera Roy, Consultant Learning Disability Psychiatrist, Birmingham, UK
Miss Mary P Ryan Bsc (hons), Consultant Medical Devices & Healthcare, London, UK.
Professor Fabrizio Schifano, Consultant Addictions Psychiatrist, MD, MRCPsych, Dip Psychiatry, Dip Clin Pharmacology Hertfordshire, UK
Dr Piyal Sen., MBBS, DPM, FRCPsych, DFP Consultant Forensic Psychiatrist, Northampton, UK
Dr Dinesh Sinha, MBBS MRCPsych MSc MBA, Consultant Psychotherapy Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Nicholas Stafford, MBBS, MRCPsych Consultant General Adult Psychiatrist, London, UK
Dr Zahoor Syed, MBBS, MRCPsych Consultant General Adult and Substance misuse Psychiatrist, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr MS Thambirajah, MBBS, MRCPsych Consultant Child and Adolescent Psychiatrist, Birmingham, UK
Dr Jay Thamizhirai Staff Grade, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Animesh Tripathi, MBBS, MRCPsych ST5 in General Adult Psychiatry, Hertfordshire, UK
Dr Mike Walker, MBBS, MRCPsych Consultant Old Age Psychiatrist, Hertfordshire, UK
Dr Theresa Xeurub, MBBS, MRCPsych Consultant Perinatal Psychiatrist, Coventry and Warwickshire, UK
Dr Rugia Zafar GP ST2 Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Asif Zia, MBBS, Mrcpsych, MD Consultant Learning Disability Psychiatrist, Peterborough and Cambridge, UK
ACKNOWLEDGEMENTS
A Special thanks to these people I have listed below some of who assisted me during the preparation for my CASC examination.
Dr Subimal Banerjee Consultant Learning Disability Psychiatrist, Amersham, Oxfordshire, UK
Dr Raju Banisetti, MBBS Associate Specialist in Eating Disorders, Reading
Dr Dulith de Silva, MBBS MRCPsych, ST5, Old age psychiatry London, UK
Dr Lalana Desinyake, MBBS MRCPsych, ST5 General adult Psychiatrist, Bedford and Luton, UK
Dr Humphrey Enow, CT2, Cambridgeshire and Peterborough NHS Foundation Trust, UK
Dr Sanjith Kammath, MBBS MRCPsych Consultant General Adult Psychiatrist
Dr Thilak Ratynake, MBBS, MRCPsych Consultant General Adult psychiatrist, Bedfordshire and Luton, UK
Dr Ashok Patel, MBBS MRCPsych Consultant General Adult psychiatrist, Bedfordshire and Luton, UK
Dr Farah Nasir, MBBS, Consultant Old age psychiatrist, Milton Keynes, UK
Dr Raja Natarajan, MBBS, Specialisist Registrar, Oxfordshire, UK (also organiser of the Oxford Course)
Dr Vishelle Ramkisson, MBBS, MRCPsych, Consultant Old age psychiatry, Bedford and Luton
Dr Roshelle Ramkisson, MBBS MRCPsych, ST5 Child and Adolescent psychiatry, Manchester, UK
Dr Samir Shah, MBBS, MRCPsych, ST5 General Adult psychiatry Manchester, UK
Dr Kenneth Singh, MBCHB Consultant Learning Disability Psychiatrist, Milton Keynes, UK
Dr Paul St John Smith, Consultant General Adult Psychiatrist, Hertfordshire, UK
Dr Akeem Sule, Consultant Psychiatrist General Adult Psychiatrist
OTHER
Dr Mark Davies, BA (Hons), MB.BS, MRCPsych, MBA
Consultant General Adult Psychiatrist, RES Consortium, UK
Dr Albert Michael, MRCPsych MD, Consultant General Adult Psychiatrist, Bury St Edmunds, UK
Dr Arun Jha and IOT, Harperbury, UK
CDAT, Stevenage, UK
Hollies, Cavell Centre, Peterborough, UK
Barbra Brook, Stuart Hunt and Roesmarie Neville for assisting with some editing
FOREWORDS
By Dr Dinesh Sinha, Dr MS Thambirajah, Professor Fabrizio Schifano and Dr Asif Zia
Dr Dinesh Sinha
The series of hoops to jump through on the way to the coveted membership of The Royal College of Psychiatrists has grown in the past few years. The process has also seen significant change and in my role as a tutor I hear trainees feeling perplexed an...
Psychiatry is prone to becoming a rather formulaic and descriptive discipline and its academic teachings mirror this tendency. Additionally in the CASC examination trainees need to hold onto the great range of theory that the training encompasses whil...
For these reasons I was pleased to become familiar with this book, as unlike many others in the market it was written by a current senior Specialty Trainee. This brought with it a great benefit, as it specifically sought to address the trainee’s dilem...
I found the clearly laid out format of the individual CASC’s similarly helpful in guiding the candidate not just in the individual scenarios but in the primary task of developing a mental framework that would allow them to calmly approach hitherto un...
The absence of unhelpful terminology and excess verbosity was also striking when compared with other choices in this genre. The last thing needed in a time limited examination of 8 odd minutes is the requirement to recall the verbal ramblings of an o...
Hence I have no hesitation in recommending this book by its enterprising author, as a useful text for success in the CASC.
Dr Dinesh Sinha
MBBS MRCPsych MSc Dual CCT MBA
Consultant Psychiatrist in Psychotherapy
Cambridgeshire and Peterborough NHS Foundation Trust
FOREWORDS
Dr MS Thambirajah
I am pleased to write a foreword for this book on CASC by Seshni Moodliar. The CASC is mainly a test of skills and attitude (by the time they get to take the CASC most trainees have sufficient knowledge of the subject). Although it is difficult to lea...
For the trainee psychiatrist, all that stands between him or her and the membership of the College is the CASC examination. While for a few it may be no more that brief clinical encounter, for most it proves to be a challenge and, for a few, an almost...
I feel that the reflective element built into the each case in the book to be the most useful. In the CASC, it is the strategy rather than the tactics that matters most. In order to conduct a meaningful interview, one has first to decipher the examine...
I would urge the reader not to rush through the cases in the book but to read them one by one taking time to think about and mentally work on each case. Candidates would benefit by using the format given in the book to analyse every case they see in t...
DR. M. S. Thambirajah FRCPsych.
Consultant Child and Adolescent Psychiatrist
Dudley and Walsall Mental Health Partnership Trust
FOREWORDS
Professor Fabrizio Schifano
I am pleased to write the foreword for the book PASS THE CASC for the MRCPsych by Seshni Moodliar.
With the introduction of the CASC exam in spring 2008 the Royal College of Psychiatrists has again taken measures to ensure a high standard of attaining the MRCPsych and gaining membership to the College. The CASC examination is not only a test of the...
The author has skilfully written this exam focussed book which comprises of CASC stations that have been encountered by candidates in the MRCPsych CASC examination since spring 2008. The structure of each scenario enables the candidate to identify the...
As well as providing a structure for preparing for the exams, these guides of interviewing skills in the various psychiatric subspecialties would be beneficial for any aspiring psychiatry core trainee to utilise in their everyday clinical practice wi...
They have all been chosen as they are experts in their field, and some of who are experienced CASC examiners.
I would recommend this excellent book to prospective candidates preparing for the MRCPsych examinations, as well as their clinical tutors, trainers and examiners.
Professor Fabrizio Schifano
Chair in Clinical Pharmacology and Therapeutics
Associate Dean, Postgraduate Medical School
Consultant Psychiatrist (Addictions)
University of Hertfordshire, School of Pharmacy,
College Lane Campus, Hatfield, Herts, AL10 9AB (UK)
FOREWORDS
Dr Asif Zia
There are a number of books covering various aspects of the membership examination. This book also covers CASC examination technique and helps trainees to answer questions in a consistent way. It is important to practice regularly a particular techniq...
Books currently available are either written by people just after passing their exams, or people who are involved with the college examinations, past and
present. Both have their value. Dr Moodliar has written this book after passing her examination and is well aware of the type of CASC questions and how the techniques need to be used. She has tried to put all this together.
Trainees need to learn the biopsychosocial model of psychiatric practice. This is especially important in psychiatry of learning disability due to heterogeneous and complex population which requires a comprehensive model of understanding the person pr...
She also with skill guides the reader to using this holistic approach in information gathering and assessments.
It is important that trainees have the knowledge and ability to communicate effectively with patients. This requires understanding and experience of the speciality, which is not always available to the trainees. Trainees are also spending less time se...
Dr Moodliar seems to have grasped the concept of a comprehensive care and has captured these skills in her book. She needs to be congratulated for doing this. I hope trainees appearing for CASC examinations will find this helpful, not only during th...
Dr Asif Zia, MRCPsych, M.D.
Consultant Psychiatrist and Clinical Director
Specialist Services Division
Cambridge and Peterborough NHS Foundation Trust
Edith Cavell Health Care Campus
Bretton Gate
Peterborough
PE3 9GZ
INTRODUCTION
Background to the CASC examination
The CASC (Clinical assessment of skills and competencies) examination was introduced in spring 2008 by the Royal College of Psychiatrists. It is based on a previous format used, the OSCEs (Observed structured clinical examinations).
The CASC examination is not only a test of candidate’s knowledge but also an assessment of their clinical and communication skills. Whilst this knowledge is imperative, it is the ability and skilfulness to incorporate this awareness into a clinical se...
Throughout these CASC stations there is an admixture of skills being tested which range from history taking, aspects of mental state examination, communication of diagnoses, management plans conducting thorough risk assessments and clinical examinatio...
About this book
Pass the CASC is exclusive in that it integrates everything that you will need in order to tackle and master the array of techniques required for your success in the CASC examinations.
My ultimate goal whilst writing this book was to incorporate both the knowledge and strategies needed for candidates to be successful in the CASC examination. This is something which I found deficient in the texts I perused in preparation for my exami...
This book encompasses common CASC scenarios in psychiatry simulated in an exam focused way. The greatest achievement and asset of these CASC stations is that they all have been peer reviewed by an expert team of about 50 psychiatrists and trainees, s...
It is fair to say that this is the most up to date book on the CASC examination. Candidates will appreciate the first chapter, found exclusively in this text, as the ultimate revision tool, as it is a summary of the collection of the past CASC examin...
The additional distinctive features which make this book, Pass the CASC unique and exam focused is the 150 meticulously worked out scenarios which have a clearly laid out format. Each begins with a construct, instruction to the candidate, a mental che...
I will elaborate further below on each of these distinctive features.
The mental checklist is a practical guide on the strategy of how you would need to approach the task; the rationale of that CASC station; the key skills which are being tested by the college and the salient aspects which you would INTRODUCTION
need to concentrate on. The intention here is for candidates to synchronize this mental framework with their ‘preparation time’ before each station.
The communication skills guide is there to give you an idea of the possible scenario to anticipate and in some cases the ‘ice breaker’ needed to be surpassed in those ‘first 2 minutes’, which most examiners consider as one of the crucial factors in de...
‘Develop rapport and show empathy’ is one of the communication skills I have repetitively used, and with the intention for this to be one of those take
home messages. I will illustrate this using 2 references.
Empathy is defined as: ‘We call empathy (from the Greek word ‘feeling with’) or atunement to express a way a person can be in tune with the internal world of another, and is also connected to what has been called emotional intelligence.’ (Orsucci, Mi...
And following that a description of showing empathy: ‘If you believe that the patient is as important as you are, you are mistaken. The patient is more important than you are. Your career depends on how well you can get on with patients, and make th...
I believe these both are excellent summations of the components of empathy and as we know it is perhaps one of the most important essential skills required as a psychiatrist.
I believe, if you are able to master this, then I can assure you, you would have won half the battle needed to overcome any given CASC scenario.
The scenario then develops into a suggested approach or dialogues which vary from a structured format of questions which need to be probed; to discussing management of the various psychiatric conditions.
These dialogues should not be repeated verbatim, and the skill candidates should aspire to, is to integrate these dialogues to create
a balanced mixture of open and closed questions. I would like to further emphasise that these should be used as a mere guide, and tailored according to the given scenario and given task.
In order to succeed in the CASC, I would recommend you to use the format given in the book to analyse every case that you see in your day to day work And needless to say ‘practice makes perfect’. So practice these in your examination groups, with cons...
I hope trainees preparing for the CASC examinations will find this beneficial,
INTRODUCTION
not only for their examinations but also when carrying out assessments once they have successfully completed their examinations. This would also be an essential read for those core trainees only just starting afresh in their careers in psychiatry to e...
As psychiatry does not come without its fair share of setbacks, I know from my personal experience the impact that these exams have not only on our family lives and work, but also the financial and emotional implications. Colleagues, the key ingredien...
And finally my outlook on psychiatry training whilst incorporating my philosophical view on life, is that whilst it is important for us as psychiatrists to have the knowledge, and continually strive for learning, I believe that it boils down to this, ...
Good luck!!
Seshni Moodliar
MBChB, MRCPsych
PAST CASC STATIONS
SUMMARY OF PAST CASC EXAMINATION STATIONS
In this chapter I have summarized the past CASC examination stations since the introduction of the CASC examination in spring 2008 by the Royal College of psychiatrists, with initial advice on the format from Dr Albert Michael.
These themes of the scenarios have been obtained from various sources including candidates that have participated in the examination.
Personally, in preparation for the CASC examination, the invaluable advice I was given was to go through the past examination stations, and I found this as a useful tool for revision and also as a guide upon which areas needed to be focussed upon.
Reading this chapter will help you identify the common themes that appear regularly in the examinations and thus highlight the importance of the task in each and every CASC station.
The scenario summaries for each examination station should be used merely as a guide in preparation of the CASC examination as we know that the MRCPsych examination format is constantly being updated and evolving.
Good luck!! Seshni Moodliar
PAST CASC STATIONS
CASC PAST EXAMINATION STATIONS
Format compiled with advice from Dr Albert Michael
PAST CASC STATIONS
June 2008
Day 1-linked
1-1A Overdose - suicide risk assessment (rape)
1-1B Overdose - discuss management with the consultant
1-2A Conversion disorder - assessment of sudden onset of blindness
1-2B Conversion disorder - discuss management with mother
1-3A Elderly psychoses - assess psychopathology and perform cognitive examination
1-3B Elderly Psychosis - discuss management with daughter
1-3A Antidepressants - sexual side effects -history taking
1-4B Antidepressants - sexual side effects - discuss management with wife
1-5A Morbid Jealousy - history taking and assess delusional beliefs
1-5B Morbid Jealousy - discuss management with wife
1-6A Head injury - collateral history from mother
1-6B Head injury - perform a cognitive examination including frontal lobe tests
June 2008
Day 2-linked
2-1A Head injury - collateral history from mother
2-1B Head injury - perform a cognitive examination including frontal lobe tests
2-2A ADHD (Attention Deficit Hyperactivity Disorder) - collateral history from mother
2-2B ADHD (Attention Deficit Hyperactivity Disorder) - explain management to father
2-3A Overdose - suicide risk assessment with teacher
2-3B Overdose - discuss management with her friend
2-4A Capacity assessment - for endoscopy due to haematemesis
2-4B Capacity assessment - discuss management with on call consultant
2-5A Puerperal illness - history taking and mental state examination
2-5B Puerperal illness - discuss management with husband
2-6A Panic Attacks - history taking
2-6B Panic Attacks - discuss management with mother
June 2008
Day 3-linked
3-1A ADHD (Attention Deficit Hyperactivity Disorder) - collateral history from mother
3-1B ADHD (Attention Deficit Hyperactivity Disorder) - discuss management with father
3-2A Overdose - suicide risk assessment-teacher
3-2B Overdose - discuss management with her friend
3-3A Capacity assessment - for endoscopy due to haematemesis
3-3B Capacity assessment - discuss management with on call consultant
3-4A Puerperal illness - history taking and mental state examination
3-4B Puerperal illness - discuss management with husband
3-5A Panic Attacks - history taking
3-5B Panic Attacks - discuss management with mother
PAST CASC STATIONS
3-6A Head injury - collateral history from mother
3-6B Head injury -conduct a cognitive examination
June 2008
Day 4-linked
4-1A Erotomania - conduct a mental state examination
4-1B Erotomania - discuss management with consultant
4-2A Delirium Tremens -assess psychopathology
4-2B Delirium Tremens - discuss management with orthopaedic nurse
4-3A Dementia - collateral history from care home
4-3B Dementia - discuss management of BPSD with son
4-4A Overdose assessment - suicide risk assessment rape
4-4B Overdose - discuss management with medical nurse
4-5A Antidepressants - sexual side effects - elicit a history
4-5B Antidepressants - sexual side effects - discuss with management with wife
4-6A Anorexia nervosa - elicit a personal and family history
4-6B Anorexia nervosa - discuss management with nurse on medical ward
November 2008
Day 1- linked
1-1A Footballer- cognitive distortions - demonstrate selective abstraction, maximization and minimization
1-1B Footballer - cognitive distortions- discuss management with
the coach
1-2A ADHD (Attention Deficit Hyperactivity Disorder) - collateral history from mother
1-2B ADHD (Attention Deficit Hyperactivity Disorder) - discuss management with father
1-3A Anorexia nervosa - elicit a personal and family history
1-3B Anorexia nervosa - discuss management with nurse on medical ward
1-4A Elderly man- Indecent exposure -assess history of presenting complaint
1-4B Elderly man- Indecent exposure -discuss management with wife
Day 1 - Single
1-1A Overdose assessment - suicide risk assessment - rape
1-2A Schizophrenia - explain management to mother
1-3A Psychosis - perform a mental state examination
1-4A Cognitive examination - perform a mini mental state examination (MMSE)
1-5A Antidepressants - sexual side effects - assess history of presenting complaint
1-6A Explain systematic desensitization
1-7A Psychosis - assess delusional beliefs
1-8A Overdose - suicide risk assessment-teacher
November 2008
Day 2 - linked
2-1A Post Myocardial Infarct (MI) Depression -Assess social history and do a PAST CASC STATIONS
capacity assessment
2-1B Post Myocardial Infarct (MI) Depression - discuss management with consultant
2-2A Early onset Schizophrenia - assess history of presenting complaint
2-2B Early onset Schizophrenia-Discuss management with mother
2-3A Overdose- suicide risk assessment (Rape)
2-3B Overdose -discuss management with the consultant
2-4A Footballer- Cognitive distortions-demonstrate selective abstraction, maximization and minimization
2-4B Footballer -Cognitive distortions- discuss management with
the coach
Day 2 - Single
2-1A Antidepressant - Sexual side effects-assess
2-2A Polysubstance misuse - history taking
2-3A Grief reaction – history taking 2-4A Temporal lobe epilepsy - elicit history
2-5A Head injury - obtain collateral history from mother
2-6A Anxious woman - history taking with a view of a diagnosis 2-7A Paedophile - conduct a risk assessment
November 2008
Day 3- linked
3-1A Learning disability - Indecent exposure - assess
3-1B Learning disability - Indecent exposure - discuss management with mother
3-2A Elderly Psychosis- assess psychopathology and perform a cognitive examination
3-2B Elderly Psychosis - discuss management with his wife
3-3A Agoraphobia - history taking
3-3B Agoraphobia - discuss management with his wife
3-4A Overdose Assessment - suicide risk assessment- bullying
3-4B Overdose Assessment - talk to consultant about management
Single
3-1A PTSD – obtain history and assess mental state
3-2A Conversion disorder - assess upper and lower limb paralysis
3-4A Violent Risk Assessment – conduct risk assessment
3-5A Explain rationale and process of desensitisation therapy for Agoraphobia
3-6A Alcohol dependence - establish history of alcohol dependence
3-7A Anxious woman - history taking 3-8A Deliberate self-harm – perform risk assessment
November 2008
Day 4-Linked
4-1A Hypochondriasis - assess history of presenting complaint and obtain medical history
4-1B Hypochondriasis - discuss management with girlfriend
PAST CASC STATIONS
4-2A Overdose Assessment - suicide risk assessment- bullying
4-2B Overdose Assessment – discuss with consultant about management
4-3A Elderly Psychosis- assess psychopathology and perform a cognitive examination
4-3B Elderly Psychosis - discuss management with her brother
4-4A Methadone in Pregnancy - elicit a drug and alcohol history and social history
4-4B Methadone in pregnancy - discuss management with her partner
Single
4-1A Anorexia Nervosa-Discuss with mother
4-2A Elderly Psychosis- elderly lady assess psychopathology and perform cognitive examination
4-3A Wandering – elderly man found wandering the streets. Perform a cognitive exam 4-4A Schizophrenia – perform a mental state examination
4-5A Social phobia - assess bride who is worried about her reception
4-6A Agoraphobia - explain management
4-7A Erotomania - conduct a mental state examination
4-8A Somatoform pain disorder – assess history of presenting complaint
March 2009
Day 1-Linked
1-1A Elderly man- Indecent exposure - assess history of presenting complaint
1-1B Elderly man - Indecent exposure - discuss management with wife
1-2A Early onset Schizophrenia - assess history of presenting complaint
1-2B Early onset Schizophrenia - discuss management with consultant
1-3A Antidepressants - sexual side effects - assess history of presenting complaint
1-3B Antidepressants - sexual side effects - discuss management with wife
1-4A Morbid Jealousy - assess his delusional beliefs
1-4B Morbid Jealousy - discuss management with wife
Day 1 - Single
1-1A Refractory Depression - assess weight gain with Venlafaxine and Fluoxetine.
1-2A Bulimia Nervosa - assess for prognostic factors
1-3A Psychosis - Schizophrenia - inpatient wants to go on leave –conduct a risk assessment
1-4A ECT - explain and obtain consent
1-5A Generalised Anxiety - assess women stressed at work
1-6A Psychosis - assess mental state examination
1-7A Cognitive examination - perform on an elderly lady who has visual loss
1-8A Schizophrenia - explain diagnosis and management to mother
March 2009
Day 2-Linked
2-1A Antidepressants - sexual side effects - assess history of presenting complaint
PAST CASC STATIONS
2-1B Antidepressants - sexual side effects - discuss with wife
2-2A Morbid Jealousy - assess history of presenting complaint and delusional beliefs
2-2B Morbid Jealousy - discuss with management with wife
2-3A Early onset Schizophrenia - assess history of presenting complaint
2-3B Early onset Schizophrenia - discuss management with consultant
2-4A Head injury - obtain collateral history from mother
2-4B Head injury - perform a cognitive examination with focus on frontal lobe tests
Day 2 - Single
2-1A ECT - explain and obtain consent
2-2A Schizophrenia - explain management to mother
2-3A OCD - history taking
2-4A Psychosis - assess delusional beliefs
2-5A Cognitive examination- perform a mini mental state examination (MMSE)
2-6A Bulimia Nervosa - assess for prognostic factors
2-7A Refractory Depression - discuss management
2-8A Schizophrenia - assess inpatient who wants to go on leave
March 2009
Day 3-Linked
3-1A Morbid Jealousy - assess mental state and delusional beliefs
3-1B Morbid Jealousy - discuss with management wife
3-2A Puerperal illness -assessment of history and mental state
3-2B Puerperal illness - discuss management with husband
3-3A Post MI Depression - assess social history and do a capacity assessment
3-3B Post MI Depression - discuss management with consultant
3-4A Elderly man confused - assess mental state examination
3-4B Elderly man confusion - discuss management with consultant
Day 3 - Single
3-1A Paedophile -conduct a risk assessment
3-2A Polysubstance misuse - history taking
3-3A Frontal lobe examination - perform
3-4A ECT - explain and obtain consent
3-5A Schizophrenia - on the ward - assess reason for distress
3-6A Bulimia Nervosa - assess for prognostic factors
3-7A Physical Examination - thyroid examination
3-8A Deliberate self-harm-suicide risk assessment
March 2009
Day 4 - Linked
4-1A Overdose Assessment - suicide risk assessment- bullying
4-1B Overdose Assessment - talk to consultant about management
4-2A Erotomania - assess mental state and establish delusional beliefs
4-2B Erotomania - discuss management with consultant
4-1A Dementia – collateral history from carer
PAST CASC STATIONS
4-3B Dementia - discuss management of BPSD with son
4-4A Hypochondriasis - assess history of presenting complaint and obtain medical history
4-4B Hypochondriasis - discuss management with girlfriend
Day 4 - Single
4-1A Psychosis - assess delusional beliefs
4-2A Alzheimer’s Dementia - discuss diagnosis and management with her daughter
4-3A Hypomania - conduct a mental state examination
4-4A Cognitive examination - perform frontal lobe tests
4-5A Psychosis - perform a mental state examination
4-6A Overdose assessment - suicide risk assessment
4-7A Agoraphobia - Explain management
October 2009
Day 1-Linked
1-1A Puerperal illness - obtain history and conduct a risk assessment
1-1B Puerperal illness - discuss management with husband
1-2A Lewy Body Dementia - discuss management with the carer
1-2B Lewy Body Dementia - discuss management with son
1-3A Footballer - cognitive distortions - demonstrate selective abstraction, maximization and minimization
1-3B Footballer - cognitive distortions- discuss management with
The coach
1-4A Conversion disorder - assess upper limb paralysis
1-4B Conversion disorder - discuss management with her husband
Day 1 - Single
1-1A Panic Attacks - explain systematic desensitization
1-2A Clozapine - rehabilitation - discuss with mother
1-3A Arson - conduct a risk assessment
1-4A Overdose Assessment - suicide risk assessment rape
1-5A Psychosis - assess for first rank symptoms
1-6A Alcohol dependence - establish history of alcohol dependence
1-7A Treatment resistant Depression - weight gain with Mirtazapine and Venlafaxine
1-8A Downs Syndrome- collateral history to differentiate dementia and Depression
October 2009
Day 2 - Linked
2-1A Head injury - collateral history from mother
2-1B Head injury - perform cognitive examination with focus on frontal lobe tests
2-2A Morbid Jealousy - assess history of presenting complaint and delusional beliefs
2-2B Morbid Jealousy - discuss with management with wife
2-3A Post MI Depression - assess social history and do capacity assessment
PAST CASC STATIONS
2-3B Post MI Depression - discuss management with consultant
2-4A Assertive Outreach Team (AOT) - collateral history from nurse
2-4B Assertive Outreach Team (AOT) - discuss with management with father
October 2009
Day 2 - Single
2-1A Lithium Augmentation-explain
2-2A Anorexia nervosa-explain diagnosis and management
2-3A Breaking bad news - discuss with relative about relative with brain tumour
2-4A Elderly Psychosis- elderly lady assess psychopathology
2-5A Cognitive examination - perform frontal lobe tests
2-6A Alcohol dependence-history taking
2-7A Interpersonal therapies (IPT) - assess suitability for IPT 2-8A Violent Risk Assessment – conduct risk assessment
2-9A OCD-history taking
October 2009
Day 3 - Linked
3-1A Elderly man - collateral history
3-1B Elderly man - cognitive examination with focus on frontal lobe examination
3-2A Footballer - cognitive distortions - demonstrate selective abstraction, maximization and minimization
3-2B Footballer - cognitive distortions - discuss management with
the coach
3-3A Delirium Tremens - assess psychopathology
3-3B Delirium Tremens - discuss management with orthopaedic nurse
3-4A Early onset Schizophrenia - assess history of presenting complaint
3-4B Early onset Schizophrenia - Discuss management with mother
Day 3 - Single
3-1A Panic attacks - explain systematic desensitization
3-2A Rehabilitation - discuss with mother
3-3A Arson - conduct a risk assessment
3-4A Overdose - suicide risk assessment and, need for compulsory detention
3-5A Alcohol Examination - conduct a neurological examination
3-6A Psychosis - elicit first rank symptoms
3-7A Panic Attacks - history taking
3-8A Alcohol Dependence - history taking
October 2009
Day 4 – Linked
4-1A ADHD (Attention Deficit Hyperactivity Disorder) - collateral history from mother
4-1B ADHD (Attention Deficit Hyperactivity Disorder) - discuss management with father
4-2A Vascular Dementia - collateral history
4-2B Vascular Dementia-explain management to wife
PAST CASC STATIONS
4-3A Assertive Outreach Team (AOT) - collateral history from nurse
4-3B Assertive Outreach Team (AOT) - discuss with management with father
4-4A Morbid Jealousy - assess history of presenting complaint and delusional beliefs
4-4B Morbid Jealousy - discuss with management with wife
Day 4 – Single
4-1A Explain Schizophrenia
4-2A Cognitive examination - perform frontal lobe tests
4-3A Depression in elderly-weight loss
4-4A Interpersonal therapy (IPT) - assess suitability for IPT
4-5A Postman Psychosis
4-6A Breaking bad news - discuss with relative about relative with brain tumour
4-7A Depression and alcohol
4-8A Bulimia and prognostic factors
March 2010
Day 1- Linked
1-1A Lewy Body Dementia - discuss management and diagnosis with carer
1-1B Lewy Body Dementia - discuss management with grandson
1-2A Panic Attacks - history taking
1-2B Panic Attacks - discuss management with mother
1-3A Dissociative motor - assess upper limb paralysis
1-3B Dissociative motor disorder discuss with husband
1-4A Delirium - obtain collateral history from son
1-4B Delirium - discuss management with student nurse
Single
1-1A Cognitive examination - perform a mini mental state examination MMSE
1-2A Schizophrenia - discuss management with mother
1-3A Rehabilitation - discuss with mother
1-4A Psychosis - assess mental state examination
1-5A Overdose - suicide risk assessment
1-6A Alcohol dependence - establish alcohol dependence
1-7A Temporal lobe epilepsy - elicit history
March 2010
Day 2-Linked
2-1A Anorexia Nervosa - elicit personal and family history
2-1B Anorexia Nervosa - discuss aetiological factors and psychological management with the nurse
2-2A Morbid Jealousy - displacement man- anxious at work
2-2B Morbid Jealousy - displacement - discuss management with his wife
2-3A Elderly Psychosis- assess psychopathology and perform a cognitive examination
2-3B Elderly Psychosis - discuss management with daughter
PAST CASC STATIONS
2-4A Methadone in Pregnancy - elicit a drug and alcohol history and social history
2-4B Methadone in pregnancy - discuss management with her partner
Day 2 - Single
2-1A Arson - conduct a risk assessment
2-2A Overdose - suicide risk assessment rape
2-3A Cognitive examination - perform a mini mental state examination (MMSE)
2-4A Schizophrenia - discuss management with mother
2-5A ECT - Explain and obtain consent
2-6A Alcohol and Depression - establish the link
2-7A Wandering - conduct a risk assessment and assess suitability for residential care
2-8A Psychosis - perform a mental state examination
March 2010
Day 3-Linked
3-1A Overdose Assessment - suicide risk assessment- bullying
3-1B Overdose Assessment – discuss with consultant about management
3-2A Anorexia Nervosa - elicit personal and family history
3-2B Anorexia Nervosa - discuss aetiological factors and psychological management with the nurse
3-3A Conversion disorder - assess upper limb paralysis
3-3B Conversion disorder - discuss management with her husband
3-4A AOT - collateral history from nurse
3-4B AOT - discuss with management with father
Day 3 - Single
3-1A Opiate Dependence - elicit history of drug and alcohol use
3-2A Interpersonal psychotherapy - assess suitability for IPT
3-3A Temporal Lobe Epilepsy - elicit history
3-4A Dementia - explain diagnosis and management to carer
3-5A Psychosis - elicit mental state examination
3-6A Capacity assessment - haematemesis
3-7A Schizophrenia - detained inpatient who wants to go on leave
March 2010
Day 4-Linked
4-1A Conversion disorder - assessment of sudden onset of blindness
4-1B Conversion disorder- discuss management with mother
4-2A Recurrent Depression - history of treatment resistant Depression
4-2B Recurrent Depression - discuss management of wife about Lithium
4-3A Delirium - obtain collateral history from son
4-3B Delirium - discuss management with student nurse
4-4A Agoraphobia - history taking
PAST CASC STATIONS
4-4B Agoraphobia - discuss management with her husband
Day 4 - Single
4-1A Antidepressants - sexual side effects - elicit a history
4-2A Anorexia Nervosa - refeeding syndrome
4-3A Paedophile - conduct a risk assessment
4-4A Erotomania - assess mental state and establish delusional beliefs
4-5A Cognitive examination - perform a mini mental state examination (MMSE)
4-6A Opiate Dependence - elicit history of drug and alcohol use
4-7A Psychosis - elicit first rank symptoms
4-8A Downs’s syndrome - collateral history to differentiate Depression from dementia
September 2010
Day 1- Linked
1-1A Anorexia nervosa - elicit a personal and family history
1-1B Anorexia nervosa - discuss management with nurse on medical ward
1-2A Puerperal illness - history taking and mental state examination
1-2B Puerperal illness - discuss management with husband
1-3A Overdose - suicide risk assessment - teacher
1-3B Overdose - discuss management with her friend
1-4A Capacity assessment - for endoscopy due to hematemesis
1-4B Capacity assessment - discuss management with on call consultant
Day 1 - Single
1-1A Temporal Lobe epilepsy - elicit history
1-2A Learning disability - assess change in behaviour - epilepsy, bruises
1-3A Explain systematic desensitization
1-4A Breaking bad news - discuss with relative about relative with brain tumour
1-5A Social phobia - assess bride who is worried about her reception
1-6A Schizophrenia - outpatient review
1-7A Cognitive examination - perform a mini mental state examination (MMSE)
1-8A Opiate dependence - person in A+E -elicit history
September 2010
Day 2-Linked
2-1A Footballer - cognitive distortions - assess to demonstrate maximization, minimization and selective abstraction
2-1B Footballer - cognitive distortions - discuss management with the coach
2-2A Erotomania - assess mental state and establish delusional beliefs
2-2B Erotomania - discuss management with consultant
2-3A Head injury - collateral history from mother
2-3B Head injury - cognitive examination
2-4A Delirium - collateral history form daughter
2-4B Nurse - discuss management with nurse
PAST CASC STATIONS
Day 2 - Single
2-1A Social phobia - assess bride who is worried about her reception
2-2A Body dysmorphic disorder – history taking
2-3A Autism – explain diagnosis and management
2-4A Capacity Assessment for Gastroscopy
2-5A Overdose Assessment – suicide risk assessment
2-6A Lithium Augmentation – explain management
2-7A Mania – perform mental state examination
2-8A Psychosis – perform mental state examination
September 2010
Day 3-Linked
3-1A Puerperal illness - history taking and mental state examination
3-1B Puerperal illness - discuss management with husband
3-2A Overdose – suicide risk assessment (rape)
3-2B Overdose - discuss management with nurse
3-3A Dementia - collateral history from carer
3-3B Dementia - discuss management of BPSD with son
3-4A Hypochondriasis - assess history of presenting complaint and obtain medical history
3-4B Hypochondriasis - discuss management with girlfriend
Day 3 - Single
3-1A Breaking bad news - discuss with relative about relative with brain tumour
3-2A Lower limb – perform physical examination
3-3A Vascular Dementia – perform cognitive examination
3-4A ECT – explains procedure and obtain consent
3-5A Psychotherapy – transference and assess reasons for discontinuation of therapy
3-6A Psychosis – perform mental state examination - First Rank Symptoms (FRS)
3-7A Opiate dependence - assess for harmful effects of substance misuse
3-8A Polysubstance misuse – assess history of substance misuse
September 2010
Day 4 - Linked
4-1A Dementia - collateral history from care home
4-1B Dementia - discuss management of BPSD with son
4-2A Early onset Schizophrenia – history taking
4-2B Early onset Schizophrenia - discuss management with mother
4-3A Erotomania - assess mental state and establish delusional beliefs
4-3B Erotomania - discuss management with consultant
Day 4 - Single
4-1A Vascular Dementia – perform cognitive examination
4-2A Psychosis – assess male patient suspects nurses and doctors poisoning him
4-3A Depression - history taking
PAST CASC STATIONS
4-4A Psychotic Depression – mental state examinations (nihilistic delusions)
4-5A Alcohol dependence – elicit history of alcohol dependence
4-6A Wandering - conduct risk assessment
4-7A Autism – obtain collateral history
4-8A Morbid Jealousy – displacement - assess man- anxious at work
January 2011
Day 1-Linked 1-1A Erotomania – assess mental state and establish delusional beliefs
1-1B Erotomania - discuss management with consultant
1-2A Delirium Tremens - assess psychopathology
1-2B Delirium Tremens - discuss management with orthopaedic nurse
1-3A Capacity assessment - haematemesis
1-3B Capacity assessment - discuss with key-worker
1-4A Elderly man - Indecent exposure – obtain history
1-4B Elderly man - Indecent exposure - discuss management with wife
Day 1 - Single
1-1A Treatment Resistant Depression - history taking 1-2A Cardiovascular System (CVS) – perform physical examination 1-3A Vascular Dementia - collateral history 1-4A OCD - discussion about psychological therapies 1-5A Delirium Tremens - assess psyc...
1-7A Elderly psychoses – assess delusional beliefs 1-8A Mania – perform mental state examination
January 2011
Day 2-Linked
2-1A Lewy Body Dementia - speak to the carer
2-1B Lewy Body Dementia - discuss management with son/daughter
2-2A Capacity assessment of LD - haematemesis for endoscopy
2-2B Capacity assessment of LD - discuss management with key-worker
2-3A Puerperal illness - history taking and mental state examination
2-3B Puerperal illness - discuss management with husband
2-4A Psychotic – detained by police for breach of restraining order -assess
2-4B Psychotic - discuss management with Crisis Resolution Team (CRT) nurse
Day 2 - Single
2-1A Vascular Dementia – perform cognitive examination 2-2A Refeeding syndrome - discuss with key-worker of anorexic patient
2-3A Heroin addict in A+E- assess poly-substance misuse and impact 2-4A PTSD – obtain history and assess mental state 2-5A Refractory Depression - discuss management 2-6A Deliberate self-harm - suicidal risk assessment 2-7A Psychosis - assess mental...
2-8A Somatoform pain disorder – assess history of presenting complaint
January 2011
PAST CASC STATIONS
Day 3 - Linked 3-1A Footballer - cognitive distortions - demonstrate selective abstraction, maximization and minimization
3-1B Footballer - cognitive distortions - discuss management with the coach
3-2A Morbid Jealousy - assess history of presenting complaint and delusional beliefs
3-2B Morbid Jealousy - discuss management with his partner
3-3A Psychotic - detained by police for breach of restraining order-assess
3-3B Psychotic- discuss management with the social worker
3-4A Post MI Depression - assess social history and capacity
3-4B Post MI Depression - discuss management with consultant
Day 3 - Single
3-1A Extra-Pyramidal Side Effects (EPSE) – perform physical examination 3-2A Anxious woman - history taking 3-3A Vascular Dementia – perform cognitive examination
3-4A Autism – obtain collateral history from mother 3-5A Deliberate self-harm – perform risk assessment
3-6A Mania - perform mental state examination 3-7A Obsessive Compulsive Disorder (OCD) - discuss pharmacological management 3-8A Psychosis – perform mental state examination – assess delusional beliefs of guilt
January 2011
Day 4-Linked
1-1A Morbid Jealousy - assess mental state and delusional beliefs
1-1B Morbid Jealousy- discuss management with his partner
2-2A Treatment resistant Schizophrenia - discuss with AOT nurse
2-2B Treatment Resistant Schizophrenia - discuss management with father
3-3A Agoraphobia – history taking
3-3B Agoraphobia - discuss management with husband
4-4A Head injury – obtain collateral history from mother
4-4B Head injury – perform cognitive examination
Day 4 - Single
1A Alcohol withdrawal – assess mental state examination
2A OCD - discuss rationale for psychological treatment
3A Mania assessment - assess elderly man
4A Schizophrenia – explain management to mother
5A Attention Deficit Hyperactivity Disorder (ADHD) – obtain collateral history from mother
6A Violent Risk Assessment – conduct risk assessment
7A Antidepressant - sexual side effects - assess
8A Psychotherapy – transference - explore options for discontinuation of therapy
June 2011
Day 1-Linked
PAST CASC STATIONS
1-1A Antidepressants - sexual side effects - assess
1-1B Antidepressants - sexual side effects - discuss with wife
1-2A Recurrent Depression - assess elderly man on Lithium and Mirtazapine
1-2B Recurrent Depression - discuss management with wife
1-3A Early onset Schizophrenia – assess mental state
1-3B Early onset Schizophrenia - discuss management with mother
1-4A Psychosis - perform mental state examination – assess delusional beliefs
1-4B Psychosis - discuss with social worker
Day 1 - Single 1-1A Bulimia Nervosa – assess for prognostic factors 1-2A Schizophrenia - explain management to mother 1-3A Interpersonal therapy (IPT) - assess suitability for IPT 1-4A ECG - interpretation of patient on high dose of Quetiapine (addit...
1-7A Alcoholic Hallucinosis- perform mental state examination
June 2011 Day 2-Linked
2-1A Conversion disorder – assess sudden onset of blindness
2-1B Conversion disorder - discuss diagnosis and management with mother
2-2A Recurrent Depression - assess elderly man on Lithium and Mirtazapine
2-2B Recurrent Depression - discuss management with wife
2-3A Elderly man - Indecent exposure – history taking
2-3B Elderly man - Indecent exposure - discuss management with wife
2-4A Mild Cognitive Impairment – history taking
2-4B-Mild cognitive impairment - discuss management with the wife
Day2-Single
2-1A Lithium Augmentation – explain 2-2A Bulimia Nervosa – assess for prognostic factors 2-3A OCD - explain psychological management – exposure and response prevention (ERP) 2-4A Elderly Depression – assess elderly with acopia
2-5A Paedophile – conduct risk assessment 2-6A Psychotic – perform mental state examination (First rank symptoms) 2-7A Schizophrenia - explain management to mother
June 2011
Day 3-Single
3-1A Bereavement – differentiate abnormal vs normal grief 3-2A Paedophile – conduct risk assessment 3-3A Lithium augmentation - explain
3-4A Mania with psychotic symptoms – perform mental state examination 3-5A Morbid Jealousy – displacement – assess man with Anxiety at work 3-6A Cognitive Examination – perform frontal lobe tests 3-7A EPSE - history taking and physical examination ...
3-8A ADHD (Attention Deficit Hyperactivity Disorder) - collateral history from mother
June 2011
Day 4-Linked 4-1A Overdose – suicide risk assessment (teacher)
4-1B Overdose - discuss management with her friend
4-2A Learning disability - indecent exposure - assess
4-2B Learning disability - indecent exposure - discuss management with mother
4-3A Panic Attacks – history taking
4-3B Panic Attacks - discuss management with mother
4-4A Frontal lobe – obtain collateral history
4-4B Frontal lobe – perform frontal lobe assessment
Day 4 - Single
4-1A Interpersonal therapies (IPT) - assess suitability for IPT 4-2A PTSD - history taking 4-3A Mania – perform mental state examination 4-4A Schizophrenia – outpatient appointment review
4-5A Wandering – conduct risk assessment
4-6A Grief reaction – history taking 4-7A Opioid - take history and assess impact on life 4-8A Schizophrenia - explain management to mother
GENERAL ADULT PSYCHIATRY
GENERAL ADULT PSYCHIATRY
1. DEPRESSION
Suggested approach
Introduction
C: Hello, I’m Dr… a psychiatrists working in this hospital. I have been asked to see you by your GP. I understand that you have not been feeling well. Can you tell me more about this?
A. Establish Core features of Depression
How have you been feeling in yourself? (Low mood)
How are you feeling in your spirits?
Does that vary at any time of the day? (Diurnal variation)
Is there any particular time of the day your mood is worst?
On a scale of 0 to 10 where would you say your mood is
on most days?
How has your energy levels been? (Energy)
Are you able to enjoy things you usually do? (Anhedonia).
What are these things? (For example find out about
hobbies like going out, etc.)
How do you spend your day?
B. Biological symptoms
GENERAL ADULT PSYCHIATRY
How have you been sleeping? (insomnia or hypersomnia)
Do you ever have any difficulty falling off to sleep?
Do you get up earlier than usual?
Do you need more sleep these days?
How has your appetite been? (Appetite)
Have there been any changes in your weight? (Weight)
Has your interest in sex changed? (Libido)
C. Cognitive symptoms
How has your concentration been? (Concentration)
Are you able to read a book, newspaper or watch the television?
How is your memory? (Memory)
D. Emotional symptoms
How would you rate your self-esteem? (Self-esteem)
How confident do you feel in yourself?
Have you cried at all?
How do you feel like about being with other people?
(Isolating themselves)
E. Feelings of hopelessness, worthlessness and helplessness
How do you see the future now?
Do you feel hopeless, helpless or worthless in any way?
(Hopelessness, helplessness and worthlessness)
F. Suicidal ideation, intent and plans
Have you ever felt like life was not worth living?
Have you had thoughts of wanting to end it all? (Suicidal
ideation)
What have you done? Or how close have you come to it?
What plans have you thought about doing?
Do you think you would harm or hurt yourself?
Have you at any time mentally rehearsed what you
would do? Have you told anyone?
Protective factors
What would prevent you from doing this? (I.e. family, friends, pets)
G. Establish presence of psychotic symptoms-(Mood congruent delusions and hallucinations)
1. Delusions of Guilt
Have you been feeling guilty about anything?
Do you think you might have done something wrong or may have committed a crime or a sin?
Do you think that you have you might have harmed your family or anyone else? Do you think that you deserve to be punished?
GENERAL ADULT PSYCHIATRY
2. Delusions of Poverty
Do you have any concerns for your finances?
3. Nihilistic delusions
Are you concerned about any parts of your body?
Do you think you are suffering from any serious disease or are there any part of your body unhealthy?
Have you ever felt that you do not exist? Do you think that something terrible is about to happen?
4. Hypochondriacal delusions
Are you concerned that you might have a serious illness?
for example cancer, AIDS (Acquired Immune deficiency syndrome)
H. Establish History of Presenting Complaint (HOPC) - onset, duration, progression and severity
How long have you been feeling like this?
What do you think may have caused you to feel like this?
Do you have any particular worries?
I. Impact on biopsychosocial functioning
How has this affected your family life?
Do you work? Has your work suffered because of this?
J. Coping and supports
How have you been coping?
Some people drink or take street drugs, how about you?
K. Insight
What do you think is wrong?
Summarise
Thank you for talking to me. To summarise what you have said is that you have been feeling low in mood and you have been experiencing difficulty sleeping. You are unable to enjoy the things you usually would do. You feel tired, and tend to isolate you...
GENERAL ADULT PSYCHIATRY
GENERAL ADULT PSYCHIATRY
GENERAL ADULT PSYCHIATRY
2. DEPRESSION
Suggested approach
Introduction
C: Hello, I’m Dr…I am a psychiatrists working in this hospital. I have seen your husband, and I understand that you wanted to find out more about his condition and how we will be able to treat him.
Before we begin, can you tell me what your understanding of his condition.
W: He is not interested in doing anything anymore, and prefers to keep to himself.
C: From my assessment with him, it appears that he has the core features of Depression. We all get sad or feel miserable in life from time to time. This usually doesn’t last for more than a few days. Depression occurs if someone continues to remain sa...
W: What are the symptoms and signs of Depression?
C: People who are depressed may feel unhappy, anxious or irritable. They lose interest in activities that were once pleasurable and find it hard to concentrate. They experience problems with sleep leaving them feeling exhausted and fatigued. They lose...
GENERAL ADULT PSYCHIATRY
W: How common is Depression?
C: Depression affects 1 in 5 people, and is equally common in both men and women.
W: What causes Depression?
C: There is no one particular cause for Depression. It can be caused by a number of different factors. It can run in families due to a genetic component. From the evidence we have, it is thought to be caused by an imbalance of chemicals in the brain, ...
It can also be triggered by stressful life events, like financial problems, death of a loved one or relationship break down.
W: What are the treatments available to treat his Depression?
C: We have a range of treatment available which includes medication, psychological or talking therapy and the social aspects of care.
W: I have heard about antidepressants, can you tell me about that?
C: Antidepressants are a group of the medication we use to treat Depression.
W: How does it work?
C: Antidepressant act on areas of the brain associated with mood and thinking and correct the imbalance of chemical messengers in the brain. [Serotonin]. Depression is thought to occur because of low levels of these chemicals or neurotransmitters. ...
W: How long does it take to have effect?
C: Most antidepressants take two to four weeks to build up in our body and have an effect. Our plan would be to start him on the lowest effective dose of the antidepressant. We usually start an antidepressant from the group called the SSRI or selectiv...
W: What are the side effects?
C: Like all other medication, antidepressants also have some side effects. They are usually mild and not everyone experiences these side effects. It is important that he is aware of the side effects. If he does experience any of them then he would nee...
The possible side effects include nausea, vomiting, diarrhoea, sleep problems, loss of appetite and restlessness or Anxiety. Most of the side effects occur in GENERAL ADULT PSYCHIATRY
the early part of the treatment and it is usually because the body becomes is becoming used to the medicine. It should gradually ease away.
W: What happens if he stops taking the medication?
C: It is important for him to take the antidepressant regularly. It is not advisable to stop them suddenly even if he does feel better. This can cause his Depression to come back and he might experience mild discontinuation symptoms, which can inclu...
W: Are antidepressants addictive?
C: Antidepressants are not addictive as they are not known to cause any cravings.
W: I have heard that Prozac® can cause people to be suicidal?
C: There has been a lot of publicity in the media about the link between suicidal thoughts and Prozac® (Fluoxetine). The Committee for the Safety of Medicines (CSM) has thoroughly investigated the evidence and did not find a link. Suicidal thoughts co...
W: Would he be able to take his other medication with these antidepressants?
C: He would need to be cautious and aware of the drug interactions that these medication can have. For example there are some over the counter medicines like painkillers, antihistamines and St John’s wart, which can interact with antidepressants so i...
W: How long will he need to take treatment?
C: The first episode of Depression should be treated for 4-6 months after resolution of his symptoms. Patients with two previous episodes should be treated for at least 2 years. In Recurrent Depressive Disorder treatment may be required for many years.
W: What is the prognosis?
C: The outcome is very promising. Nearly 80% of the people benefit from treatment and can lead a normal life. About 4-5 people get better even without treatment.
W: What can I do to help him?
Your support and understanding of his condition is important in his recovery and wellbeing. We will also endeavour to keep you informed at all stages of GENERAL ADULT PSYCHIATRY
his treatment in order to make decisions about this.
Summarize
Thank you for talking to me. I have told you more about your husband’s condition Depression, and the possible treatment options like antidepressant medication. We also have psychological treatment called CBT or Cognitive behavioural therapy which is a...
I have some leaflets for you to read. The useful organisations to contact are the National Depression campaign and Depression alliance.
Support groups and websites
Depression Alliance:
Information, support and understanding for people who suffer with Depression, and for relatives who want to help. Self-help groups, information, and raising awareness for Depression.
Depression UK:
It is a national mutual support group for people suffering from Depression.
Royal college of psychiatrist’s health information leaflets for patient’s www.rcpsych.ac.uk
GENERAL ADULT PSYCHIATRY
GENERAL ADULT PSYCHIATRY
GENERAL ADULT PSYCHIATRY
3. OVERDOSE
Suggested approach
Introduction
C: Hello, I’m Dr ….I am the on call psychiatrist. Thank you for agreeing to see me. I understand from the doctor in the Accident and Emergency department (A+E) that you had been brought here as you had taken an overdose. I am sorry to hear that. Are y...
A. History of Presenting Complaint (HOPC) (onset, duration, progression and severity)
P: Hello
C: I know this may be difficult for you. However because of what happened I do need to ask you some questions.
Further enquiry about overdose
GENERAL ADULT PSYCHIATRY
Para suicide
Where were you at the time when you took the overdose?
What did you do?
What tablets did you take? How many tablets were there? [Calculate dosage]
Did you take anything else with them? Did you perhaps take any alcohol?
Degree of Preparation
Planning
Did you have a plan to end it all and for how long?
Has it been a spur of the moment decision? (Impulsive)
How did you get the tablets?
Suicide note
Did you write a note, send text messages, email, Facebook, or call anyone?
Last acts
What preparation did you do?
Did you bid farewell to anyone? Have you told anyone?
Circumstances of overdose
When did you take the tablets?
Were you been alone? What did you do to prevent someone finding you?
Post suicidal attempt (after the act)
How did you feel after taking the tablets?
What did you do next?
Did you make yourself sick?
Did you seek help?
How were you discovered? How did you get to the hospital?
Do you regret that your overdose did not succeed in killing you?
Do you still think about killing yourself? (Suicidal ideation)
Is it possible you might plan to end it all again? (Suicidal intent)
Suicidal ideation and intent
What was your intention? What were you thinking at the time?
Did you have thoughts of wanting to end it all? Did you believe that that amount would kill you? (lethality)
Current suicide risk
How do you see the future now?
Do you still have thoughts of wanting to end it all?
What do you think you might do?
Precipitating factors
GENERAL ADULT PSYCHIATRY
Why did you take the overdose?
What sorts of things have been troubling you?
What do you think was the final straw?
How are things at home, school, work, college?
Are you in any relationship?
Recent history of Depression
How have you been feeling in yourself? (Mood)
How has your energy levels been? (Energy)
Have you been able to enjoy things you usually would do? (Anhedonia)
How have you been eating? (Biological symptoms)
How have you been sleeping?
Have you lost or gained any weight?
Screen for psychotic symptoms if necessary
I should like to ask you routine questions which we ask of everybody. Have you had any strange experiences?
Do you ever seem to hear noises or voices when there is no one about, and nothing else to explain it?
Hopelessness
Do you ever feel hopeless?
Do you ever feel that things will not or cannot get better?
Are there times when you cannot see beyond your suffering?
Do you ever wish your life would end?
Relevant past psychiatric history
B. Past Deliberate self-harm attempts (DSH)
Can you tell me how you usually cope?
Have you self-harmed in the past? If so, how serious was it
Other means of self-harm (cutting, jumping in front of a car or a train, bridge, carbon monoxide poisoning, tying ligatures, attempted hanging)
C. Past psychiatric history
Have you ever seen a psychiatrist in the past?
D. Personal and family history
Is there anyone in the family that has any similar problems?
E. Medical History
How is your physical health?
F. Medication
Are you on any regular medication?
G. Social history (establish social support network)
GENERAL ADULT PSYCHIATRY
With whom do you live?
Is there anyone you can confide in? Is there anyone you
feel comfortable to share your problems with?
Who is the one person that you are able to trust?
H. Drug and alcohol history
I. Risk Assessment
Summarise according to severity of risk
To assess for further management plan of inpatient treatment or community treatment dependent on the severity of the risk assessment.
Risk assessment according to severity
a) Mild Risk
Thank you for talking and opening up to me. I know that this must not have been easy. To summarise, you have taken an overdose and it was due to certain personal difficulties. You now regret taking the overdose and have good support at home. What woul...
b) Moderate risk
Thank you for talking to me. I know this must not have been easy. To summarise you have taken an overdose and this is related to some difficulties you are experiencing. You now regret the overdose, however you have expressed that you are continue to h...
supporting people, like you in crisis. They would visit you at home, assist with dispensing medication and support you through this.
What do you think?
c. High risk
Thank you for talking to me. I know this must not have been easy. To summarise, you have taken a serious overdose with the intention of wanting to die and that it appears you are experiencing some depressive symptoms. I would like you to stay in hosp...
Thank you
Support groups and websites
GENERAL ADULT PSYCHIATRY
OVERDOSE –SUICIDE RISK ASSESSMENT
HOPC (onset, duration, progression and severity)
Para suicide
Preparation
Preparation
Planning
Suicidal ideation and intent
Precautions
Preparatory acts
Post suicidal attempt
Precipitating factors
Regrets
Establish presence of underlying mental illness
Past Deliberate self-harm (DSH)-other methods i.e. cutting, jumping in front of cars etc, carbon monoxide poisoning, tying ligatures)
Past psychiatric history-Depression
Personal and family history-suicide
Medical History
Medication
Social history and support network –confidant
Risk Assessment-tailor management according to severity of risk
Mild – discharge home
Moderate –referral to crisis team
Severe- admission either informal/detained under MHA
© Smartsesh
GENERAL ADULT PSYCHIATRY
Start the interview by developing rapport and showing empathy.
Seek to understand the subjective feeling of the individual.
GENERAL ADULT PSYCHIATRY
History of presenting complaint (HOPC)-severity, onset, duration, progression
Deliberate self-harm attempt
Precautions
Planning
Lethality
Precipitating factors
Regrets
Past history of Deliberate Self-harm (DSH) - other methods i.e. cutting, jumping in front of cars etc, carbon monoxide poisoning, tying ligatures)
Exclude presence of underlying mental illness- Depression, Anxiety
Elicit borderline personality traits-[Emotional stability, tolerance of frustration, risk behaviours, frustration, fluctuating mood, empty feeling]
Past psychiatric history
Personal and family history-suicide, self-harm
Drug and alcohol history
Social history-establish support network, confidant
Suicide risk assessment
You have been asked by the cardiologist to assess this gentleman Nicholas Pritchard who is suspected to be suffering with a Moderate Depressive Disorder.
TASK FOR THE CANDIDATE
TASK FOR THE CANDIDATE
Past psychiatric history, Personal and family history, Medical
History, Medication, Drug and alcohol, Forensic,
Psychosexual, Social,
Risk Assessment-If evidence of suicidal ideation, intent or plans
Risk factors for cardiac disease-alcohol, smoking, sedentary
lifestyle, exercise, diet, stress
Mental state examination
Assess for depressive symptoms
My differential diagnoses are
Adjustment disorder
Skin conditions: acne, psoriasis and eczema.
Precautions in pregnancy
Consider psychological treatment
Consider alternative medication
Repeat TFT and U+E(Urea and electrolyte) bloods every 6 months.
Lithium level will be repeated every 3 months and is usually done 12 hours after the last dose.
Practical Tips
PSYCHOSIS
History of presenting complaint HOPC (onset, duration, progression and severity)
Assess his psychopathology.
When eliciting for auditory hallucination, use a clustering approach to elicit hallucinations in other sensory modalities
For example-Do you see anything or smell anything at the same time as you hear voices?
Explanation, effects and coping
What is the explanation? Do you know anyone else who has this kind of experience?
Auditory hallucinations
Complex
second person
third person running commentary
derogatory command
thought echo
Differentiate true hallucination from pseudo-hallucinations
Auditory hallucinations
Elementary
Musical hallucination Visual hallucinations Lilliputian hallucinations
Elementary type
Complex visual hallucinations or phantom visual experiences
Differentiate an illusion from hallucination Hallucinations in other sensory modalities
Gustatory, olfactory Olfactory Gustatory
Tactile -Haptic, Fornication, Hyric, Kinaesthetic, Vestibular, Autoscopy
Extracampine hallucination
Hypnogogic and hypnopompic hallucinations Reflex hallucination
Functional hallucination
©Smartsesh
Possible variations of theme
Speak to the mother of an 18 yr. old who has been smoking cannabis. She is upset that her son has been given the diagnosis of Schizophrenia as she is certain that it is due to the cannabis.
Antipsychotics
F20 Schizophrenia
F41.1 Generalized Anxiety disorder
F41.0 Panic disorder [episodic paroxysmal Anxiety]
F40.0 Agoraphobia
F44 Dissociative [conversion] disorders
Take a history with a view of a diagnosis.
Explore aetiological factors.
Develop rapport and show empathy.
1.36 yr old lady who had a fear of going in public as she might be sick.
2.45 yr. old man who declines social events as he feel he will be ridiculed.
F40.1 Social phobias
F40 Phobic Anxiety disorders
OCD spectrum disorders to consider
Are you concerned about your physical health? (Hypochondriasis)
Do you have any repetitive, seemingly driven behaviour such as nail biting (Tourette’s syndrome)
Stereotypic movements (skin picking, nail biting, scratching, body rocking)
Have you had sudden movements or made sounds that you were unable to control?
What about things like eye blinking, grunting, sniffing or snorting.
How often do these movements or sounds occur?
Have you ever pulled your hair, leaving bald patches or leaving you with thin hair?
(Trichotillomania)
F42 Obsessive-compulsive disorder
F43.1 Post-traumatic stress disorder
F45 Somatoform disorders
F45.4 Persistent somatoform pain disorder
You are about to see this 45 year old lady Kim Daemon who is in the medical ward, and she has presented with weakness of her left arm.
Develop rapport and show empathy.
Show sensitivity.
Personal and family history
Medical History
Medication
FRONT TEMPORAL DEMENTIA
History of presenting complaint HOPC(onset, duration, progression, severity)
Assess his capacity.
Assess his delusional beliefs.
Develop rapport and show empathy.
You are about to see this 34 year old gentleman, Aaron Simms, who was referred by his GP with concerns of ‘weird turns’ he has been having. Additional information: he is on Dosulepin.
Please take a history to arrive to a diagnosis.
Develop rapport and show empathy.
Seek to understand the subjective feelings if the individual.
Establish presence of Borderline personality traits.
Identity disturbance: Emotional stability, empty feeling.
Poor tolerance of frustration.
Self-harm attempts.
Mood instability.
Establish quasi psychotic symptoms.
Exclude underlying co-morbidity.
COMMUNICATION SKILLS
INSTRUCTION TO CANDIDATE
You have assessed this 65 yr. old lady who was admitted under section 2 of the Mental Health Act (MHA 1983) (MHA). She has been diagnosed with Psychosis and is currently on Olanzapine. Discuss management with brother, Mr Hall.
TASK FOR THE CANDIDATE
Discuss her management with her brother.
INSTRUCTI0NS TO THE CANDIDATE
You will be seeing the carer of Mr Barrett, who is a 65 yr. old gentleman living in a residential home. The carers are concerned as he has assaulted a resident and has become increasingly agitated. He has a diagnosis of Alzheimer’s Dementia.
TASK FOR THE CANDIDATE
Get collateral history from carer
INSTRUCTIONS TO THE CANDIDATE
You have been asked to see Mr Barrett’s son, who is concerned about his father. He has been told that his father was prescribed Olanzapine. He has read some information that this can cause falls in elderly and should not be used. He wants to discuss t...
F01 Vascular dementia
F01.0 Vascular dementia of acute onset
F01.1 Multi-infarct dementia
A gradual onset, usually following a number of ischaemic episodes resulting in an accumulation of infarcts.
Incl.
Skin conditions: acne, psoriasis and eczema.
Consider psychological treatment
Consider alternative medication
Repeat TFT and U+E(Urea and electrolyte) bloods every 3 months.
Lithium level will be repeated every 3 months and is usually done 12 hours after the last dose.
Practical Tips
ICD F00 Dementia in Alzheimer's disease (G30.-+)
F00.0 Dementia in Alzheimer's disease with early onset (G30.0+)
F00.1 Dementia in Alzheimer's disease with late onset (G30.1+)
F00.2 Dementia in Alzheimer's disease, atypical or mixed type (G30.8+)
F00.9* Dementia in Alzheimer's disease, unspecified (G30.9+)
Perform a mental state examination.
Explore her psychotic symptoms and psychopathology.
PSYCHOTIC DEPRESSION: HISTORY
HOPC (onset, duration, progression and severity)
Past psychiatric history
Personal and family history
Medical History
Medication
Start the interview by developing rapport and showing empathy.
History of presenting complaint HOPC (onset, duration, progression and severity)
Forensic
Police involvement, charges and convictions
TASK FOR THE CANDIDATE
Obtain a collateral history.
ACUTE CONFUSIONAL STATE/DELIRIUM
HOPC (onset, duration, progression and severity)
Circumstances
Past psychiatric history, Personal and family history, Medical History, Medication, Drug and alcohol, Forensic, Psychosexual, Social
Risk Assessment
Mental state examination
He has the following features of an acute confusional state
My differential diagnoses are-Acute confusional state, Acute confusional state superimposed on an underlying Dementia, Acute psychotic episode
Reasons for delirium:
Acute onset, fluctuation in level of consciousness, disorientation, incoherent speech, present of visual hallucinations and disturbance in sleep wake cycle
You are asked to see this 16yr old Paul Banner. His GP referred him as his parents were concerned about him.
Start the interview by developing rapport and showing empathy.
History of presenting complaint (HOPC)-severity, onset, duration, progression
Impact on his functioning
Past psychiatric history
Forensic history
Discuss your assessment and management with the consultant on call.
OVERDOSE –SUICIDE RISK ASSESSMENT
History of presenting complaint(HOPC)-severity, onset, duration, progression
Para suicide
Preparation
Preparation
Planning
Suicidal ideation and intent
Precautions
Preparatory acts
Post suicidal attempt
Precipitating factors
Regrets
Past DSH-cutting, ligatures, carbon monoxide poisoning
Past psychiatric history
Personal and family history-family history of suicide
Medical History
Medication
Forensic, Psychosexual,
Social support-confidant
Risk Assessment-according to severity-mild, moderate, severe
Start the interview by developing rapport and show empathy.
OVERDOSE –SUICIDE RISK ASSESSMENT
History of presenting complaint(HOPC)-severity, onset, duration, progression
Para suicide
Preparation
Preparation
Planning
Suicidal ideation and intent
Precautions
Preparatory acts
Post suicidal attempt
Precipitating factors
Regrets
Past DSH-cutting, ligatures, carbon monoxide poisoning
Past psychiatric history
Personal and family history-family history of suicide
Medical History
Medication
Forensic, Psychosexual,
Social support-confidant
Risk Assessment-according to severity-mild, moderate, severe
Past psychiatric history
Personal and family history
Medical History
Medication
Drug and alcohol
Forensic, Psychosexual, Social
Risk Assessment(low, intermediate, high )
Protective factors
Mental state examination
Comment on whether evidence of Depression, Psychosis or PTSD symptoms present.
Evidence of suicidal thoughts, ideation or plans
My differential diagnoses are
TASK FOR THE CANDIDATE
Take a history to come to a diagnosis.
INSTRUCTIONS TO CANDIDATE
You are the psychiatry doctor on call. The staff at the local residential home has called you due to their concerns of a 34 yr old man Simon Barbell with moderate learning disability. They are concerned about recent changes in his behaviour. Please ta...
TASK FOR THE CANDIDATE
Elicit collateral history from carer on challenging behaviour.
PAY PARTICULAR ATTENTION TO THE FOLLOWING (MENTAL CHECKLIST)
Elicit a history of challenging behaviour using an antecedent, behavioural and consequence approach.
Identify the aetiological factors using a biopsychosocial approach.
Conduct a risk assessment.
Get carers view as to possible cause for challenging behaviour.
COMMUNICATION SKILLS
Start the interview by building rapport and show empathy.
Acknowledge the carers concern and distress.
History of presenting complaint (HOPC) (onset, duration, progression and severity)
INSTRUCTION TO CANDIDATE
You are about to see Mrs Geraldine Barlow. The GP has referred her 34 yr old son Christopher who has Down syndrome, as there has been a sudden change in his presentation following a fall.
TASK FOR THE CANDIDATE
Elicit a collateral history to differentiate Depression from Dementia.
Past psychiatric history
TASK FOR THE CANDIDATE
Take a collateral history from key worker.
PAY PARTICULAR ATTENTION TO THE FOLLOWING (MENTAL CHECKLIST)
Establish history if presenting complaint.
Establish aetiological factors using a biopsychosocial approach.
Conduct a risk assessment.
Explain the need for further investigation.
Establish Safeguarding issues (SOVA) safe guarding of vulnerable adults.
COMMUNICATION SKILLS
Start by developing rapport and showing empathy.
History of presenting complaint (HOPC)-onset, duration, progression and severity
Details about the bruising
F84.5 Asperger's syndrome
ASSAULT -RISK ASSESSMENT AND FITNESS TO BE INTERVIEWED
History of presenting Complaint (HOPC) (, onset, duration, progression, severity)
Forensic
Risk Assessment
POSSIBLE VARIATIONS OF THEME
35 yr old banker who is alcohol dependent and depressed and suicidal
43 yr old man who has been depressed and recently increased his alcohol consumption
Speak to the mother of 19yr old gentleman who has been admitted and has a diagnosis of Schizophrenia. His mother feels that his illness is due to cannabis.
Discuss this with his mother.
Develop rapport and show empathy.
Show sensitivity and anticipate a concerned mother with possible guilt feelings
Impart information as if you are breaking bad news.
EATING DISORDER- Dr MS Thambirajah
Dr Rajini Rajeswaran
Dr Tony Jaffa
TASK FOR THE CANDIDATE
Elicit history of eating disorder.
PAY PARTICULAR ATTENTION TO THE FOLLOWING (MENTAL CHECKLIST)
Establish current eating pattern.
Establish the core criteria(weight loss, distorted body image, amenorrhoea, including BMI <17).
Establish body image perception.
Elicits compensatory behaviours.
Establish physical sequelae and effects on hypothalamic pituitary gonadal axis.
Establish the psychological sequalae of anorexia nervosa.
Conduct a risk assessment of weight loss and suicidal risk.
Explores co-morbid symptoms.
COMMUNICATION SKILLS
Anticipate denial and reluctance to discuss eating difficulties.
Enquire about eating pattern to latter part of the interview.
ANOREXIA NERVOSA –HISTORY TAKING
HOPC (onset, duration, progression, severity)
Establishing BMI and eating habits
Establish typical day history - all meals
Bingeing – triggers, behaviours, calories, emotions
Preoccupation with food-calorie counting
Aetiological factors-elicit using bio-psychosocial approach
Biological - family history of eating disorders
Psychological- dealing with conflicts
Premorbid personality – Perfectionist, Obsessive, Borderline, Anxious Personality Traits
Exclude co-morbidity- Depression, Anxiety and OCD
Summarise
Consent to speak to parent
INSTRUCTIONS TO THE CANDIDATE
You are about to see a 21 yr. old lady who has a known history of Bulimia Nervosa.
TASK FOR THE CANDIDATE
Obtain an eating disorder history with a view of eliciting bulimic prognostic factors.
PAY PARTICULAR ATTENTION TO THE FOLLOWING (MENTAL CHECKLIST)
Consider possibility of bulimia nervosa, and anorexia –bulimia and bulimia nervosa complicated by borderline personality disorder.
Family history of eating disorders
Medical History
Medication
PERINATAL PSYCHIATRY- Dr Theresa Xeurub.
Dr M S Thambirajah
1. Puerperal illness-Postnatal Depression
2. Puerperal illness-Postnatal Depression
3. Puerperal illness –Post Partum Psychosis
4. Puerperal illness –Post Partum Psychosis
PUERPERAL ILLNESS
History of Presenting Complaint (HOPC) (onset, duration, progression, severity)
Explore for risk factors for postnatal Depression and puerperal Psychosis
Pregnancy-complications, delivery
TASK FOR THE CANDIDATE
Discuss her management with her husband.
PUERPERAL PSYCHOSIS
HOPC (onset , duration, progression, severity)
Explore for risk factors for postnatal Depression/post-partum Psychosis
Pregnancy-complications, delivery
Social services involvement
An important part of this assessment would include discussion with social services to obtain history and if there were any other child protection or child in need issues.
Urgent referral needs to be made to social services and the police
Need to ascertain if there are any other children at risk
Establish if there is a protective carer/ plan
PUERPERAL PSYCHOSIS
Epidemiology: 0ccurs in about 1 in 1000 women post-delivery
Aetiology
Parity, pregnancy complications, past psychiatric history, family history, poor social support
Prognosis: 50-60 % risk in future pregnancies
ICD 10
Section F53 Mental and behavioural disorders associated with the puerperium, not elsewhere classified, can be used in such circumstances.
THYROID FUNCTION TESTS
If you are given thyroid function test results comment on your findings.
INSTRUCTIONS TO THE CANDIDATE
You have been asked to see this 21 yr. old lady Rochelle Carrere who has come from her father’s funeral. She has sudden loss of vision in her left eye.
You have been asked to see this 21 yr. old lady Rochelle Carrere who has come from her father’s funeral. She has sudden loss of vision in her left eye.
TASK FOR THE CANDIDATE
Please do a Fundoscopy examination.
PAY PARTICULAR ATTENTION TO THE FOLLOWING (MENTAL CHECKLIST)
Explains procedure with Ophthalmoscope.
Check for visual acuity using Snellen’s chart.
Examine optic disc.
Identify for any abnormalities.
Summarises.
COMMUNICATION SKILLS
Obtain consent.
Ask if a chaperone is required.
Express your condolences
📜 SIMILAR VOLUMES
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