Category: Psychiatry

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a treatment that has been used in psychiatry since the 1930s. The procedure involves passing an electric current between two electrodes placed on the scalp of the patient to induce a generalised seizure. This article outlines the history, indications, procedure, and side effects of this therapy. History of Electroconvulsive Therapy  Proposed

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Prescribing in Old Age Psychiatry

The general prescribing principles from both Old Age Psychiatrists and Geriatricians is to start at a low dose for a drug, and then titrate up slowly. A small dose for a general adult patient may be large than for an elderly patient, owing to co-existing factors such as low body mass index (BMI), kidney disease, liver disease, and polypharmacy. Medication choice should also be dictated by likely compliance, especially in light of cognitive impairment leading to unintentional overdose or suicidality. These patients often have a high pill burden and so like in a general hospital, can benefit from medicine reconciliation and optimisation. One way to do this can be by prescribing a modified release single dose of psychiatric medication, as opposed to repeated shorter-acting preparations. 

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Obsessive Compulsive disorder

The psychiatric condition obsessive-compulsive disorder (OCD) is estimated to be present in 1.2% of the UK population. This condition has been oversimplified in the past and present media as being only an obsession with cleanliness or order, whereas in reality, it can have potentially a diverse list of presentations. The key to the diagnosis is

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How to Be Prepared for the MSRA

The Multiple Specialty Recruitment Assessment (MSRA) is a computer-based exam increasingly being used by many different specialties as part of core training applications. For all specialties, the MSRA score will contribute to or be the sole consideration for shortlisting candidates for limited interview slots for each specialty. Subsequently, the MSRA score will also (often) contribute

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Psychosis refers to patients suffering a loss of contact with reality. It affects 3 out of 100 people in their lifetime. Psychosis is a constellation of symptoms and signs rather than a diagnosis itself. Causes of psychosis Psychiatric Schizophrenia Mood disorders: Bipolar affective disorder Severe depression with psychosis Schizoaffective disorder Delusional disorder Post-partum psychosis Unspecified

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Psychotropic medication

Psychotropic medication includes some of the most commonly prescribed medication in the the world. This article will cover the types of medication you will tend to encounter, important side effects, monitoring and emergencies. Mood disorders When initiating patients on anti-depressant medication it is important to follow them up within 2 weeks. This is because one

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Risk assessment

Determining the risk of harm to the patient, and sometimes to others, is an essential part of a psychiatric assessment. It is useful to know what questions to ask whether you’re at the hospital front door or on an inpatient psychiatric ward. Self-harm/suicide risk assessment The aim is to assess acute risk for a patient

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Anxiety disorders

Anxiety is a commonly experienced symptom as part of the body’s reaction to stress. It becomes a mental health disorder if exaggerated, lasts >3 weeks and interferes with daily life. Features Psychological: Dread Tension Poor concentration Depersonalisation/derealisation Physical: Insomnia Loss of appetite Globus Diarrhoea Urinary urgency Panic: Palpitations Dizziness Diaphoresis Breathlessness Chest pain Tetany Co-morbid:

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Mood (affective) disorders

In this article, we cover depressive disorders, bipolar affective disorder and schizoaffective disorder with an overview of the epidemiology, diagnostic criteria, assessment and management steps. Depressive disorder Annual prevalence of 5% Depressive episodes last >2 weeks Core symptoms: low mood, anhedonia, anergia Associated: sleep disturbance (early wakening, insomnia or hypersomnia), poor appetite, loss of libido,

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How to take a psychiatric history

Psychiatry, as a specialty is unique in that diagnostic methods, rely very heavily on symptomatology, therefore assessment has to be thorough. Components of psychiatric assessment Full history with mental state exam (MSE) Physical examination and investigations to rule out organic causes 1. Presenting complaint This should be from either the patient and a collateral Ask

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