LIAISON PSYCHIATRY CASC TIPS Dr M Wong Dr A Guirguis 09/06/2011 Aim and Objectives • Understand the process of CASC station • To set up a content What and how to say • Two main things the college expect 1- Content 2- Process Content • • • • Range and depth of history Range and depth of risk Range and depth of psychopathology Range of cognition tested and appropriate use of cognitive testing • Quality and extent of physical examination Process • Questioning style, use of open and closed question • Listening and responding appropriately • Fluency of the interview • Focus on the task required • Prioritisation • Professionalism Agenda • Phase of the interview a- Opening Set down an appropriate introduction and aim b-Middle Requested task, cues c- End SUMMARISE & devise a plan • RAPPORT, RAPPORT, RAPPORT Liaison Psychiatry topics • Capacity • Conversion/Somatisation/Medically Unexplained Symptoms • Acute confusional states • DTs/alcohol • Eating disorders • Depression/self-harm/Mania/Psychosis • Body dysmorphic disorder SBAR • Situation who am I/where am I? who is the patient? What is wrong? • Background Admission diagnosis? Relevant past hx? Summary of Rx to date? • Assessment Mental State/vital signs? I think the problem is…I have done… • Recommendations What I would like u to do/Is there anything you would like me to do? Mr Frank was admitted to the medical ward following acute GI bleeding. The medics called you as he is refusing IV fluids, medications, sedatives, and upper GI endoscopy. He is known to have past psychiatric history and is on depot injection. Medics requested an assessment to determine whether he has the capacity to refuse treatment. Miss Sarah White is a 27 year old lady who has seen her GP complaining that her eyes are wide apart. Obtain history to explore the nature and extent of her problem Assess her to clarify her diagnosis Mr Lewis was referred by his GP to your OPC for psychiatric assessment. He is not happy with the referral and thinks that he suffers from severe chronic pain and there is nothing wrong with him mentally. Obtain history to reach a diagnosis The cardiac rehab team has referred Mr Grant, 55 year old man who was not coping well since he had MI 2 month ago. They are concerned about his attitude and his cooperation. Please take a history and assess his attitude and his self management towards his IHD. DO NOT do physical examination, or assess his cognitive function. You will need to take some note to discuss his management plan with the consultant at the next station Discuss the out come of your assessment, management , and prognosis with your consultant who did not meet with the patient Mrs Clarke is a 45 year old lady who have developed a sudden loss in her movement on her right side, she was referred for a psychiatric assessment as all her investigations was normal. Take a focus history to arrive to the diagnosis Mr Clarke is waiting next door o discuss his wife diagnosis and management . You are now meeting with Mr Clarke who would like to discuss her diagnosis and her management plan Preparation • • • • • Depression Antidepressant Psychosis Antipsychotic Psychotherapy Blue Print RCPsych GA OA CAMH LD Psychotherapy forensic % History X X X X X X 30-40 MSE X X X X X 30-40 Risk assessment X X X X X 15-30 Cog exam X X X 10-20 Phys exam X X Case discussion3 X X X X X X 15-30 Difficult communication X X X X X X 5-15 5-15 • • • • • History may include obtaining collateral history as well as taking a history directly from the ‘patient’ Risk assessment may include assessment of capacity Case discussion can be with medical and paramedical professionals as well as lay people including the patient, family, carers and other professionals. It also includes skills related to psychotherapy formulation (cognitive and dynamic) and discussion of treatment. General Adult includes all subspecialties There will be minor variation in the percentage of stations for each skill area according to how skills are represented in each station. This is due to some station constructs assessing more than one skill (e.g. risk assessment requiring a mental state examination or difficult communication occurring within the context of a case discussion) At any one sitting of the CASC, candidates will face 16 stations. Normally candidates could expect to encounter the following make up of stations: • At least one station with a psychopathology focus • At least one station with risk assessment as the focus • At least one station with cognitive assessment as the focus • At least one station with a psychotherapy theme • At least one station with an old age psychiatry theme • At least one station with either a learning disability or child and adolescent psychiatry theme • Possibly one station with a forensic psychiatry theme • Possibly one station testing physical examination skills • Possibly one station testing communication skills • Remaining stations will cover general adult psychiatry themes, including sub-specialties • Throughout these stations there will be a mix of skills required including history taking, aspects of mental state examination, communication of diagnoses, management plans, and prognosis.