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Showing posts from 2020

Biopsychosocial Model of Healthcare and doctor-patient relationship

The biopsychosocial model of healthcare emphasizes the following paradigms of doctor-patient relationship Psychosocial assessment, Use of communication skills, Informational care, Counseling, Crises intervention, and Extension of care to the family.     "The biopsychosocial model is an interdisciplinary model that looks at the interconnection between biology, psychology, and socio-environmental factors. The model specifically examines how these aspects play a role in topics ranging from health and disease models to human development. George L. Engel developed this model in 1977 and is the first of its kind to employ this type of multifaceted thinking. The biopsychosocial model has received criticism about its limitations but continues to carry influence in the fields of psychology, health, medicine, and human development." Source: Biopsychosocial model -

Mental Health Professionals As ‘Silent Frontline Healthcare Workers’: Perspectives from Three South Asian Countries

Mental Health Professionals As ‘Silent Frontline Healthcare Workers’: Perspectives from Three South Asian Countries Sheikh Shoib 1 , Anoop Krishna Guppta 2 , Waleed Ahmad 3 , Shijo John Joseph 4 , Samrat Singh Bhandari 4 Abstract Mental health professionals across the globe foresaw the mental health impact of the coronavirus disease 2019 (COVID-19) pandemic. They have faced a scarcity of trained professionals, rising morbidities, lack of protective gear, shortage of psychotropic drugs, and poor rapport building because of masking and social distancing. Amidst all, they have responded with approaches that focus on continuing mental health services to the patients already in care, educating the vulnerable people to help them cope with these stressors, and providing counselling services to patients and families affected by the pandemic. LEAD-IN The unprecedented impact of the coronavirus disease 2019 (COVID-19) pandemic has caused a jolt to various realms of life and various groups of peo

NICE Guidance on Electroconvulsive Therapy

NICE recommends to use electroconvulsive therapy (ECT) only to attain quick and short-term improvement of severe symptoms if an adequate trial of other options has not been effective and/or when the condition is considered to be potentially life-threatening, in individuals with: catatonia a prolonged or severe manic episode. Indication to an individual must be based a documented assessment of the risks and potential benefits to the individual. Exercise caution when considering electroconvulsive therapy during pregnancy, in older people, and in children and young people. Valid consent should be obtained in all cases where the individual can grant or refuse consent. The decision to use electroconvulsive therapy should be made jointly by the individual and the clinician(s) responsible for treatment, based on an informed discussion after full information about the risks and potential benefits, without pressure or coercion, the involvement of patient advocates and/or carers is strongly enc

What is the approximate salary package in the psychiatric department for a junior doctor?

Is it different from the ED salary packge for a junior SHO level? My current packge is 42,969 plus 50% banding = 64,453 per annum in emergency duty, junior level non-trainee post. Will it decrease if I move to a non-trainee SHO (speciality house officer) post in the same trust in psychiatry? £64,000 is a good salary for a junior doctor. The salary packages depend on level of responsibility and frequency of oncalls. All jobs advertised will have a range & given your previous experience you can ask them to give you higher side of the range It will definitely go down but you will have more time and more work life balance,—more valuable than money. I assume your salary is so high as there is so much unsocialable hours. I imagine base salary will be the same but total less as just some twilights, night and weekends- normal day will be 9-5. It should say pay in the job description

Can you apply for the MTI UK Scheme before passing MRCPsych?

You do not need to pass MRCPsych paper-A or Paper B before you apply for the MTI. You can apply to the program before passing any part of the MRCPsych exams. The following are your requirements to enter the MTI scheme.  GMC-recognized primary medical qualification from an internationally accepted medical institution.  An acceptable internship (or equivalent) of 12 months.  Three years of experience working in Psychiatry in the last five years.  Working in psychiatry for the last year.  A score of 7.5 in IELTS academic or grade b on OET taken in the last 18 months.   You have received or will work towards a postgraduate qualification in psychiatry.

What was the 1970s psychoanalytic approach to children with autism?

The 1970s psychoanalytic approach: Applied Behavior Analysis (ABA), based on operant-conditioning, target behaviors (excess of unwanted and or deficits of wanted) are modified with reinforcement approximations ( shaping ). Applied behavior analysis, also called behavioral engineering, applying empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism and the experimental analysis of behavior. (Wikipedia)

1960s Psychoanalytic Approach to Children with Autism

The 1960s psychoanalytic approach to children with autism: Base on Lovaas- socialization study Building social behavior in children with autism by use of electric shock. Method- use of identical twins: Tell them to come here and shock them until they move toward the experimenter. They based applied behavior analysis on it, supported by decades of research behind the Lovaas approach and more if you include the research into Skinner's theories, on which they base it. Predictors of response Early: better the outcome in younger children.  Intensive more sessions per week.  Duration: longer duration of therapy.  With Parents: Children accompanied by parents in therapy do better.

What are the psychoanalytic approaches to the treatment of patients with autism?

Holding therapy (Tinbergen 1983): A failure to bond Parent holds child to cause the autistic defense to crumble. Humanistic play therapy (Axline 1965): Encouraged the expression of feelings through play and unconditional positive regard. OPTIONS (Kaufman 1976) Parents spent every waking hour with child follow child lead

Factors that Obstruct Effective Communication

Factors that Obstruct Effective Communication The following factors can interfere with effective communication during clinical assessment.  Lack of exclusivity, for example, assessment on the bedside inside a unit of 20 patients.  Anxiety by a doctor, because of which divides their attention and concentrating, not the assessment is difficult.  Awkward seating that makes it difficult to relax while assessing a patient.  Lack of attention to the nonverbal cues Offensive remarks. Frequent interruptions.  Selective listening. Daydreaming. 

Capacity and Consent for MRCPsych Exams

Capacity and Consent What is the definition of consent? Consent is permission for something to happen or agreement to do something consent is to give permission for something to happen What do you need for valid consent? Given freely without duress or coercion legally capable of consenting cover the intervention/procedure it must be informed it has to endure the time needed for treatment.  If a patient consents to treatment can they then change their mind? Yes, either before treatment or at any point during treatment.  What information do you have to portray to the patient when trying to get consent? What the treatment consists of the main beneficial effects, risks, and unwanted side effects of treatment. What sort of additional aids could you use in trying to obtain consent? Written/ visual aids translators’ friends/relatives time to reflect- especially if a large treatment What is capacity? Capacity is the ability to make a decision What is the capacity to consent like in delirium? A

Open Ended Questions

An open-ended question is one that puts the least restrictions over the answer to a select option-list. For example, an open-ended question to assess the thoughts would be: What do you think about most often? You can already notice, it is impossible to ask an absolute-open ended question.  For the purpose of the Research Workshop, the College of Physicians and Surgeons states:  Open-ended questions elicit detailed responses and provide no preselected options. These types of questions are the hallmark of qualitative research.   Also, learn the advantages of open-ended questions. 

The new Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

New: The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry  Authors : David M. Taylor, Fiona Gaughran, Toby Pillinger The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry provide an evidence-based and practical approach for psychiatric and general practitioners to screen, investigate, and manage common physical health conditions observed in persons with severe mental illness. The book bridges the gap between psychiatric and physical health care for the seriously mentally ill and is written by an extraordinary team of acknowledged professionals in medicine, surgery, pharmacy, dietetics, physiotherapy, and psychiatry. The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry cover the following:  Assessment and care guidelines for well over a hundred various medical and surgical presentations encountered often in persons with major mental illness. Physical health emergencies in the psychiatric context. Evidence-based m

Age Disorientation in Schizophrenia

Age Disorientation in Schizophrenia Age-disoriented patients are cognitively more impaired than their age-oriented counterparts. Whether the cognitive impairment is present to a greater degree premorbid among these patients, studies have not yet established this, but some data support this. Others have reported that rated school performance and grade-level do not distinguish age-disoriented from age-oriented subjects. Some have suggested that marked cognitive decline occurs following the first break.  Harvey et al. reported that age-related decline in mini-mental state examination scores is dramatically greater among age-disoriented schizophrenia patients than age-oriented subjects, consistent with more rapid deterioration. Examination of the specific PANSS items revealed that the age-disoriented group was consistently more delusional and more conceptually disorganized and showed increased stereotyped thinking, motor retardation, unusual thought content, disorientation, and poor attent

Advantages of Open-Ended Questions

What are the advantages of open-ended questions? During the clinical assessment, open-ended questions are always preferred to close-ended questions. there are several advantages to the open-ended questions.  If you still don't know What are Open-Ended Questions? Open-ended questions allow patients to start talking about themselves and puts them at ease as they have the floor.  Allows you time to think and plan areas of questioning as you assess their style and content of the response. Allows a period of non-verbal response from interviewer; listening and facilitating.  >> Just slight info: To Have the floor means to have the right or opportunity to speak in a group, especially at a formal event or gathering.  Please, Dr. Dunstaple, your colleague has the floor. You'll have the opportunity to reply when he has finished speaking. 

Clinical Vignette: Management of a Patient with Treatment-Refractory Depression

Clinical Vignette: Management of a Patient with Treatment-Refractory Depression Mr X is a known case of depressive illness for the last 1 year. He has stopped responding after two different groups of antidepressants were tried and has been labelled as a patient of treatment-resistant depression.  How will you assess the cause of this resistance? Write the treatment algorithm that you will follow for his management? If you had to start lithium in this case, what protocol would you follow to start it and how will you monitor it? Treatment Options for Refractory Depression

Vignette: Assessment of Depression

A 33-year-old man who is a driver-by-profession presented to you with decreased appetite, loss of sleep, and irritability for the last three months. There is no past or family history of psychiatric conditions. He is the only earning member of his family and must go to work every day to make a living. On physical examination, his pulse is 90 beats per minute with an irregular rhythm. a) Outline your assessment and management plans. b) What precautions you will take while prescribing psychotropic medications in this case? c) Enumerate all possible differential diagnoses in this case.

Assessment of Treatment Resistance in Depression

  Assessment of Treatment Resistance   Reconsider the diagnosis, especially considering bipolar depression and hypothyroidism.   Identify comorbidities.   Ensure that adequate dosages for adequate durations have been given   Confirm adherence to treatment   Evaluate for maintaining factors and repeated experiences of stressful circumstances.

Delusions in Psychotic Depression

(Mnemonic: GINPH) ● Delusions of Guilt ● Delusions of Impoverishment (can also be considered as a type of nihilistic delusion. ● Nihilistic delusions, including Cotard syndrome ● Persecutory delusions* ● Hypochondriacal delusions Patients with Psychotic depression  consider these thoughts well-deserved unlike in schizophrenia where patients feel remorse towards them and mania where patients consider them a response to the great position they have earned.  When these delusions occur against a background of depressed mood, they are mood-congruent and favor the diagnosis of psychotic depression. When patients with depression have delusions of grandeur or even neutral delusions e.g. delusions of reference, they are mood-incongruent delusions" and favor the diagnosis of schizophrenia (ICD-10).

Psychosis Versus Neurosis

Psychosis Versus Neurosis What is psychosis? A psychiatric disorder in which the thoughts, affective-response, ability to recognize reality, and ability to communicate and relate to others shows impairment sufficient to interfere grossly with the capacity to deal with reality. The classic characteristics of psychosis are. Impaired reality testing Hallucinations Delusions Disorganization. Psychosis Insight is absent in patients with psychosis.  In patients with psychosis, there is an impairment in judgment and reasoning.  They lose contact with reality. For example, they believe in the voices they hear.  Delusions are often present. Delusions are psychotic features and are never normal (if a belief meets any criteria of normality, it's not a delusion).  True hallucinations are present, even though hallucinations, especially hypnagogic and hypnopompic hallucinations, also occur in normal people.   Patients with psychosis may exhibit changes in personality, especially patients with sc