MRCPsych CASC: Assessment of School Refusal This MRCPsych CASC Sample Case assesses a child's refusal to attend school. It is important to consider several key factors when evaluating the situation. First, it is crucial to determine the age of the child and whether they desired to attend the scheduled appointment. It is also important to determine who is currently responsible for their care and if they have any connections to CAMHS (Child and Adolescent Mental Health Services) or social services. The duration of the child's refusal to attend school should also be considered, as well as the different perspectives on the cause of the refusal from the child, their parents, and the school. It is important to determine if the child is refusing other situations. If the child is exhibiting signs of separation anxiety, it is important to note that they may have worries about the safety of their caregiver and follow them closely in all situations. It is also important to assess the pote

MRCPsych CASC: Assessment of an aggressive Patient in the Emergency Department Scenario: A patient with a severe psychiatric disorder has become aggressive. You have been called to assess him in the psychiatric emergency department.  Introduction  Assessing a patient with a severe psychiatric disorder can be a challenging task, especially if the patient is aggressive. It is essential to approach the assessment with caution and to prioritize the safety of both the patient and the assessing psychiatrist. Here are the steps for assessing a patient with a severe psychiatric disorder: Establish rapport:  The first step is to establish a rapport with the patient. This can be done by introducing oneself and explaining the purpose of the assessment. For example, the trainee psychiatrist can say, "Hello, I am Dr. [Name]. I am here to talk to you and assess how you are feeling." Gather information: The next step is to gather information about the patient's current symptoms and past

CASC Notes: Emergency Assessment of an Angry or Anxious Patient or Relative As you enter the station, it is important to show your badge to the examiner and nod while saying a quiet "Thanks". When you meet the relative or patient, they may be standing up, so it's best to start by taking a seat yourself. You can say, "Hello, my name is Dr Waleed. Thank you so much for agreeing to see me today. Do you mind if I take a seat?" Starting with a calm and friendly approach is crucial in building rapport with the patient or relative. You can say, "First of all, thank you so much for coming to see me today. Good communication between patients or relatives and the psychiatry team is very important to us, and we value it greatly." You can also express your empathy and acknowledge their difficult situation by saying, "I can't imagine how difficult it must be as a mother/father/sister/carer to see your loved one suffering like this." If the relative or

Assessment and Management of The Risk of Violence in Schizophrenia Scenario A 21-year-old lady with the diagnosis of schizophrenia informs you she will kill her neighbour tomorrow as she has ruined her life. She tells not to disclose this to anyone. How will you assess the homicidal risk in this patient? What treatment and follow up recommendations will you make in this case? Clinical Assessment  Listen to the patient and develop a therapeutic relationship.  begin the assessment and enquire about her demographics.  Enquire about the issue that she brought up—she will kill her neighbour.  Elaborate on how she thinks her neighbour has ruined her life.  Explore her thoughts a nd whether the patient may have persecutory delusions Assess how much resentment she feels? Follow up with inquiry about her mood, esp. about irritability and depression How she plans to commit the act Has she threatened the person? Whether she has done so in the past If so, what provoked such an in

Important Points about the History of Drug Use Regular or intermittent Amount (know the units) Pattern dependence/withdrawal  Impact on work, relationships, money, police  Screening questionnaires e.g. CAGE

Behavior and Body Language During History Taking Establish and maintain eye-contact and rapport.  Relaxed non-threatening posture and appear unhurried.  Use facilitated noises (I see, okay, etc.) Pick up on nonverbal cues  Acknowledge what they are saying  Show a willingness to understand  Do not offer opinion/advice to early  Control over-talkativeness with polite authority at the right time

Differentiating Factors of Epileptic and Non-epileptic Fits Factors That Favor Epileptic Fits The following Favor epileptic fits.  An abrupt onset A stereotyped course lasting seconds to a few minutes. Tongue biting, especially on the sides Urinary incontinence during the fit Evidence of cyanosis, for example, face turning blue. Injury during the episode Prolonged postictal confusion Favour Non-Epileptic Fits Treatment resistance to over two antiepileptic drugs. Antiepileptics do not affect seizures. Fits occur with specific environmental or emotional triggers. Presence of witnesses, for example, family members at the time of an event. History of chronic pain, fibromyalgia, chronic fatigue, syndromes. History of comorbid psychiatric illness, personality disorder or substance abuse. History of remote or current abuse or trauma. Presence of repeatedly normal EEGs in the presence of recurrent seizures. Drawn from Benbadis and LaFrance (2010). Sociological features of Psychogenic Non-Epile