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Sample CASC-Opiate (opioid) Withdrawal Assessment

Opiate Withdrawal History and Physical Examination   Opiate withdrawal symptoms peak between 36-72 hours. Symptoms run their course in 5-7 days, though craving continues for some time.  Withdrawal from Heroin Withdrawal from heroin may begin up to 8 hours after the last use. During the next few hours, the person experiences muscle pain, sneezing, sweating; tearfulness; yawning excessively.  At 36 hours after the last use, symptoms are most severe. These symptoms include chills, muscle cramps, flushing, sweating, tachycardia, hypertension, inability to sleep, vomiting & diarrhoea . Symptoms typically continue for about 72 hours & gradually diminish over 5-10 days. History  This history part is in Urdu/Hindi. I will add the " Objective Opiate Withdrawal Scale"  soon here so anyone can benefit.   For now: COWS  Aap kia istemal karty Akhri bar kab lia hai aap ne Abhi dil chahta ke aap dobara se kar lyn? Kitna had tak?   Gutno ya baqi jorhon mai dard ho raha hai? Baqi

Differentiating Factors of Epileptic and Non-epileptic Fits

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

Assessment of Risk Factors in Post-traumatic Stress Disorder

A 37-year-old woman, who is an intelligent computer programmer, presented with insomnia, restlessness, and anxiety. On detailed assessment, she reveals that the symptoms started after some thieves robbed their house 3 months ago. In the incident, they had killed one of her sons. She also experiences intense imagery related to the event and often wakes up after experiencing a nightmare. The woman feels uncomfortable talking about the event and requests not to talk about it. She had experienced another such incident when she was a child. She also received treatment for depression three years ago. Personality assessment revealed neurotic traits. No one else in the family developed such symptoms, even though all of them experienced the event. 

What are the aims of the Counseling Sessions

What are the aims of the Counseling Sessions? Counseling Sessions are an important part of psychiatric management. The following list sums up the Aims of Counselling Sessions;  Establish mutual trust Clarification and explanation Freely expresses emotions Reassurance Understanding of health Indent various choices Making decisions Seeking support Learning the necessary skills

What are the Basics of Communication Skills?

The Basics of Communication Skills Communication skills are central to clinical assessment. The following are the basic techniques that improve communications Skills.  Attending and listening Active listening Verbal techniques Funneling Paraphrasing Selective reflection Empathy building Checking for understanding.

CASC on Phobic Disorder

CASC on Phobic Disorder A dentist refers a young man to you; he cannot get the treatment and needs the dental procedures urgently. What causes phobia and anxiety and how you will treat it? Explain this to the patient. Sitting and introduction Rapport building and inquiries Explain the fear of pain, injections anesthetic and side effects. Explain the helplessness, embarrassment and feeling of loss and treatment plan Close the interview

Using Watch For Physical Examination During CASC

  Using Watch For Physical Examination During CASC Since September 2018, the college expects candidates to provide their own timing device should there be a physical or other examination that requires the use of one. Digital watches/timing devices will not be permitted. Similarly, the Royal College has clarified that they do not permit mobile phones and other such devices these in CASC and will lead to disqualification if used. The candidate brings their device to the exam center. As with other components of the MRCPsych examination, the College does NOT provide spare timing devices and they will accept no liability if a candidate’s device is defective. The Royal College entertains no appeal if you do not bring your own timing device or a defective one and cannot perform a task requiring timing to the satisfaction of the examiner. CASC means the clinical assessment of skill and applied knowledge 

Assessment of Fitness to Plead (Capacity to Stand Trial) Pritchard Criteria

Capacity to Stand Trial (Prichard Criteria) Introduction To stand trial, the accused should be able to describe his behaviour and whereabouts at the time of the alleged offence, understands what happens in the courtroom and understands the role of the courtroom personnel, instruct his solicitor, distinguish between various pleas and understand the range and nature of verdicts. Pritchard Criteria In the law of England and Wales, fitness to plead is the capacity of a defendant in criminal proceedings to comprehend the course of those proceedings. Its equivalent in the United States and Canada is ‘competence to stand trial.’ If the defendant raises fitness to plead, a judge will decide whether an individual fit to plead, usually following a psychiatric evaluation. To decide whether a patient is fit to plead, it is important to determine the extent to which the defendant can:  Understand the nature of the charge Understand the difference between pleading guilty and not guilty Follow the co

Diagnostic Formulation

Diagnostic formulation What is the diagnostic formulation?? We use a diagnostic formulation to integrate and better evaluate the information we have obtained from the assessment of the patient. It has these components: The problem Differential diagnosis Etiology Management Prognosis

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. 

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. 

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. 

Post-Traumatic Stress Disorder: Sample CASC

So, I have been asked by your GP to have a chat with you because you are having some difficulties in judging. So, as far as I know, you have, you were in an accident. A few months ago and since then you've been having some difficulties. But if it's okay, I'll let you explain what led you to come in here already. Yeah, I just had an accident about six months ago. And ever since then, I just can't get out of my head. was it was a serious accident? Yeah, it was it could have been, you know, the car was all messed up in a way you know to sort of concussion to split a whiplash room in the car was really hard. I can see where you're getting a bit anxious even talking about it. If you find questions difficult to answer It's okay, we can move on. And you can take your time, too, if you're feeling anxious. So you had this unfortunate accident you said that, although you will not seriously injure the car was quite badly damaged, and you make the most depending on how

Courses and Mock Exams for MRCPsych CASC

Courses and Mock Exams for MRCPsych CASC Different courses offer unique features. The primary focus of CASC courses is the practice of different stations.  How the authors have organized them can differ; for example, whether candidates take turns completing stations or do complete circuits.  Psychiatrists from higher trainees to consultants staff these exams. Sometimes these might include college examiners themselves.  The role-players include those who have taken the exam themselves.   Communication-focused You can best cover communication and clinical skills within local deanery-run MRCPsych courses. This includes CASC scenarios and can be helpful in the run-up to exams. This may help if communication skills at your medical institute, you did not learn communication skills or if English is not your first language.   Private Courses There are also several private providers that vary in terms of content, cost, and quality.  Some focus on communication skills (e.g. Oxford course), some