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PLAB 2

PSYCHIATRY

Topics to Cover
MMSE
MSE
History taking
Drug Abuse
Depression


Postpartem Depression
PTSD
Anorexia Nervosa
Obsessive Compulsive Disorder
Panic Disoder
Insomnia
MMSE
How it comes in exam
Orientation (5)
Place (5)
Registration (3)
Attention (5)
Recall (3)
Language and Copying (8 plus 1)
MMSE
Inference of MMSE
Failing points for GMC
MSE
How it comes in exam
Mood
Delusion
Thought Insertion, withdrawl, broadcasting
Hallucination
Cognition
MSE
Insight
Suicide
Inference
GMC failing points
SUICIDE
Ever thought
Ever tried
Why, Where, When, How, How often
Arrangements done
Suicide note
Alone, Alcohol and Drug influence
How does it feel to be alive, will u do it
again ?
HISTORY TAKING
GRIPS
Confedientality
Condition related questions
Mood
Suicide
FAMISH
Counselling
FAMISH
Family, Friends, Forensic, Finance
Alcohol, Drug, Smoking
Medical Conditions, Medications
Insight
Sleep, Apetite, Libido, Stress
Hallucinations, Delusions

Counselling

Diagnosis
Treatment: Psychotherapy Medications
General Advice
Leaflets and Websites
Patients concerns
DEPRESSION
Mood
Loss of interest
Guilt, Hopelesness, Worthlesness
Fatigubility
Concentation difficulty
Suicide - FAMISH - Counselling
POSTPARTEM DEPRESSION
Preg planned or unplanned
Difficulty in preg or labor or postpartum
period
How do u feel about the baby
Breast feeding
Thoughts of harming the baby
Mood Suicide FAMISH - Counselling
PTSD
How long
How often
Any incidence in past ( try to find about it)
Flashbacks Nightmares Startled
Avoidance Depression
Mood Suicide FAMISH - Counselling
ANOREXIA NERVOSA
How much weight lost
In what time
How did she loose her weight( Diet -
Exercise)
Vomit, Medications
Why, Family and friends thoughts


ANOREXIA NERVOSA
Complications : Amenorrhea Electrolyte
Imbalance
Mood Suicide FAMISH - Counselling
OCD
How long, How often, Why ?
Persistent thoughts, interfering with life
What happens if he doesnt do it
Insight, Thought insertion
Other phobias
Mood Suicide FAMISH - Counselling
PANIC DISORDER
Palpitations, tremors, hyperventilation,
sweating, dryness of mouth, choking feelin
Precipatating factor
Other phobias ( D/D )
Mood Suicide FAMISH - Counselling
DRUG ABUSE
Alcohol, drugs, smoking or medications
Alcohol: CAGE, Tolerance, Withdrawl,
ppting factor
Medications: Contraindications, Side
effects, Counselling ( imp )
AMITRYPTILINE
C/I : Cardiac arrythmias, Epilepsy, Anti
depressants ( MAO,SSRI )
Side effects: Confusion, dry mouth,
constipation, urinary retention, postural
htn, sexual dysfunction (imp)
Monitor: fbc, cardiac and lfts
AMI COUNSELLING
No effect 4-6 weeks
Increase suicide thoughts
General medicine advice
No smoking and Alcohol with medications
PAROXETINE
C/I: Anti depressants like MAO, Mania
Side effects: headache, Nausea, GI upset,
Sexual dysfunction ( imp )
Withdrawl symptoms: if time
Counselling ( same as amitryptiline )
DRUGS
Do u do drugs
What type, How long, How much, How
often, What route
If i/v route: share needles Needle
exchange programme ( imp )
What happens if u dont
Money for drugs
Interfering with daily acitivties
INSOMNIA
Rule out D/Ds
Mood Suicide FAMISH Counselling
Counselling : bed unless sleepy, coffee
alochol, tv, warm bath milk music, sleep
diary for a week, medication ( at end after
consulation with seniors )
Patients concerns


THANK YOU