1 CAPITULO
2.6 Consideraciones éticas
3.1.8 Publicidad Online: Pagina Web y Redes sociales
Delirium tremens (‘DTs’): tremor
clouding of consciousness fever, sweating, tachycardia mortality ten per cent
Alcoholic hallucinosis: hallucinations in clear consciousness Pathological jealousy Depression Neurotic/anxiety disorders
Social harm
Employment problems Crime Drunkenness offences/accidents Economic factorsASK WHETHER HE HAS ANY QUESTIONS
THANK HIM
FOR EXTRA MARKS
Good timing during this station is essential. The time should be divided equally into discussing the physical, psychological and social hazards. FURTHER READING
Gossop M, Marsden J, Stewart D, Kidd T. The National Treatment Outcome Research Study (NTORS): 4–5 year follow-up results. Addiction 2003; 98: 291–303.
STATION 1
This 54-year-old gentleman has been taking sertraline for 18 months for a moderate depressive episode (F32.01). He ran out of medication 3 days ago as he was unwell and could not get to the general practitioner for a repeat prescription. Since then, he has been feeling ‘rotten’. He thinks his cold/flu symptoms have got worse and he has been unable to sleep. He has been dizzy and nauseous and also describes having been tearful.
Explain to the patient the most likely cause of his presentation. Explain the commonest symptoms of this condition.
Discuss how you plan to help him.
[advice on page 104]
STATION 2
This 59-year-old man has been behaving differently recently, and his wife has expressed concerns to the family doctor. He has a strong family history of late-onset dementia and his GP feels he may have mild cognitive impairment. You see him in an outpatients’ clinic.
Assess his frontal lobe function.
[advice on page 106]
STATION 3
Mr Nicholls, a 53-year-old bus-driver, attends the outpatients’ department with his wife. She says he has been drinking alcohol heavily since he was dismissed from work a year or so ago.
Assess this gentleman for the features of alcohol-dependence syndrome.
[advice on page 108]
STATION 4
Mr Johnson, diagnosed recently with bipolar affective disorder, is about to be discharged from an acute psychiatric ward.
Advise him on how to cope with any possible relapse in his condition. Focus on what Mr Johnson needs to do in the event of a relapse.
Stations 101
STATION 5
Mrs Sutherland, a 46-year-old housewife, reports that she has become increasingly anxious at the prospect of leaving her home. Until recently, she was just about able to leave the house and go shopping, although she did so with dread. On a few occasions, she experienced panic attacks when in the shopping centre, and an ambulance was called. She does not feel anxious at home and has now become almost housebound.
Explain to Mrs Sutherland her most likely diagnosis and exclude important differential diagnoses.
Explain how you will help her.
[advice on page 112]
STATION 6
You are in your outpatients’ clinic. A 34-year-old woman has been referred to your team by her GP. The patient has been concerned about her weight for many years and believes she is overweight. As a teenager, she was seen by a child psychiatrist, who diagnosed anorexia nervosa. She was never admitted to hospital, but she was extremely underweight and needed specialist treatment. She made a slow but steady recovery and by her twenties needed no further psychiatric intervention. She is a high achiever and works in a high-pressure job, which she feels has led to an abnormal eating pattern once again.
She wants to know whether she has bulimia and, if so, what causes it.
STATION 7
You are seeing this 65-year-old in the outpatients’ department. She has a history of anxiety and depression and has been worrying about the results of her brain scan. Your consultant had requested this investigation as the patient had complained recently of poor memory and headache. On clinical examination, there is no obvious abnormal neurology.
Report back to the patient the findings from her scan.
She wants to know what type of brain scan she had and whether there were any risks to her health from such a scan.
[advice on page 117]
STATION 8
This 45-year-old man has a history of disabling panic attacks. He has told a nurse that he is extremely short of breath and is worried he is dying.
Examine this patient’s respiratory system.
[advice on page 120]
STATION 9
The partner of a 46-year-old school teacher has asked to see you. He explains that his girlfriend has been convinced for the past 5 years that she has serious cardiac disease. During this time, she has been investigated by numerous physicians for physical disorders. She reports twice-weekly episodes of sweating, dizziness, tingling sensations in her left arm and a feeling that she is going to die from a heart attack. He says she has become fully preoccupied with the possible outcomes of her ‘cardiac disease’.
Stations 103
He asks:
What is the most likely diagnosis? How did she get it?
What is the most appropriate treatment in this case?
[advice on page 122]
STATION 10
A 29-year-old woman with long-term emotional problems was referred to your clinic by her general practitioner. She is requesting information on CBT and was looking for a referral to a therapist.
Speak to her about CBT.
[advice on page 124]
STATION 11
A 69-year-old woman who lost her husband 7 months ago due to cancer has been attending her GP over the past few weeks. The GP noticed that she is still grieving and is unsure whether this is normal. He would like your opinion.
Assess this woman’s response to the loss of her husband.
[advice on page 126]
STATION 12
This is a 53-year old man with a 20-year history of schizophrenia. He is hardly bothered by auditory hallucinations any more and does not have clear delusions as he once did. His next-door neighbour and community psychiatric nurse have become increasingly concerned about him because his personal level of care has declined significantly. He does not interact well with others and he shows few signs of emotion.
Examine him for features of chronic schizophrenia.
The CPN asks how we could help with his negative symptoms.
STATION 1: ANTIDEPRESSANT
DISCONTINUATION SYMPTOMS
INTRODUCE YOURSELF
‘Hello, my name is Dr Smith. It’s nice to meet you.’
SET THE SCENE
‘I’m sorry to hear you’re not feeling so well. Can you tell me how you’ve been feeling since you stopped the antidepressant?’
FIND OUT WHAT THEY ALREADY KNOW
‘Have you ever before stopped your medication suddenly since you started taking it?’
‘Was it ever explained to you that some people can get withdrawal effects if the medication is stopped suddenly?’