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About dharma

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  1. ... well that sounds like fun when all 5000 of us will be applying for jobs all at once approaching august 2007!!! - to be squeezed into the run through grade! ahem - : good news is... there is now no real pressure... as apart from the stream of jobs that seem to have just been advertised (june 2006)... things will dry up (no recruiting until fro sprs from late 2006 until August 2007 - for run through) ... so if you're still thinking psychiatry by then - might be a good time to apply and get back in the system
  2. Remember, the case that this is based on, ended with the patient going to the courts, the courts deciding against the (foot off) operation, and the patient surviving... and keeping foot!!! the principle is that you can only use common law for immediate life saving treatment and if patient has capacity, and tx is not life saving then u would be actually assaulting the patient oh joy... when this is over!
  3. Issues: LD change in behaviour culture, language, attitude to western medicine, engagement with services clarification of herbals - may need to ring poisons unit assessment and management of current change in behaviour - including intervention for the family DD: environmental: change in setting - respite, change of carers, routines physical: ?epilepsy infections effect of the herbals? drug/alc pain/cosntipation... mental: LD - degree, any assoc phenotypical behaviours?? depression psychotic phenomena... Invx.... mgt.... functional analysis, medication if necessary, mdt approach, refer to behaviour nurse, psychologist if nexessary - engage with the family, use of interpreters... issue of consent/confidentiality - in the UK, once u r an adult (over 18) even if learning disabled no other adult can make decisions for you, so doctors can act on your best interests, duty of care, etc need to consider issue of vulnerable adult...? could they really be poisoning him, so clarify what they are using, and the possible effects Sensitive cultural isssues, use a translator, understand their perspective, look at engagement with services. attitude towards mainstream medication, stopping the herbal remedies, or not... etc,etc,etc... have i missed anything major??
  4. (in terms of work related issue) - how about phased returns back to work... : i mean while actively psychotic/manic priority is treatment - so down the MHA route if unwilling for volntary, but after recovery of episode... follow social inclusion agenda... reassess with Occie Health (assessment of risks) ... look at options for graded return, etc - the reality is most people with bipolar disorder are fine between episodes, right??? so she's got a right to go back to work once the relapse has been treated. For the somatisation/panic guy I would - look at the impact of work on his symptoms, consider triggers and precipitating factors, if there are work related triggers (he may wish to do some bahavioural expreiments with his CBT therapist haha!!), take some time off, on a short term basis - and then once Sx improve re-evaluate his situation - patient choice, ur role is more like advice, advocate, etc :-/ From what people say a lot depends on the examiners on the day.... not fair!!! >
  5. i love it when psychiatrists become agents of social control :... to be quite honest... u choose how u get your kicks!!! at least we're not chasing homosexuals anymore - changing times!!!! for purposes of pmp... i shall play the game
  6. in 7 min u'd be lucky... I'd wait to be prompted ...does anyone actually get time to prepare these boxes beforehand!!... coz i dont :'( i hate revision!!!!!!!!! (bored & fed-up >)
  7. an affective disorder is definitely a possibility, and i think no one would fault u for wanting to exclude depression and mania ok justifying adjustment disorder :... maybe that's a bit more tricky, but still possible (remember u r just excluding, u could follow on asking about any relevant lifel events in the history - that may have caused unpredictable behaviours...
  8. ... and you'll get more irritated if u dont tick the right boxes... so they're asking for diagnosis, and u have to give them... and be comprehensive i think all of the ones above (post by sr) are relevant. in terms of risk factors: 1. was he reposding to any psychotic phenomena, or as a consequence of a mental illness and can this be treated? 2. was he under the influence of drug or alcohol at the time of the offence 3. any previous sexual offending? 4. need to take into account whether at the time of the offence he was masturbating, erect, or whether he tried to touch someone (victim). is there escalating behaviour? prognosis - if this is his frist offence risk of reoffending is quite low (80% do not reoffend) other issues to consider - be clear that this is a court report, needs to be requested in writing, explain to the patient the purpose of the encounter, and that u will be writing a report to the courts with the information that he gives u (and therefore will not be a confidential encounter) - u may want to explore how he feels about the offence, being caught and prosecuted, may be something quite stressful, and this person may as a consequence become depressed... or even suicidal
  9. agreed the whole YARVIS thing doesnt convince me... i dont have that many of those patients - (and cant remember wot the R n S stand for... so not to be trusted :
  10. suitability for psychotherapy: ability to form relationships (eg with therapist!) previous track ecord of engagement ego strength: ability to tolerate anxiety/ discomforts raised in therapy 'psychological mindedness': ability to undrstand their problems as being derived from circumstances of their lives etc - ability to verbalise thoughts (those who think they feel this way because of chemical imbalance in the brain may be less likely to benefit from psycotherapy willingness, and positive attitude to change (ie u cant do therapy with someone who doesnt want it - and unlikely to get any benefits ffrom it if ur unwilling to take things on board ability to commit ie they have the time to attend regularly on a weekly basis for x weeks/months if for example doing CBT u might explore whether they would be willing to do homework tasks/ experiments, etc there's also something called the YARVIS criteria: Young, Articulate, R....., Verbalise thoughts, Intellingent, S.... anyway, these dream patients dont turn up on the NHS
  11. a lot of what comes up is osceable material.... The manchester notes have lots of examples of observed interviews: demonstrate frs, insight, examine for epses, suitability for psychotherapy, assess capacity, demonstrate formal thought disorder, explore premorbid personality.... can revise some of the osce books for this part u can't afford to go there thinking there's anything u can fail (i dont think anyway)...
  12. hiya! there's a whole section being discussed about this in the part i osces... it always makes me laugh... u have clearly taken it to the next level... with hair and facial complements I would wear something formal that you would wear to a job interview. wear something that also makes YOU feel confident (but also comfortable) personally i'm going to wear exactly what i wore to the osces (thats cos i'm stupid and supersticious - will make me feel better on the day) - details: trouser suit dark blue. Hair - i tie it back... but that's personal glasses... well ... whatever u normally do will be fine we do get caught up in silly stuff!!!! :
  13. Have just C&P'd a few more things that i found useful @@@PMP PLAN address the key points that you think are important first then tease them out individually any case will need more information gathering and the sources are- good history, previous notes, GP records, Police depositions, Court reports these depend on what PMP you have got current mental state examination as pointed out by tom, everyone would agree is very important and do not forget physical examination then the most important thing will be the risk or the problem in this case. risk to self,to others then management- both short&long term medical biological, social' psychiological @@@CONFIDENTIALITY The law is relatively clear about when you have to break a patients confidentiality, and there are only three situations where this has to happen:- 1) If a patient has been involved in a road accident a police officer may require you to give their name and address (although no other details) 2) Under the prevention of terrorism act if you believe that someone is a terrorist or is about to commit a terrorist act you are required to notify the police of this 3) If a court orders you to give the information. In other situations the legal situation is a bit less clear. However you should not , in general, break confidentiality unless you believe that it is in the patients best interest for you to do so, or more rarely that it is in society's best interest. In these cases the patient should be informed of the breech. If possible these issues should be discussed within a team setting. For answering the PMP remember that Trusts now usually have a confidentiality policy which could be referred to, and legal advice can be sought either from the trust's solicitors or from the medico-legal defence bodies. @@@@BOLAM Bolam v Friern Hospital Management Committee (1957) ' A doctor will be deemed to have acted in the best interests of an incapable patient and will be immune from liability in trespass to the person if he establishes that he acted in accordance with a practice accepted at the time as proper by a responsible body of medical opinion skilled in the particular form of treatment in question'.
  14. i had this station for my osces, the lady was not been unco-operative... i think that's the thing to remember, that sometimes you may need to change tack, if what ur doing is not working. if someone is very fixed on their belief... dont confront them - it will only antagonise them!! my approach was to go along with her, just be curious: what makes you think that? when did you know that you had died? what were the reasons why you died? how did you feel before you died? how do you feel about it now? ... she then goes on to tell you about the angel on the bed, that she was a stressed out school teacher, that she has been depressed, she just wanted to dispose of her body by putting it in a fire, hence she was extremely high risk... and it's all a piece of cake Best of luck!!
  15. ohhh u r sooo getting hotter by the day.... i would've said more old tatty land rover with the wellies in the back country boy!!!