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rajeevkrishnadas

PMP... General principles

19 posts in this topic

Do we keep going nonstop after the first question... or do we wait for them to come up with the probes...

The sample answers in the Olumoroti book is so overinclusive... cant get where the head or tail is... do we do that or is it better to structure the answers...

Can we solve the PMPs as in just give the key issues for most of the Previous PMPs please... (like we did with the ISQs...

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one thing i found myself having done pmps last time is that examiners can do 2 things - they will either not say anything at all in the 10 minutes or they will interrupt you at the 2nd or 3rd minute.

you are absolutely right in saying that olurmoroti is overinclusive (esp regarding organic causes!!)

many of my colleagues who passed the exam have suggested sticking to basic differentials - not to be oversmart and include a lot..

structure is vital.. even if the examiners interrupt try and quickly focus and get back on track..

these tips helped me pass the pmps last time.. shame i failed the long case

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I have Olumoroti but he's doing my head in with his issues and tasks and clarify and buzz words.

I'm just going to try for reasonable, simple and safe.

I still feel I need a Christmas tree structure planted in my head to hang my baubles on for each PMP (that sounds a bit weird, but that's how I picture it!)- eg

Main issues that strike you when you first get the PMP (you'll look a twit if you don't say someone being restrained is an emergency- you know it is, they know it is, it's obvious, but you've got to remember to say so)

Hx- what you'd be looking for in different sections

Collateral Hx

MSE

Physical

Differential diagnosis (obvious first? or in order of ICD-10)

Management-short term/ medium term/ long term, bio-psycho-social?

I can't do this, by the way...I'm just trying to find a way of thinking about it that will make sense to me in my head and the examiners when I say it out loud!!!

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Do we keep going nonstop after the first question... or do we wait for them to come up with the probes...

The sample answers in the Olumoroti book is so overinclusive... cant get where the head or tail is... do we do that or is it better to structure the answers...

[highlight]Can we solve the PMPs as in just give the key issues for most of the Previous PMPs please... (like we did with the ISQs... [/highlight]

This is a very important suggestion.

Which paper should we start from?

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Do we keep going nonstop after the first question... or do we wait for them to come up with the probes...

Going from my experience of taking the clinicals twice- the first time, it was like a rapidfire session- frequent interruptions(sometimes rude)every minute- structure just went haywire, and I just kept answering all the questions they threw at me, to the point. The second time, they let me go on and on, and I had to pause, in the hope that they would give me some probe, but since none was forthcoming, I just rambled on. Which is better? I have no idea- I passed PMP's first time around as well(they failed me in long case)

So, I would suggest is be prepared for both types of examiners- ask ur colleagues to frequently interrupt u, or say nothing.

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I have Olumoroti but he's doing my head in with his issues and tasks and clarify and buzz words.

I'm just going to try for reasonable, simple and safe.

I still feel I need a Christmas tree structure planted in my head to hang my baubles on for each PMP (that sounds a bit weird, but that's how I picture it!)- eg

Main issues that strike you when you first get the PMP (you'll look a twit if you don't say someone being restrained is an emergency- you know it is, they know it is, it's obvious, but you've got to remember to say so)

[highlight]Hx- what you'd be looking for in different sections

Collateral Hx

MSE

Physical

Differential diagnosis (obvious first? or in order of ICD-10)

Management-short term/ medium term/ long term, bio-psycho-social?[/highlight]

I can't do this, by the way...I'm just trying to find a way of thinking about it that will make sense to me in my head and the examiners when I say it out loud!!!

I think this order can also change depending on the PMP.. in some PMPs it would be wiser to put in your differentials earlier

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Dear folks, i had the opportunity to take the exam a few times. I can give some tips .

Long Case

If you see that someone is on clozapine, please think of treatment resistance as one of the important differentials. I was sticking by my ICD diagnosis of Paranoid Schizophrenia as treatment resistance is not mentioned in the ICD. My feedback was that '' I did not appreciate the importnace of treatment resistance even though I did talk about augmentation.

Focus on the aspect that is striking form the '' Word go''

For ex- If forensic history , past psychiatric or current history is prominent , focus on that particular aspect for a bit longer. not too long.

Practice a long case presentation for 8-10 minutes. An examiner asked me to present in 8 minutes once. It was nerve racking.

PMP's

Please focus on merit of intervening early . If you are dealing with a lady behaving bizzarely with a 9 month old child, I would advice urgency in action with some sensitivity but the safety of child is paramount. The mistake some people make is to get overwhelmed by the background history , information from all the sources. That information can be important but can have more relevance to some scenarios than others. We actually practiced very naturally putting the idea of background information behind us and we did very well. Have a structure but let it not get too rigid . have some malleability .

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Do we keep going nonstop after the first question... or do we wait for them to come up with the probes...

The sample answers in the Olumoroti book is so overinclusive... cant get where the head or tail is... do we do that or is it better to structure the answers...

[highlight]Can we solve the PMPs as in just give the key issues for most of the Previous PMPs please... (like we did with the ISQs...[/highlight]

22 yaer old women,referred by the gp because of heroin  use and now want to stop.

she tells you that she is irritable and violent towards her children aged 1 and 3.

how will you manage?

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The issues i would mention here are child protection, understanding the nature and extent of substance misuse and underlying mental illness.

Any comments wellcome.

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Totally agree with ohceedee  :)

There are definitely two types of examiner - 1) will let you talk and talk and then use the probes. Sometimes you'll think you've already answered what they've just asked - don't be phased by this it just means they're following the rules - answer it again. 2) Will interrupt you as much as possible. As long as you can justify what you're saying you should be ok e.g. I told them I would use motivational interviewing as part of my treatment for alcohol dependence and they interrupted asking me to tell them what it was.

Having a loose structure is helpful. Thinking 'psychiatry' and 'medicine' is helpful, using as much terminology as possible and keeping the 'gathering information' bit to a minimum. Have loads of management options at your disposal and use as many of them as you can. This will also help with the long case discussion. Before the exam I wrote a long list of buzzwords e.g. CPA, assertive outreach, home treatment, use of the Mental Health Act etc. - as much (relevant) terminology as you can think of.

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Thanks guys, OCD, Elton... much appreciated...

Lad can I start the PMP in another thread???? I am going to copy paste it... If thats OK...

And shall we start from the latest PMPs... from a previous thread...

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OM ,

You made a good start. I guess those are the most important issues.

I would like to confirm with the G.P if he wants her seen urgently and if any suicidal risk worries him. Regarding child protection, I would like to confirm with the G.P if he has any concerns about their safety. Is there prior social services involvement. Be specific about this background information here . I would get lthe other routine info from the G.P

Will see her in clinic , get a thorough history

What is the motivation currently?

Why now?, has she tried stopping before. what did she use to detox in the past

Current use of drugs, money spent per day, does she smoke or inject them, where does she inject them [ groin injection can lead to complications], medical, psychological, forensic complications. thorough history and mental state examination. Usual features on MSE , consider risk here, does she have active ideation of harmimg the children, Is it a delusional belief or irritability.

I guess it will be safe to say that you will contact the social worker if you feel the children are at risk. You have to tell the mother that you have to do it by law and that there is no choice for anyone insuch situations. The examiners might be cheeky and ask you, how easy is it to get a social worker.[ Show familiarity with the community drug team by saying that each CDT usually has a social worker ].

It is important to reassure the mother that Social services are there to assist her and not to take her baby away.

Discuss treatment

Emphasise on safe injection practice

routine drug testing for drugs

confirm opiate use, watch for wihdrawals. [ sweating, yawning, lacrimation , increased secretions, cold, clammy skin.

Methadone prescription or subutex based on her preference. I will stick to methadone . treat concurrent mental illness.

Know about psychoogical compications of drugs

Cocaine and stimulants- '' crash''- Depression like state, cocaine- psychosis, Amphetamines- Paranoid psychoss.

Based on this skeleton, you can fit it as part of a logical answer depending on your style.

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Forensic proceedings... and diversion from court

I have just added a few notes on court proceedings... for Forensic naive people like me who have no clue about who is who and what is what in the court...

In the below posts 'YOU' means defendant not the psychiatrist

Cheers

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Courts and who is who

There are three kinds of court that you may be called to: a magistrates’ court, a Crown Court, and a youth court (which may be held in a magistrates’ court building).

Who is in court and how it is set up depends on what type of hearing it is. For the first hearing, there are likely to be you, the defence and prosecution solicitors and the magistrates. If your case then goes to trial in the Crown Court, there may be a jury and witnesses at later hearings.

Magistrates’ courts and Crown Courts are usually open to the public (including friends and relatives of those involved in the case) and often have a section for the public to sit in. In a youth court, members of the public are only allowed if a court official invites them and the court agrees.

Magistrates’ courts

Most cases that go to court are dealt with in magistrates’ courts. In a magistrates’ court, the case will first be heard by one, two or three magistrates (sometimes called justices of the peace or JPs), or one district judge. There is no jury in a magistrates’ court.

A clerk sits in front of the magistrates and gives them legal and procedural advice and deals with the administrative work. Wigs are rarely worn in magistrates' courts but the usher may wear a gown. You may be asked to sit in the dock.

If you have pleaded not guilty, the magistrates or the district judge will listen to all the evidence and decide whether or not you are guilty. This is not all likely to happen at the first hearing. If you are found guilty, or plead guilty in court, the magistrates or district judge will usually decide on an appropriate sentence.

Youth courts

Young people aged from 10 to 17 are dealt with mainly in the youth courts by specially trained magistrates and district judges and no jury. You can get more information on youth courts and other issues concerning young people at www.rizer.co.uk.

Crown Courts

More serious cases are heard in a Crown Court. If you have pleaded not guilty, a trial will take place in front of a judge and a jury. The jury of 12 members of the public will listen to all the evidence and decide if you are guilty or not.

The judge is there to make decisions on legal issues and decide on the sentence. An usher helps out at the court and will bring you into the court when your case is called. The judge and the lawyers (solicitors and barristers) may wear gowns and white wigs.

Making a plea

The court process is often long and complicated. To make it easier for you and everyone else, you should get advice from a solicitor as soon as possible, and you must make sure you turn up to court.

At court you will be known as the defendant. This is another word for the accused, and means that you are there to defend the charges against you. Your solicitor will be known as the defence solicitor.

The other side is the prosecution. Normally, the Crown Prosecution Service (who are independent from the police), prepare and present the charges against you.

There are several stages in the court process, and at your first appearance you will normally be asked to plead guilty or not guilty to the offence or offences you are charged with. Your solicitor will be able to give you advice to help you decide how to plead.

If you committed the offence, you can plead guilty at any stage in the process. The earlier you plead guilty, the more likely you will be to receive a lower sentence, and the earlier the plea, the greater the ‘sentence discount’.

If you plead guilty, the court will then pass sentence . If you plead not guilty, the case will probably go no further that day, and a date will be set for your next hearing. The court will also decide if you will be given bail while you wait for the trial.

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The Trial

If your case goes to trial, the prosecution will present the evidence against you. You or your solicitor will be able to challenge the prosecution's evidence and present your own evidence.

Under the legal system we have in England and Wales, you are ‘innocent until proven guilty’. This means that the prosecution must prove ‘beyond all reasonable doubt’ that you committed the alleged offence. If they do so, you will be found guilty, if they don't, you will be found not guilty and be free to leave.

In a magistrates’ court, magistrates or a district judge decide whether you are guilty based on the evidence given. In a Crown Court, a jury made up of 12 people who represent ‘the general public’ decide. If you know anyone on the jury, tell the court and that person will be replaced.

If you want to, you may choose to give evidence yourself. You will also have to promise to tell ‘the truth, the whole truth, and nothing but the truth’, and either affirm or make an oath on a holy-book of your choice.

Your lawyer will usually ask you questions first, followed by the prosecution lawyer. You may also be asked questions by a magistrate, the clerk or the judge. Your lawyer can ask the judge or magistrate to stop the questioning if it is not relevant to the case.

When you give your evidence, be as clear and polite as you can. If you think you might have any language difficulties, discuss this with your lawyer so they can arrange translation or interpreting services.

Once the jury or magistrates have heard all the evidence, they talk in a private room until they all agree on a verdict. If the jury cannot all agree, the judge can accept a ‘majority verdict’ as long as at least 10 of the jurors agree. The verdict is announced in open court for everyone to hear.

There may be several hearings between you making a plea and the end of a trial. You may be released on bail during this time, but it is important that you go to all the hearings you are told to attend.

Sentencing

If you are convicted (found guilty of the offence), you might be sent to prison, fined or given one of the many community sentences that are available. A wide range of factors will influence what sentence you get.

You may be sentenced at the time you are found guilty, or you may be called back to court for sentencing at a later date. If your case has been heard in the magistrates’ court, you may be sent to a Crown Court for sentencing.

The court will often order a pre-sentence report to help them decide the most suitable sentence for you. Although this report can sometimes be provided immediately, it can take up to four weeks. You may be held in custody during this time.

The pre-sentence report is carried out by a probation officer who will meet you to assess your needs. It is in your best interests to co-operate with the probation officer.

Your solicitor can give you advice on appealing against your conviction or sentence.

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So...

We may be called in at any stage

At all points

To look for mental illness

After arrest

Fitness to be detained

Fitness to be interviewed

After being charged and when being brought to court

Fitness to plead - ie the fitness to plead guilty or not

As a professional or expert witness

Report on the persons mental illness by the defence lawyer or the court

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Hi Dorianne,

That's great. Could you please tell us something more about writing a court report as well??

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