Transcript CASC Tips - The Cambridge MRCPsych Course

LIAISON PSYCHIATRY
CASC TIPS
Dr M Wong
Dr A Guirguis
09/06/2011
Aim and Objectives
• Understand the process of CASC station
• To set up a content
What and how to say
• Two main things the college expect
1- Content
2- Process
Content
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Range and depth of history
Range and depth of risk
Range and depth of psychopathology
Range of cognition tested and appropriate use of
cognitive testing
• Quality and extent of physical examination
Process
• Questioning style, use of open and closed
question
• Listening and responding appropriately
• Fluency of the interview
• Focus on the task required
• Prioritisation
• Professionalism
Agenda
• Phase of the interview
a- Opening
Set down an appropriate introduction and aim
b-Middle
Requested task, cues
c- End
SUMMARISE & devise a plan
• RAPPORT, RAPPORT, RAPPORT
Liaison Psychiatry topics
• Capacity
• Conversion/Somatisation/Medically
Unexplained Symptoms
• Acute confusional states
• DTs/alcohol
• Eating disorders
• Depression/self-harm/Mania/Psychosis
• Body dysmorphic disorder
SBAR
• Situation
who am I/where am I? who is
the patient? What is wrong?
• Background Admission diagnosis? Relevant
past hx? Summary of Rx to date?
• Assessment Mental State/vital signs? I think
the problem is…I have done…
• Recommendations
What I would like u to do/Is
there anything you would like me
to do?
Mr Frank was admitted to the medical ward
following acute GI bleeding. The medics called
you as he is refusing IV fluids, medications,
sedatives, and upper GI endoscopy. He is
known to have past psychiatric history and is on
depot injection.
Medics requested an assessment to determine
whether he has the capacity to refuse treatment.
Miss Sarah White is a 27 year old lady who has
seen her GP complaining that her eyes are wide
apart.
Obtain history to explore the nature and extent of
her problem
Assess her to clarify her diagnosis
Mr Lewis was referred by his GP to your OPC for
psychiatric assessment. He is not happy with the
referral and thinks that he suffers from severe
chronic pain and there is nothing wrong with
him mentally.
Obtain history to reach a diagnosis
The cardiac rehab team has referred Mr Grant, 55 year old
man who was not coping well since he had MI 2 month
ago. They are concerned about his attitude and his
cooperation.
Please take a history and assess his attitude and his self
management towards his IHD.
DO NOT do physical examination, or assess his cognitive
function.
You will need to take some note to discuss his
management plan with the consultant at the next
station
Discuss the out come of your assessment,
management , and prognosis with your
consultant who did not meet with the patient
Mrs Clarke is a 45 year old lady who have
developed a sudden loss in her movement on
her right side, she was referred for a psychiatric
assessment as all her investigations was normal.
Take a focus history to arrive to the diagnosis
Mr Clarke is waiting next door o discuss his wife
diagnosis and management .
You are now meeting with Mr Clarke who would
like to discuss her diagnosis and her
management plan
Preparation
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Depression
Antidepressant
Psychosis
Antipsychotic
Psychotherapy
Blue Print
RCPsych
GA
OA
CAMH
LD
Psychotherapy
forensic
%
History
X
X
X
X
X
X
30-40
MSE
X
X
X
X
X
30-40
Risk assessment
X
X
X
X
X
15-30
Cog exam
X
X
X
10-20
Phys exam
X
X
Case discussion3
X
X
X
X
X
X
15-30
Difficult communication
X
X
X
X
X
X
5-15
5-15
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History may include obtaining collateral history as well as taking a history
directly from the ‘patient’
Risk assessment may include assessment of capacity
Case discussion can be with medical and paramedical professionals as well as
lay people including the patient, family, carers and other professionals. It also
includes skills related to psychotherapy formulation (cognitive and dynamic)
and discussion of treatment.
General Adult includes all subspecialties
There will be minor variation in the percentage of stations for each skill area
according to how skills are represented in each station. This is due to some
station constructs assessing more than one skill (e.g. risk assessment requiring
a mental state examination or difficult communication occurring within the
context of a case discussion)
At any one sitting of the CASC, candidates will face 16 stations. Normally candidates could expect to
encounter the following make up of stations:
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At least one station with a psychopathology focus
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At least one station with risk assessment as the focus
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At least one station with cognitive assessment as the focus
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At least one station with a psychotherapy theme
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At least one station with an old age psychiatry theme
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At least one station with either a learning disability or child and adolescent psychiatry theme
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Possibly one station with a forensic psychiatry theme
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Possibly one station testing physical examination skills
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Possibly one station testing communication skills
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Remaining stations will cover general adult psychiatry themes, including sub-specialties
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Throughout these stations there will be a mix of skills required including history taking, aspects of
mental state examination, communication of diagnoses, management plans, and prognosis.