MRCPsych: Passing the CASC Exam, Second Edition PDF
Preview MRCPsych: Passing the CASC Exam, Second Edition
MRCPsych: Passing the CASC Exam SECOND EDITION MRCPsych: Passing the CASC Exam SECOND EDITION Edited by Justin Sauer Maudsley Hospital, London, UK Malarvizhi Babu Sandilyan Prospect Park Hospital, Reading, UK Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular, (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2017 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper Version Date: 20160826 International Standard Book Number-13: 978-1-4987-2218-6 (Paperback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guid- ance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instruc- tions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. 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For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright. com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for- profit organization that provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging‑in‑Publication Data Names: Sauer, Justin, editor. | Babu Sandilyan, Malarvizhi, editor. Title: MRCPsych : passing the CASC exam / [edited by] Justin Sauer and Malarvizhi Babu Sandilyan. Description: Second edition. | Boca Raton : Taylor & Francis, 2017. | Includes bibliographical references and index. Identifiers: LCCN 2016019550 | ISBN 9781498722186 (alk. paper) Subjects: | MESH: Psychiatry | Mental Disorders | Examination Questions Classification: LCC RC457 | NLM WM 18.2 | DDC 616.890076--dc23 LC record available at https://lccn.loc.gov/2016019550 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface xi Acknowledgements xiii Editors xv Contributors xvii Exam guidance xix 1 Old age psychiatry Oliver Bashford 1 Linked stations 1 Station 1(a): Treatment-resistant depression 1 Station 1(b): ECT 5 Station 2(a): Memory loss 8 Station 2(b): Frontal/temporal/parietal lobes 13 Single stations 17 Station 3: Wandering 17 Station 4: Testamentary capacity 21 Station 5: Cognitive assessment 23 Station 6: Behavioural and psychological symptoms of dementia 26 Station 7: Psychotic depression in the elderly 29 Station 8: Lewy body dementia 32 2 Anxiety disorders Priyadarshini Natarajan 37 Linked stations 37 Station 1(a): Somatisation disorder 37 Station 1(b): Discuss diagnosis and management with the patient 40 Station 2(a): Generalised anxiety disorder 43 Station 2(b): Generalised anxiety disorder – Aetiology 46 Single stations 49 Station 3: Phobia 49 Station 4: Obsessive compulsive disorder 51 3 Child and adolescent psychiatry Matthew Fernando and Dennis Ougrin 57 Linked stations 57 Station 1(a): School refusal 57 Station 1(b): Explaining a diagnosis 60 Station 2(a): Mood disturbance 63 Station 2(b): Explaining treatment and prognosis 67 Station 3(a): Suicidality 71 Station 3(b): Engaging a parent 76 Station 4(a): Self-harm 79 Station 4(b): Addressing bullying 83 Single stations 85 Station 5: Learning disability 85 Station 6: Autism spectrum disorder 90 Station 7: Medically unexplained symptoms 93 Station 8: Attention deficit hyperactivity disorder 97 Station 9: Fire-setting/abuse 102 vi Contents 4 Eating disorders Thomas Gilberthorpe 107 Linked stations 107 Station 1(a): Anorexia nervosa – History taking 107 Station 1(b): Communication with a professional colleague 110 Single stations 114 Station 2: Anorexia nervosa – Dietary and weight history in a first presentation 114 Station 3: Bulimia nervosa – Communication and explanation to a relative 117 5 Addiction disorders Mark Parry 123 Linked stations 123 Station 1(a): Opioid dependence 123 Station 1(b): Discussion with probation officer 126 Station 2(a): Physical examination of drug intoxication/withdrawal state 128 Station 2(b): Discussion with consultant 131 Station 3(a): Cannabis and schizophrenia – Discussion with family 133 Station 3(b): Cannabis and schizophrenia 136 Single stations 139 Station 4: Alcohol dependence – History taking 139 Station 5: Alcohol dependence – Management 143 Station 6: Benzodiazepine misuse 146 Station 7: Motivational interviewing 150 Station 8: Substance misuse – Management in pregnancy 153 Station 9: Substance misuse history and managing withdrawal 156 6 Forensic psychiatry Marc Lyall 161 Linked stations 161 Station 1(a): Self-harm in custody 161 Station 1(b): Discussion with police officer 164 Station 2(a): Duty to warn 166 Station 2(b): Discussion with relative 169 Station 3(a): Prison assessment 171 Station 3(b): Discussion with consultant 174 Station 4(a): Schizophrenia and violence 176 Station 4(b): Discussion with colleague 179 Station 5(a): Erotomania 181 Station 5(b): Discussion with colleague 183 Single stations 185 Station 6: Arson 185 Station 7: Dissocial personality disorder 188 Station 8: Morbid jealousy 191 Station 9: Indecent exposure 194 7 Learning disability psychiatry Sharada Deepak 199 Linked stations 199 Station 1(a): Behavioural change – History taking 199 Station 1(b): Behavioural change – Discussion 202 Single stations 204 Station 2: Learning disability and capacity to consent 204 Station 3: Behavioural disturbance in LD 207 Station 4: Fragile X syndrome 210 Contents vii 8 Liaison psychiatry Babu Mani 215 Linked stations 215 Station 1(a): Psychiatric lupus 215 Station 1(b): SLE – Discussion with rheumatologist 217 Station 2(a): Capacity to consent 220 Station 2(b): Discussion with relative 223 Station 3(a): Conversion disorder – History taking 225 Station 3(b): Conversion disorder – Explanation 229 Station 4(a): Alcohol withdrawal – Collateral history 231 Station 4(b): Alcohol withdrawal – Management 235 Single stations 238 Station 5: Delirium – History taking 238 Station 6: Adjustment disorder 241 Station 7: Korsakoff syndrome – Explanation 244 Station 8: Neuroleptic malignant syndrome 248 9 General adult psychiatry David Okai 253 Linked stations 253 Station 1(a): Bipolar affective disorder – Type II 253 Station 1(b): Bipolar affective disorder – Discussion with consultant 256 Station 2(a): Depression 259 Station 2(b): Depression – Discussion with colleague 262 Station 3(a): First onset psychosis 264 Station 3(b): First onset psychosis – Discussion with relative 267 Station 4(a): Rapid tranquilisation 270 Station 4(b): Rapid tranquilisation – Discussion with nurse 273 Single stations 276 Station 5: SSRI discontinuation syndrome 276 Station 6: Treatment-resistant schizophrenia 278 Station 7: Post-traumatic stress disorder 281 10 Neuropsychiatry Derek Tracy 285 Linked stations 285 Station 1(a): Assessment of a head injury 285 Station 1(b): Testing of a head injury 288 Station 2(a): Assessment of non-epileptic seizures 292 Station 2(b): Discussing non-epileptic seizures with a relative 295 Station 3(a): Unusual behaviour in Parkinson’s disease 298 Station 3(b): Discussing unusual behaviour in Parkinson’s disease with a relative 301 Single stations 305 Station 4: Assessment of temporal lobe epilepsy 305 Station 5: Explanation of the neuropsychiatry of a glioma 309 Station 6: Medically unexplained symptoms 312 Station 7: Low mood in multiple sclerosis 316 11 Personality disorder Pranathi Ramachandra 321 Linked stations 321 Station 1(a): Borderline personality disorder – Assessment 321 Station 1(b): Borderline personality disorder – Management 325 viii Contents Single stations 328 Station 2: Paranoid personality disorder 328 Station 3: Personality assessment 331 12 Perinatal psychiatry Ruaidhri McCormack 337 Linked stations 337 Station 1(a): Postnatal depression 337 Station 1(b): Discussion with partner 340 Station 2(a): Puerperal psychosis 344 Station 2(b): Discussing the management plan with a professional colleague 348 Single stations 351 Station 3: Bipolar disorder and pregnancy 351 Station 4: Baby blues 355 Station 5: Methadone in pregnancy 357 13 Psychotherapy Dinesh Sinha 361 Linked stations 361 Station 1(a): Psychotherapeutic techniques in patient management 361 Station 1(b): Assessment for psychodynamic psychotherapy 364 Station 2(a): CBT first session 367 Station 2(b): Behavioural experiment in CBT 369 Station 3(a): Overdose in accident and emergency 372 Station 3(b): Borderline personality disorder 374 Single stations 377 Station 4: Post-traumatic stress disorder – Treatment options 377 Station 5: Psychodynamic psychotherapy 380 Station 6: Managing anger 383 Station 7: Psychodynamic interpretation 386 Station 8: Cognitive distortions 389 Station 9: Patient experiencing transference reaction in psychodynamic therapy 391 14 Physical examinations Sangita Agarwal and Justin Sauer 395 General points for all physical examination stations 395 Station 1: Alcohol examination 395 Station 2: Eating disorder 398 Station 3: Extrapyramidal side effects 401 Station 4: Thyroid dysfunction 404 Station 5: Lower limbs 408 Station 6: Upper limbs 411 Station 7: Cranial nerves 414 Station 8: Cardiovascular system 417 Station 9: Eye examination 419 Station 10: Basic life support 422 15 Investigations and procedures Russell Foster 427 Single stations 427 Station 1: Advising IVDU on injection technique and risk minimisation 427 Station 2: Abnormal blood results in an alcoholic patient 432 Contents ix Station 3: Physical examination and laboratory investigation of eating disorders 435 Station 4: Basic electrocardiogram interpretation 439 Station 5: Initiation and monitoring of clozapine 443 Station 6: Interpreting thyroid function tests 446 Station 7: Interpretation of lithium levels 448 Station 8: Interpretation of laboratory results (metabolic syndrome) 452 Station 9: Diagnosis and management of neuroleptic malignant syndrome 455 Station 10: Diagnosis and management of serotonin syndrome 459 Station 11: Diagnosis and management of hyperprolactinaemia 463 16 Miscellaneous disorders James Main 467 Single stations 467 Station 1: Gender reassignment 467 Station 2: Grief reaction 471 Station 3: Selective serotonin reuptake inhibitors and sexual dysfunction 475 Station 4: Body dysmorphic disorder 479 Station 5: Seasonal affective disorder 483 Station 6: Urine drug screen 486 Station 7: Psychotic depression in an older adult 489 Index 495
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