Basic skills for first year residents of psychiatry

1. AHMED ELAGHOURY
Egyptian & Arab Boards in Psychiatry
Abbassia Hospital for Mental Health, MOH
Cairo, Egypt

2.  Psychiatry started as “inpatient” practice eg
Kraepelin, Khalboum, Bleuler
 Basic residency tasks
 Not available in many mental health facilities
in Egypt
 Still current practice is affected by “mind-body”
dualism, so psychiatrists may work in
poor-facility hospitals deprived from other
medical services / coverage ie depend on
their skills in inpatient care
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3. 1. Admission process
2. Working DD
3. Initial assessments / orders
4. Management plan
5. Followup / Progress notes
6. Psychopharmacology
7. Discharge plan / arrangement
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5. Type of admission according to Egyptian
MHA
Source / Through
Supervisor psychiatrist: responsible
Accurate record of date and time with clear
physician name
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

8. Phenomenology
Age of onset
OCD: onset, course, duration
Risk factors: 3Ps
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Byrne P & Byrne N: Psychiatry : clinical cases uncovered. 2008, Wiley-Blackwell

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ICD 10 symptom checklist, WHO 1994

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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18.  All admitted pt to mental health hospitals
should be assessed by:
• Security / Nurse aide / Nurse
• Internal medicine
• Clinical psychology
• Social worker
 Neuro exam:
• Cognitive
• Gait
• Motor
• CNs: (2, 3, 4 , 6), 7, (9, 10, 11)
• DTRs: bi, tri, ankle, knee / Superficial: plantar
• Coordination
• Stretch signs
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19.  Initial orders regards:
• Vital signs
• Diet: regular / diabetic / cardiac / easy to chew &
swallow
• Elimination: stool & urine
 Activity: with help / walking stick etc
Precautions against: Fall / Aspiration /
Seizures / VTE
ECG / Labs / Imaging
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20. Avoid crystalloids without I / O monitor
Avoid D5W without thiamine
PRN medications: as needed
STAT medications: you must attend
qHS medications: at bedtime
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21. Do NOT give conflicting order ( 2
connected orders in same phrase) eg
• PRN Chlorpromazine 50mg IM if BP ≥ 90 / 60
• Monitor pt meals, except when sedated / confused
• [ - PRN Chlorpromazine 50mg IM – Notify if BP ≤
90 / 60 ]
• [ - PRN haloperidol 10 IM – Do NOT exceed 50mg
/ d]
• [ - Notify if RBG ≥ 200 mg / dl]
• [-Monitor pt meals –Notify if pt is oversedated –
Notify if meals are left as same]
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23. CBC, LFT, KFT, Chemistry, TFT
PRL
Vit D3 & B12
Hepatitis viral markers / HIV
Tumor markers
Immune profile
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Quick LabRef app. Nika Informatics, 2014

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27. Acute / Short term
Long term
Durations
Scales / outcome measures
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29. MSE is a part of followup note
 Nurse’s observation
Ward behaviors toward staff / other pts
Side effects of medications
Trace initial target symptoms
Examples & discussion
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31. Oral
Parenteral: IM, IV
Enteral: NGT, G tube, PR
Inhalational
Sublingual
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32. Who?
• Recently admitted without proper data regards
previous mental / medical / drug Hx
• Pt in other health facilities
• Drug naïve pt
What to do?
• Avoid depot inj at start
• Avoid frequent daily dosing
• Avoid high doses
• Start low & go slow
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33. Poor Compliance is main indication
Start during inpatient stay: at least 2 wks
before discharge
Oral first
Challenge doses
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34. Try know cause: psychotic / not
 Containment & calming down
 Follow predetermined protocol: drugs & how
to after monitor?
Eg Haloperidol , Olanzapine, Zuclopentixol inj
Eg BZD inj
Try avoid IV inj esp in poor facility hospitals
 Keep alert to oversedation: dehydration,
hypoglycemia, aspiration, constipation etc
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35. Discharge summary
Final diagnosis
Drug treatment
OPD appointments
Special precautions to pt / family
Rehab arrangements
Keep contacts of critical pts, esp in poor-record
systems
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