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ACE IT! PSYCH 22

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Summary

This on-demand teaching session with Dr. Lynn will cover the key aspects of the Psychiatry Progress Test series. The interactive Q&A session will discuss the mental health conditions and the various treatment options. Join in to learn how to distinguish between general anxiety disorder and phobias, understand personality disorder subtypes, get an overview of the different types of psychiatric medications and more. Get tips from Dr. Lynn and participate in polls for a chance to win!
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Learning objectives

Learning Objectives: 1. Recognize the various types of personality disorders and which groups they belong to within the DSM. 2. Understand the different treatments available for depression and the importance of assessing cardiovascular risk before starting a treatment with tricyclic antidepressants. 3. Distinguish between mild, moderate, and severe depression and the accompanying symptoms for each. 4. Differentiate between social anxiety disorder and general anxiety disorder and recognize prominent symptoms of each. 5. Identify the importance of psychotherapy, cognitive behavioral therapy, and other mental health treatments in managing personality disorders.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

mhm. Yeah, sure. Yeah, sure. No worries. Thank you so much. Lynn, for, um, Yeah, we're doing it. Um, should we give it? Should we give it about five minutes to let me so that we can get as many people as, uh, yeah, of course. How do you guys do? You usually do questions and stuff right at the end. Um, so, yeah, basically, the we do Q and A at the end. Sometimes people might ask questions, like in the middle of the lecture. Um, but it's it's up to you. If you want to ask, answer them as you go, or if you prefer to just do it at the end. I can just note them all down, and, uh, then we can You can go through them at the end. Um, yeah. No, that's fine. How have you been, Len? Uh, how how have you been eating? Like Okay. Yeah, I've been Okay. Can you hear me? Okay. Yeah, Yeah. Hello? Yeah, I can hear you. Yeah, yeah, yeah. I think I can, um, I might take my visa. Um, yeah. No, I've been okay. I'm just taken. I'm on some, uh I'm on a whole day at the moment in Bulgaria took some, I believe and stuff, but now I'm, like, ill. So, um, I've got a bit of a cold, I think. Yeah, but no, I've been okay. How are you? I'm not too bad. Thank you. Just, uh, just getting, like my last for the last couple of weeks in e d before I, uh, finish. Nice. Nice. Um, I might stop shivering. Uh huh. Uh huh. Okay. In case my internet cuts or anything, just let me know. Yeah, sure. I'll text you. Fine. Thank you, guys. Um, good. It will Will try and start at, like, five past seven. Just so, um, we can get as many people as we can. Can everybody hear us? Just let us know in the chat. Mhm. Okay, guys, high. We will, um we'll make a start. So, um, thank you everyone for coming in. Um, we've got an amazing speaker today, Doctor Lin. Um, and she's an f y one, um, working in sub times scenery. Um, and she'd be her, um, going to the psychiatry, um, SBs with us to help us through the progress test division. Um, so yeah. Thank you, everyone. for coming in. Um, this evening. Um, Lynn, do you mind just going to the next? So, um yeah. So this is that our final, um, session in the progress test series. Um, So, um, thank you. Everyone who have joined us, um, through the whole series, and hopefully we'll, um we'll be doing another series soon. Um, so yeah. So I think you guys make sure you follow, um, Lynn on to becoming Doctor Lin on her instagram, um, and just follow her journey through, um, as a as a foundation doctor. Um, so, yeah. Thank you, everyone. I'll hand everything over to Lynn. Hi, everyone. Um, nice to meet you all. Thanks for joining today's session with a sit on their medical series. Um, so this is the final, um, teaching session, um, for or the progress test? Um, and it's on psychiatry, so it's supposed to be an interactive S p A. So feel free to either comment in the chat function. Um, send me a message, or you can always just get like, a scrap piece of paper and write your answers down as we go along. Um, if you've got any questions, feel free to pop in the chat. And if it's, um, you know, specific to that question we've just answered, I'll try and answer it. Otherwise I'll try and do it all at the end. Um, so without further a do, um Oh, yes. So these are some of the topics will be covering today. Um, it's in no particular order. Um, but, you know, it's a starting place. Um, for psych revision. Um, and the common things are common. So without further a do, we'll start with the first question. I'll give you guys a couple of minutes to have a read and answer, and then we'll have a look at the, um, yeah, we'll see what the answer or what the options are. Um, Lynn, um, I was just say you're thinking Do you want me to use the pole? You've got a pole here. Yes. Yeah, yeah, Yes. Please. Just launched the pool. Thank you. So we found a couple of your answer. Um, if a female movie can answer, that would be great as well, shall I? And the pole? Um uh, what do you want to? So, um, let's see. What do people see? Um, okay, so we've got an answer. Choices between a If I scream or, uh there we go. Yes. So for about 50% of you that said See, um, that's the correct answer. So, essentially, um, there are a number of Oh, I'm sorry. So there are a number of different personality disorders, and essentially each of them have their own unique features. A lot of the time they tend to start in childhood or late adolescence, and essentially, they're like patterns of, like, inexperience and behavior. Um, so in this example, you've got 26 year old lady that's been having a bit of low mood her emotions a little bit all over the place. Um, you know, she's acting impulsively. She's also showing signs of, you know, self harm, but she's not suicidal. So the most likely diagnosis here is, um, emotionally unstable personality disorder. Now, this is a condition that's really common in young women. Um, and as I was saying before, with personality disorders, they're essentially patterns of behavior that remain. Sorry, it's a poll. I'll do it. Go, um, that a lot of young, generally young people experience Um, but essentially what happens is that there are different forms, So there's like three subtypes cluster A, B and C, which we'll talk about, um, in just a moment. Um, and there are essentially two types of emotionally unstable personality disorder, so you've got borderline and impulsive, and in the borderline type a person, the person tends to form quite intense relationships with fluctuating, rapid changes in their mood, whereas with the impulsivity type subtype, they tend to be quite disturbed about their self image. And they have, you know, recurrent self harm as well as, like, chronic feelings of emptiness. So, um yes. Like I said, personality disorders can be grouped into three categories. Plaster A, which tends to be like odd and quite eccentric. Um, and that includes things like paranoid, schizoid and schizotypal. Um, cluster be. It's more like dramatic and erratic. So those are you, your anti social behaviors, your borderline, your narcissistic behaviors. And then we have cluster. See, they tend to be quite anxious and fearful. So what? We would call you know, you're dependent personality disorders as well as your avoidant, um, and obsessive compulsive disorder. So these are all can, um, classified under the D. S m. Um, and generally speaking, in terms of management, we tend to not really give any medication for it, and it tends to be more focused on psychotherapy, CBT and that kind of stuff. But you do have to be careful with patient's like this because they can present with other mental health conditions. So it's really important that when you're assessing them, you know you're taking a full history and you're doing your mental state examination so that you can fully understand if it is there ongoing personality disorder or if they are exhibiting other mental health conditions such as depression, anxiety or bipolar, for example. So I hope that makes sense. Moving on to question to, um, be able to share the pool again, please. Thank you. Okay, So, um, next question, we've got 78 year old man that's got severe depression. Um, he's tried several treatments, and he's just been prescribed a tricyclic antidepressant. And the question was, what's the single most important investigation before you start? So again, we've got mixture of responses here, and the correct answer is, um, be so well done to a few of you that got that. Correct. Um so tricyclic antidepressants. Um, they essentially can slow the cardiac, the heart, the conduction of the heart and can cause things like arrhythmias and heart blocks. So it's really important that you assess the patient's heart. You know, baseline heart function before we'll start in. Um, it's particularly quite dangerous in elderly patient's who tend to be quite prone to, um, you know, postural hypertension and that kind of stuff. So it's really important that you assess the heart function beforehand. Um, but just to quickly talk about depression, then I'm sure most of you know a lot about depression, which is a mood disorder, and it's categorized by three core symptoms. So low mood and head Donia, um, and so basic low mood, um, lack of any energy and, you know, not wanted to engage in, um, stuff that usually find pleasurable. And it can be classified into mild, moderate or severe. Um, so in terms of mild depression, that's usually about five symptoms. Um, but no particular know minor, like functional impairment. So as well as the three course, um, symptoms. You also have other associated symptoms as shown on the on the right There, with things like, you know, changed in appetite, reduced libido feeling guilt hopeless and worthless. Whereas moderate depression tends to be more martyr, severe depressive, depressive symptoms. And you start to see, um, an impairment in the patient, you know, functional day to day activities. And then with severe depression, um, they usually tend to have, um, extreme depressive symptoms. Um, they have their functional. Um, you know, they did. Today. Social activities are quite limited, and they may or may not show signs of psychosis as well. So in terms of treating them, first line is usually SSR rise, such as sertraline, fluoxetine or citalopram. Um, and then you have second line is usually non SSRI. So things like S S N R rise or T C A. So tricyclic antidepressants such as, um, triptolin, um, for more severe depression. Sometimes you can start patient's on mood stabilizers such as lithium or some antipsychotics, depending on, Like I said, the symptoms that they're presenting with. But if you've tried all these medications, the patient still not showing any improvement over, you know, several months, then, um, uh, consultant might want to start them on like e c t. Um, just, uh, you know, improve the mood. Um, so just quickly about tricyclic antidepressants. Um, remember when I used to study for, um, exams? I'd always focused on SSRI. So I thought maybe I'd bring an SBA just to ensure that you're covering all bases so they essentially block the serotonin and Nora Grenell in re uptake. Um, and examples. Um, you triptolin, um And they they do have greater toxicity in overdose. Um, and some of the side effects include things like arrhythmia, seizures, um, sexual dysfunction, weight gain, postural hypertension. So that's why in the question it was important to check the patient's, um, you know, do an E c g beforehand. Okay, next question. Okay. I've just relaunched pulling the pole again. I hope that What? So I'm gonna end the poll there? Yeah, Um, looks like most people went for E closely followed by B and C. So let's see what the answer was. Um, so yes, it was e social phobia. Um, so, you know, you've got a young lady that's having panic attacks in mainly social settings. Um, and yeah, she feels anxious when she meets her friends. Um, So I thought I would talk about the differences between general anxiety disorder and phobias. So in this case, this lady had, um, social anxiety disorder because the emotions and the thoughts that she she has our induced in social settings. Um, so general anxiety disorder is persistent anxiety that has no particular trigger. Um, and it's disproportionate. Worry about, you know, everyday situations across life. Um, and it usually impairs, um, like, uh, you know, your social functioning, you might feel a bit irritable, restless might have poor concentration, as well as physical symptoms such as headaches, dizziness, palpitations, muscle tension and stomachaches. Um, um, it's usually managed with CBT s as well as, like, self help self help groups. Um, you can always start patient's on antidepressants. Um, and you can give things like bisoprolol to help with the palpitations that some patients might have, whereas phobia in this particular case, social phobia. Um, it's anxiety around a particular circumstance. So they tend to avoid, um, that particular trigger because they get an immediate response to that exposure, and it does impact their function. Um, So like I said, in this case with social, um, it's anxiety lead into, um, you know, induced by social settings. Um, and your patient's usually talk about wanted to, like escape and in terms of like, managing, um, that you tend to focus more on the things like CBT relaxation training, um, and just desensitizing them to the triggers. Um, there's another type of phobia called agoraphobia that's usually anxiety and unfamiliar situations. Um, and patient's tend to describe it as like they can't escape or they perceive having like little control, which can sometimes be quite debilitating and result in patient's not wanted to leave there. So I just thought I wanted to draw. Um, I hope I've explained that, like properly, um, the slight differences between generalized anxiety disorder and other Fabius. But they all fall under the umbrella of anxiety. Um, disorders. Okay, next question. Who? I'm going to end the poll there. So most of you went for De uh, which is the correct answer? Um, so let's talk about lithium, then, um, so lithium is a mood stabilizing drug. Um, and it's usually used prophylactically in bipolar disorder. Um, but you can sometimes use it in, like refractory depression, depression as well. It has a very, very narrow therapeutic range, so no 0.4 to 1 minimal per liter. Um, and It has a long half life because it's primarily excreted by the kidneys. And so you have to. It's one of, um it's an important drug that you need to know about for PT as well as, um, when you come to do the P s a exam and as well, um, so you tend to generally see, um, lithium toxicity in concentrations above, um, 1.5. So in terms of, um, features of toxicity, you can get things like tremors, seizures, coma, you know, acute confusion and hyperreflexia. So the features of toxic okay city are in order of, um, lesser extreme to, you know, um, fatal death. Essentially, um, And just to clarify that in terms of the tremor, you tend to see a fine tremor in, um, in therapeutic levels. And so let's talk about you know, what might actually cause a precipitate toxicity. So things like dehydration, renal failure and certain medications such as, um, diuretic, 68 inhibitors, um, a RBS, um, NSAIDs and stuff like that. So if you've ever noticed the patient is on lithium and any of these medications just bear that in mind and keep a close eye on them um, in terms of management. Then if it's like Martin moderate toxicity, you can just fluid give them some fluids with normal saline. If it's severe toxicity, you might want to consider hemodia Humoud Alexis. Um and then there is talks of, like, sodium bicarbonate. But, um, there's limited evidence to support this. Um, and I couldn't really see anything in the research. But essentially, like normal saline is enough to, um, help bring down the like, low the toxicity levels. Um, as well. Okay, next question. I'm gonna end the poll there. So most of you went for E, which is the correct answer. Um, so oh, just explain. Mhm. Okay, uh, so should I just first rank symptoms of schizophrenia are symptoms that essentially, if our present are strongly suggestive of schizophrenia, and they include things like auditory hallucinations, which is like hearing thoughts spoken aloud, hearing voices referring to patient's referring to themselves in the third person thought withdraw insertion or interruption thought broadcasting somatic hallucinations and, um, feelings or actions, um, experienced as being generated or influenced by external agents. Um, so in terms of, you know, managing patients', then you would consider things like, um antipsychotics, which usually split into typical or atypical. I think I go on to explain that a little bit further, so I'll just move on to the next question just because of time. It's doing cool. We're gonna end the poll there. Um, most of you said E, which is the correct answer. Um, so there's a high chance that this lady has, um, anorexia nervosa, Um, with a persistently low b m I below 17. Um, she needs to be assessed and managed by a psychiatrist. Um And so, of course, you can always, um, refer her to a G p after, but she needs a specialist help to help direct treatment. Um, so anorexia and bulimia are part of the eating disorders spectrum. Um, they are very similar, but have major differences. So with anorexia, you've got the extremely low weight. Um, usually, um, b m I of lesson 17.5. Um, and a lot of the weight loss is actually self induced by things like excessive exercise, vomit in appetite suppressants. They also have a lot of cognitive distortion about how they perceive themselves, so they often think they're too fat or they have a fear of gaining excessive weight. Um, and you can have some, um, endocrine disturbances for such as amenorrhea in women and in men. Loss of sexual interest, Um, and libido, whereas bulimia is more about it's more about recurrent episodes of, like, overeating. So, um, being Jeetan, um, they do attempt to, you know, um, counteract the excessive calorie intake by self, um, inducing vomiting again. They can use, like, appetite suppressants, um, or go through periods of starvation. But in terms of their, um, you know, the way they perceive themselves, um, they do also think that they might be too fat. And do you have a fear of, you know, gaining weight? Um, but yeah, those are the two major differences between, um anorexia and bulimia. Next question, uh, I'm gonna end the polls. It, um amazing. Most of you went for B, which is the correct answer. Um, so I've literally just copied and pasted this from past bed. Um, they have a long table of, um, you know, overdoses and their antidotes. So have a look through that. Um, yeah, I won't bother reading through through all of this. Um, but essentially just wrote, learn it because it comes up in the exam all the time. Okay, Next question. Oh, apologies. This one was quite worthy. Um, so most of you said C and best correct answer. Um, so I hope you all managed to read through the clinical stem. But in this case, the patient does have capacity, and they're not suffering from any mental impairment. Although they do have a prior history of postnatal depression. Um, therefore, although, although it might seem like an unwise decision, she does have a right to refuse surgery. Um, however, if it was, um, Well, in this case, it's quite complicated, um, and potentially life threatening. So it's always wise to seek a second opinion and obviously, like, involve, um, you know, you might want to consider involving the legal department. Um, but yeah, it was STI. So the Mental Health Act and the Mental Capacity Act essentially legal frameworks that allow, um doctors to provide care or treatment for patient's that may or may not have, um, some kind of mental health. Uh, well, in the case of the Mental Health act, a mental health condition or, um, yeah. So for pages without capacity to consent to or um, admit, due to the nature a while of their disease of their illness. Um, sorry. Let's start that again. So the mental capacity act was in 2005. It provides, like, a legal framework, um, to essentially empower and protect vulnerable people that might not be able to essentially make their own decisions. And there are five key principles. Um, that you must, um, uphold. So, um, ensuring that it's time and questions specific. Um, so you have to assume the principles that you have to uphold that every adult you need to assume that every adult has capacity unless it could be proven otherwise. Um, and you want to support the individual and making their own decisions and allowing them to weigh up the pros and cons of any decision that they decided to make. Um, and the individuals have the right to make whatever decision they want to make, even if you might think it's unwise. Um, and that any Axion that the individual might then take must be done, you know, in their best interest. So, um, if a patient do is deemed to like capacity, then you need to hold a best interest meeting, and that might involve every that needs to involve everyone that's involved in their care as well as you know, family members as well as the patient. Whereas the mental health act, um, is, uh, you know, again illegal frame work that allows doctors to basically detain patient's under specific time periods in specific areas, um, to either treat them or to assess or to treat them. Um, so these are the important sections that you need to be aware of. Um, so you've got section 136, which is, um, done by the police, usually in places of, um, in a public place. I could be done by a nurse or doctor. Um, and that that's basically for patient's that are actually inside the hospital. Um, and then you've got section two, which lasts for, like, a month. Um, for that one, you do need, um, to doctors. So, um, the doc so that's looking after the patient and then, um, an approved camp. Um, and then section three is quite similar Section two. But it lasts for a longer period of time, and it's usually for, you know, longer term treatment. Um, as well. Oh, so um, next, Mr uh, someone just ask what time of this is on until So it's for about an hour. Um, we're just over halfway through. So maybe in about another 2025 minutes or so. Okay, let's end the poll there. Um, interesting. Um, answer options. Uh, let's see what the answer is. Um, so it was actually see korsakoff syndrome. Um, so I'll just try and explain why, um, in delirium and a postictal state, there would be an altered level of consciousness. Um, and in the stem, it says that there's no impairment, his level of consciousness with Alzheimer's, the person would have generalized cognitive impairment, and it's usually quite progressive. Um, and if it was normal pressure hydrocephalus, they'd have a triad or of a taxi, a dementia and urinary incontinence. And that's why the answer is See, here there is another question coming up, so I won't explain why we'll just move on to the next question. Um, no. Oh, sorry. Hold on. Okay. Next question. Bull. So we end that there. Most of you said C, which is the correct answer. Um, um, yeah. So you've got a patient essentially with on Plaza pine. Um, and they started complaining of a sore throat and temperature, so something should be jumping out at you here. Um, and you should be worried about if slide changes. Uh, agranulocytosis iss, um, so close. A pine is used for treatment resistant schizophrenia. So it's when you've used, um, at least two different antipsychotic medication, or the patient has, um, psychosis associated with Parkinson's disease, and you want to consider starting them on closet pine. Unfortunately, it has some side effects, including agranulocytosis. So when you do prescribe patient's on these, you do want to warn them about having any, you know, flu or cold like symptoms, as the patient had in the clinical stem. So close pine is a typical antipsychotic. Um, and you want to Yeah. Like I said, um, inform the patient about signs of a low neutral field. So raised temperature or flu or sore throat like, um, symptoms. And you have to remember to check their, um, full blood count weekly for the 1st 18 weeks of starting them on medication and essentially the way clozapine works, is that it? Um, it blocks the dopamine two receptors, um, and some other side effects include, um, g eye obstruction as well as myocarditis. So it's a really important and psychotic medication to be aware about of the, um, and it's medications and its side effects as well. Sorry. Uh, next question, After this, we have two more questions. So we might actually finish on time. Uh, okay, I'll end the poll there. We've got a lot of mixed responses. Um, the correct answer is, in fact, um, function D. So bone profile use and ease. And TFTs. Uh, so this patient's got bipolar effective disorder. They started on lithium. Um, and you want to check these blood test? You know, do these blood tests every six months on top of their lithium levels. Um, so I'll briefly talk about bipolar disorder, then, um, so we have two types. Bipolar one, which is essentially manic episodes with depressive episodes. Um, whereas bipolar, too, is recurrent depressive episodes with intermittent hypomanic episodes. And essentially, it's, um it's like a spectrum, and I like to think of it like that diagram that I've got on the slide there, Um, in terms of the mania, then it's got to be, um, you know, about a week more. Well, equal to more than a week of change in their moods. And they've got elevated mood with at least three mania symptoms. Um, and that's essentially, um, impairs. Um, they're functional day to day, um, living, whereas hyper main is usually about four days, so it's a shorter duration. The mood is elevated, but it's not necessarily impact in, um, they're functional ability. And in terms of the symptoms of mania, I've just listed it over there. Um, and so when it comes to treating the acute episodes, then if they're not already on bipolar medications for the mania you should consider stopping any antidepress is that they might be on already and prescribes them. Anti, uh, Saikat sticks. But if they having a manic episodes. But if they're having a depressive episode, you would want to consider an SSRI such as fluoxetine with a Lanza pine or Katia pine as well. Um, so that's to treat. They're cute episodes for the more longer term treatment. First line is lithium, Um, and then second line is, um, you can always add something like sodium evaporate as well. However, that is contraindicated. If they are female of child bearing age, as Well, so that's just something to be, um, aware of. Uh, so, yeah, I think that's the second to last question then. Yeah. Oh, so we've got, um I think most people are split between C and D. Um, the answer is, in fact, um, see, um, so I actually hadn't heard of the audit or cage questioner until I started working in, um, psych, But I'll explain why it's see here, um, so decreased MCV. You would actually expect patient's to have a microcytic anemia, which would be increased MCV. And they would expect to have high levels of G t. So it's not a or B, um, with the audit questionnaire then. So that's a simple, like 10 question test developed by the World Health Organization and essentially determines whether an alcohol's a person's alcohol consumption is harmful. Um, and it's designed to be used internationally. Um, and it's been validated, um, in studies from, you know, patient's across, like, six countries. So with the reason why it's not D, um, is because d you wouldn't really expect positive response. Actually, when we went to the next slide here. So, yeah, so this was my slide on everything to do with alcohol misuse, then, um so, as I was trying to say So Cage focuses on it, asked the patient questions like, you know, you're cutting down on alcohol. Um, you know, are they angry when asked or guilty or they drinking in the morning? Um, and then the audit, then, is the 10 questions um, developed by who? Um so in terms of alcohol misuse, you've got intoxication, dependence and withdrawal. Um, with intoxication. Patient's tend to have, um, you know, the initial phase of like, you know, they feel quite relaxed. Um, the mood is a little bit is, you know, fluctuates. They might share a bit of aggression, but when they become dependent, um, they start to have, um, other exhibit others symptoms size of symptoms such as compulsions, uncontrolled drinking, you know, tolerance and some stereotyped behavior patterns. Um, and then with withdrawal, then alcohol withdrawal. If it's been about 36 hours, patient's would have things like sweating, nausea and vomiting. Um, cause tremors. Um, and then once that's more than 72 hours. Um, you start to see things like ataxia, delirium, tremors, hallucinations, um, and some like electrolyte, um, imbalances. So from the previous question, we saw the course. Cough was one of the answer options, so that's a complication of alcohol misuse. And, um, that's got triad of memory loss. Confabulation is and disorientation, whereas Vennochi's encephalopathy is essentially thiamine deficiency. And so, in terms of, um, one of the medications that you can give to one of the drugs that you can give to patient's, um you can give them something I mean, which can help with them with, like, the detox and the withdrawal symptoms. Um, as as well, um, yeah, so I'll just move on to the last. Oh, yes, the last question. Then, Um Oh, so, um, what did people say? Most people went for option B, which is the correct answer. Um, so I just wanted to briefly talk about a D h D, which is attention deficit hyperactivity disorder. Um, so first signs tend to often be seen before, like, you know, the school age. But most people don't actually get diagnosed until, um, they become an adult. It's common in common. It's more common in males. Um, but I think most of the research says that it's actually under diagnosed in females and there's a strong genetic link as well. So in terms of the presentation, then, um, a lot of kids tend to be quite impulsive. They don't have much tension. The hyperactive, um it's before usually before the age of 12. Um, and they do present, um, you know, in two or more, um, settings, Um, in terms of assessment, then they do need to undergo, like Children need to go undergo, like interviews and observations in clinic. Um, you do like general physical examinations, and then you do want to look at school reports and what they're like. School teachers and educational psychologists, um, have said as well as give question is like parents and teachers as well. Um, with terms of treatment the most, um, common one that most people would have heard is Ritalin. Um, but some of the side effects of that could be like headaches, anorexia, um, dizziness as well. So just be mindful of that. And then you do want to support parents as well in how to, like, manage, um, their Children's behavior, Um, and how to deescalate things. If things, um, get our planned, you could consider things like behavioral or CBT therapy. um, And then look at the more social aspect of things. So what kind of routines do they have And supporting the Children and the teachers, Um, in school, um, as well. So, yeah, that was the end of the presentation. Quick. Also, stop tour of, um, some psych SBS. Um, just some last minute tips for, like, PT, you know, read the question carefully. Um, try. And if you're ever stuck on a question, you know, use a process of elimination and make like, an educated guess. And of course, I think the PT is like, next week. Um, so just keep doing the loads and loads of practice questions. Um, if any of you have any questions or anything, you can always reach me on my new instagram page, which essentially is like documenting what I do as a junior doctor, as well as like trying to support and help final year medical students. Um, as well, I'm just all medical students. Um, so, yeah, um, thank you all for coming. Does anyone have any questions? I might stop sharing, know? Oh, yeah, very good. Thank you so much. Guys, please fill in the feedback form. Um, I'll also quickly share the share the Oh, yes. Um, the, uh so, yeah, so either you can use the link. Um, I just bought it on the chart. Or you can use the barcode here, so yeah. Thank you so much, Lynn, for that amazing teaching. That was great. Um, yeah. So that was the last the last, um, teaching in the series. Um, So thank you for bearing with us. And good luck to everyone sitting progress test next week. I hope it goes well. Um, and yeah. And hopefully we'll see you in the next series. Um, make sure you do the feedback for Lynn. Have you been able to organize all of this on top of, like, you know, it It wasn't me. It's It's been like, um, so you know, it's been thinking. People like safe and a beer, and things haven't haven't contributed much. Um, but yeah, but thank you so much. Landfall for coming. It was really useful. Thank you. Yeah, I know. Happy to help whenever? Yeah. No, it was great. Really. You know, I even, um I learned I It's just it was a good division for me as well as I haven't touched on psych for a long time. You do? We see a bit of it, and I'd like to see a bit of it, like, you know, like, overdoses and things. But, you know, you don't see as much, you know, you know, don't see the you know, but yeah, it was great. It's a great session. Thank you. To be honest, doing these questions made me realize how much of psych I still haven't actually seen. Yeah, because I work in the hospital and liaise and psychiatry, so right. The referrals we tend to get from Eddie tend to be like overdoses, you know, like alcohol stuff. And then from the world's a lot of like dementia. We didn't get a lot of like like e u PD patient coming through as well. Um, as well as, like, overdoses and those with, like, suicidal ideation and stuff like that. So it was also a good refresh in for me to see what else, um, is in psych. Yeah. Mm. Yeah, that's great. Thank you. Then super helpful. Okay. Um, so at about 10 past guys, I'm going to end the meeting. So if you have yes, If you could make sure that you do the feedback form. Yeah. Uh, progress. Test the memories. Yeah, I lost that one in February. So it's been such a long time. It is nice not having to revise for an exam. But I do remember the feeling of, like, yeah, not not knowing if I had covered everything I needed to before the exam. Yeah. No, I think you know, I I never felt like 100% ready for progress is like, every time I used to go in there, I used to feel like there's so much more that could have Yeah. Yeah, like you can never be, like, fully prepared for that test. Could you know? Um, but yeah, but it's good. No, I think it'll be fine. I think everybody will be. They will do. Great. I'm sure. Um, usually it's like it. It always people. It's fine. Yeah, Yeah. Most people, most people. It's fine. And, you know, most of the time, like you, it depends on how your group does. Like if the if, the if the if the questions that were hard and then that kind of particular progress test in the chances are like most people in your your group would be, like having the same difficulty. So the actual great boundaries or, you know, Yeah. Um, no, it's interesting, because I remember just before I left, they changed, like everything with the PT. Yeah, this was the third year for the second years, but yeah, I'm just glad I left before any of that affected me. I know. And it's in a couple of years time. They're bringing the Emla as well. The medical license. Think I think that would be good. It would just make things a bit more uniform and standardised. Yeah, but also that you're now competing against other universities. Do you know what I mean? Because yeah, it's like different levels Isn't because everybody is like, I don't know. No. I guess it's important that things are standardized, just like you know, s J T s G t is like standardized, isn't it? Yes. Yeah, exactly. Um, yeah, that would be interesting. Okay. Okay. Let me stop this

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