Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone will just give it a few minutes for people to join. Ok, let's get started then and thanks everyone for joining, um, as part of your part of your evening. Would you mind just letting me know if you can hear me? Ok. And if you can see the slides as well? Perfect. Um, so just to introduce myself, my name's Ed. I'm an academic F I two doctor in Glasgow. Um, having graduated from Edinburgh. Um, my pronouns are he and I'm going to be chatting through, um, a bit about psychiatry. Hopefully get you, um, folks involved as well. Um, and yeah, ready to, hopefully by the end of the session, get, yeah. Hopefully you've got a good grasp of some of the things that are expected for your, um, finals in Psychiatry. Um, so my last blocking effort here was, was in Psychiatry and I've applied for it, um, next year. So Psychiatry is what I'm interested in and hopefully, um, some of you here might be as well though. I understand that this is part of the series, um, geared towards final exams. Um, fine. So hopefully those changes. Um, I've not done teaching quite like this on, on metal before. Usually I just do it on Zoom. So I don't know whether you can, you know, turn your mics on and, um, engage that way. Um, but certainly please do ask lots of questions on the, on the chat. Um, and a lot of what we'll be doing will be very interactive. Um, and I've purposely not kind of put loads of information on the slides because you could very much spend an hour of your time, you know, reading a textbook if all you wanted to do was um, learn a load of facts about psychiatry. Um I thought we'd do a bit more of a kind of engaging approach. Um But what I have done is kind of as an appendix to the slides. I put a load of kind of high yield psychiatry information for uh finals exams. Uh So hopefully there's a way for you to be able to get access to those slides again. I've, I've not used them at all before. Um I'll ask, um the mind the Bleak team to, um, see if there's a way to get you access to those, um, if you don't tolerate. OK. So these are the main things I thought we'd um, chat through shout if um any of those look, um not what you're looking for. Um, but just going through some common psychiatric disorders and, you know, their broad um symptoms, differential diagnoses and, and management have a bit of a practice at doing an M SE because that's an important part of ACY in final exams and, um, have a look at some cases and, and M CS. Ok. Um, so that's, that's what we're doing. Does that sound kind of broadly what you're hoping for from, from this kind of hours session? And a second question to tag on to that while I'm asking questions are, is, are my slides progressing on the screen for you? Perfect. Okie Doke. So what I'm not going to be able to cover just because we only have an hour and um the there is just a limit on what on what we can do. So I'm not gonna go into history taking, I'm not going to go into risk assessment of someone who's suicidal or um who self harmed or overdosed. Um I'm not going to go into specific drugs, so I probably won't mention if any um any like specific drug names or, or mechanisms of drugs. Um Not because it's not important, but purely because we only have an hour. And yeah, that, that seemed a a quite a big track to go down that we might not necessarily have time for. There are a few kind of more niche things within psychiatry. I'm not going to mention those include personality disorders, neurodevelopmental disorders like autism and ADHD functional neurological disorders. Um I'm not going to mention the Mental Health Act partly because I in Glasgow and and Scotland's, um, sections are, are different to in England anyway. Um, and I'm not really going to talk about either. Ok. It's just because of the time we have. So I'll just highlight those now so that if you want to, you know, maybe focus on those in, in your own time as well, then that would probably probably be a good jump. Ok. So, psychiatric disorders, I've made this little, um, I guess family tree of, of psychiatric disorders, um just showing the main ones that are possibly, you know, going to come up in finals exams, um and broken them down into broadly into kind of cognitive substance related psychotic affective anxiety is quite a and panic is quite a broad heading and eating disorders as well. Um So I guess my question first off, are there any that you'd like to particularly focus on? And we can just, we can just focus on those um because we won't have time to go through absolutely everything. So I guess in my mind, probably the big topics are anxiety and depression and bipolar. Just the kind of anxiety and affective disorders, schizophrenia and then probably eating disorders as well. I know that's, that's covered about um about most of the tree. Um But kind of within those, were there any main things we wanted to definitely touch on? Ok. No one's um ok, so we, we've got a couple of people talking about uh, well, antipsychotics and, and schizophrenia. So we can definitely have a look at that. Um, we, we, we can have a look at the side effects, uh, for, for sure. Um, I hadn't planned and, and I don't have slides for, um, specific drugs, as I said, but definitely side effects of antipsychotics as a, um, as an important topic that we can, that we can definitely go into. And, yeah, ZZ schizophrenia um, fits nice. That, so why don't, why don't we start with that? And then um go from there um based on, you know, what time we've got. OK. So what I want you to do is think of a patient that you've seen with these condom. OK? Because just as a kind of a side point on, on teaching and, and on learning, it's gonna be really helpful for you if you can bring actual kind of concrete experiences or clinical encounters and use those experiences as we kind of um talk about the, the diagnoses and differentials and symptoms and management um of each one. OK. And it's almost about building up in your head. And this is what a lot of medicine is actually a kind of bank of um kind of prototypes for each disease that you kind of carry around in your head and, and draw on rather than necessarily kind of rope learnt quite laborious algorithms for coming to a a diagnosis. So if you can picture something really concrete in your head and build up a bank of those from different patients um and different talks like this that you come to. Um that's what's gonna be really helpful for you. OK. So what I'm going to do at this point is switch over to look at some uh concept maps um or, or mind. Um And what I thought would be if we can go through these together, kind of thinking through what are, what are some of the features, what are some of the differentials? What some of management? Um I think that would be a, a kind of useful way to think about this kind of inactively. So hopefully, now you can see on my screen the, er, the kind of mind maps the concept maps. Um, and it should now be right in the middle of your screen, the schizophrenia one. So that's what people have mentioned. Ok. So, um stop me if that's, if that's not the case, but I'll, I'll assume it is and carry on. So let's have a bit of a think about clinical features then of schizophrenia. No, I'm not going to go through the, the exact ICD and DSM and, and all that kind of thing because you don't need to know that for finals. Er, but I have broken this down into, er, er, Schnyder's first rank symptoms of schizophrenia, of which you need at least one to get a diagnosis. Um, and then out with those first strength symptoms, there were other positive symptoms. Um And there are negative symptoms. Ok. So anyone want to um kinda let me know through the chat or um on microphone, if you have access to it, um What might go into any of these things of clinical features? I'll, I'll start off with one just while people are thinking. So I'll put down for echo and insertion and well, all sorts of thought disorders really um withdrawal and broadcast. So they, they will all, all kind of come under that. Um Perfect. So we've got a few mentions there. We've got auditory hallucinations. Um and it is specifically auditory hallucinations um that we're looking for here. Ok. So that could be voices that are given a, a running commentary or they're discussing the, the person er kind of between themselves. Um So, auditory hallucinations, um we've got men of delusions. Um and we're, what we're looking for for kind of strength symptoms is specifically delusions of control or um passivity or perception. Ok. So that's kind of a um a summary of some of the first rank symptoms I'll say as well as auditory hallucinations, you can also have hallucinations coming from like part of the body. Um and as well as yeah, sorry from, from part of the body. Ok. So we've got these as our kind of first rank symptoms and people have mentioned, yeah, kind of audit auditory. Um Other things like um visual hallucinations would probably come under um kind of other positive symptoms. So, um hallucinations of any modality, whether that be visual or um olfactory or, or anything else. Um And we've got delusions and then thought disorders. So you have the thought echo insertion, et cetera, ok, in terms of other positive symptoms. Um so these are kind of symptoms that you, that you see because they're in, they're kind of in addition to what you'd normally see in, in a, in a kind of um normal person. So in terms of positive symptoms, these could be things like tangential speech, it could be quite um classic. There could be things like, yeah, um Liam's mentioned uh low mood. Yep. So you get, that's kind of now going into the negative symptoms of, of schizophrenia. So we've got kind of an anhedonia um apathy. Um, you know, symp symptoms similar to that potentially of um, of depression. I don't know what it just disappeared. Ok. Um, instead of speech being quite kind of tangential, you could have it kind of go, go the other way and um speech being quite limited or blunted. Um So I'll put kind of blunting of responses. Um, poverty of speech. Ok. So this, this is kind of filling out this, this mind map really nicely. Um It's a good job so far on, on some of those symptoms. Ok. Um And does everyone understand that concept that we need at least one of the first strength symptoms to get to diagnosis and other kind of branches are other symptoms that can be present in, in schizophrenia. Ok. Um We've mentioned delusion. Um or lia mentioned delusions. Can anyone just maybe pop quickly in the chat? What, what do we mean by delusions? What is a delusion? Ok. Um So no, no one's jumping in there. So I guess a delusion is uh yeah. OK, great. So it's, it's a fixed belief that's arrived at illogically. Um and it's, and it's, it's false. So it's not, um, it, it wouldn't be kind of believed in that kind of culture or that setting can be quite bizarre. Like, er, it could be quite a paranoid delusion. It could be quite a grandiose delusion. It's often very b bizarre. Like, you know, people have, um, put a microchip in my head to monitor my thoughts. Um, or, um, yeah, I'm actually the, the, the, the ruler of the world or I'm, I'm actually God and, and people do what I say kind of thing. Ok. So it's, it's not cul culturally normal, it's not resisted. Like o CD, people kind of resist. Um, the, the kind of thoughts that they're having. So they're not delusions and they're not amenable to reasons, they are fixed if you try and question them and reason. Uh, they, they stay fixed. Ok. Great. So that, that was just a quicker side. So, differentials for schizophrenia. So any other causes this, basically that anyone can think of just pop them in the chat. Mhm. Yeah. Yeah, great. Ok. So I'm, I'm just gonna start populating the, the mind map for some of these. So I just say uh kind of drug induced. Um, so that could be alcohol, cannabis LSD withdrawing, um, like in delirium tremens, withdrawing from alcohol. Um. Right. So that covers substances and alcohol. I'll just put, um, you know, schizoaffective disorder, um which is a kind of, er, is primarily a mood or an affective disorder. So, either mania or depression or both. Um but with some schizophrenic symptoms as well, um that I, yeah, I said I won't go so much into personality disorders and actually they're not. Um so um relevant finals, but that's definitely ad differential. So um so I'll pop that down. OK. And OK. Yeah. So an important one is um kind of organic psychosis. Um fine, good. Um OK. And I guess that also includes things like delirium. So if it's an infection, driving kind of confused delirious state. Um Yeah, so Liam, you can get hallucinations, you sometimes get visual hallucinations even with Lewy body dementia. So I guess it's a, yeah, II guess that's a um one to consider I'm just going to leave that within the kind of organic um organic differentials like like delirium, Lewy body dementia and the kind of hallucinations that come up, you could also have depression with psychosis. Um especially you get kind of these delusions of guilt or paranoia or persecution um, or you can even in depression get, um, kind of auditory hallucinations where a, a very kind of heavily, um, in a critical, um, you know, again around this kind of guilt. Um, anything. Ok. So, I think we're probably getting a, a good number here. Um, at least it's, you know, a, a good, um, set to have in your head for, for finals and then Liam. Yeah, it's a kind of postpartum psychosis. Um So it's a kind of severe mental illness, postpartum. So in the kind of days or weeks after having um a baby and yeah, it can include hallucinations, delusions, uh confusion, effective um stuff in there as well. So mood, mood kind of elements in there as well. Um Yeah, all that's a a good one as well. OK. Um What else have we got? Um Oh, so we talked about the delusion definition already. II won't write that down, but it will be in the slides afterwards and then the management for schizophrenia um because it's a psychotic condition is uh ba basically antipsychotics, obviously, in psychiatry, you also want to think you want to think through your kind of biopsychosocial model. Um And think about, you know, other social things we want to put in place like occupational therapy and, and that kind of thing. Um But I'm just going to mention um antipsychotics from a medical perspective. Um And I know um I know there was a question early ear earlier on, I can't find it just now about side effects of antibiotic, uh, antibiotics, antipsychotics. So that's definitely something we can go into. First line. It really, I know you also mentioned, you know, what's the first line? It really depends kind of where you are in the, in the country. So, um I could give a response from, from Glasgow Scotland. Um, but it might be completely different elsewhere and it depends very much on the, um, the patient. Is there a kind of effective element? Their schizophrenia with mood and stuff? Um, are they quite aggressive, are they already quite sedated? You know, there's quite a lot of options. Um, and you wouldn't be expected in medical school finals to be choosing, I don't think, um, don't quote me on this, but I don't think you'd be expected to choose between different first line antipsychotics. Um, so that's quite a specialized decision. Um, but side effects are really important for a junior doctor because if you're on a psychiatry ward or in your, if you're in a general hospital and someone's on antipsychotics and they present with one of these side effects, you need to be able to recognize them and, and know what to do about it. Ok. So we've got, um, I've kind of split it here into, um, antidopaminergic, anticholinergic anti adrenergic, that should say. And antihistaminergic and the uh kind of E CG uh side effects are just as a kind of a separate thing. OK. So can anyone think of some of the anti-doping magic side effects? So these are extra pyramidal side effects or um you might have heard um heard them referred to as EPS, which is the acronym for that or if you want to jump in with, with side effects under any of the other categories? Yeah, perfect. OK. So first one is in. So we've got tardive D um and we've got um, yeah, kind of parkinsonian um, symptoms which it yet comes under the kind of extrapyramidal stuff ache. Yeah. A a feia, oops, I can spell it. Ok. And, and that is kind of general restlessness. So they won't be able to sit still but very constantly kind of wobbling the left leg. They'll go on to be pacing up down the room, potentially. Um We've got dystonia. Um, yeah, so I'll put acute dystonia. Oh, I'm sorry, I ii missed yours a bit further up the, um, oculogyric crisis, which is a, I guess it's a form of dystonia. Um, we're gonna manifesting in, um, and kind of these involuntary movements of, of the eyes. Um Yeah, so I'll, I'll kind of group that under dystonia and then the last one that um, hasn't been mentioned, which I will just put down is neuroleptic malignant syndrome. Ok. Perfect. Um Just for time, I'll, I'll fill in some of these other ones. Uh, so rigidity that, that's more of a symptom and it could be that could come under some of these other side effects. So it could be uh to do with the kind of Parkinsonia, parkinsonian symptoms. It could be uh a symptom of neuroleptic malignant syndrome, which that is one of the symptoms that you get there. So you can get rigidity in different circumstances. So you really want to see what else is going on and what your bloods like to be able to distinguish that. Um, and it could be quite hard to distinguish, um, because there is some overlap that, um, it can kind of reveal themselves as, as they progress. Um So as I say, I'll fill in some of these others. So, anticholinergics, that's the kind of classic dry mouth, uh constipation, et cetera, antiadrenergic. I'll just change that. That's your hypertension, antihistaminergic. That's things like weight gain, um, sedation and CD changes. Um The key one you're looking for is QT prolongation, um, with a QT prolongation that can lead to um, problems like ventricular arrhythmias. Um, and so on. Ok. And so just I know that, you know, we've got a few people on the chat replying to the um, to these things, but just for the sake of everyone here, I'll just quickly mention each of these side side effects. So we've got, um, er, so got Dystonia, um which could be things like, um, an OC G like, um, like Lia mentioned where you've kind of got eyes rolling upwards, that kind of thing. It could be kind of contractions or spasms of the, of the neck. It could be a clenched jaw and the treatment for acute dystonia is an anticholinergic like procyclidine. Ok. Um, a three. Yeah. So it's, that's the kind of general restlessness got to kind of run around. Um, and so on the management for that is propranolol. So beta block blocker, er, you could consider as well a short term benzodiazepine charge of discards. Um, so this is when someone, um, has maybe been on, on, on antipsychotics for quite a long time and you get these symptoms that basically just look a bit odd. Ok. So it can be kind of chewing, grimacing, these kind of darting tongue movements. Um, and it's a fairly slow onset, it's not an acute onset, it's a slow onset in patients who have been on anti antipsychotics for a long term. Um, and basically the management is you just have to withdraw the antipsychotic because there's nothing else that you can give. If you don't like an acute dystonia, want to give an anticholinergic because that can make things worse. So don't give an anticholinergic, you just have to withdraw the, er, the antipsychotic. Ok. And then neuroleptic malignant syndrome is really important. Um, it uh presents as a kind of reduced neuromuscular activity and also autonomic autonomic dysfunction. Um, usually a week or so after you've initiated an antipsychotic or increased the dose of an antipsychotic. Um, so things to look out for are rigidity. Um, as part of the kind of neuromuscular activity decrease, um, hypotension as part of the autonomic dysfunction. Um, and also people seem to, um, have a CK that's very high. Um, and not just a little bit raised, like very high, like over 1000 high. Ok. The management here again is withdraw the antipsychotic. Um, the temperature can go off, they can become very, um hyperthermic, so cool them down if so, um make sure they're um hydrated. Well, um ok. Uh you know, keep on top of their hemodynamics. If they're really low BP, then they need fluids, all that kind of thing. And if someone has this syndrome and they're in a psychiatric hospital, chances are they will need transferred to a medical hospital for these things. Ok. So that's kind of how serious um serious it is. Ok. Um Fine. So that's kind of what I was I was gonna mention about schizophrenia. Um And I know that's took a bit of time but, but hopefully that's helped think through, you know, about the features. What a delusion actually is differentials management. Does anyone have any questions about schizophrenia at all before we moved on? That's ok. Yeah. Ok. So, and feel free to keep going on the chat and I'll, I'll come back if, if there are any questions. Um but schizophrenia was the anti antipsychotics was the only thing that was mentioned at the start. Um So if it's ok, I'll, I'll, I'll switch back to the slides. As I say, these slides will include some high yield information on all the different psychia psychiatry disorders. I just don't want to kind of, you know, be listing facts for you all these things. Um Right. So hopefully that's helped with schizophrenia because that's the one that was, that was mentioned. And as I said, if you want to look at the others, then you can look at the sites afterwards, gonna look at Aces. Um once it's come up and one I actually want to focus on, first of all is, is this one? Ok. So the, the intro to this is fairly short. So I'll um I'll read it out for you. So he's a 29 year old man. Um he's unemployed, lives alone and is becoming increasingly afraid of leaving the house. He's brought to A&E by his friends who are concerned about the way he's been acting and they say for the last week he's been acting crazy, he's been saying crazy things about his neighbors seeming paranoid. Um and he's becoming angry when they try and explore things. Ok. So what I'm gonna do is that's the intro, I'm now gonna play a video of an interview with Jason. Um And what I want you to do is have a think about forming an MS ea mental state examination of er, Jason in the video. Ok. So just to um just to remind people. Although hopefully this is part of your revision for Acies for Finals that includes commenting on appearance and behavior, speech, emotion, perception, thought cognition and insight. Um And the the the kind of acronym you can use to remember all those is aseptic. Um of course, cognition and insight should be in the the other way around for that acronym to work. OK. Um Now what I suggest is if you can get your screen big enough to take a photo of this, this is just a really helpful table that as we watch the video, you can be kind of thinking through in your head or even Yeah, well, probably thinking through in your head. What what are we ticking in in these boxes um for each of the aspects of a mental state examination. Um So I'll just give you a second just to um maybe get a photo of that. Um And you could, for example, just make your the screen full screen for a second if you need to make it bigger. Um and then is I'll just move on and play the the video. OK? Ok. OK. So sorry, just give me a sec. Let go. I'm not gonna play the whole video, don't worry. Hello, Robert Smith. Yeah, thank you for coming. Someone just saying I'm one of the doctors that works here. Um Obviously anything that we say is confidential between us and the team as I work with a GP, who's asked me to see you? Ok. Um, I hear there have been some problems with your housing. Do you want to tell me a little bit about that? Yeah, I've had all sorts of problems. I mean, where do you want me to start? Um, my neighbors, um, police, um, people spying on me on my street. Um, I, you know, none of them admit to it but I, but, you know, my neighbors they, but it's mainly, it's mainly them at number nine, but I've seen them talking to the ones at number six and across the road as well. You know. So what, when did things start to go wrong? I don't know. I mean, you, you, you'd have to ask them what, like when they started properly, like deciding that they wanted, they wanted me out of the street. II think it was a few months ago. Months it's been going on for months. What makes you think they want you out of the street? Well, it's, it, it's, it's the harassment, it's the spying on me putting bugs in my, in my house, in my phone, you know, and that, you know, at first they thought I couldn't hear it but now they know, I know that, that they're there, you know, uh, saying things, saying things about me through the window, you know, talking about what I'm doing. I know, I, you know, I know they're doing it, you know, whenever I leave my front door woman at number seven, she's always there. You know, she's clocking where I'm going and what I'm doing. Why do you think they're doing that? Well, I don't know, they're just, I think they want, I think they want me out. I think they're, I think they're testing me and they're trying to, they're trying to find out how far they can push me. Basically. It's all part of some, some tests. I don't know why. I don't know what for, you know, you'd have to ask them. That's what I said to the police time and time again. I've said to them. Why, why are you asking me these questions? Why don't you just talk to them? You said that your phone was clicking, what was that about a landline? The landline. Yep. Yep. Um, somebody rings me or I ring somebody between seven and 10 seconds in, I hear it. Click, click, click, click, click, click every time. Any other explanation for that? I don't know. Well, well, it could be but, you know, every single time and then, and then they're talking to me and then they, they know what I've been saying down the phone. You know, how are they talking? Where were they talking to you? Well, I can hear him next door. Always on the phone again. Always reading that book again. You know, I can hear him saying it and they know that I can hear them and that's why they're doing it. Ok. So just to summarize at this point, your, your, your, your phone's something's happening to telephone. You can hear your neighbors talking about what you're doing, making a commentary on your actions every day, every day. And you feel that there's some sort of reason for all their actions doing this any other? See, ok, so pop back on again. Um I'm really keen to, to hear your thoughts um kind of on this and maybe we can go through in a, a step wise, we go through the M SE. Um So did anyone you can either use this table that's up or your, your own way of doing an M SE? But does anyone have any thoughts? First of all on either a parent, attitude or behavior? You don't have to kind of, you give a whole MS a word or, or phrase is also fine. Yeah, probably, probably normally dressed and, yeah, all groomed. Yeah. So II would say appearance is pretty normal and what about his kind of attitudes and behaviors? Ok. Yeah, it may be a little on edge and for sure. Yeah, a lot, quite a lot of arm movement. Um potentially a little bit agitated. Um II wouldn't say kind of aggressive at, at this point. Um but a little agitated, maybe an anxious, maybe it would be a better way of describing anxious of what's been going on for him. Um And behavior. Yeah, I guess kind of the arm movement comes across as a little bit restless. Um Yeah. Ok. And what, what about, well, actually there wasn't much to say about speech, to be honest. II think that was fairly normal. It wasn't pressured it. Um Yeah, II would say that was fairly normal. Um Similarly with effect and mood. Um I would say that his mood was um reactive. Um He had a kind of normal range of moods but it was something that seem kind of blunted or constricted and it seemed fairly euthymic. Um He was probably a little bit anxious. Um But II don't think there are signs there of depression. Um And I can't remember if he mentioned it in that particular clip we watched or it was later in the video, but he did mention that a sleep pattern was disrupted as well. So II would put that all in where it can read an effect. OK. So then we get to the really um meaty part of, of this m se for this particular person. Um And I would say that, you know, this isn't particularly kind of um fantasized or exaggerated. This is how people can present um kind of um most definitely. So, you know, thought, thought process or, or content any thoughts from, from your folk about that. Well, it was mostly content really actually. So the, the process, I guess it, I think it was still quite logical and goal goal orientated. He definitely wasn't derailing from the conversation in any way. But definitely the content was, was abnormal. So it was paranoid. So he had these delusions exactly as he's a paranoid delusions. Ok. So more specifically, I would say they were delusions of reference. So for example, about the TV, um about people at the window, I would say he had delusions of persecution as well from his neighbors. Um When he said they're trying to, um he said they're trying to find out how far they can push me. Um I would say that's an example of potentially persecutory thought, um thought content. Um What about perception? Again? I think there was, this was abnormal. Ok. Ok. So it, it, it was subtle. I think there was just that mention of hearing a clicking when he makes a call. I now I don't know what, what he does, but I think it's unlikely that someone would want to tap his phone. Yeah. Exactly. Ee Exactly. So hearing clicking when he's making a call, it is non verbal, but it is an auditory hallucination. Ok. Great. Um, orientation wasn't assessed memory, er, concentration wasn't, wasn't assessed. Um I think probably given the level of thought, content, disturbance and perceptual disturbance he's having and not acknowledging them that, that they could be a part of an illness. Although it wasn't explicitly asked about insight. I think we can probably guess his insight is quite poor into his, into his mental illness. Ok. Really? Well, done. I hope that was kind of useful in thinking through an M SE or, or at least that this table, if you've taken a photo of that is a useful um kind of resource for you to think through in your head when you're doing an M SE. Um For those of you who, you know, find things that a bit easier when you've got, you know, a, a bit more structure to work from. Um I'm now gonna flip back or a, a previous. Um I just wanted to definitely know when to do that one because it, um I thought it was, it was useful doing the video for it. Um This case, it is just a written one and, and it's um it's too much for me to read out. So what I'll do is I'll just give you a minute or two to have a read through that and then I'll ask you some, some questions about it. OK? So there's, there's no video for this one. It's just a um it's, it's just what's on the slide just now. OK. So everyone had a, a chance to kind of read through all of that. I'm just gonna take the opportunity at this point to mention something that's really important in psychiatry and, and actually all of um and I'm just gonna go on this quick tangent relevant to this case. Um And that's the concept of childhood experiences. OK? So kind of chronic stress and trauma, especially during the neurodevelopmental um stages of childhood can have massive, massive impacts on, on how people are both in terms of psychiatric um outcomes, but also physical outcomes. So we see here that um Jay started drinking at the age of 13, his home life was unhappy and his father was a drinker who could be violent too. Um uh I assume that means to Jay's mum and, and Jay um at times. Ok. So that's kind of a classic history though, of someone who has a lot of adverse childhood experiences. Um, and the reason that this is important and I know you may not think this because, you know, you're kind of in, in exam mode getting rid of ready for finals. Um, and it's unlikely to come up from that, but it's really important in, in general medicine when you are on the woods, um, and clinics to be thinking about this as a risk factor. You know, we think about all these physical risk factors for diseases. We don't think a lot about kind of, um, chronic childhood stress from, from adverse childhood experiences just to highlight a little bit if someone has four or more adverse childhood experiences, they are doubly as likely to develop obesity, heart disease, stroke, diabetes, cancer, and to smoke to get an ST I, um, and to get an au autoimmune disease, ok. They're four times as likely to get CO PD depression and use illicit drugs they're 10 times as likely to use IV, illicit drugs. They're 12 times as likely to attempt suicide. And they're 32 times more likely to, um, be diagnosed with a learning or behavioral problem. People who have six or more A CS have a 20 years shorter life expectancy than other people. Ok. So it's a massively important risk factor for psychiatric illnesses and physical health or methods. Um, and I thought this was a good case, just hopefully kind of tag on that a bit of a memory to the case. And then in your future practice, it's really important to ask about these things as a risk factor. Ok, great. Let, let's think a bit, a couple more kind of medical, a bit more. Um ab about the case. So do you think Jay has alcohol dependence? And, and if so what, what are the symptoms of dependence that he has? Yeah. Uh-huh, great. Yeah. Ok. So drinking the first thing in the morning is a classic kind of symptom of um alcoholism. He's tried to cut down. Um, he's aware of a compulsion to drink. Um uh drinking kind of relieve withdrawal symptoms. He's mentioned there are some features of withdrawal, like sweating, shaking, nausea that's relieved by further drinking. Um He's had periods of absence and gone back to it. Um And, and it, it seems like drinking has become a very important aspect of, of his life. Ok. Uh What I was going to get you to do, which I won't do because of time was to calculate how many units of drink he's having a day. Um, but in three bottles of Frosty Jack a day, that that's, um, a lot of units. Uh, so just broadly, the, the reason I bring this in is just to think about kind of what some of the more serious effects of, um, alcoholism. If he presented with delirium Tremens DT S, do you know what other kind of broad investigations and management you'd need for that? So, it's a real kind of medical emergency. Yep. Ok, great. So PEX is there to uh it's a vitamin, it's reducing the risk of uh causing kind of toxicity to the brain. Benzodiazepines to help with the symptoms. Um Yeah, great. I mean, they're, they're, they're big two. obviously there's all sorts of things that you'd do to someone if they came into hospital with um with DT S bloods and um all that kind of thing and, and treating any electrolyte dis um disturbance and so on. Um, we'd probably get an EKG and chest X ray and all that kind of thing. Um fine. But the, the core treatment of um of this is uh Benzodiazepine two to treat the symptoms and vitamins of PEX IV um two um protect the, the brain. Ok, great. And just last last question then in terms of psychiatry, what uh do you know any drugs that we can give people with alcoholism to help their um help them be abstinent to help their cravings or help uh avoid alcohol. So this would be for example, prescribed by a um yeah, community psychiatry substance abuse team. Um So there are a couple, there's, there's one called disulfiram. Um OK. Nickel. So, so yeah, that's another kind of benzodiazepine. Um so it can, it can kind of help with the symptoms of withdrawal um for sure. Um And Liam's, yeah, men mentioned one of the drugs that I was more trying to get at which was drugs to help be abstinent from alcohol. Um So not necessarily treating withdrawal symptoms but you know, helping them stay ab abstinent. So disulfiram is one of those. Um and it basically it creates quite an unpleasant reaction to alcohol. So kind of flushing and headache and tachycardia and nausea and vomiting and if people drink, so the because the rationale is you take the disulfiram regularly and then if you do have a moment of weakness and or not weakness, that's, that's not a nice word. Um But you know what I mean? If you have a moment and you do take consume alcohol because you've been taking the disulfiram, it causes the unpleasant reaction. So it really kind of puts you off. Um And the other thing is acamprosate. So it's an anti craving drug. So you don't crave the alcohol is, is the, is the rational. Ok. So that's a little bit of a glimpse into substance, misuse, alcohol, misuse psychiatry. Um, so hopefully that was helpful as well. Um, it is now, um, eight o'clock. So, what I'm going to do is just encourage you to have a look at the slides and look at some of the MC Qs on the slides and because I've, I've got them there and obviously we've been focusing on, on other things which is, um, absolutely fine. Just while I'm scrolling through to the last slide, did anyone have any kind of questions or um or comments? Um Obviously, this is also an opportunity while, you know, there's a group of people from around the country to share resources. Um If you have any, if not, I'll, I'll just do my closing spiel. Um What I suggest is straight out a session once we've finished up just time yourself for a minute and just write down three key learning learning points. It's a really good way to reflect on what you've learned. It's a really good way, you know, if you're coming to lots of webinars like this, you're not going to take on an hour's worth of the information. But if you can take three key learning points from each session and really commit those to many, then that's probably a, a, a job well done. Um I've put some recommendations there for some further learning again. Hopefully you have access to these slides. I'll chat to mind the bleep to make sure you don't do. Hopefully we've met these learning outcomes, um especially if you go back and look at some of the MC Qs in the slides. Um And lastly, thank you for coming. Um Hopefully that was helpful. Um Mind the bleep have asked me to really encourage you to fill in this feedback. Uh but I also personally um would love it if you could fill in a feedback and in a, in a couple of short years or maybe in the next year for some of you, um you will be doing teaching for med students and needing to gather feedback to um kind of help develop yourself as a, as a teacher. So please do be as honest if there are things that you as possible. If there are things that you like, ideally say, why you liked them, if there were things you didn't like, ideally say why you didn't like them. Um And if you do have questions, now's the chance or just message me on Twitter any time if you have questions about um academic foundation program, I'm happy for you to ask those. Just message me if you have questions about applying to Psychiatry uh for core training or sitting in the M SRA which I've done. Um Message me on Twitter. I'm more than happy to try and help and answer any questions. I think there will also be a um a link to fill in the feedback. If you go to like, the event page or maybe med or email you automatically. Um, and I think it gives you a certificate of attendance if you fill it in, if that's, um, if that's any persuasion. No. Ok. Ok. So I'll stick around, um, if there aren't any, uh, questions, good luck in, um, learning and revising psychiatry. Um, and, yeah, I hope, I hope that's been help to. No. What I'll actually do if there's anyone here still is. I've just made a little link there to the flight. So you'll be able to actually, um, uh, just get them straight from there. Um, it cuts out the middleman of trying to get mind to send them out to you. Ok. No. Mhm. Yeah. Yeah. Ok. Mhm. Ok. If there are no other questions I'm gonna, um, uh, finish yourself off there and enjoy the rest of your evening.