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There we go. Ok, so sorry. Just for the people who have just joined the recording Now, we might have skipped a couple of slides, but in effect, you haven't missed anything. This is where we're starting off. We were just saying that these are the most common stations that normally normally could come up and the topics that could come up with in psych. Um, but whatever comes up, please, please, please. One thing to learn. One thing I would rather you learn from today. Just one thing is, uh uh, okay. Always, always do a risk assessment. Um, as in always check to see if they can do any harm to yourself or there is a risk of harm to anyone else. Um, if you miss that out, I think that is the most common reason to fail a psych station. Um, yeah, but if you if you can If you can get that in, you basically nailed majority of the station. Um, right now, classic psych history. Um, psych histories tend to have more things, uh, to ask rather than our normal history. Uh, structure, but just going through very quickly. Introduce yourself. Confirm patient patient details as always, you could then ask for the reason for referral, or you don't even have to ask. They might tell you or, um, it would be in the presenting complaint. Most likely so. But it is something to something to think about and whether, um, they've had to use any mental health act like whether they were brought in by the police or any of those stuff, like how they were, how they came in. And then you start with your presenting complaint. Um, and the big thing would be screening for Let's let's call it GPS. So not not deposit protection scheme. It is literally depression, psychosis and suicide or self harm. And you have to make sure you ask that because that is literally the one thing that, if you ask, you'll definitely get everything from the history. You don't have to worry about anything else, but we'll go through that in a bit. Um, and then you go through ice, uh, then past psychiatric history, which is different medical history because often times people don't worry. If you just ask about medical history, even in a psych station, people won't actually tell you that they had um, they had like, uh, I don't know, depression like, 10 years ago. They would tend to miss it. So you need to ask about psych history. And obviously it's a psych station, and then you go into medical history and drug history. Then you go into family history, including family psychiatric history. Uh, and then you move into personal history. Now, this is a different bit compared to other history, because now, ideally, you would want to ask about how they grew up their childhood. Um, because if they have had any, like, adverse childhood experiences, um, you need to ask about their relationships if appropriate, Um, and the big one would be forensic history. Um, because that plays a big role in psychiatry. Um, then you go into social history, uh, as normal alcohol drug gambling. That's something you could ask, and then the very important thing again. Now it's a pre morbid personality. So it is so important that you understand how the patient was before their symptoms started. And now well, it's something that I'm not sure if you can ask the patient, it depends on their condition. But if it's a collateral history, then clearly you will get an answer to that. Um, now, that being said, I know it's a long history structure, and, unfortunately, psych histories. Um, I don't I don't know how many of you guys have done your psych placement so far, but psych history is, uh, are theoretically meant to take one hour long and clearly clearly in an escape. You don't have that much time you get, like, maximum seven minutes. So it is very important that you just ask what you need, but at the same time, don't miss out what you have to such as, like screening for depression and psychosis are, um, self harm or suicide. You have to ask, um, you have to ask about past psychiatric history. You have to ask about ice. But there are things you can miss out in in history, such as childhood experiences. If it's not relevant. If you think it's not relevant. Um, any questions? Okay, uh, now, main key points with psych history station is again, As I said, never forget to essence risk. Um, if you don't have this risk, that kind of automatically goes into a fail. So just don't forget to do that. Um now by, by the way, risk assessment is kind of, uh I think of psych to be a bit different to normal medicine. Um, in the medicine world, you know how you say you need acute emergency management now acute and chronic. This guy, I think if you say they have a high risk, that's kind of like saying acute in a way. So it just means you need a quicker management. You need to send them in all of that, Which is why it's so important to do a risk assessment. Um, and what you're looking for when you when they ask you to risk asses, would be something physical or medical. So just if they refuse to eat and drink and that's been going on for a month, clearly they're not. They're gonna have metabolic problems now in medical problems so that they're putting themselves at risk so that then that would be a high risk scenario. Classic ones like trauma, um, self harm, suicidal ideation, or wanting to hurt other people. Um, that Again, that is clear risk. Um, some people could have hallucinations that that although they haven't attempted to hurt anyone, sometimes they can have commands. And that could be a red flag as well, because, um, sometimes they could have come on saying, Oh, you need to do this to this person. So those are things to look out for a while now? Um, very quickly, uh, I was going to ask you about depression, psychosis and suicidal self harm. What do you actually look for now or what do you have to ask for screening? So that would be so with depression again, you can classify it into mild moderate and Sylvia, and you're like, you have three core symptoms. I was going to ask you guys. What? What they were because classic classic pt consultant questions. Um, but yeah, low mood energia as in low energy Antidonia. As in, um, having no more interest in otherwise in interesting activities, um, and psychoses, um, just to get a bit of interactivity going. Does anyone want to tell me on the chat what, you would be looking for cyclists or what? Do you think it's okay to get it wrong? Anyone? Auditory hallucinations. We've got Okay. Good. Um, good. Um, I have had one more answer saying delusions. Yes. Good. Uh, good. Perfect. It's delusions and hallucinations, I think are the two most important things to ask, uh, for psychosis. Uh, and the main main other main psych history station thing, Um, would be, you know how you know how we always, um I don't know if you guys know, but for management and investigation for normal medical stations, uh, they normally ask you to go conservative management, surgical and medical instead. For psych, you always go biopsychosocial so you always take a biopsychosocial approach. Um, and that is one other thing you need to think about in psych. Okay, Now we have gone through depressed what to look at and for depression and psychosis. So this idol m self harm, we have a proper slide, so Well, come come to that in a bit. Well, how how do you actually ask people without coming this awkward a route? I don't know if this is a question that that's been going on in your head, but definitely was when I was in year four, because mm, some questions can be weird. Like, for example, let's say Okay, Ronan, you be the patient. Um, um let's say you are schizophrenic, or you just have okay. Yeah, it's just a psych history. I don't know what you have, but I need to screen. So now let's say I'm screening for, um, psychosis. And I need to figure out whether he has hallucinations. I guess a diary question would be so. So, Mr Fitzgerald, do you have Do you Do you hear anything that you're not meant to or do you Do you see anything weird? I don't know. I mean, I see the same thing that you would see, wouldn't I see. So now that that's the question. So, um, the big thing is that especially with hallucinations, patient's don't really know what is real and what is not real. So there is a certain way that you need to phrase side questions with in order to get the actual answers and whether to know if it's actually hallucinations. In fact, I used to just just interject is now. I always used to kind of prepare for those very difficult questions that a patient would ask in a psych history. Um, particularly, like, you know, you're talking about things like, uh, auditory hallucinations. And then they say You think I'm crazy? Don't, don't you, um And being prepared to pretty much say, Say to the patient, I don't think anyone is crazy. Um, but what I do you want to do is kind of to understand why some people are slightly concerned about you at the moment. It's a nice way to show that you're care. You want to see what's going on with the patient and that you care about them without coming to any judgments. You're not there to judge them as a person. Um, so think about those kind of difficult questions or difficult scenarios and phrases. Always that you can control the consultation without offending. Don't we have a question? Could you say this is a question we ask every patient? Yeah, So? So, in fact, they have in general practice. It's actually a specific term that they use. It's a psychological term called normalizing. It's very commonly used in practice, and it basically states that we either do it across the board for everyone, or the other way of normalizing is to say for people who, uh, you know, if they've got a low mood for instants and you're going to ask Oh, do you have any hallucinations? You know, the best way to Obviously not in that direct way, but to normalize it. You would say so when some people are feeling slightly low and mood, they can sometimes experience certain things that they can hear or see that other people are unable to has that. Has this ever happened to you? So it kind of normalizes it, and it justifies why you're asking it. So that's always a good technique to use. Yeah. So yeah. So exactly what Ronan was saying. Um, couple of things that might help was like, um, communication. Um, one just always reassure confidentiality. Um, that will kind of help and to signpost. So I will. I have a phrase later on, but you can just say it's something that we normally ask all the patient's, which is why we're asking it. And then you can ask the question so that would be that awkward. Um, yeah, and as Ronan was saying, Normalize it. Just say everyone something like every There are things that everyone experiences, which is why I'm asking it. So now you're normalizing and it's thought it doesn't come across judge as well. And that's the other thing, which, like just literally don't be judgmental. Um, yeah. And acknowledge embarrassments just be like, Oh, I know this might This question might sound a bit embarrassing, but and then ask. So these are little things that you can do to make it easier for you and also very much pick on nonverbal cues. Um, psych actors love acting, especially in an escape. Um, and yeah, they will give you a lot of non honorable keys. Um, I think my patient the one I had, uh, seemed a bit low, although she came, came in with eating disorder. So I guess that was my clue of screening for depression because she actually ended up having depression as well. But we didn't know that. So they give you an honorable keys, pick on it. Um, you might have some patient's, like, looking around while you're talking. What do you think that shows? Possibly on the chat, by the way, aside to the aside for the chart I was typing up, um, particular things that certain patient's can say. Balance checked. Well, afternoon. That's fine. Thank you. Rona. Yeah, I'm going. I'm going some answers. Um, exactly. Um, we've got some people saying auditory hallucinations. Yes, uh, visual hallucinations. Yes. Anxiety. Possibly so. Yeah. Now, I have gotten all of that without even asking anything to the patient. I mean, you still have to ask about it, but that's what I mean. They will give you an honorable chief. Very, very important. Um, and also, when you're practicing with your friends, um, yeah, Feel free to give vulnerable keys. I'm pretty sure I gave the same with rodent as well. I'm pretty sure we gave We were acting out absolutely fantastic with psych histories. Um, yeah. Uh, but anyway, now, um, going back as the main three screening questions that we have to ask that I've been trying to grill it grill in, uh, depression's a low mood. Possibly you could ask. Um, have you noticed any changes in your mood recently or with, um, Antidonia? You could be like, Oh, do you still enjoy the things that you used to enjoy or things that used to make you happy? And then energy were a bit weird. You I guess you can't ask someone. Are you feeling energetic? I don't know how they would answer to that, but, um, yeah, I just phrase it around. Use your own ways, but I think I use, uh, You can also go like, Oh, um, on a scale of 1 to 10. How energetic do you feel something like that? Um, and then psych psychosis. Yeah. Um, you delusions. So delusions tricky one. But this is the way you can ask. So you you can literally go. Or do you have any worries, or do you feel you Do you feel safe? And then if they have delusions, um, they could come up with answers like, Oh, no, I know there are some people trying to attack me or planet or where they're part of the team. Or then they come out with, like, all the delusional worries. So that is a question that you could ask about whether they have a worry in specific or whether they feel like they're safe. Um, hallucinations. Yeah. Um, What? I was explaining to you what I was trying to get show you while Ronan was being the patient. Um, you could just be like, Oh, um, are there any voices? Um, or any anything. You here. See that? Others seem others cannot here, or they have mentioned that they cannot hear Um, and a lot of times they probably will have family or friends who are, like, who may have picked up picked on it. So maybe they may have mentioned it. Um, now very important question to ask, though, if they have hallucinations, you need to ask whether the voices are talking about them or to them or commending on what they're doing. Um, and this is to see if it's a 2nd, 2nd person, third person hallucination, um, or whether they're recommending hallucinations, which would also help with diagnosis of like, let's say, schizophrenia. Um, or it would help you with risk assessment. If, um if there if the voices are telling them to do things, then you know that's a bit risky now, Yeah. Um, so, yeah, feel free to write these down, take a picture or we'll send you the slide. So these are things you can How you can phrase your history, Um, and signpost, um always comes handy. You can just be like I'm now going to ask you about experiences some people have, but maybe difficult to talk about. Good way to start right now. Uh, no, Monix, we all love my Monix. Um with depression. Uh, yeah, this is mainly for depression, but I tend to use it pretty much for all my psych stations because, um uh, if you do cover all of these, you will basically be covering all kinds of questions you could potentially ask. Um, and these are the clinical features of severe depression. So that's like dead swamp. So the for decreased mood so you can ask about mood energy Antidonia Now then comes suicidal is a shins. Whether they've been thinking about death, all of those questions you need to ask about any mental health, um, psych station. Just ask about sleep, um, appetite And, like, wordless nous or guilt, um, ability to concentrate And, um, psychomotor, um, issues. Um, also, just let me know if I'm going too fast or slow, by the way, Um, yeah, no moving to the big one. Uh, and trust me, they will always be looking whether you're assessing risk. And this is a very common station to come up, um, self harm or suicidal ideations. What you need to ask when these questions come up or when these stations come up is first you need to assess the risk. You need to assess whether they are at risk right now or again. Or do you think they will self harm again soon? All of that. And I have written down questions you could ask again. Um, so do you feel like life is not worth living? Do you have suicidal thoughts? Um, and yeah. Have you attempted suicide in the past? Um, then you then need to ask about their plan. So that would be, like, What? What? What was the plan? So were they planning in, like, overdosing, which is a very common classic station to come up. Um, and if so, then how How were they going to do it? How much? Let's say, how much personal were they going to take? For example, when were they going to do it? Where were they? Where was it? Um, who else was there? Whether someone else was involved and whether someone has been informed? Um, can anyone think about any reasons why? Why patient's may or may not inform someone about suicidal ization from a side point? Okay, I'm going. I'm going to answer saying guilt. Um, anything your side wrote it. Anyone messaged? Okay. Um, yeah, it could be guilt. It could be, uh, attention seeking behavior. That is something to look at for as well. Um oh, yeah. Someone has messaged e p. D. So that's, uh, emotionally unstable personality disorder again. Yeah. They are at higher risk for self arms to civilization. Um, good. Um, so that is why you ask that question? Um um again, just rather than informing, there are people who would make arrangements like leaving a note behind or something where people can find them or not locking the door, locking the door, all of that. So you need to ask all of that in a station where they have come with South Farmer attempted suicide. Um, And then there's subjective things which I think are very important, because now you need to ask about the purpose. Why they why they did it. And, uh, and their knowledge is and how how much do they know about what they did and why they did. And the main big question is attitude to being alive now, because now, clearly, there in the hospital now, So, um, you need to, uh you need to see if they are more likely to attempt it and a lot of patient's will have guilt and will be like, Oh, I don't think I'm ever going to do that again. So that means they would be on a lesser risk. Um, but then there are some people who are like, No, um, I didn't want to come to the hospital that, uh that would probably mean that they're still at risk so that you need to You need to keep your thoughts around there. Um, and the big, big, big questions would be checking if they have any protective factors or risk factors. So protective factors or things are the reasons why people wouldn't sell farm and wouldn't, uh, go for suicide. So things like, uh, yeah, protective factors would be like marital status relationships, uh, friend's family's pets, housing all of that risk factors at the same side would be unemployment, isolations, bereavement, all of those. So those are things you have to explore, and what I would actually say would be Just think, think before, during after. So what happened before? Like before they were before they were found, how they were planning all of that during what did they actually do? What? How, how much When? Where? All of that and then after. So whether they're guilty now, are they planning again? Or do you think they you can ask whether they will attempt They plan in attempting it again or anything. You can be direct, and they will answer you. Um, I know. So that weird asking, but it's completely okay to ask. Um yeah. Any questions? Oh, actually, before that right now, these are actually the risk factors for self harm. And then the moniker would be I am fat person. So, um, the and so literally just means institutionalized. Like if they're living in a home, like care home or something. Um, age. If it's more than 40 and less than 19, they tend to have a higher risk if they have a mental health disorder. Um, sex. So males are more likely. Yeah. Statistically, males are more. Um, they tend to suicide more, whereas females tend to have a self harm wall. Um, but it's just statistics. Um, if they're alone, if they're depressed, if they've had any previous attempts or plant reattempt, um, if they were drunk, or they use, uh, ethanol alcohol quite a lot. They used drugs quite a lot. Um, if they've lost their rational thinking social isolations separated. Um oh, and the big one big risk factor would be, um, if they've kept if they're made a will already, that that would be a risk factor. Um, if they don't have any hobbies, like n person and, um, sickness. Um, yeah, that's a little pneumonic for you to remember. Um, yeah. Any questions so far? Okay, moving on. Um, now, regarding we have one question. How do you ask about very Minden? Insensitive way. Um, Roman, do you want to chip in? Um, so I mean, it depends when it was volunteered in the history, I guess. But if it's, um if it's something that the patient has volunteered, you know, acknowledge it and, you know, saying that I can understand this is, you know, a very difficult time. Do you want to tell me how this has been affecting you? You know, it allows them to then talk about kind of their mood, the symptoms that they've been experiencing. Um and it allows you to gauge as well whether this is a reactive, uh, these are reactive features to the morning normal morning phase or visit, Um, been going on, and this has just triggered it to kind of push it over the edge. So asking whether this whether these symptoms were there still before a family man passed away is important. Um, there's no one right way with any kind of sensitive question, but, um, it's being quite human. A new response, I would say. Um, right, um, moving on if there's no other questions. But I hope that answered your question, though, uh, we have one more question. Um, online place. But I was told to ask if there, by the way, guys, could you message Roland so he can answer a while. So I'm the gatekeeper of questions. Or are you gonna ask everyone? There are not many people, I think. Well, we're a small group, anyway. So just ask to everyone that might help, um, on my placement. Sorry question. From the chat on my placement, I was told to ask if there was any major life events recently that have affected them, and they usually talk about deaths and breakups. Right. Thank you. That was the answer for your question from before. Um, so, uh, asking just asking about whether there is any major life events recently, and they will tell you the bereavement if that was, uh, OK, moving on with Oh, um, alcohol and drug misuse. Um, So the pneumonic here is sore drink. Just think about, uh, alcoholic seeing the drink. Um, so that kind that kind of that kind of leads to alcohol dependence. Now. So Esper subjective awareness of convulsion to drink so they may feel it, but yeah. May not, um, to a for avoidance of, uh, avoidance or relief of, like, withdrawal symptoms by further drinking. So it kind of makes sense. And then three would be having withdrawal symptoms if they don't drink. Um, and then comes D for drink. Seeking behavior predominate. So they're thinking about drinking all the time. All of that are for reinstatement of drinking after attempted abstinence, and I for increased tolerance. Um, that is a good thing to ask in the history. Uh, if you if you do have, um, alcohol dependence station. Um, you could ask about how much they're drinking now. How much they used to drink before then. You know, whether they've had an increased tolerance and then end for narrowing of drinking repertoire. Um, it just means they will then start having a fixed routine in a way. So people who are, uh, dependent tends to go. Oh, I drink every day at eight. PM at this specific, um, in in my garden, like they have a specific repertoire, and that becomes very pro predominant. Um, but that's the context now for is key. How do I ask questions would be to think About what, Where, when and why. So what? What do they drink? How much are they drinking? Like, um, is it wine lager? All of that? Like what? Kind of how much? So, units, um, where do they drink now? That's going back to the repertoire that we were talking about. Um, where If they have an answer to exactly where, then, you know they have a routine, Um, when again, Uh, when do they drink? And why? As in, they might have social reasons. So it could be that it could be stress of work. Could be stress from family. Um, they're they may have reasons for why they drink. So what? Where, when? Why? It is a good, um uh, way of structuring history for alcohol dependence. um you could also ask about social effects. So that would be, um yeah. Uh, do they have a dribble symptoms? Is this affecting their work? Is this affecting their relationships? Uh, is it affecting their friendships? All of that. So those are things that you should be asking when you have alcohol? Uh, dependence or drug misuse stations? Um, yeah. Any questions? Just probably in the shop. And I don't know if you've heard of this before, but this is a questionnaire that they normally use. And it's called the cage question. Uh um, And if you have any if you have yet, if you have a yes answered, do any of the two or more then that means you have alcohol dependence. Basically, So one would be see would be for Have you ever felt the need to cut drinking? A Would be have people been and have people annoy g by criticizing your behavior G would be Do you feel guilty about drinking and e eye opener? So what that means would be Do you do you wake up in the morning and then want to have a drink first thing in the morning? That would be like eye opening kind of thing so that that's Cage questionnaire is something that they officially used. Um, although I think there are other questionnaires coming up, so I think it's, um, not being used or probably will not be used in the future. But, um, they do use it. Yeah, with the the Cage questioner that it's slightly outdated, it still has its purpose. It's quite a good, quick screening tool. The sore drink that risen a kind of mentioned earlier on that actually is a quoted they. They use it in a lot of history taking, but it's actually quoted from a specific criteria quart um, Edward and gross criteria, Um, and that that's kind of the more up to date criteria version that they used to diagnose something like independence history. But both are equally valid or and have their uses in their own way. Cages quicker and more, uh, straight to the points or drink is a bit more, uh, extensive. Cool. Um, and lastly, eating disorders. Um, they use the singles cough question A, um you need to make sure you ask these questions in an appropriate way, though. Um, but the main ideas, um do they feel sick? Because they're uncomfortably full, Um, or do they make themselves sick? So that would be Bolivia, for example. Um, do they worry that they have lost control? So, secret control? Oh, for one stone, have they lost more than one stone in three months? Um, f for Do not Do not mention the word fat, by the way, in a station. But please put in a nicer way. But for the purpose of the demonic. Do you believe yourself to be fat when others say you're too thin and then food? Whether does it dominate your life? Um, and you're just thinking about food. Um, everyone to be aware of. It makes a very good point in the control that when you say, do you worry that you have lost control, you can apply lost control to practically most of the symptoms. And, uh, you know, presentation of an eating disorder, as in reality, it's It is basically a, um, an issue where people feel like they've lost control of all these aspects and their own forms. So, you know, if you wanna repeat wording, it's a good way to keep it sensitive. Uh, asking the right things. Cool. Um, now, quick bonus question. Um, erosion for PT as well as the scheme. Uh, can anyone tell us the biological signs of anorexia Come? I hope you didn't see that. Any answers, Rodan? No, not yet. To be honest, I don't even know this one, actually, so I'll be learning something myself. Okay, We got, uh, bradycardia and, uh, yeah, lanugo hair. Yeah. So? So a couple of yeah. Bradycardia. Yeah, it they do tend to be bradycardic sometimes. Yes. Good. Um, and amenorrhea is common. So that's something you should ask about. Um, Are their parents regular of that, uh, loss of libido? That's something else. Um, you can ask for relationships, um, and let you go. Here is a big one. Um, classic PT question. But you should Also asking Muskie, um, is where they have tiny, tiny hair, like maybe like in the face or just random places, but they have very tiny thin hair. Yeah. Um, sorry. I was gonna put a picture in, but I didn't, uh you can just google it cool. And lastly, mental state exam. Um, I don't I'm not sure if they're actually going to ask you per se to do a mental state exam. Um, but I think it's still very useful, even if it's in a psych history. Um, and all you have to remember is aseptic That is an ammonic a being for appearance and behavior. And yeah, so appearance, right? Some people wear brightly colored clothes, so that probably shows like that's very common in, like, manic patient's mania. They could be overactive wrestlers over friendly, um, increased appetite. And as appearance and behavior uh, aseptic. As for speech, um, that you can definitely get get from a history without you asking where they would probably go to say multiple things talk too fast. All of those. And some people have this thing called flight of Ideas where, um, again, Simon mania, where Just have multiple ideas. Just coming in. Um, so again, you these are things that you will notice when you are talking to a patient. I e taking a his psych history without you asking. So if when you present your psych history, if you can. If you have noticed anything within the mental state exam if you put it in, that would actually look good. Um um Hello. Sorry, aseptic e for emotions that I would be mood and effects. So are they cheerful related euphoria? Um, irritable or thought aseptic p for perception. Uh, so sorry. Uh, perceptions that that would be now it mainly to do be with hallucination. Um, which we talked about how to get gap from a history. Um, pnm aseptic tea for thought. Their flight of ideas come in their judgment. Um, their ideas. So some people have this thing called brand deals Ideon City, where they're like, Oh, I'm gonna, um I'm going to be a millionaire in two months. Um, they'll be like, Oh, I'm going to be the king. Japan. Something like that. Um, and I a septic I for insight, that is when they know whether they have a problem. Mental, um, disorder or not And see for a cognition. So, uh, concentration, memory, all of those that would be competition. Any questions? Lisbon. Did you teach? I I was answering something. Did you? Did you Did you just teach a septic or just kind of going through in ST? Okay. Yeah, that's fine. Um, cool. Uh, right. And the final thing is, when it comes to investigation and management. Um, as I said, always use a biopsychosocial approach. Um, even if you don't quick tip, Um, just when you present just be like so Examiner is probably going to be like, Oh, what is your management plan? You can just be like I would take a biopsychosocial approach to this patient, literally. Just say that statement you will get the more. I mean, you also do need to think about it, but just make sure you start without, um and it just means you think about, like all of that. So by bio biological, for example, would be like medications, blood test, All of all of those psychological, Um, the CBT and I would go and do socialism. Psychosocial. Um, yeah. And then the social would be like, um, support groups and all of those, um, and regarding investigation. Now, this is a big red flag. When it comes to SK, you need to always make sure that your investigation plan has a organic or medical thing in it, at least one. So that would be like, let's say, anorexia, for example. You would want to think about doing a blood test to look for, uh, yeah to look for all the biological effects of anorexia. Like like I would problems. For instance, I would is a big one in in, uh, kind of psychic psychic psychiatric conditions. There's a lot of cross over there. Yeah, actually, my little tip would be Feel free to write this down anywhere, but just make sure you mention I would do a thyroid function test for pretty much most like, uh, stations as an investigation. And then you also talk about questionnaires and whatever after that, but you need to make sure you rule out organic causes. Right? And that is it. And this is what we covered. So we have covered quite a bit. Uh, we've covered risk. Destin's what Do ask insight. Stations have to ask them, um, we mentioned briefly about self harm, suicide, suicide history, eating disorders, alcohol history and a mental state exam. Um, do you have any questions? When do you question question one? Uh, when do you perform mental state exam? Wait one second. Uh, okay. So, uh, I I can Do you want me to answer this, or do you want to? Yeah. So mental state exam That there's a lot of crossover but basically they'll tell you outside the exam anyway, what you're going to do but in your own, practicing further down the line. If you're taking a psychiatric history, you're focusing at least on like the symp like the symptom that they've come in with, I would say, And then you're kind of, you know, digressing to see. Is there any other symptoms involved and ruling things out? A mental state exam is almost like for you to get, like, gauge the person as a whole. So if you were doing like a home visit in GP land, then you probably be doing a mental state exam because it's not necessarily we're taking a full conference of history. You're more just kind of trying to gauge how this person is behaving. Um, there's a lot of crossover with both, but a mental state exam allows you to see the person as a whole. A psychiatric history basically makes you focus on, um, the symptoms and med it like the medical aspect. Does that answer? It's a difficult question, but in the exam, at least you can be assured that they'll they'll specify and unlikely that they'll ask you to do a mental state exam, I would say more likely that they'll ask is do a psychiatric history. Um, for those of you who want to stay over, actually, I do have a little extension slide. Um oh, actually, you know what? I'll send those slides. I think that might be easier. Um, I was just gonna say that I had a little pneumonic for, um, mania. Um, um, these are literally the clinical features. Um, just think about think about someone very being very manic and going digging things up quite fast, and then we'll send you this light. Um, yeah. Any questions? I've not got any in mind. Um, just for an extra tip for this, uh, for everyone out there, Obviously, you can get an alcohol dependence history, but also, it can be a recreational drug history. And when you're doing, like, risk assessment for instances and this also applies to alcohol, you have You should ask risk history, whatever kind of psych psychiatric elements is involved. But not only would you ask risk to self risk to others, but if I'm taking a recreational drug history, you want to ask about kind of, um, share ing of needles for instants or where they're getting their needles from. Or, um, uh, sometimes it's appropriate to actually ask about safe sexual practices because of transmission of things like hep B HIV. Um, so when risk comes to the forefront of your mind, I think obviously about risk suicide and mental health. But also think on the other aspect of what is risky behavior in patient's of this demographic. Um, but yeah, for recreational drug that those would be kind of my three big ones. Um, yeah, and same thing. If you're taking an alcohol dependence history, you should, uh, just ask about any other kind of dependence that they're on as just because the alcohol dependent doesn't mean they also are taking recreational drugs on the side or, um, smoking, for instance. I like to stop the recording now.