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Hello, everyone. Hopefully you can all, um, see and hear me. Let me know in the chart. If you can't, we're just gonna give it to about five past and, um, to let everyone come and hopefully join in time and then we will start the presentation then. So hang tight. Right. I think we'll get started now. So, um, hi, everyone. I'm Chloe. Um, I'm the Psychiatry Society president for the University of Southampton. I know some of you might not be actual medical students at the University of Southampton. So I just thought it'd be good to introduce us and just let you know, this is, uh mostly about giving you a good introduction to psych history taking and how to do a good m se as well, mental state exam. But later at the end at about 40 minutes past, we're aiming for, we will make it more specifically based for the Southampton students so that they can, um, prepare for their placement in psychiatry and give them TIPSS and stuff like that. So, just for people who are watching who might not be, um, from the University of Southampton, it's just to let you guys know but welcome to everyone and I hope you guys find this useful. Uh We will. Uh So as I said, we're just gonna do a few introductions now and just let you know, uh sort of let people join and things like that, then I will be taking you through a brief really so speedy overview about how to take a good psych history uh that I can't cover everything. We don't have enough time, but I'm just trying to give you a good outline to, you know, introduce you to it. If you've never taken a psych history before, if you're early on in your sort of clinical studies, or if you're revising now for finals exams as I am and, you know, haven't covered psych yet. I haven't done that revision. I'm on a good bit of introduction and a bit of, you know, jogging of your memory to remember how to do that and all the different sort of sections you need to cover because it's the most thorough history taking, you'll probably do um out of all of them and then we will do 20 minutes going through the mental state exam. I want to allow plenty of time just because it is a bit complex and there's lots of quite niche vocabulary. So I thought we'd try and go through that a little bit. And then hopefully at about 20 to 27 Dara, the psych of treasurer who's also really interested in psychiatry will join. And between us, we'll go through more obviously specifically for the Southampton students, how to do really well in your psych placement. If you're coming up to it, if you're in your four, and maybe even if you're currently in it at the moment, it's really helpful to give you some tips and, um, how to approach it, how to do the assessments called A CCS within it. And then also, uh, to pass the placement, you have to do something called a CBD case based discussion. And we'll go through a little bit about that and then at, uh, five minutes to nine, we'll just, uh, five minutes to seven. Sorry, we'll just go through some questions and conclusions. So that would be about it really. Um, if you have any questions, pop them in the chat and I'll try and answer them. We've also, I've also hope to set up a few polls that will help. So, sort of get you guys involved a bit. So we'll start by just going through how to take a good psych history. So I wanted to go through some general tips first. These are things that I found really useful when I've been on placement and things that doctors and psychiatrists have told me as well. So I think the best one is using the patient's own language when they talk about how they're feeling. It's easy to be like, oh, well, that means you're depressed and that might not be what they're alluding to. So try and reframe your questioning and uh the history process using the words that they use and you can push that, you know, definition a bit and clarify with them. That's really helpful. But I think using your, the patient's language can um really build that rapport with them as well. It means that you're already engaged with what they're feeling. I want to understand it well, and they recognize that. So, uh, just be careful with how you listen to the patient as well. It's a bit different to normal history taking. You do have to be quite affirmative and, but also respond appropriately if they're telling you something quite, you know, troubling, quite dark, you need to be responding, you know, differently than how you would if you're taking a normal history where you're sort of just nod, nod, nodding along and going through stuff in your head and just be careful not to accidentally reaffirm some of the patients beliefs. If they have negative beliefs about themselves, sometimes they might say something, you know, I just feel so worthless and if you're going, that's not great because obviously they're going to see that as a affirmation of what they're feeling. So just make sure you are really paying attention and matching your affect to what they're saying. Then also just always worth remembering, don't be afraid to ask about suicide or self harm, including in that it does not increase the risk of suicide. Sometimes people think if you ask it, it's going to increase it. It does not, please just, um, you know, ask it, we'll go through when and, um, it's really important because sometimes you might be the only person to have asked and that can really make a big difference as to whether they do attempt suicide or not. And then finally, it's a long history, it will take more time. So it might not come up explicitly in on, in a setting. It might come up more specifically as like to part of the history taking or do the M SE part. So A is obviously so quite short, but do still and you're doing it on the wards, make sure you give yourself plenty of time, plenty of space, a good environment to do it in. You're asking very sensitive questions. So moving on to the structure of psychiatric history, it's quite a few sections. So don't be put off, it feels like it's a bit hard to cover, but it's not too different from a normal history taking. You've just got to add in the past psychiatric history and then a bit more personal history slash social history that, you know, that's more important and then potentially forensic history and like premorbid personality. But you can sort of vary how that feels with, um, you know, see how that goes when you're doing it. Some people, you know, you need to do more things than the others. Um So if we start off with the presenting complaint, just open it up really broad open question. How are you doing? What's been going on? It could be contextual as to where they are, you know, what's brought you in the hospital? Why do you think you're in the emergency floor? Why do you think the police have brought you in whatever, but just start off really broad and give them plenty of time to answer some people. It takes a really long time to warm up and open up and it might just be a very small response, but just gives them time to do that and make sure your non verbal communication is showing that you have that time. Often we say, you know, give them time that you're looking at your watch, you're fidgeting, you're, you know, shuffling with notes, really pay attention. And then once they've sort of done that, then open up a bit and ask them to tell them, tell you more, tell them what's been going on and make sure that you let them speak uh fast. But in the history of the presenting complaint, you can go through and explore in more detail about what's been going on and that will give you time to move from open to closed questioning slightly, really exploring your ideas and ruling out certain things. So in this sense, I can't cover everything. This is part of, you know, your training and your revision, learning about all the different psychiatric conditions and whilst they're talking to you, you can be going through them in your head, what to exclude what might be included, what's covered, what's not. So there can be lots of different things and that's just a bit of a list there as to what you might cover and what might be explored. I like to use the acronym notepad for this because I think it's quite uh useful to kind of, it's quite broad, not just in psychiatry, it's in anything and it really gives a good structure of how to explore presenting complaints. It can feel a bit like, well, where do I go from here? What do I do? Especially if there may be a bit, you know, struggling to communicate, you can really go for it and say, you know, what is, how are you feeling? When did this start, you know, what was going on in your life when this brought this on? You know, what has made it better or worse? You know, how has it progressed? Do you feel better than you did, you know, a few weeks ago? Have you felt worse? Do you also get any, you know, episodes of mania, for example, if they're depressed, do you get any psychotic, you know, things we are seeing things, hallucinations, that kind of thing and then ask about how bad it is for them. That's what we mean by disability, you know how much does it affect their life? Because that's what we're really looking for in terms of the extent to which it's impacting their day to day life and preventing them from doing things. Then we've got the actual psychiatric history. Obviously, this might be the first time they're presented. So you want to rule that out and if it, um, but if they have presented to, um, you know, secondary primary care before you want to know with what conditions, how they've been treated, what did did that help? Did that not? Were there side effects or you were admitted hospital? And then if the inpatient stays asked for the number of admissions, the dates, you know, it's very different if a patient is coming to you and they were an inpatient 20 years ago than it is if they were three weeks ago. So bear that in mind and then ask them how they would attain, was it, you know, voluntary admission or was it unfortunate under, you know, the Mental Health Act? Because those are very different states of mind, um, and suggest different levels of insight and things like that. And then finally, just see if they've been admitted to a psychiatric intensive care unit before, because that can help gauge the severity of the disease, how it might have been managed. Then looking at past medical history and medications more broadly cover what medical conditions they have. You know, even though we'd often separate mental and physical health. They are very interlinked. You know, there's a lot of risk factors for physical health that can link into mental health and vice versa. So do make sure that you cover those and cover any medications there on here. You can ask about recreational drugs or you can leave it into the social history and tackle it there. It's up to you how you feel comfortable whether it flows or not, but make sure you cover that next family history. So you want to find out mostly if there's any first degree relatives with a psychiatric disease. And it's important because that's more likely to indicate issues. Things like, you know, autism or ADHD, they are very strongly linked, you know, um anything as well linked to suicide. So I just wanted to ask a little poll of you guys um about if a person dies by suicide, how likely is it that their family member, you know, someone really closely related to them will attempt, attempt suicides themselves. Um Compared to if that person had died by natural causes? Great guys. So you got a few answers. Keep them coming. So a bit of a mix between 4065. So the answer is 65% is really high. So it's something worth noting, you know, for yourself. Um, you know, it's really likely that, you know, someone might try to take their own life if, if a first degree relative or someone really close to them has taken their own life. It, it, it is quite, there's a lot of studies about how contagious it is and things like that, but it's worth being aware of and knowing the state of mind that they're in the family members like that. Um And then if you want to draw out a little genogram, like I've shown genogram, I don't know how you say that, but it's really useful and they are a bit hard to learn. You can look them up if you're struggling but draw something rough as much as you can get because that will really help you. Especially when family relationships are quite complicated. I use that a lot on my placement and it really helped me because, you know, we have family members that are quite confused, but it really helps paint the picture of who they are and why they, you know, come to you at this point. So it's all about painting that picture moving on to personal history. This is something much more specific to psych history and that's related to um what their birth was like, early development or problems. Anything, you know, changes like that. Autism presents quite early adhd and then talk about education. Were they bullied? Did they enjoy school? Was it nice growing up in that family? Was it not? I quite like that question. What was it like growing up in your family? It's very open, it's non judgmental. It allows them to really reflect, then move to occupation, what they're doing at the moment. Are they employed? Are they a student? You know, people are unemployed and more at risk for poor mental health or certain jobs are quite stressful. So think about that and then you can ask about sort of sexual relationships, general romantic relationships. What are they like any problems? Um You can explore, you know, issues with abuse or um sexual assault here but try not to go into too much detail, I think because you can cover that later and it can be quite triggering. You're just here to gather information at this point. So then think about substance abuse. II like to think about it here or in social history, but it depends on where you want to frame it. I just popped it here. Think about smoking, recreational drugs, alcohol and just remember not to demonize that drug use. It's a lot of the time it's a coping strategy and it's, you know, we can be quite judgmental, especially with sort of alcoholism that they can just stop if they want to. It's very hard and often it's genetics, it's environment, it's, you know, this mental health condition, they all feed into each other. So try to avoid that stigma and then um just trying to also integrate gambling, it's an increasingly prevalent problem now and is becoming, it's quite a hot topic within the psychiatry community about people suffering from gambling. Addictions and the mental health crisis that it causes they moving on to forensic history. Obviously, not everyone will have a forensic history. Some might, you just want to know what happened, what was their charges? And if they have any past or pending charges and if you can as well just identify whether they have any, um, history of aggression, even if they haven't been in trouble with the police, whether they've gotten away with stuff and it hasn't been caught. It's just useful to know, to help frame the sort of place that they're in at the moment or in the past and then premorbid personality and collateral history, they kind of merged together. I think it's about what they like before they got sick. It might not always be that true. It depends on the condition. But, you know, it's really useful for someone who's presenting with sort of psychotic like symptoms. What were they like before where they have, has their personalities changed? Is this normal for them? And that can be gained, you know, from the person, but mostly likely from the collateral history. And so, yeah, just explore that you can, it also depends on the level of insight they have into their condition. So you can explore that a bit with ice. What they think the problem is then moving on to social history. This again can cover these sort of alcohol and drug side of things, but it can also more likely to cover sort of their current living conditions, what they're doing, what their life is like? Are they homeless? Have they got Children at home? Have they got social support, other forms of support, like social workers or a um mental health support worker? What's been going on there and just ask them those kind of questions that I put there that really explore that quite openly. So, moving on to the mental state examination. So I'm trying to keep really tight to time because we don't have much time. So, um it's a few little sort of TIPSS again for the mental state. You want to set it in the present, it kind of is different to a psychiatric history, which is gaining all the history. This is meant to be a snapshot shot of that person. And it's almost as if you, are you taking that picture of them, but it's a sort of moving picture that you're exploring who they are and what they're like. But in that precise moment so that someone, you know, 10 years down the line could read your notes and they could completely paint that picture of that person in their mind. So it's not about what they were like. It's not if they were having hallucinations, are they currently having hallucinations? Um So that's what I want you to sort of think about and then try and do it at the same time as you're taking the history though. If you really want to be quite slick about it. Do it simultaneously gather that information? I'd like to maybe jot it down on a sort of separate piece of paper, all the different aspects. And so as I'm taking the history, I can write something else down that they might do just so I don't forget, um, and then just don't forget to mention symptoms that are present, but also those that are absent. Obviously, it depends. I think some consultants just want to know about the positive symptoms, the ones that are present. But I think it's really good to say, you know, they are not having delusions, they are not, you know, having hallucinations, it just, it does help it, you know, clarify that. Otherwise there might be a bit of a question mark. So there are lots of different aspects of it. We'll go through all of them and it's quite um tricky to remember all of them. So I think, you know, do focus on making sure you cover every single one in your revision. So in terms of appearance and behavior, we're looking at general appearance, what are they dress like? What are they wearing? You know, what's their hair like? I know they wearing makeup, what's their self care like? Then their behavior? Are they showing good facial expressions? Are they making good eye contact? What's their posture? What's their activity level? All of these things feed into it and you need to make sure you've noted that down, are they being really hyperactive and jumping up and down? Uh can they not sit still or they just slumped in the chair? No eye contact, very little movement. All of these things come together and then other movements by that, I mean, sort of different aspects that they might be doing. So, um you know, for example, they might be doing lots of repetitive movements, they might have ticks. And one of the questions I want to ask you guys is uh the following which is what might be a sign in an M se that a patient is on antipsychotics. What kind of things might they be presenting with if they've, if they're on an antipsychotic? Great. Yeah, exactly. Yeah. It's all of the above. It's just worth remembering that. You know, obviously we think about it in terms of Parkinson's, they present with Parkinson's like syndromes, but it's also um it's more an extra what we call extra peral side effects. And those can cause all of the above a eia which is like a kind of restlessness. It's, they do often describe it as just feeling restless like they can't sit still. Um the shuffling gait and then the tardive dyskinesia is these like involuntary rhythmic movements that they do. Um And you, you will see that in, in clinic or in a inpatient facility. Um Sometimes it's worth remembering those kind of things. Um And then obviously think about things like if they're responding to hallucinations or, um, sort of any smells, anything like that. So, then speech, do you want to think about the rate how fast they're talking? What volume they're talking at? Is their tone? Is it emotional or is it very monotonous? And then how, how well does it flow? Is it spontaneous? Do you, you know, have that conversational flow where it's the back and forth or is it quite, you know, uninterruptible and continuous and it just doesn't stop? Um all things like that and moving on to mood, you want to think about it. I like to break it down into subjective objective and then their affect. So their like subjective mood is what they say that they're feeling. But then your objective idea of what their mood think is. So what does it present like, you know, what do you think it is? Um And then finally, their effort is how they're presenting their mood on their face that they might be describing to you and saying I'm feeling super depressed, but it looks like they're quite happy. That's an incongruous mood. It doesn't fit, but it, it can be the sort of range of the effect as well. Do they suddenly look really, really smiling and then they're crying, like how intense is it? Is it really like angry, really aggressive and then nothing all of that kind of thing and then thought is quite a lot to cover. So um just break it down into thought form, thought content and then thought possession. And I think that helps really break it down. You can see that there's lots of different things to cover. Um But I think breaking it down into form content, possession that's really helpful. Um Great then moving on to perception, this is where the hallucinations come in and then the illusions and depersonalization and derealization. So hallucinations come in lots of different types. It's worth getting to know them. Some of them, I didn't know what gustatory is until I was like revising last year. And I was, it's, it's a kind of um thank you feeling of um something sort of in your stomach and um like you're tasting something poisonous or something off in your food, it feels really weird uh whereas olfactory smell, so think about that and then depersonalization and deep realization is when it's very, you don't feel like you're quite in the world, you feel very separate from it. You don't quite feel real almost like you're in a dream. That's how people describe it. And then go through cognition, insight and risk assessment to go through thinking, you know, are they able to think clearly? Are they well orientated? And this can do come in the form of doing maybe a mental mini mental state examination or mocker these really quick examinations, but it would depend on your clinical skills and your knowledge to be able to judge that. And an insight. We talked about it a bit earlier. You can look into it. Now, how aware are they that they are? Well, can they recognize that they've got a problem? And do they agree that it is a problem that they need treatment? There's different extents and levels and you can, um, you know, write that down as to what you think their level of insight is and then judgment, we mean more in the sense that they have good judgment, you can ask a question like, you know, are you if you left, um, you know, do you think it's acceptable to leave a candle in the house lit when you go out, most people will be like, no, it's a risk of a fire. So ask them something like that. And then the big one that I think sometimes people forget to do is the risk assessment. It's vital. You want to ask them about their risk yourself and their risk to others and just please make sure you cover that. It's really important. And as I said before, you know, talking about suicide does not increase the risk of it. It's really important to cover exactly what kind of suicidal thoughts they're having. Have they self harmed? Because people with self harm are more likely to attempt suicide. Ask them about, you know, if they're using drugs that's also a risk to themselves or just from self neglect. You know, if they're really dirty and smelly you need to ask them, you know, are you taking care of yourself? Can you do that? And then if they have concurrent, you know, physical health needs, you know, if someone has bipolar disorder, they might neglect the fact that they have diabetes and need to monitor their insulin and sugar levels. So we're a bit early. So I thought um we would just go through any questions that you guys have first, um, about any part of the like mental state examination, any questions you have at all? I know that was quite a rush through, but it's obviously, I want to cover as much as possible. Um If not, I can go through a little bit briefly about how to create a formulation as well because that's something that once you've done your history taking and your mental state examination, that's often what you'll be asked to do. And a formulation is a kind of full final assessment um of a person. And um it's like a case synopsis of what's been going on in what's really important in their history, in their exam, all of the information that you've gathered and presenting it in a really good way so that it's just really clear and it really helps when you're talking with colleagues about formulating what to do next. Um And, and sort of going through that. So, yeah, I will answer your question in a sec. I know, but let me just go through quickly formulation. So it starts with just a bit of a case synopsis. So you want to do, you know who are they, what's been going on with them? Just a summary of what their current experience, their current crisis, for example, any particular relevant parts of the history. So, you know, are they have they had some childhood abuse, childhood trauma, have they got a family member just really the salient parts? And um and then in terms of the examination, again, the salient parts of the M se. So what's important that you found? And I know we talked about both the absent and present um symptoms. So this is when you can filter out the absent symptoms and just focus on the present ones in your formulation, but not in the actual mental state examination writing up. You want to keep that in there, but just for the formulation, just talk about what's actually present that you found the sort of salient findings. And then you can also just go through if there's anything physical going on with them, if they come into the hospital and you've done a bit of a physical workup, just bring that up any positive findings there. Um And then you want to do differential diagnoses. So think about all the options that could be sometimes it's really clear cut and easy to see what a patient might be presenting with. But often, you know, it is a bit more tricky there will be lots of different options and you want to talk about different areas of um that could be covered, you know, it could be a schizophrenia, but it could be depression with schizophrenic features. It could be also a kind of bipolar episode because that can present with psychotic features as well. So talk about those and talk about why you think it could be one or the other, what the, you know, you know, what are the, what's the evidence of this patient that they presented with that would suggest one thing or another, for example. Um And then just quickly go through the risk assessment and then sort of any investigations you've done any bloods, anything like that or the MC, for example, and then finally go through how you want to like manage them, what your plans are and what you think the prognosis might be. Um That's really good for a formulation. So yeah, that's just a quick summary of formulation. Um So first question, thank you so much. Um Just asking thoughts of self harm and suicide as two separate questions. So they are, they're very separate. Um So wait, where is that? I'm just trying to find where so far? Yeah. So suicidal thoughts you want to, this is a bigger question. It's quite hard to cover in a short time, but suicidal thoughts. Do you want to cover how intense their thoughts are? Are they just thoughts or are they making plans? So, that's a really good question to ask them. Have you made any actionable plans on it? You want to also ask, have they got any access to things that could harm themselves? So, have they got access to a gun, for example, or do they have somewhere that's quite private that people wouldn't maybe check on them for a long time. Um, do they have, you know, have they been stockpiling any medication? Have they got access to any shops? Things like that? Um, so that's all covered in sort of suicidal thoughts. And you want to ask as well if they've made plans about sort of leaving people behind? So, have they written a note, have they drawn up a will? Things like that? And self harm is quite separate because people, self harm often not with the intent of ending their lives. They do it because it's a means of sort of releasing pain and, um, expressing how they're feeling obviously in a, in a detrimental way. But it's the, it's the only way they feel they're able to. So what you want to ask for self harm is it's good to screen it and ask, you know, did you do this in order to end your life? And if they say no, then you'd be like, why did, what triggered this, what brought you into doing this? What were you feeling before it? What were you feeling afterwards? You know, and then ask them about sort of safety with the self harm. It depends on what they do if it's cutting, you want to. Now ask them, do they know how to clean themselves? Do they have access to things to clean themselves and be ready? Um Be careful with that. Um And then you also like, want to um ask them if they can have access to maybe some things to stop them self harming. So there's some good apps which can help people monitor and um monitor the thoughts that they have that would trigger their self harming. And it can help sort of mitigate that behavior and provide them with alternative methods of self harming. So they are already set questions because the intent is often different. And so it's good to cover them separately and explore them um both individually in depth. I hope that answers your question. And then second question is, is it generally safe to ask about details on the subject of abuse should be worried about treating the patient? Great question. I know I brought that up. Um I was generally, you know, taught by various consultants that you definitely can bring it up and should bring it up. It's important to ask often the patient will ask, you know, bring it up themselves. Um But it's probably not, we probably don't have the time as well to fully explore what went on. And it also wouldn't necessarily help them to fully explore that abuse. They can just tell you, I was abused as a child. They might go into detail as to who it was. You know, it's important to know probably who it was, but you don't want to really explore it too much in terms of how it happened. What exactly went on the really intense details of it? Um I know you said you might be worried about triggering the patient. I don't think you will trigger them that much by bringing it up and just screening for it. It is just a screening tool here. You can say, I, we ask this to all of our patients because you know, it does increase your risk of hurting yourself and it would also might contribute to your psychiatric condition. But have you ever or are you currently experiencing abuse of any kind? Um We need to know as well because if it's currently going on, we need to think about safeguarding and you can bring it up in that context. Um It's definitely worth talking about, but just, I don't think you have the time to fully explore it, you know, to really go into detail and to try and unpack that abuse with them. That's not your role here. Your role here is to gain a full psychiatric history and assessment of them as the patient and, and that's all you can't do more than that. Um So a lot of questions I have is um in terms of risk monitoring as needed. I think that's quite, that's quite a niche question. I don't think that will, that kind of question will come up, um, in a kind of a station kind of question like that. Um, in terms of like asking about risk and thinking about risk with that patient, you have got some risk factors there if they're a widow and they've also probably got some physical health problems that will, um, you know, you're worried about self neglect and managing their physical health needs. In that case, you'd probably be bringing in an MDT team to think about how they are um being supported for that, those physical health needs. And um and then in terms of exploring that with her, you can ask her, you know, what are your, you know, have you had any suicidal thoughts? Um often that's quite challenging in an elderly patient because they are um there's a, you know, a lot more stigma for, for that generation, talking about those things quite openly. So explore it sensitively. But um yeah, it's good to involve that the medical team on that side. If she has is quite thin, she's at risk care of um not managing her own physical health needs. So make it an MDT situation. Um And then going about to make um how would you ask our cognition in asking? So as I said, in condition you want to, you can kind of do that by talking um with the patient and seeing what they're like is slightly a judgment call on your part as to assessing cognition. But um the tools like the MMSE which is the mini mental state exam, it's a 10 point checklist. I think of questions. Like, can you tell me what month it is? What year it is? Can you tell me who's Prime Minister? You know what was um can you count backwards from 20? Can you remember this address? That kind of stuff? That's what we're assessing here. The mocha is another one that's quite quick and easy to do. Um And is also quite good if they have any sort of visual or um impairments or sort of learning impairments as well. There's lots of them like that. Um I think in an Aussie situation you could just tell them in this case, I would often I'd like to perform an mm but for me, I think that um the cognition is in a good state and nothing to worry about, but you can just tell them I do further investigations. Um So yeah, that, that I think um Dora you're here. So if you want to um joint and we can talk about sort of acing your psych placement again for people who are more international. This is more specifically for Southampton students. Um So totally understand if that's not of interest to you, but this is specifically for when you're on your placement and how to get the most out of it. Um and make sure that you can, um, do really well and ace your assessments which are A CCS and then um also your haze based inertion, which is this sort of quite big presentation you need to do and prep for at the end of your placement. So we'll just uh get Dara to join. Hopefully you can join and then we will discuss. Ok. Nasal. Great. Hi, darling. All right. How are you? Hello? Yeah, Dara is also a final year student. Um and we both did our psych placement. So I just want to ask you like, if you had any specific tips to sort of help um future sort of fourth years doing their placement. What would be your suggestions? Yeah, absolutely. So I have a couple. Um one of the things that I'd be very keen, especially for your exams is to get to grips with the terminology in like now I appreciate it can be a little bit unwieldy at times. But remember that everything that they use describes a specific circumstance and that can help point towards different diagnoses and things like that. So we had a woman today who we weren't sure if I'm, I'm doing my SS U on CYA. So I love it so much. I came back for fifth year. Um and there was an acute woman in the Acute medicine Ward and she was claiming to be hearing things, but in actual fact, it wasn't. So in the opinion of the doctor I was with, she didn't have a psychosis, she was saying to get attention. Um, but she did have one psychotic feature and this lady also had uh an eating disorder and she was refusing to eat, which is what brought her in. But she believed that there was a brain block. That's how she described it, like something around her brain stopping her from eating. And when I was writing it up, I said that that is thought blocking and the doctor said afterwards, no, it's not thought blocking. That's where you're in the middle of a sentence and you stop, that's thought restriction. So in our exam last year and our fourth year exams presumably for your MLA, you may get situations where they will ask you what is this? You know, what's this an example of, I mean, you definitely had one last year, Chloe, the guy, you, a lot of people fucked up on myself included. Absolutely. Get your terminology, right. Make an effort to sit down and learn it if you don't learn much else because that probably will come up in your exam. Yeah, definitely. I need like a little list as I went through of like the terminology that you came across just so you have this list that you can then revise because it's really hard to get a full list of all the different words you might need. But I thought that that was quite a good like little thing in the back of like a notebook, just write them down as you find them. And, uh, yeah, as you come across them as well, you can link them to patients. So things seem a bit kind of more clear in your head though. That patient said that, um, the government was stealing his thoughts as thought withdrawal. Um, another thing depending on where you are. Southampton is normally very good. So I was in the west area. Um, the hospital I was attached to sent me to all different places, try and see or inquire if you can see a variety of patients. So if you're in an inpatient setting, see if you can go to a community clinic, see if you can join what's called an outreach team. So they work with people who are in vulnerable situations like homeless and things like that in your area. It gives you a good idea that psychiatry isn't just people in acute inpatient, in fact, a lot of these days. So being able to grow our community person is fantastic. So if you can get as much involvement in different things, yeah, I'd say that's really important as well because I think depending on which area you are placed in, you can get quite varied experiences. And I think that's one of the downsides in Southampton is they are not very standardized, the experience you get. So if you can really push to get that variety, you know, often people will have a area to that they allocated to. I was in community team, but I got loads of different days, taste days in lots of different areas of psychiatry. And it was really great because we're often not told much about the different areas of psychiatry. And you might really like one aspect, you know, I've met people who just love forensic psych and that's it. They don't really like the rest of psychiatry at all. So it just gives you that really big opportunity. And then also just for your learning um to have that range of stuff because in community, you won't really see much sort of active psychosis, you'll see that in inpatient, but in community, you will see lots of interesting sort of depression and management of like long term conditions. That's really interesting. Um So yeah, I definitely to make sure you do push to get that variety within your placement, it will benefit your learning and able to see a variety of conditions. Um And let me think so two things, one is cautionary and one is sort of based on my own lived experience. Um So the first thing is I appreciate that for a lot of people. I am 35 and I have a list of mental health problems, the length of your arm. So I'm interested in psychiatry, but I appreciate that for many of you, um particularly if you're younger, it doesn't seem that important um the truth is mental health and physical health go hand in hand. We've been to see patients who have been in acute settings. We've been to see postoperative patients. We've been seeing quite a lot of patients who have had major life changes and in fact, they're not going around saying that the aliens are going to abduct them. They're just really emotional and they need somebody to talk to her about that. So mental health and physical health are very much intertwined. If you have a mental health issue, your life expectancy is reduced by about 20 years, I think. And quite often a lot of people that you see as like physical health in patients will have some degree of mental health stress as a result of what's happening. So be mindful of that. And also I hate to say this, I'm seeing some people be just like so disengaged and just hating life to show an interest. This is the day in day out job that these people do. They may not know this but it pays the bills for them and they have to do it. And II personally find it very disrespectful when people come in. Like I hate, II could not think of a worse type of medicine to do than ophthalmology mind that maybe I'll learn something if I go into this with an open mind. No, no, that's definitely true. I think, you know, psych is not for everyone. Obviously, we're both very keen on it and we're here to encourage you to consider it. But even if that's not at all of your interest, you will gain so much more for your learning and for your vision, if you do engage, because it, it does sound silly. But, you know, if you've seen a patient actively who has those extra pyramidal side effects, and you felt that kind of lead pipe rigidity that is often described it just, you know, it's just so much better cemented in your mind for exams and you will know what it's like in an Os. And that's definitely something that could come up. And I think that's reasonable if someone did present and they were on antipsychotics, long term, it could come up. And so all of that stuff, it does help your learning to really, um, you know, engage and do your best, even if you hate psych. And I, like, I can't wait to leave, just, you know, it will go faster if you engage. Probably the last thing that I'd say is, um, excuse the language, but don't be an asshole. Um These people, some of them are floridly psychotic and they will come out with the most ridiculous shit that you've ever heard of. Some of it might be quite funny. Like today I saw a guy pulled down over his head and he was convinced that because the lampshade was on his head, you know, we couldn't see him So, um, he manifested us all those voices speaking to us but we couldn't see him and he couldn't see us. But like, quite often, not always, they will remember some element of what they happened. They might recall it as a dream or something like that and they, they will remember how people treated them. So, even though it might sound completely ridiculous and funny and things like that. And, yeah, some of it is quite funny. I, I'd admit even the, even the doctors will admit that, um, just be mindful that these people, the vast majority of time will recover. And exactly. Yeah. No, definitely. I think that's really important and, you know, you're often asking people some of the most personal things that you could possibly ask someone and you're doing that pretty much as a stranger. So it's inviting a lot of trust um, as a sort of medical professional to do that. So, yeah, just be mindful of that and, and go into it with that, you know, level of respect. I think that's definitely true. Um More practically, do you want to talk about sort of A ccs and how to do well in those? Certainly. So you will probably be assigned people for your ac. So we certainly we do that. Um, again, try and get an idea. So if you have access to the notes beforehand, the system here is called Rio read up in Rio. See what you might expect um if you're allowed to, sometimes the doctors don't like you to and they just want you to go in blind. Um make sure that you have a rough idea of what you're dealing with. So, so if it's depression, know the questions to ask, but know that you should be asking about anemia, lack of energy change in sleep and motivation, things like that, but be prepared to drop in a few questions like do you hear or see things that other people might not hear? Yeah, some screening questions and be mindful about how you ask them. So a good one to think about with this is asking the question. Do you often feel like other people are controlling you? So recently we had somebody say, well, you know, somebody tells you what time to come to work at. Somebody tells you what time train comes out. Are they controlling you? And I was just like shit. I didn't, I didn't actually think of it that way but in a way they are. Yeah. So try and find ways to phrase things as well and remember that not everybody you're dealing with has medical jargons or things like caught insert and thought at all. Try and find ways that you would ask the questions that you would ask them to maybe a 12 year old child. Because remember CS could be one of your place to you given an ACC or not. Um rely on sources of collateral history. So again, Rio the Notes is a good one. If they have family in with them or family with people come in with community with their family and that was really valuable to get that insight. Yeah, and they will know the kind of baseline level that they're at. So some people go around life with low level kind of delusional perceptions all the time. Um But they have such a good level of insight that they are able to kind of cope in their daily life with these things. So that could be something um again, with things like cas ask family questions and that's quite difficult. It would be very mean of them if they did give you a CAM ec because that's quite often very traumatic family circumstances, but be mindful that family if you want, I think also for A CCS, at least the advice I got was often to try and be fairly um what's the right word like confident and make sure you are assertive because, you know, especially if you've got a patient who, you know, I had one who was obviously very like psychotic and just had complete, you know, would just not start talking and that can be really challenging. So do make sure you really are firm and try to interrupt and try and you know, be assertive and get your questions across. Don't just sit there in the background and say nothing, be assertive, get those questions that you want to ask really, you know, interrogate it, not interrogate them, but interrogate the, the issue. Um And then do you wanna move on to sort of any advice for um CBD S? Yes. Get them done. So I please get them done so early. I think I can admit this. I used myself as a case based discussion because I had only five done by the end of it. And I was like, fuck me, where am I going to find a patient? And I was like, I am a patient just to clarify. So they are case based discussions. You have to do six of them. So it's quite a lot on, they give you a list and it has to be on sort of different um different pathology and then also covering sort of different aspects. So management versus such as pathophysiology or various aspects for each one. So it's quite a lot of work. You have to also have taken a really big thorough history of that patient. So you have to know all their notes, go through it, you need to have spoken to them as well because you have to do an MSC as part of it. So it is quite a um a large undertaking. So that's why we're advising to uh to get it done as soon as you can if you know, it's only eight weeks like placement. So try and do one a week ish as much as you can because that will just help you so much. I was also struggled to get them all done in time because I got, you know, I had a week where I was ill. So, like, that's a whole week gone and, you know, you are constantly trying to catch up and it's a lot of work. So, get them done early. But yeah, you're gonna say any suggestions or thoughts. Yeah. So I think it's 10 minutes and then they ask you questions if I remember, right? But just to clarify the time thing yourself, just to make sure and sit down, record yourself, practice them with a friend, speak to your stuffed animals, just make sure you get your time on point because if you run out of time, there will be information that you wanted to get across and they, they will cut you off and you won't get a chance to get that in. That's really good. They are very tight with time. Um And just making sure you come across really well and it's really fluid as if you know it and you thought about it and can discuss it quite freely because my one they didn't, they didn't want us to do any powerpoints either with it. It was just you talking at a screen. So that is quite hard. Um So you need to be really comfortable about the case and know the case is really intimately. Um So any other tips and advice just to wrap it up. Da Yeah. So um so keep them beside you just, you know, don't make it really obvious if it's a Power Point II used a word document with some brief notes in the patient um because I couldn't memorize all of it ad HD uh and also don't forget your organic causes. So the case that I was eventually asked to present was a patient who had dementia, but he also had a history of bipolar disorder. So was his presentation bipolar, was it dementia? And he was sent in for an MRI and in the heat of the moment I forgot what he'd been sent for. And that was to establish whether he had an organic for dementia. So remember that even though people are presenting with sometimes quite floridly psychotic things, it could actually be down to an electrolyte imbalance or alcohol withdrawal or anything like that. So just be mindful of that. And in your notes and in your writing up the patients in the case, remember organic causes can definitely. Yeah. Yeah, I had a similar case when it was questioned whether he actually had schizophrenia or he also had multiple brain tumors. So it was like what was causing it. So actually, you know, they, they can overlap, you know, it's complex, it's not simple. Um So yeah, definitely. Don't forget about those. Um Anything else do you want to um say all done? I think we will wrap it up because we've already run over a little bit. So I feel kind of bad, but thank you guys for sticking around. Um If any questions you can pop in the chat or like, please feel free to email me. Um And then just final little plug for our socials if you wanna scan that QR code that joins our new whatsapp group, which we set up. Um So yeah, please do follow us and we've got like much, many more revision sessions coming up and we're organizing to help before we have finals in January. So, but we're hoping it's also helpful for, you know, earlier years who are just starting their sort of psychiatry learning and um and just on in lectures and stuff. So please follow us and yeah, uh Thank you so much for, for coming and hope it was useful. Thank you.