First clinical reasoning session Build on opening lectures and skills sessions aimed at history and mental state examination Aims

Transcription

1 Schizophrenia CRS

2 First clinical reasoning session Build on opening lectures and skills sessions aimed at history and mental state examination Aims Develop skills in identifying psychopathology Develop skills in presenting psychiatric history and MSE Emphasise the biopsychosocial model in the description of aetiology and treatment in psychiatry

3 Biopsychosocial model of schizophrenia Predisposing Precipitating Perpetuating Bio genetic head injury neurotransmitters gender drug abuse head injury drug abuse compliance metabolism Psycho conflict self esteem trauma EE life events coping style EE hopelessness Social Role Social class isolation gender Poverty migration isolation social network work family stigma

4 Sessions Learning outcomes Learning activities CASE SELECTION Interview patient with schizophrenia Two students where feasible Gather a relevant and comprehensive patient history Perform an accurate and appropriate mental state examination Synthesise clinical findings to develop prioritised differential diagnoses Select, justify and interpret investigations Elicit a full history emphasizing psychopathology, comorbidity, risk assessment, level of disability MSE emphasizing phenomenology Formulate diagnoses and problem list, including patient concerns Prioritise differential diagnoses Prepare case presentation Allocation of case CASE PRESENTATION minutes CASE DISCUSSION incl. CLINICAL REASONING (Approx 30 mins) Total time 45 mins TOPIC PRESENTATION S 15 min EBM PRESENTATION 15 mins MANAGEMENT PLAN 20 mins Develop skills in the presentation of psychiatric case history Accurately use descriptive language to describe case Explore the interaction of biological and psychosocial factors in the individual s case Reflect on fears encountered in assessing a psychiatric inpatient Acknowledge stigma in psychiatric illnesses and the reactions of the community (including professionals) to it. Develop an understanding of the diagnostic systems used in mental health Develop an understanding of the bio-psychosocio-cultural origins of schizophrenia Examine evidence base for effective treatments Reflect on conflicting or inadequate evidence Formulate a comprehensive management plan Understand the need for psychosocial interventions in schizophrenia Appreciate the role of primary care in good treatment physical health` CLINICAL REASONING SESSION1 Present patient case Ask open-ended questions to promote interpretation and discussion Identify and discuss key features of the case Explain clinical reasoning process, how arrived at diagnosis, supporting documents/results (presenters) Discuss clinical reasoning (group) Identify learning issues for personal study Discuss potential research questions CLINICAL REASONING SESSION2 Discuss learning issues Evaluate scientific research relevant to medical practice (EBM) Discuss practical limitations in the application of management plan Evaluate EBM and CRS leaders Direct towards key missed features Develop skills in describing phenomenology Develop understanding of range of differential diagnoses Allocate discussants and topics Check EBM task is clear Give context to learning topics & EBM Help develop optimal management plan, Discuss reality base of service provision Ensure evaluation

5 Case Selection Gather a relevant and comprehensive patient history Perform an accurate and appropriate mental state examination Allocate / find case Synthesise clinical findings to develop prioritised differential diagnoses Select, justify and interpret investigations

6 Case Presentation & Discussion Develop skills in the presentation of psychiatric case history Accurately use technical language to describe case Reflect on fears encountered in assessing a psychiatric inpatient Acknowledge stigma in psychiatric illnesses and the reactions of the community (including professionals) to it. Direct towards key missed features Develop skills in describing phenomenology Develop understanding of range of differential diagnoses Explore the interaction of biological and psychosocial factors in the patient s case Develop an understanding of the diagnostic systems used in mental health Allocate discussants and topics Check EBM task is clear

7 EBM & Management Develop an understanding of the bio-psycho-socio-cultural origins of schizophrenia Examine evidence base for effective treatments Reflect on conflicting or inadequate evidence Formulate a comprehensive management plan Understand the need for biopsychosocial interventions in schizophrenia Appreciate the role of primary care in good treatment physical health Give context to learning topics & EBM Help develop optimal management plan, Discuss reality base of service provision Ensure evaluation