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The Royal College of Psychiatrists Improving the lives of people with mental illness

Useful tips and tools

Mental state examination

Learn how to perform a mental state examination: this is the psychiatrist's most useful tool and is the closest equivalent to the physician's objective physical examination. It purports to offer a clear, objective snapshot view of someone's mental functioning at a given time-point.  

See patients in pairs for mental state examinations and present the mental state of the patient to each other afterwards. Later, present to a ward doctor, and see if they can guess who the patient is from your description. 

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Diagnostic manual 

Familiarise yourself with a diagnostic manual: it is the means by which psychiatrists make diagnoses and looks at clusters of symptoms. The most commonly used clinical manual in the UK is the ICD-10. A pocket ICD-10 published by Churchill Livingstone would be useful to get out of the library and to carry around for your reference. ICD-10 is also available online at: http://www.who.int/classifications/apps/icd/icd10online

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Reading up

As in medicine, it is useful to read up about a condition after you have seen someone to consolidate learning. A good starting point is the Oxford Handbook of Psychiatry (akin to the 'Cheese and Onion' handbook of medicine), which can fit into a bag and can be carried around. It is a treasure trove of useful information, and is usefully whipped out in those idle moments when waiting to speak to a patient. See the reading list for other books that you may find helpful.

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Web resources

Make use of the internet for up-to-date resources. As a starting point, have a look at the Royal College website, which has a mindfield  of useful information, including patient information leaflets:

http://www.rcpsych.ac.uk/mentalhealthinfo.aspx 

There are NICE guidelines available for a large number of psychiatric conditions, from eating disorders to depression. This can be found at http://www.nice.org.uk/ It may also be useful to look up some of the mental health charity websites which can contain useful information and advice, for example:

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Seeing patients: be proactive but safe

Patients are your best teachers and their stories are what makes psychiatry so fascinating. However, you need to be PROACTIVE! See patients opportunistically for mental state exams, not just for full histories, which can be tiring and inappropriate if a patient is unwell. Moreover, background information is obtainable from the notes, which are useful to read carefully after your clinical encounter. It is also an eye opener to follow core trainees on call: interesting problems tend to present out of hours. 

Unlike on medical and surgical wards, patients are not conveniently lying in rows in hospital beds. In psychiatry patients are generally ambulant and wards are like hostels with bedrooms and communal areas. It will make your life easier if you familiarise yourself with the ward timetable: that is community meetings, group activities and mealtimes, and make yourself known to the nurse in charge on the wards. You could leave your mobile number on the wards and with the specialist trainees so that they can contact you. 

Ensure your safety when you see patients. Do not be overly frightened of patients, but take sensible precautions, for example always alert ward staff prior to seeing patients, and if the ward has an alarm system. It is often advisable to start seeing patients in pairs whilst you gain confidence.

For some safety dos and don'ts, please click here.

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Follow patient journeys 

Get to know the day-to-day work of your team, including the consultant and other doctors. Although psychiatry attachments are often short, it may be a possible to follow a patient through from being acutely unwell to being improved and discharged. This counters the old adage that psychiatry patients never get better. It would be a nice touch to then do a home visit, post discharge, with the home treatment team!

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Consider psychiatry as a career

There is work available to suit a range of personalities within psychiatry and some of the subspecialities are rapidly being developed. Even if psychiatry is not for you, you can still learn a lot from an attachment if you keep your eyes open and look for opportunities to learn. You will learn many useful skills which will help with other areas of medicine, including general practice and medical and surgical specialties.

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Dr Meinou Simmons

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Page last updated on 16 May 2010 by E Baker-Glenn

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