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.
Back to top
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
Back to top
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.
Back to top
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:
Back to top
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.
Back to top
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!
Back to top
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.
Back to top
Dr Meinou Simmons
Back to student area home page
Page last updated on 16 May 2010 by E
Baker-Glenn