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DEPRESSION

Q1. Mrs. Kate is a 32 year old patient presenting with low mood. Her husband passed away a few

months ago. Please take patient history and counsel her.

Q2. Mr. Brown has been suffering with Rheumatoid Arthritis and now presents with complaints of

Insomnia. He is on medications, please take patient history and counsel.

Hello Mrs Kate My name is Samson; I am one of the junior doctors in this department

“I can see that you are feeling bit low Mrs Kate”

Is there anything bothering you?

Express your concern and ask her if anything else is bothering her.

In RA ask her if she is okay with her medicine.

Ask her if her joints are bothering her despite medications.

Ask her if it’s alright to start talking to her about her problem?

Presenting complaints of depression

S - Suicidal thoughts, plans or attempts

U - Unexplained feelings of guilt or worthlessness.

I - Inability to function (psychomotor agitation/retardation)

C - Concentration impaired.

I - Impaired appetite and libido (Appetite↑/↓=wt↓/↑ by 5%)

D - Disturbed sleep (early morning awakening/hypersomnia)

E - Energy levels low.

These are the core symptoms. The mandatory symptoms are: low mood & Anhedonia is lack of

pleasure in life.

For Diagnosis, low mood and Anhedonia must be present + at least 2 symptoms from the core of

symptom list. They must be present everyday for at least 2 weeks.

Questions to Ask

Start asking from low mood and Anhedonia and stop with suicidal risk.

How do you feel in your mood?

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If you were to rate your mood in a scale of 1 to 10, 1 being the lowest and 10 being your

best, how would you fair?

Do you enjoy going out with friends? What do you normally do for fun? Do you still enjoy it?

Do you feel fatigued most of the time?

How long have you been feeling this way?

Do you notice any change during the day? How is your sleep?

How about your appetite and weight?

How’s your concentration level?

How’s your sex drive?

Do you feel slowed down or restless and agitated all the time?

Are you feeling hopeless and worthless? Do you have any guilty feelings? Weighing you

down?

At such times people tend to hurt themselves. Has such thought ever crossed your mind?

PAST AND OTHER HISTORIES: (FAMISH)

F - Friends, family and forensic history and finances.

Are you living alone or do you have a family?

Are they supportive?

Do you have friends?

How is your financial status?

Have you ever been in trouble with the law?

A - Alcohol, smoking, drugs( Ask permission first)

Do you drink Alcohol? (If yes, does low mood make her drink more?)

How about smoking cigarettes and drugs?

M - Medical illness and medications. History of hospitalization.

I - Interest in life

How do you see your future?

S - Stress at work/home

Where do you work? Is there any stress at work? How about home?

H - Hallucinations and Delusions

Do you hear any voices when nobody is around you? Do you think any voice? Is anyone

commenting on your thoughts and actions?

Do you have any firm belief that others do not agree with?

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COUNSELLING:

From what you’ve told me, there is a possibility that you are suffering from depression. However

we’ll have to rule out other problems that may sometimes present similarly. For this we will have to

request a few investigations. However, do not be alarmed. We shall provide you with all the

support we can.

Try to tell people who are close to you how you feel. It is not weak to cry or admit that you

are struggling.

Do eat regularly, even if you do not feel like eating. Try to eat healthy diet.

Don’t drink too much alcohol. Drinking alcohol is tempting to some people with depression

as the immediate effect may seem to relieve the symptoms.

Don’t make any major decisions whilst you are depressed.

Do tell your doctor if you feel that you are getting worse.

If patient asks “Will it happen again?”

A one-off episode of depression at some stage in life is common.

EXERCISE

In addition to the above to the above treatments, regular exercise is thought to help to improve

symptoms (if you are able to do some work exercise).

PSYCHOLOGICAL TREATMENTS (Talking treatment)

Various psychological treatments have been shown in research trials to be good for depression.

ANTIDEPRESSANT MEDICINES

An antidepressant does not usually work straight away. It can take 2-4 weeks before the effect

builds up fully. So you need to give it time.

LEAFLETS, WEBSITES, SUPPORT GROUP.

FOLLOW UP IN CLINIC.

DRUG ABUSE

Q1. A young man comes to you with the intentions of stopping drug abuse. You are the junior

doctor; assess him for drug abuse/dependency.

Q2. The police have brought in a young man; please assess him for drug abuse dependency.

GRIPS

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Depending on how he comes to you, on this own or brought by the police, you have to talk

likewise

If he comes on his own, he is going to be very receptive to you but if not, you will have to

calm him down, reassure and make him understand that the questions you are asking him

are for his own good

Questions

Do you do drugs?

What type of drug do you use?

How long have you been using it?

How do you use it? Do you use needles too? Do you know of the Needle Exchange

Programme?

How much do you use in a day?

How often do you use it?

Do you need to use more of it to get the same effect as time passes?

What happens if you do not use it for a day or two? Do you have any problems? What are

they?

Where do you work? How much do you spend in a day on drugs? If not sufficient, how do

you procure the money for the drugs?

FAMISH

F – Do you live alone? Do your friends and family know of your dependency? If he has come

to you for help are they going to stand by you as you go in for a de-addiction programme?

How are your finances?

Have you any trouble with the law?

A – Do you smoke or consume alcohol?

M – Medical illness and medications?

I – Interest in life

Is there any particular event in your life that forced you into this?

Do you feel better when you indulge in your habit?


Do you suffer from low moods?

Any thought of self harm?

S – Is there any stress at home or work?

H – Any voices commenting on you or any buzzing/ringing noises in your ears? Any beliefs you

hold that others do not agree with

COUNSELLING

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Catherine, from what you have told me you do not have sufficient amount of food. I know you feel

well and I am sure you are doing well but sometimes when you tend to eat less and when this goes

on for sometimes there is a condition called Anorexia Nervosa that people suffer. They tend to eat

less to lose weight. Would you like to have a leaflet to read about it?

We feel you are exercising a lot. We will fix an appointment with our gym instructor who would

advice you.

You may go home now but if there is a problem like pain, dizziness come to us.

D/Ds:

Infections

Diabetes Mellitus

Malignancy

Mal absorption

Hyperthyroidism.

INSOMNIA

Mrs. Janet is a 60 year old lady who has come in with complaints of difficulty sleeping. This has been

present since past 4 months. She also complains of irritability and confusion. She has been suffering

with Rheumatoid Arthritis since last 7 years. Please take detailed patient history and council her

(remember not to take medicine history).

GRIPS

Offer confidentiality

Empathy/ eye contact/ make the pt. Talk

Ask about sleeping pattern or sleeping schedule.

D/Ds:

Shift worker

Living environment Depression

Mania/Anxiety

Grief

Nocturia (BPH), ( DM)

Nocturnal cough (asthma)

Medication

Pain( joint problems)

Negative history (questions for)

Panic attack

OCD

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PTSD

Psychosis

Insight

Past history of any psychiatric illness

Family history of any psychiatric illness

Social History: What do you do for your living?Are your family and friends supportive?

Personal History:

Smoking

Drinking

Drug abuse

Any problem with police or law

Suicidal risk

Counselling bio/psycho/social

Effective plan but need your co-operation

ADVICE

Pls don’t go to bed unless you feel sleepy

Pls don’t have coffee/alcohol before you go to sleep

Pls don’t watch TV for late hours at night

Plz have a warm bath before going to bed

Pls have a glass of milk or listen to any kind of music which makes you feel sleepy

We would also like to mark your sleep on a diary called “sleep diary” at least for a week and

pls bring it back to us so that we have a fair idea about your sleep.

Even though these measures are not helping you we would like to put you on medication

which would help you to go to sleep, which will be decided by my team if required later on.

ANY QUESTIONS?

Obsessive Compulsive Disorder

Mr Jeffries has been brought to hospital by her wife who says he has been washing his hands all the

time. Please take history from the patient .

RIPSOUR

R – Repititive

I – Intrusive

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P – Persistent

S – Senseless

O – derived from his own thoughts

UR – Unable to resist

Q. A lady who washes her hands excessively.

Ask about her presenting problems

What exactly is her problem?

When did it start?

Is there any particular event you remember that triggered it off?

Is it repetitive?

How many times a day do you wash your hands?

Do you think these thoughts are your own?

Do they intrude upon your flow of thoughts normally and hamper daily activities?

Do you feel they are senseless?

Have you tried resisting them?

Do you get anxious when you try resisting them?

Do you have any other problems like checking on the locks all the time, ID cards?

Do you fear crowds, open spaces or talking to people?

Are you otherwise a rather neat and clean person who is very meticulous and finds it very

difficult to complete tasks at times after beginning them?

Has this made you depressed?

How’s your sleep and appetite?

Any tendencies to self harm?

How about alcohol, smoking, drugs?

Is this problem driving you to drink?

Are your friends and family supportive?

Any medical problems and medications?

Stress at work?

Hallucinations and delusions?

COUNSELLING:

Tell her whatever she has said makes you feel she suffers from OCD.

Offer her support and encourage her

Counselling and psychotherapy

Behavioural therapy and relaxation therapies

Medications if necessary

Leaflets on problems and management

D/Ds:

OCD

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Phobias

Panic attacks

Generalised Anxiety Disorder

Post Traumatic Stress Disorder

DREAMS

D – Disinterest in life, detached and emotionally numb

R – Reliving the incident through intrusive flashbacks, nightmares or vivid memories

E – Extreme nature of the event

A – Avoidance of similar circumstances, avoid watching TV, war movies, avoidance of

vehicles, avoid routes.

M –

Months

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Try to take amitriptylline at the same time(s) each day to avoid missing any doses.

If you do forget to take a dose, take it as soon as you remember unless it is nearly time for

your next in which case leave out the missed dose. Do not take two doses together to make

up for a forgotten dose.

FOR YOU TO GET THE MOST FROM YOUR TREATMENT

You may feel that Amitriptylline is not working for you straightaway. It can take a week or

two after start of this treatment before the effect builds up and 4-6 weeks before you feel

the full benefit. Do not stop after a week or so, thinking it is not helping.

Try to keep your regular appointments with your doctor. This is so your doctor can check on

your progress.

Do not try to drink alcohol while you are being treated with Amitriptylline. Taking

Amitriptylline and alcohol increase the chance that you experience side- effects.

If you buy any medicines, check with a pharmacist that they are safe to take with

Amitriptylline.

There are several types of antidepressants and they differ in their possible side-effects.

While you feel depressed or are taking amitriptylline, you may have thoughts about harming

yourself ending your life. It is very important that you tell your doctor about this if it

happens.

Amitriptylline may cause your skin to become more sensitive to sunlight than usual. Avoid

strong sunbaths and sunbeds until you know how your skin reacts.

Do not stop taking Amitriptylline unless your doctor tells you to do so. Stopping treatment

suddenly sometimes causes problems.

COMMON SIDE EFFECTS OF AMYTRIPTYLLINE

Dry mouth – try chewing sugar free gum or sweets.

Constipation – Try to eat well balanced diet containing plenty of fibre and drink plenty of

water.

Feeling of a fast heartbeat- Speak to your doctor if this continues.

Feeling dizzy, faint or light-headed when getting up- Getting up more slowly may help. If

you begin to feel faint, sit until the feeling passes.

Feeling sleepy, blurred vision- If this happens, do not drive, use tools or machines. Do not

drink alcohol.

Feeling or being sick- Stick to simple foods. Try smaller meals but more regularly.

Feeling anxious or confused, Difficulties sleeping, Tingling feelings, Breast tenderness,

difficulties with sexual function, Changes in appetite and weight, Change in taste, Ringing in

the ears, Itchy skin rashes, Loss of hair, Increased sweating.

If any of the above becomes troublesome, speak with your GP for advice. If you experience any

other symptoms which you think may be due to this medicine, speak with your GP or pharmacist.

HOW TO STORE AMITRIPTYLLINE

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Keep all medicines out of the reach and sight of children.

Store in a cool, dry place, away from direct heat and light.

LEAFLETS AND WEBSITES.

PANIC ATTACK

FEATURES

Tremors

Breathing difficulty and tachycardia

Tingling and numbness in hands and feet

Dryness of the mouth

Palpitations

Choking sensation in throat

Feeling of impending doom

Butterflies in stomach

GRIPS:----------------- h/o presenting complaints

How long have you been having problems?

What happens to you? Do you have drumming in your chest, feel dizzy and numb, have

breathing problems and have a sense of impending doom?

What brings it on? How long has this been going on?

Does it occur only when you are faced with such a situation or at any time? Can you at all go out of the house?

Are you afraid of crowd and people?

Any special fears?

Is this hampering your daily life?

What do you do to have them subside?

Is your family and friends supportive?

Is there stress at work/ family?

Do you enjoy your daily activities/ interest/ otherwise?

Is this problem making you suicidal?

Any other medical/ mental condition you wish us to know of? And any medications?

D/Ds:

Panic attacks

Generalised anxiety disorder

Hyperthyroidism

Pheochromocytoma

Alcohol and substance abuse

MANAGEMENT:

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CBT

Rebreathing into a paper bag

Medications

Counselling in psychotherapy is rarely necessary

Leaflets and websites.

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MINI MENTAL STATE EXAMINATION

Scores of 25-30 out of 30 are considered normal; NICE classify 21-24 as mild, 10-20 as moderate

and

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POST NATAL DEPRESSION

Mrs lopez is a 27 year old lady who gave birth 3 weeks ago. She has been feeling low recently.

Please take history from the patient and address her concerns.

Hello Mrs Lopez. My name is Lucy I am one of the junior doctors in this department.

First of all congratulations for having a baby?

QUESTIONS TO ASK

I gathered from your notes that you are feeling a bit low.

Can you tell me more about your mood?

Are you having this low mood since the birth of your baby?

Was it a planned pregnancy?

Did you see your GP regularly during your pregnancy?

Were there any problems during your Pregnancy?

Was the child birth difficult?

How is your sleep and appetite?

How many children do you have?

How do you feel about your baby?

Do you breast feed the baby?

Whom do you live with?

Are your family and friends supportive?

Do you have any thoughts of harming the baby or yourself? Do you drink at all or take other illicit drugs?

Do you have any other medical illness?

Have you ever seen a psychiatrist before?

Does anyone in your family suffer from mental illness?

Have you ever heard any voices or noises or seen any visions when you were all alone in the

room?


FAMISH

COUNSELLING

Reassure her and tell her to confide in people whom she trusts and seek help from her family and

social services. Tell her to pursue her hobbies.

Keep time for herself.

MANAGEMENT

Counselling

Support groups and social groups

Help lines and crisis lines

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Friends and family

Drugs when needed

D/Ds:

Baby blues

PND Post partum psychosis.

INFORMATION ABOUT PAROXITINE

Mrs willis is a 50 year old lady who has been prescribed paroxetine for depression. Please explain

the medication to the patient and address her concerns.

Paroxetine – this medication belongs to a group of medication called serotonin reuptake inhibitor,

which means it blocks some chemicals in the brain and by so doing it improves the mood of people.

Ask few questions

Is there any chance you could be pregnant?

Are you trying for a baby or breast-feeding?.

Do you have heart, kidney or liver problems?

Do you have epilepsy?

Do you have diabetes?

Do you have glaucoma (increased pressure in your eye)? Do you have a bleeding disorder?

Do you have ever had abnormally 'high' moods?

Have you ever had an allergic reaction to this or to any other medicine?

Have you taken any other form of anti-depressant?

Are you taking any other medicines, including those available to buy without a prescription,

herbal and complementary medicines?

How to take paroxetine

Take paroxetine exactly as your doctor has told you. It is usually taken once each day in the

morning. Take paroxetine with a snack or after eating a meal.

If you are taking paroxetine tablets, swallow them whole with a drink of water. Do not crush

or chew the tablets.

If you are taking paroxetine oral liquid, do not take indigestion remedies for the two hours

before and the two hours after you take the medicine.

Try to take your doses at the same time each day as this will help you to avoid missing any.

If you do forget to take a dose, take it as soon as you remember. If you do not remember until

the following day, skip the missed dose. Do not take two doses together to make up for a

forgotten dose.

Getting the most from your treatment

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You may feel that paroxetine is not working for you straightaway. It can take a week or two

after starting this treatment before the effect begins to build up, and 4-6 weeks before you feel

the full benefit. Do not stop taking it after a week or so, thinking it is not helping.

You are advised not to drink alcohol while you are being treated with paroxetine. Taking

paroxetine and alcohol may increase the chance that you experience side-effects.

Paroxetine may cause your skin to become more sensitive to sunlight than usual. Avoid

strong sunlight and sunbeds until you know how your skin reacts.

If you buy any medicines, check with a pharmacist that they are safe to take with paroxetine.

There are several types of antidepressants and they differ in their possible side-effects. If you

find that paroxetine does not suit you then let your doctor know, as another may be found that

will.

Do not stop taking paroxetine unless your doctor tells you to do so. Stopping treatment

suddenly can cause problems and your doctor will probably want you to reduce your dose

gradually if this is necessary.

While you feel depressed or are taking paroxetine, you may have thoughts about harming

yourself or ending your life. It is very important that you tell your doctor about this if it

happens.

If you are taking paroxetine for depression, you should expect that a normal course oftreatment will last for around six months after your symptoms have eased.

Can paroxetine cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not

everyone experiences them. These usually improve as your body adjusts to the new medicine, but

speak with your doctor or pharmacist if any of the following side-effects continue or become

troublesome.

Common paroxetine side-effects:

These affect around 1 in 10 people

who take this medicine What can I do if I experience this?

Feeling or being sick, diarrhoea Stick to simple foods and drink plenty of water

Sleepiness, dizziness, weaknessIf this happens, do not drive or use tools or

machines

Dry mouth

Try chewing sugar-free gum or sweets

Headache

Ask your pharmacist to recommend a suitable

painkiller. If the headache continues, speak withyour GP

Feeling restless, shaky, nervous, anxious or

agitated

This may happen when you first start taking

paroxetine but usually settles within a few days. If it

becomes troublesome or severe, speak with your GP

Constipation

Try to eat a well-balanced diet containing plenty of

fibre and drink plenty of water

Increased sweating, yawning, blurred vision, If any of these become troublesome, speak with

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Important: if you develop any of the following, contact your doctor straightaway or go to the

accident and emergency department of your local hospital:

Any swelling of the mouth or face.

Any shortness of breath or difficulty swallowing.

An itchy rash.

If you experience any other symptoms which you think may be due to this medicine, speak with your

doctor or pharmacist.

How to store paroxetine

Keep all medicines out of the reach and sight of children.

Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

MENTAL STATE EXAMINATION

1. Apppearance –

1. Apparent age and ethnic origin

2. Style of dress and level of cleanliness

2. Behaviour –

1. Eye contact

2. Rapport

3. Appropriateness of behaviour

4. Level of motor activity

5.

Anxiety levels

difficulty sleeping, abnormal dreams, lack of

appetite, weight changes, sexual difficulties

your doctor

Never take more than the prescribed dose. If you suspect that someone has taken an overdose

of this medicine go to the accident and emergency department of your local hospital at once.

Take the container with you, even if it is empty.

If you are having an operation or dental treatment tell the person carrying out the treatment

which medicines you are taking.

This medicine is for you. Never give it to other people even if their condition appears to be

the same as yours.

Never keep out-of-date or unwanted medicines. Take them to your local pharmacy which will

dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

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Mr. Brown appears to be a gentleman of white origin, 28 years old. He is dressed appropriately and

appears clean. His behaviour is appropriate and he maintains proper eye contact. He developed a

good rapport and his mood is low though he denies it. He has got normal speech volume with good

tone and no flight of ideas. He has got no signs of psychosis, his cognition is intact and he has

insight to the problem. He has no risk of committing suicide.

SUICIDAL RISK ASSESSMENT

Mrs. Williams is a 25 year old lady who has taken 25 tablets of paracetamol following an argument

with her husband. Assess the suicide risk of the patient and discuss management with the examiner.

Hello Mrs. Williams, my name is Johnson I am one of the junior doctors

I need to ask you a few questions, is that alright?

Whatever we discuss is confidential.

1. I understand that you have taken paracetamol tablets and this is why you are here, is that

correct?

2. Can I just confirm again was it paracetamol you took? Did you take anything else apart from

paracetamol?

3. How many tablets did you take?

4. What time did you take it?

5.

Where were you when you took the tablets?

6. Were you alone?

7. Did you plan this?

8. Did you write any notes?

9. What were your intentions when you took these tablets?

10. How long have you had these thoughts of harming yourself?

11. Have you ever tried to harm yourself before?

12. How do you feel now?

13. Are you still having the thoughts of harming yourself?

14.

Do you think you will do this again?

15. Who brought you to the hospital?

16. Did you inform anyone about this?

17. How do you see your future?

18. Do you think you need help with this?

19. Do you hear voices when there is nobody around you?

20. Do you have beliefs which other people disagree with?

21. Do you think other people are putting thoughts in your head?

22. Do have family?

23. Who do you live with?

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NB – if patient regrets about the action and has no thoughts of harming himself then he is a low risk

patient.

Management

Always admit even if low risk

1.

Needs psychiatric assessment

2. Needs medical treatment of paracetamol overdose.

DRUG ABUSE

A 25 year old gentleman with history of drug abuse has come in with an intention to stop using

drugs. Take history and counsel the patient.

Hello my name is Samson, I am one of the junior doctors.

I just wanted to assure you that what all we discuss is confidential.

1. May I know what brings you to hospital?

2. Okay, definitely we can help you with that. Can I ask you a few questions before we proceed?

3. Which recreational drugs have you been using?

4. How long have you been using them for?

5. How do you take them? Do you smoke these drugs or do you inject yourself? If injecting does

he share needles?

6. How often do you use these recreational drugs?

7. How much do you use in a day?

8. Do you do it on your own or do you have friends? If you decide to stop do you think your

friends will support you?

9. What happens if you do not use these drugs for a day or two? Do you experience any

problems? If yes what exactly happens?

10. Have you tried to stop using recreational drugs before?

11. Do you think you have to increase the amount of the drug to achieve the same effect?

12. Do you drink alcohol? How much do you drink?

13. Who do you live with? Do you have a family?

14. Do you have any medical problems? Do you take any regular medications?

15. What do you do for a living?

16. Do you smoke? If yes what do you smoke?

17. Do you experience any stress at home? Or at work? (if he works)

18. Do you hear voices when there is no one around you?

19. Do you have any beliefs which other people do not agree with?

20.

Are you having any thoughts of harming yourself? Have you ever had such thoughts at anypoint in time?

21. How do you see your future?

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22. How are your finances?

23. How did you start using recreational drugs? Was there anything which forced you into it?

24. Do you suffer from low mood?

Counselling

Okay, we have what we call the drug addiction programme and we can put you into the programmeto help you stop.

Our addiction rehab clinic is a friendly warm place where you can successfully stop the use of

recreational drugs and you will have a good experience. They also offer advice about how to handle

life in general after stopping using recreational drugs and you can always remain in contact with

them as long as you want to.

Do not worry about the symptoms people experience when they try to stop we will give you

medication for that and you will not develop any symptoms.

We will also refer you to a support group where you will meet people who have successfully

stopped using recreational drugs and they will share their experience with you.

We will also provide you with our telephone number through which you can contact us if you need

to speak to us.

I know you will be very successful in stopping using recreational drugs but should there be any

problem at any time and you had to use injections to administer these drugs we have what we call

needle exchange programme, in which you can go get needles for free and avoid sharing needles

and therefore avoid risk of infections like HIV and hepatitis.

DRUG ABUSE-PSYCHOSIS

A 25 year old gentleman Mr. Webber has brought in by the police as he was found on the street.

Please assess the patient for drug abuse or dependency.

Hello Mr. Webber

Patient: Police, Police, Police, Police Doctor.

Doctor: my name is Johnson I am one of the doctors here, do not worry Mr. Webber there is no

police here.

I am here to help you.

The police will not come here do not worry.

Nobody will come in here, you are safe here now.

We would like to help you.

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Can you sit down please, so that we can talk?

Patient: Police Doctor Police Doctor!

Doctor: No Mr. Webber there is no police here, they cannot come in here.

We don’t bring police in here.

Here we are friends and we want to help you.

Can I ask you a few questions Mr. Webber?

1. Who brought you here Mr. Webber?

2. Do you know why they have brought you to the hospital?

3. Where did they find you? Were you on the street or at home?

4. Is there any chance you use recreational drugs?

5. Which recreational drugs do you use?

6.

How long have you been using them for?

7. How do you take them? Do you smoke these drugs or do you inject yourself? If injecting

does he shares needles?

8. How often do you use these recreational drugs?

9. How much do you use in a day?

10. Do you do it on your own or do you have friends? If you decide to stop do you think your

friends will support you?

11. What happens if you do not use these drugs for a day or two? Do you experience any

problems? If yes what exactly happens?

12. Have you tried to stop using recreational drugs before?

13. Do you think you have to increase the amount of the drug to achieve the same effect?

14. Do you drink alcohol? How much do you drink?

15. Who do you live with? Do you have a family?

16. Do you have any medical problems? Do you take any regular medications?

17. What do you do for a living?

18. Do you smoke? If yes what do you smoke?

19. Do you experience any stress at home? Or at work? (if he works)

20.

Do you hear voices when there is no one around you?21. Do you have any beliefs which other people do not agree with?

22. Do you think you need help with this?

23. Do have thoughts of harming yourself? Have you ever had thoughts of harming yourself?

24. How are your finances?

Counselling

Do not worry Mr. Webber you are now in safe hands, this is a good chance for you to stop using

recreational drugs. We will help you in every way.

Drugs are not very good Mr. Webber, they will destroy your family, and you cannot sustain work

and basically destroys life.

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Now that you are with us this is a very good chance for you to stop using recreational drugs and get

your life back.

As you can see you are here now, this is what drugs can do. Drugs cannot do anything better than

destroying your life.

As for now we need to examine you and run few tests to make sure you are medically okay.

Psychosis in a calmer person

Mr. Avery is a 50 year old gentleman who has been hearing voices and has been brought to hospital

by his family. Please speak to the patient and address his concerns.

Hello my name is Johnson I am one of the junior doctors. Whatever we discuss is confidential.

I need to ask you a few questions, is that alright?

1. May I know what brings you to the hospital?

2. Do you hear voices when no one is around?

3. Do you think other people are hearing your thoughts?

4. Do you think other people are putting thoughts in your head?

5. Do you think other people are taking out your thoughts

6. Do you have beliefs which other people disagree with?

7. Do your smell strange smells?

8.

Do you see things which other people don’t?

9. Do you think somebody is asking you to do certain things?

10. How long have you had this for?

11. Do you have any medical conditions?

12. Anybody in the family with similar problems?

13. Do you drink alcohol? If yes how much?

14. Is there any chance you use recreational drugs?

15. Do you think you have got a problem?

16. Do you have thoughts of harming yourself? Have you had such thoughts before?

17. Who do you live with?

18. Do you have family? What do they think about you?

Counselling

Okay do not worry Mr. Avery we are here to help you.

We will have to run a few tests, to make sure you are okay.

We will refer you to a specialist called a psychiatrist.

This is not to say that you are mad, this is just to make sure that you are okay.

Do you have any questions?

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Alcohol History

Mr Williams is a known alcohol drinker. Take Hx

C – Cut down

A – Annoyed

G – Guilty of drinking

E – Eye opener

T – Tolerance

W – Withdrawal

C – Have you ever felt that you need to cut down on your drinking?

A – Have you ever got annoyed because other people are concerned of your drinking?

G – Have you ever felt guilty because of the way you drink?

T – Do you feel that you have to increase the amount of alcohol you drink to achieve the same

effect?

W – What happens if you do not drink for a day or two?

PSYCHOSIS

1) Do you have any belief which other people do not agree with?

2) Do you hear voices when there is no one around you?

3) Do you think other people are hearing your thoughts?

4)

Do you think other people are putting thoughts in your mind or they are taking away yourthoughts?

SOCIAL CIRCUMSTANCES

1) Who do you live with?

2) Where do you live?

ALCOHOL Related CONDITION

1) Paracetamol

2)

Liver problems3) Per-rectal bleed

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ALCOHOL COUNCELLING

1) The level of alcohol intake is too much and is very dangerous for your health

2) You can develop serious conditions like:

a. Damage your liver

b.

Bleeding from the blood channels in your stomach → and people die from this

condition

3) If your liver is damaged you can experience things like

a. Low blood sugar levels and die from it.

b. Your brain can get damaged due to toxic substances in your body, since your liver is

not working to prevent this.

4) With the levels you are drinking you cannot build a family properly → your family can break

→ Do you have a family?

5) With the level you are drinking you cannot sustain a job for long time.

6) I strongly recommend that you stop drinking Mr Williams. We have alot of help to offer to

help you quit

a. We have alcohol anonymous group → where you can meet people who also are

trying to quit and people who have successfully stopped drinking.

b. We have medications to help you stop to have the desire to drink.

c. I can refer to these services and you will get a lot of help, so many people have

managed to stop drinking using these services

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