Tiêu đề PSYCHIATRY OSCE ✅

PSYCHIATRY 18Q 2P QUESTION 1 Anxiety 1 A 35 year old woman presented to the clinic with symptoms of palpitation and breathlessness for 2 months. Investigations were done and blood tests, ECG and Chest X Ray are all normal. NO ANSWER SOURCE 1 Elicit anxiety symptoms from this patient. General Inquiry: - Have you been experiencing any feelings of nervousness, tension, or unease recently? - Are there specific situations or circumstances that seem to trigger these symptoms? Physical Symptoms: - Have you noticed any physical signs of anxiety, such as muscle tension, trembling, or restlessness? - Do you often experience a racing heart, sweating, or feeling lightheaded during these episodes? Thoughts and Mental State: - Can you describe what goes through your mind when you experience palpitations or breathlessness? - Have you noticed any racing thoughts, difficulty concentrating, or a sense of impending doom? Sleep Patterns: - How has your sleep been lately? Any difficulties falling asleep or staying asleep? - Do you often wake up feeling restless or fatigued? Behavioral Changes: - Have you made any lifestyle changes recently, such as avoiding certain places or activities due to these symptoms? Mastering Psychiatry Textbook 2016 edition page 77-86
- Are there any changes in your social interactions or relationships that you've noticed? Life Stressors: - Are there any major life events or stressors that you've been dealing with recently, such as work pressures, relationship issues, or financial concerns? - How do you typically cope with stress? Duration and Frequency: - How often do you experience these palpitations and breathlessness? - Have you noticed any patterns or triggers associated with these episodes? Previous Episodes: - Have you had similar experiences in the past? If so, how were they managed? - Did anyone in your family ever experience similar symptoms or have a history of anxiety? Impact on Daily Life: - How are these symptoms affecting your daily life, including work, relationships, and activities you enjoy? - Have you had to make any significant adjustments due to these symptoms? 2 What is the diagnosis? (Depending on the patient's clinical presentation), can be - Panic disorder - Generalized anxiety disorder 3 Medication for this patient 1. Selective Serotonin Reuptake Inhibitors (SSRIs) - sertraline, fluoxetine, and escitalopram (first-line treatment) 2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): - venlafaxine and duloxetine Mastering Psychiatry Textbook 2016 edition page 81
- effective in managing both anxiety and depressive symptoms 3. Benzodiazepines: - Clonazepam, lorazepam, and diazepam are examples of benzodiazepines. - They are fast-acting and can provide rapid relief but are generally prescribed for short-term use due to the risk of dependence. 4. Beta-Blockers: - propranolol can help control physical symptoms of anxiety, such as palpitations and trembling. Anxiety 2 You as a medical student in Psychiatry posting, a 34 years old male clerk part time student complained of recurrent palpitation and worry of getting a heart attack. NO ANSWER SOURCE 1 Enquire the chief complaint - Excessive preoccupation with illness for a minimum of at least 6 months. - Somatic symptoms, if present are mild - Pervasive anxiety about health - Excessive health related behaviors e.g. repeatedly checking for signs of illness - Maladaptive avoidance e.g. avoiding doctors’ appointments and hospitals 2 Educate patient regarding his concern - Reassure the patient - Cognitive therapy - reattribution and developing alternative explanations of concerns of serious illness - cognitive restructuring can modify dysfunctional assumptions - Behaviour therapy - self-monitoring of worries, negative thoughts and illness related behaviours - also involves exposure and response prevention and Mastering psychiatry, 16th edition, pg 198
reducing repeated reassurance-seeking behaviours NOTES Anxiety 3 History taking for a 37 years old male having fear and worry of going outside the house since 8 months ago. NO ANSWER SOURCE 1 History taking Onset and Duration: - When did you first notice these feelings of fear and worry about going outside? - Can you describe how these symptoms have changed or evolved since they started? Triggers and Specific Situations: Mastering Psychiatry Textbook 2016 edition page 77-86