What are some of the skills required when interviewing patients? What information is required when taking a patient history or completing a mental state examination? These are just some of the questions you'll seek answers to as you work through the course material. Mental health is an important public issue across the world, and the role of the psychiatrist is crucial in helping to address these. This course aims to give you a more nuanced understanding of the role of a psychiatrist, developing clinical skills and therapeutic relationships. Understanding the impact of mental illness in society and ethics in medicine are some of the key themes central to this course. This course is designed to provide essential background knowledge and practical skills that apply to any mental health clinical setting.
Case Study - Psychosis
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Do curso por The University of Melbourne
Foundations of International Psychiatry
17 classificações
Na lição
The Biopsychosocial Model
Now that you are familiar with the Mental State Examination, you will be required to write and submit your second peer reviewed assignment for this course - documenting a mental state examination.
Later this week, we'll take a closer look at 'the biopsychosocial model' - a framework for integrating different aspects of the patient’s life into a wholistic understanding of their mental illness. In this module, you will learn about the model, and apply it to a clinical scenario.
Conheça os instrutores
Greg ShieldsDr.
Department of Psychiatry
Mahesh JayaramDr
Department of Psychiatry
[MUSIC]
Hi, Eddie, my name's Greg Shields, I'm one of the psychiatrists here.
I've been talking to your nurse and
she says she's a little bit concerned about you.
She's brought you in to speak to me today, so thank you for coming in.
>> Is she still here?
>> Yeah, she's just waiting outside.
How are you feeling at the moment?
Looks like you're struggling a little bit.
>> Yeah, a little bit, >> Is there something
that you're worried about at the moment?
>> There's a lot of people out there,
just kind of a hell of a lot of people outside, just don't like it.
>> Okay, you're feeling bit unsafe?
>> Yeah.
>> Look you're quite safe in here
at the moment.
>> Okay.
>> What is it that's maybe making you feel like this recently?
>> Just the things that people are saying, just the things that I can hear.
>> Okay, okay, how long's that been going on for?
>> A while, a while, about six weeks now, maybe more.
>> Okay, you started to hear things?
>> Yeah.
>> What sort of things are you hearing at the moment?
>> Just people saying stuff to me.
People telling me that I'm not good,
I'm worthless, I'm ugly, I'm a bad person,
just horrible feelings.
>> Okay, that's awful.
How often are you hearing that?
>> A lot.
A lot.
>> Okay, are you hearing that at the moment?
>> And I hear lots of things right now.
I just don't, I just want to shut down.
I don't want to hear it anymore.
>> Okay, have you ever heard things like this before?
>> Sometimes yeah.
I've heard it for a while now.
>> Okay, has it ever been this bad before?
>> Not as bad as it is now, no,
it's the worst it's ever been.
>> It's the worst it's ever been
and you said it's been the last six weeks or so.
Okay, has anything been stressing you out or worrying you,
that might have made them worse recently?
You say that you heard them before, but it wasn't quite as bad as this.
How did you manage it before?
>> I had to take medication for it.
The voices would just get really bad, and they wanted me to hurt myself.
Yeah, yeah.
>> You took some medication,
do you remember what you took?
>> It started with O >> Alanzopine?
>> Yeah, that's it, alanzopine, but I didn't like it, I didn't like it,
it made me sleepy and it didn't make me feel good, I couldn't do anything and I didn't like it.
So I got put on something different and I want to say A, Allentropy.
>> Is it Aripiprazole?
>> Yeah, yeah, yeah.
And I haven't taken it for awhile but that's the one they gave me to take.
>> Okay, when did you stop taking it?
>> A while back, my aunty came over from Nigeria and she was asking me
how I was feeling and she looked at the tablets and was like,
you don't need to take that, and I agree, I was feeling better.
>> Okay >> So I stopped taking them.
>> How long ago was that? >> About six, eight, six, weeks ago,
maybe a little bit more.
>> Okay, and since that time things have got a little bit worse for you.
>> Yeah. >> Okay,
and you taking any medication at the moment?
>> No.
>> No, okay.
And you said that they're saying nasty things to you.
>> Yeah.
>> They saying anything else?
>> That I shouldn't be here anymore and
then they're commenting on everything.
They're just being mean all the time, just mean.
>> So they're commenting on what things that you're doing?
>> Yeah.
>> So is it always in a nasty way?
>> Yeah, always.
>> So they talk to each other about you?
>> Sometimes I can hear them, it's my neighbours, I know it's them.
>> Okay >> I can hear them, because they're together,
and it's the two of them.
I could tell you what they look like, I could draw a picture, so if you see them,
if they come here you know it's them
because it's always them that is trying to get me, they want to hurt me, its them.
>> Okay,
how do you know it's your neighbours?
>> Because, when I'm in my house I can hear them, and
then I listen to the wall and then it will go quiet
and then as I move away, it gets louder again
because they know I can hear them, they know I'm working it out.
>> Okay, and when you're here are you hearing the voices as well?
>> Not so much now, but I know if I go out there I'm going to hear it again because I
know they're going to be out there.
>> Okay, so you're not hearing them at all now or just less?
>> No I can hear a little bit it's just not as loud.
>> Okay, who do you think might be talking to you now then?
>> No.
>> Is it your neighbors still?
>> I think they're behind it all, I don't know if it's just them or
if they got other people involved.
I don't know.
>> Why do you think they'd want to do that to you?
>> I don't know. I tried to find out.
I knocked on their door.
I was banging on it and it just wouldn't open.
>> Okay, do you know your neighbours at all?
How many people live there?
>> I think two.
Maybe it's two.
I think it's a man and a woman.
I've seen them, but there may be other people in there.
I don't know.
because I've not really been inside.
I tried to go inside.
>> And what would you do if you got inside?
>> I'd tell them to stop, I'd say leave me alone.
>> Okay, do you sometimes talk back to the voices?
What happens if you do that?
>> Sometimes it goes quiet for a minute.
Sometimes they laugh.
>> Okay, is there anything you can do to make it better?
>> No, I've tried to prevent it.
It don't work.
>> And you said you banged on the neighbour's door?
>> Yeah. >> Was that just the one time?
>> A couple of times but they never open the door.
>> Okay, have you ever seen them out and about?
>> Sometimes I've looked through the window and I've seen them
and then I've tried to go down and then they've gone
but I don't want to leave my house anymore.
>> Okay, and other than sort of telling them to stop,
is there anything else that you've thought of doing?
>> I wish I could, I just don't know how I'd make them stop.
I just want to stop them but I can't.
>> Okay, do you think it would ever get to point of trying to hurt them in any way?
>> No, I'd want to, but I can't
I'm too scared.
>> Okay, have you ever hurt anybody in the past at all?
>> Never, never.
>> And you said the voices tell you to do things,
do they ever tell you to hurt yourself?
They do?
Okay, have you ever tried to hurt yourself in any way?
>> Yeah once.
The voices told me that I had to kill myself
saying that I was useless,
that I shouldn't be here anymore.
And they told me to get the knife and do it and it's easy and you can do it.
And I put a knife to my arm and I just I couldn't do it
and then the voices laughed and they said I was weak, and I can't even kill myself.
And I couldn't even do something that was so easy, and then.
Now they're even worse because they want me to kill myself.
And they're like, my pills are there, and they're just telling me to
take them all the time, just take them all, just take them, and I can't.
>> Okay, so it sounds like that's not something you want to do.
>> But I feel I have to do it, I feel like I should do it
because maybe they're right, maybe I am worthless,
maybe I should go and no one will miss me, no one will care.
>> How do you think you've been able to resist doing what they're telling you?
>> I don't know, I don't know.
It's hard because sometimes the voices just stop for a minute and then I try and
watch a film or something, or try and stop myself from hearing them
but then they come back and I think it's because of fear.
>> Yeah, sounds awful.
Do you worry that other people are trying to hurt you in any way?
>> I've just been protecting myself from everybody.
>> Okay, does it feel like other people are talking about you when you're out of
the house at all?
So anyone in particular?
>> No it's just everyone out there, there's people just talking about me all the time.
>> So even now, it feels like people are talking about you?
>> Yeah. >> Okay,
how about when you watch television?
Does that ever feel like they're talking about you or talking to you at all?
>> No, I can't concentrate, if I'm trying to watch something I can't because then
the voices just, it's like they just get louder.
They don't want me to watch anything.
>> Okay, and do you ever get the sense that people can hear what you're thinking?
Or they know what you're thinking?
>> No, I don't, no, no.
>> What about a feeling that people are sort of playing with your thoughts.
So they've put thoughts in your head or can take them out of your head.
>> Yeah, I think that,
I think that they can put them in.
Like, the idea to kill myself wasn't mine.
I didn't have that idea,
I didn't want it.
And I don't want to take the pills, but
that's what they're telling me is the right thing to do.
>> Do you feel like you're being controlled at all?
In what way?
>> because I can't leave my house anymore.
>> Okay.
>> They've stopped me, I can't.
I can't eat, I can't do anything.
>> Okay, so you're not eating at the moment.
Do you get hungry at all?
Why is it you can't eat?
>> Because I can't go out.
I can't go and get the food because I'm scared.
>> Okay.
>> It's silly, I know, but I am.
>> Well no, it sounds like it's been really troubling you.
Have you lost any weight at all?
>> I can't fit in my jeans anymore.
I've gotta wear my jogging bottoms and my tracksuits because nothing else fits.
>> And is that just the last couple of months or
has it been a bit longer than that?
>> It's been full on, the last six, seven weeks.
Before that I weren't eating much, but I was eating more than I was now.
>> Okay, and before that would you go out and see people?
>> Yeah, yeah.
>> Okay, so this is a big change for you.
How about sleep?
Not so good.
How many hours sleep do you get a night?
>> Some nights two, three hours.
>> Okay, if we went back a couple of months,
what would a normal night's sleep be like for you?
>> I think about eight hours, I sleep right through.
>> Okay, how's your energy at the moment?
>> It is low.
I don't want to do anything.
I haven't got the energy to do anything and
I don't want to do it anyway so I just sit at my house.
>> How do you spend your days at the moment?
>> If I do sleep, when I wake up I just wait and
then the voices start straightaway
and then I try and watch something to get rid of them
and then I can't because the voices get louder.
And then I walk around and then I'm seeing if I can see the neighbours outside,
I'm seeing if I can see anyone coming to get me.
And then I just I can't do anything.
I just spend my days just in my room,
just walking around just trying to get rid of these voices.
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