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Harniess 01
- 1. Importance of Physical Examination in Mental Health Assessment Dr D A Harniess MBChB MRCGP DCH DRCOG
- 10. What different physical examinations would you consider in someone presenting with anxiety symptoms? depressive symptoms? psychotic symptoms? manic symptoms?
- 14. Signs of Cushing’s Disease
- 15. Signs of Addison’s Disease
- 17. A 73 year old lady comes to you concerned she has a tremor that goes away when she starts eating and is worse when she is under stress and worry. Her husband has also noticed she seems to have difficulty getting out of a chair and feels she has been more withdrawn recently. What is your differential diagnoses? What is the likely diagnosis in this lady’s case? How would you tailor your neurological examination to check for this condition? Case Scenario – an anxious old lady?
- 24. Cardiovascular Risk Factors and Schizophrenia 1 Davidson et al. Aust NZ J Psychiatry. 2001;35:196–202 ; 2 Herran et al. Schizophr Res. 2000;4:373–381 ; 3 Dixon et al. Schizophr Bull. 2000;26:903–912; 4 Kato et al. Prim Care Companion J Clin Psychiatry. 2005;7:115–118 Non-modifiable risk factors Modifiable risk factors Prevalence in schizophrenia Gender Obesity 1 30–40% (1.5–2 ×) Family history Smoking 2 50–80% (2–3 ×) Personal history Diabetes 3 11–15% (2 ×) Age Hypertension 4 58% Ethnicity Dyslipidaemia 4 45%
- 25. Prevalence of Obesity is Increased in Schizophrenia BMI = Body Mass Index Allison et al. J Clin Psychiatry . 1999;60:215–220 Normal weight Overweight Obese 0 5 10 15 20 25 30 BMI category Schizophrenia No schizophrenia <20 20 – 22 >22 – 25 >24 – 26 >26 – 28 >28 – 30 >30 – 33 >33 – 35 >35 Percentage
- 26. Prevalence of Diabetes in Schizophrenia vs. General Population Prevalence (%) 25–35 15–35 35–45 45–55 55–65 Age range (years) De Hert et al. Clin Pract Epidemiol Mental Health. 2006;2:14 n=415 patients with schizophrenia
- 27. What do you think should go into a annual health check with someone with severe mental illness?
Hinweis der Redaktion
- Utube clip temporal epilepsy?
- ?UTUBE clip Check for tremor Inspection of facial expression – loss of movement, lack of expression Gait – difficulty with initiation, shuffling stooped gait, loss of arm swing, difficulty turning around – moving around like a statue Cog wheel rigidity What are the positive signs diagnostic?? – check NICE guidelines
- General rules on record keeping GMC guidance Verbal Scenario – written recording of clinical encounter – discuss with friend? SOAP acronym Positive and negative findings Show evidence of discriminatory (hypothetic-deductive) thinking Medicolegal back up Continuation of medical treatment – can a colleague follow up on this patient from your records? Examples of good and poor documentation ?MDU/MDDUS
- Screening qu’s with chronic disease – would they bring it up example of cancer on oncology ward
- Screening qu’s with chronic disease – would they bring it up example of cancer on oncology ward
- A prospective study focusing on metabolic disturbances in patients with schizophrenia, including an oral glucose tolerance test indicated that metabolic abnormalities are already present in first-episode patients, and considerably increased with increasing duration of illness. When compared to the general population matched for age and gender, much higher rates of the metabolic syndrome (MetS) and diabetes were observed for patients with schizophrenia. For MetS, the increase over time was similar to that of the general population. In contrast, the difference in the prevalence of diabetes in patients with schizophrenia and the general population dramatically and linearly increased from 1.6% in the 15-25 age-band to 19.2% in the 55-65 age-band. The data suggest that on the one hand metabolic abnormalities are an inherent part of schizophrenic illness, as they are already present in first-episode patients. On the other hand, however, the results suggest a direct effect of the illness and/or antipsychotic medication on their occurrence. The data underscore the need for screening for metabolic abnormalities in patients diagnosed with schizophrenia, already starting from the onset of the illness.