Psychiatry

Abstract

This chapter covers all major psychiatric presentations and how to take a psychiatric history and from this, make a formulation detailing predisposing, precipitating, perpetuating, and protective factors for the patient with a psychiatric problem. The chapter also describes the mental state examination. The chapter identifies the multidisciplinary team that students will encounter on a psychiatry placement, including community psychiatric nurses, occupational therapists, and psychologists. The chapter opens with a summary of the UK Mental Health Act and the principles underlying capacity and the assessment of capacity. The chapter analyses psychosis, describing both hallucinations and delusions, and links these to both organic causes (e.g. a brain tumour, alcohol misuse, central nervous system infection, autoimmune conditions) and psychiatric disorders (schizophrenia, bipolar disorder, and drug-induced psychosis). Schizophrenia is discussed in detail, including Schneider’s first-rank symptoms (e.g. auditory hallucinations), and first- and second-generation antipsychotic drugs are described, including their side effects. Bipolar affective disorder is described, including acute management of acute mania. Depression is also covered, including Beck’s triad of helplessness, hopelessness, and feelings of worthlessness, and further breaking these down into biological and psychological features. Indications for antidepressant medication and electroconvulsive therapy and their side effects are discussed. Emotionally unstable borderline personality disorder, obsessive–compulsive disorder, eating disorders, and anxiety disorders are also explored.