AHMED ELAGHOURY Egyptian & Arab Boards in Psychiatry Abbassia Hospital for Mental Health, MOH Cairo, Egypt
Jul 12, 2015
AHMED ELAGHOURYEgyptian & Arab Boards in Psychiatry
Abbassia Hospital for Mental Health, MOH
Cairo, Egypt
Psychiatry started as “inpatient” practice egKraepelin, Khalboum, Bleuler
Basic residency tasksNot available in many mental health facilities
in EgyptStill current practice is affected by “mind-
body” dualism, so psychiatrists may work inpoor-facility hospitals deprived from othermedical services / coverage ie depend ontheir skills in inpatient care
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1. Admission process
2. Working DD
3. Initial assessments / orders
4. Management plan
5. Followup / Progress notes
6. Psychopharmacology
7. Discharge plan / arrangement
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Type of admission according to Egyptian
MHA
Source / Through
Supervisor psychiatrist: responsible
Accurate record of date and time with clear
physician name
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
Phenomenology
Age of onset
OCD: onset, course, duration
Risk factors: 3Ps
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Byrne P & Byrne N: Psychiatry : clinical cases uncovered. 2008, Wiley-Blackwell
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ICD 10 symptom checklist, WHO 1994
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc
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All admitted pt to mental health hospitals should be assessed by:• Security / Nurse aide / Nurse
• Internal medicine
• Clinical psychology
• Social worker
Neuro exam: • Cognitive
• Gait
• Motor
• CNs: (2, 3, 4 , 6), 7, (9, 10, 11)
• DTRs: bi, tri, ankle, knee / Superficial: plantar
• Coordination
• Stretch signs
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Initial orders regards:• Vital signs
• Diet: regular / diabetic / cardiac / easy to chew &
swallow
• Elimination: stool & urine
Activity: with help / walking stick etc
Precautions against: Fall / Aspiration /
Seizures / VTE
ECG / Labs / Imaging
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Avoid crystalloids without I / O monitor
Avoid D5W without thiamine
PRN medications: as needed
STAT medications: you must attend
qHS medications: at bedtime
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Do NOT give conflicting order ( 2 connected orders in same phrase) eg• PRN Chlorpromazine 50mg IM if BP ≥ 90 / 60
• Monitor pt meals, except when sedated / confused
• [ - PRN Chlorpromazine 50mg IM – Notify if BP ≤ 90 / 60 ]
• [ - PRN haloperidol 10 IM – Do NOT exceed 50mg / d]
• [ - Notify if RBG ≥ 200 mg / dl]
• [-Monitor pt meals –Notify if pt is oversedated –Notify if meals are left as same]
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CBC, LFT, KFT, Chemistry, TFT
PRL
Vit D3 & B12
Hepatitis viral markers / HIV
Tumor markers
Immune profile
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Quick LabRef app. Nika Informatics, 2014
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Acute / Short term
Long term
Durations
Scales / outcome measures
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MSE is a part of followup note
Nurse’s observation
Ward behaviors toward staff / other pts
Side effects of medications
Trace initial target symptoms
Examples & discussion
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Oral
Parenteral: IM, IV
Enteral: NGT, G tube, PR
Inhalational
Sublingual
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Who?• Recently admitted without proper data regards
previous mental / medical / drug Hx
• Pt in other health facilities
• Drug naïve pt
What to do?• Avoid depot inj at start
• Avoid frequent daily dosing
• Avoid high doses
• Start low & go slow
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Poor Compliance is main indication
Start during inpatient stay: at least 2 wks
before discharge
Oral first
Challenge doses
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Try know cause: psychotic / notContainment & calming downFollow predetermined protocol: drugs & how
to after monitor?Eg Haloperidol , Olanzapine, Zuclopentixol injEg BZD injTry avoid IV inj esp in poor facility hospitals Keep alert to oversedation: dehydration,
hypoglycemia, aspiration, constipation etc
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Discharge summary
Final diagnosis
Drug treatment
OPD appointments
Special precautions to pt / family
Rehab arrangements
Keep contacts of critical pts, esp in poor-
record systems
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