Psychiatry : clinical cases uncovered by Peter Byrne, Nicola Byrne pdf
is the ultimate clinical speciality. No other branch of medicine relies so much on empathic listening skill and the integration of biological, psychological and sociological theory to unravel a patient’s story into a coherent aetiological formulation. Whether you hope to call yourself a psychiatrist or are just passing through, be aware that this is a golden opportunity to acquire competencies that will serve as foundations for your working life (e.g. understanding reactions to illness and adversity, the relationships between physical and mental health, working with ‘difficult’ patients and relatives, and keeping your cool in unpredictable situations).
The focus throughout the book is on developing your clinical reasoning and core competencies up to a standard of passing undergraduate examinations, workplace-based assessments of your early years as a doctor, and beyond. Part 1 is a guide to psychiatric assessment and introduces the range of treatment options, Part 2 is a collection of case studies covering the range of mental disorders, and Part 3 is for self-assessment.
Ultimately, clinical judgement comes from experience, and the more patients you encounter, the more skilled you will become. Some clinical dilemmas have no ‘textbook’ right answer. Medical professionalism is based on working within our shared ethical framework (Box A); whenever the rights and wrongs of a situation are opaque, it can be helpful to return to these first principles to determine your action.
You will get the most from the case studies by stopping to answer every question posed as the responsible doctor. The cases vary in complexity, beginning with easier ones. An index of cases by diagnosis is provided on p. 223 – useful for revision or if you want to select a case for peer group learning or tutorials. All cases are amalgams of patients and situations we have come across, and none describe identifiable individuals.
In relation to diagnoses, we have used the World Health Organization’s categorization of mental disorder, the ICD-10 (International Classification of Diseases).
The terms here are used to describe disorders, not people: people with borderline personality disorders or schizophrenia are not ‘borderlines’ or ‘schizophrenics’.
Diagnoses do not define identity, and they need to be used sensitively in mental health.
We have both been lucky enough to learn through great clinicians we have been taught by and worked with, and from the generosity of our patients. None of us can fully understand what something is like until we experience it ourselves, and first-hand accounts of mental disorders that we have found valuable are listed in Further reading below.
You will not need them to pass exams, but they are worth reading to balance your clinical experience and reading with the realities of mental illness and its consequences.
Peter and Nicola Byrne
The duties of a doctor
Patients must be able to trust doctors with their lives and health . To justify that trust you must show respect for human life and you must:
• Make the care of your patient your first concern
• Protect and promote the health of patients and the public
• Provide a good standard of practice and care
• Keep your professional knowledge and skills up to date
• Recognize and work within the limits of your competence
• Work with colleagues in the ways that best serve patients’ interests
• Treat patients as individuals and respect their dignity
• Treat patients politely and considerately
• Respect patients right to confidentiality
• Work in partnership with patients
• Listen to patients and respond to their concerns and preferences
• Give patients the information they want or need in a way they can understand
• Respect patients’ right to reach decisions with you about their treatment and care
• Support patients in caring for themselves to improve and maintain their health
• Be honest and open and act with integrity
• Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
• Never discriminate unfairly against patients or colleagues
• Never abuse your patients’ trust in you or the public’s trust in the profession
You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.
How to use this book
Basics, 1 Approach to the patient
Mental health treatments
(Part 2) Cases
Case 1 A 20-year-old student who collapses in the supermarket
Case 2 A 47-year-old woman who lives in fear that God will punish her
Case 3 An 18-year-old college drop-out gets an eviction order from his parents
Case 4 An 18-year-old trainee chef who cannot go to work
Case 5 Sudden deterioration of a 78-year-old woman in a nursing home
Case 6 A 72-year-old woman with antisocial behaviour
Case 7 A 64-year-old retired teacher’s depression is getting worse
Case 8 A 17-year-old man has been cutting his arms
Case 9 A 9-year-old disruptive child faces expulsion from school
Case 10 A 48-year-old security guard with new symptoms every day
Case 11 A 28-year-old man has been arrested at the airport
Case 12 A 24-year-old new mother in distress
Case 13 A 15-year-old head prefect with pneumonia is behaving secretly
Case 14 Insomnia in a 26-year-old successful City man
Case 15 A 15-year-old child assaults his foster mother
Case 16 A 42-year-old woman insists she is pregnant
Case 17 The wife of a 66-year-old GP with Parkinson’s disease is worried about him
Case 18 Complete loss of memory in a fit middle-aged man
Case 19 A 32-year-old woman puts her GP under pressure
Case 20 The 21-year-old critical medical student, 182
Case 21 A 24-year-old legal secretary with depressed mood and suicidal thoughts
Case 22 A 41-year-old woman with epilepsy develops a different pattern of fits
( Part 3) Self-assessment
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