The Practical Handbook Of Psychiatry

By Ishaan Gosai

The practical handbook of psychiatry has been written, by 'everyday, jobbing psychiatrists' passionate about education.

This crucial handbook is a practical guide, explaining concepts and specifically designed to make complex concepts understandable and easily digestible by anyone wishing to know more.

Inside you will discover approaches:
-Assessing the suicidal patient
-How to assess and manage the violent patient
-Assessing and managing Insomnia, depression, bipolar affective disorder, substance misuse, Attention Deficit Hyperactivity Disorder (ADHD)
-The Mental State Examination
-And much, much more

This essential handbook brims with simple, practical, assessment approaches and criteria, management plans and pragmatic clinical algorithms. These have proved, internationally, to be exceptionally useful to medical students taking exams, junior psychiatric trainees, primary care physicians, nurse practitioners, counselors, psychologists and interested others. For this purpose it has been kept focused, concise, and as jargon-free as possible.

Feedback includes:

“... an absolute godsend. ...clear, concise and filled with such a practical, easy-to-understand approach to common psychiatric conditions, ...became my best friend.
Because it is written by consultants, but explained in a way that the average person and medical students can easily understand, it helped me answer many of the questions that I considered important, and I finally understood the concepts that are important in psychiatry.
Not only that, but the authors welcome feedback - for the next version they say. I particularly enjoyed reading the sections on insomnia - which I always have before any stressful activity.”

“A tour de force by Dr Gosai! ... ideal companion for a medical student or junior doctor wanting to learn the basics of psychiatry. It simplifies the very complicated topic of psychiatry, and makes it accessible for people... searching for a practical opening into the subject. It is equally good for those who have previously studied the subject matter, but are looking to refresh their memory on the topic.
The narrative style is exceptionally readable...very engaging and indeed entertaining. The photographic illustrations are also a bonus!”

“This book is exactly what it says, it is 'a practical handbook of psychiatry'. A perfect book for mental health practitioners, students, or anyone with an interest in Psychiatry. ... offers a very readable, ‘back to basics’ understanding of psychiatric conditions, treatments and that, ‘need to know knowledge’. ... easy to read, ‘real-world’ book, which quickly becomes a ‘the book to go to’ when those questions arise about, the ‘do's and don’ts of psychiatry’. It isn't at all stuffy or pretentious and doesn't pretend to be any more than it is; ‘a must read’ – I believe the author is about to bring out new UK edition – definitely worth a look.”

“As someone who's not medical practitioner,... this book does a good job of describing different psychiatric issues to me. It's handy in that it's nicely sized and well laid out for an easy read - searching for a particular disorder is a breeze and sample case scenarios help with the mental digestion of the stuff in this book. Clear, easy to understand, most definitely helpful.”

“As a 3rd year nursing student I can definitely recommend this book it's a easy read and is exactly what is says on the tin great little handy guide for any nursing student”

“As a medical student beginning to study psychiatry, I have come across no other book which delivers learning in such a clear and concise manner. Would definitely recommend!”

If you wish to learn (simply) what Consultants look for when assessing cases, this is possibly one of the easiest guides out there that will help you unlock the secrets of Psychiatry.

• Language: English
• Publisher: Ishaan Gosai
• Release date: Jan 29, 2020
• ISBN: 9780463695722

Book preview

For my mum and dad, Neelie and Caps Gosai, who showed me the box, then taught me how to think outside it;

And for my late Grandmother, who taught me that a curious spirit often earned one a spanking, and that spankings should never stop one from being curious.

Dr Ishaan Gosai

This work is for my mum, Cheong Pak Foong, who opened our eyes to the world, although she left it too soon;

My dad, Chua Hai Siang, who selflessly loves and protects;

And my brother John, who has brightened our lives ever since his very first moment.

Dr Chua Tze-Ern

I would like to dedicate this book to my late mother, Mary Alias, who taught me to be compassionate, tolerant and affectionate.

Dr Lijo Alias

Acknowledgment

We would like to acknowledge the invaluable input of Owen Lam. We have always told you we know what you’re worth, and we do.

Contents

Introduction

Dedications

Acknowledgment

Psychiatric assessment

Chapter 1 - The psychiatric history

Chapter 2 - Mental state examination

Chapter 3 - Physical examination

Chapter 4 - Investigations

Clinical presentations

Chapter 5 - Insomnia

Chapter 6 - Depression

Chapter 7 - Bereavement/grief

Chapter 8 - Bipolar disorder

Chapter 9 - Anxiety disorders

Chapter 10 - Psychosis

Chapter 11 - Substance misuse

Chapter 12 - Attention-deficit/hyperactivity disorder

Chapter 13 - Dementia

Chapter 14 - Delirium

Psychiatric emergencies

Chapter 15 - The suicidal patient

Chapter 16 - The violent patient

Chapter 17 - Neuroleptic malignant syndrome

Chapter 18 - Serotonin syndrome

Special issues

Chapter 19 - Confidentiality

Chapter 20 - Mental capacity

Chapter 21 - Perinatal patients

Psychiatric referrals

Chapter 22 - The psychiatric referral

Chapter 23 - Local psychiatric services

References

About the authors

Introduction

Welcome!

This handbook is the brainchild of Dr Ishaan Gosai (me!) and Dr Chua Tze-Ern, with assistance from Dr Lijo Alias.

As a hospital-based psychiatrist and consultant, I have received referrals from house officers, medical officers, the odd registrar, consultants and general practitioners. My responses have varied from pleased surprise to abject dismay, depending on the level of understanding and common sense shown in said referrals. I started thinking that maybe there wasn’t all that much information pertaining to psychiatric practice available to my non-psychiatric colleagues. Trouble is, not knowing the psych stuff does nothing to prevent psych stuff from actually cropping up in non-psych settings.

That’s where this handbook comes in.

In its pages, you’ll be provided with all the basic information you need to assess, manage, and refer patients associated with this most obscure discipline. They are a mixed bag and often need handling in ways different from the usual medical patient. What’s more, because it was written by people who like doing this for a living, you’ll find usable tips on communicating with these patients in a safe, effective and compassionate manner. Also, because it was written by fellow colleagues who are intimately familiar with the mad rush that clinical practice can be, you’ll find mainly the common needful things, presented in sensible, easy-to-read format.

You may think that psychiatrists are as mad as their patients (yes, we’re all a bit eccentric), or that it’s practically impossible to differentiate one lot from the other (we don’t wear uniforms and that mistake has been made before), but we really do tend to enjoy our work. Not many other specialties give us time with patients whose stories teach us this much about medicine and human nature and, well, life.

Join the ride. Read our book. We think it’s pretty good (but of course we’d say that, wouldn’t we?).

Happy Psychiatry Experience!

Dr Ishaan Gosai

MBBCh, MRCPsych, BSc (Hons) Addictions

Consultant Psychiatrist

Psychiatric assessment

Chapter 1.

The psychiatric history

First things first – keep safe.

- If the patient feels threatening, trust your instinct and avoid seeing them alone (refer to chapter 16 on managing violent patients)

- Keep your path to the door unblocked

- Position yourself where the patient cannot easily corner you

- Be the person sitting nearest the door

- If there is a help-summoning alarm in the room, be sure to know where it is and how to use it

In most cases, though, patients do want to seek help and are able to cooperate in providing a history.

A psychiatric assessment is somewhat different from a medical or surgical assessment. It may feel awkward asking about a patient’s emotions. Here are some pointers that may help to ease you in.

- Consider scheduling about half an hour for the interview

- Being systematic will help you cover the bases

- Speak clearly, calmly and non-judgementally, especially for difficult questions

- Simply talking about their emotions may give patients some relief and perspective

- Do keep a box of tissues nearby

These are the basic components of a psychiatric history:

1. General information:

a. Patient’s name, age and marital status

b. Are they employed? If not, why not?

c. Do they have family, and are they in a relationship?

d. Who referred them to see you and why?

2. Presenting complaint (please refer to the chapters on specific diagnoses for more details on what symptoms to assess):

a. What symptoms has the patient noticed?

b. When did these symptoms start occurring?

c. Have these symptoms occurred before? If yes, when?

d. What life events occurred at or around the same time?

e. To what does the patient attribute their symptoms?

3. Current risks at this time (refer to chapter 15 on managing suicidal patients):

a. Why are family/people in the community concerned?

4. Past psychiatric history:

a. What psychiatric diagnoses does the patient have?

b. Who is treating the patient for these illnesses?

c. List episodes of psychiatric inpatient and outpatient care, and episodes of symptoms for which no treatment was