Makindo Medical Notes

Related Subjects: |Introduction to Psychiatry and Assessments |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Panic Disorder |Acute Psychosis |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Post-Traumatic Stress Disorder (PTSD)

🧠 Introduction

• Psychiatry is the medical specialty focused on diagnosis, treatment, and prevention of mental, emotional, and behavioural disorders.
• Unlike many specialties, psychiatric conditions may lack clear physical signs but profoundly impact quality of life, functioning, and relationships.
• Effective psychiatry requires a blend of medical knowledge, empathy, and communication skills.
• It integrates the biopsychosocial model – biological, psychological, and social factors all influence mental health.
• For medical students, learning the foundations provides the basis for advanced study and clinical practice.

💡 Note: Each disorder has unique diagnostic criteria, symptoms, and management strategies essential for effective care.

📌 Key Psychiatric Conditions

• 😔 Depression: Persistent low mood, loss of interest, functional impairment (major depression, dysthymia).
• ⚡ Bipolar Disorder: Cycles of mania/hypomania and depression affecting mood, energy, and activity.
• 🌀 Schizophrenia: Hallucinations, delusions, disorganized thought/behaviour.
• 😰 Generalized Anxiety Disorder (GAD): Excessive, uncontrollable worry.
• ⚠️ Panic Disorder: Recurrent, intense fear episodes ± physical symptoms.
• 🔄 Obsessive-Compulsive Disorder (OCD): Intrusive thoughts + compulsive behaviours.
• 🎖️ PTSD: Trauma-related re-experiencing, avoidance, hyperarousal.
• 🧩 Personality Disorders: Enduring maladaptive patterns (borderline, antisocial, narcissistic).
• 🥗 Eating Disorders: Anorexia nervosa, bulimia nervosa – affect weight, health, self-perception.
• 🍷 Substance Use Disorders: Alcohol/drug misuse with social, physical, and psychological impact.
• ⚡ ADHD: Neurodevelopmental, with inattention, hyperactivity, impulsivity.

📖 Studying these conditions builds understanding of the diversity of mental illness and prepares students for effective clinical care.

🧾 Psychiatric Assessment: History & Identification

A structured, empathetic approach improves diagnostic accuracy and patient trust.

• Basic Information: Age, gender, occupation, presenting complaint.
• Referral Source: Self, family, GP, or other professionals.

🗣️ Presenting Complaint & HPI

• Main Concern: Patient’s own words (open-ended).
• Duration & Course: Onset, frequency, progression.
• Triggers: Trauma, stress, substance use.
• Functional Impact: Work, relationships, daily life.

📜 Past Psychiatric History

• Previous diagnoses & treatments.
• Hospitalisations & admissions.
• Medication history – efficacy, compliance, side effects.
• Therapies (CBT, DBT, counselling) and outcomes.

👨‍👩‍👧 Family History

• Mental illness in relatives (e.g. depression, bipolar, schizophrenia).
• Substance misuse or genetic risk factors.

⚕️ Medical History

• Relevant medical conditions (e.g. epilepsy, hypothyroidism).
• Medication review – consider psychiatric side effects.
• Substance use: alcohol, drugs, prescriptions.

🏠 Social & Personal History

• Childhood & early trauma.
• Education & employment history.
• Living arrangements & financial stability.
• Relationships, support systems.
• Hobbies, interests, recent changes.

🔍 Mental State Examination (MSE)

• Appearance: Grooming, hygiene, posture.
• Behaviour: Eye contact, cooperation, psychomotor activity.
• Speech: Rate, volume, coherence.
• Mood & Affect: Subjective vs observed, congruence.
• Thought Process: Flow, organisation (tangential, blocked, pressured).
• Thought Content: Delusions, obsessions, suicidal thoughts.
• Perception: Hallucinations (auditory/visual), illusions.
• Cognition: Orientation, memory, attention, abstraction.
• Insight & Judgment: Illness awareness, decision-making ability.

⚠️ Risk Assessment

• 💭 Suicidal ideation: Thoughts, plans, means, intent.
• 🔪 Homicidal ideation: Harm to others, paranoia, delusions.
• ✂️ Self-harm: History, frequency, triggers.
• 🍷 Substance abuse: Pattern, withdrawal, risks.
• 🛡️ Protective factors: Family, beliefs, goals, social support.

🛠️ Formulation & Management Plan

• Diagnosis: Working and differential diagnoses.
• Treatment: Medications, therapy, social interventions.
• Follow-Up: Regular reviews, referrals, care coordination.
• Safety Plan: Coping strategies, support contacts, emergency resources.

🗂️ Documentation

• Comprehensive Records: Include findings, clinical reasoning, risk notes.
• Continuity of Care: Ensure clarity for team handover.
• Legal/Ethical: Maintain confidentiality, compliance with GMC/ethical guidelines.