Lesson 2.8 : Psychiatric Framework and Consultation Stations

Module 2: The Consultation Toolkit

Lesson 2.8: Psychiatric Framework and Consultation Stations

Psychiatric history-taking and consultation stations both require structural adaptation. This lesson covers both.

Onset, duration, and progression of current symptoms.
Impact on function: sleep, appetite, work, relationships, daily activities.
Psychiatric history: previous episodes, admissions, psychiatric team or CMHT, what has helped before.
Premorbid personality: "How would you describe yourself before all of this started?"

Domain	What to Observe / Ask	Key Descriptors
Appearance & behaviour	How the patient looks and presents.	Dishevelled, agitated, slowed (psychomotor retardation)?
Speech	Rate, volume, form.	Pressured, slow, coherent, disorganised?
Mood	Subjective — what they report.	Depressed, elated, anxious, empty.
Affect	Objective — your observation.	Congruent with mood? Full / restricted / blunted / labile?
Thought	Form (logical?) and content.	Delusions, obsessions, flight of ideas.
Perception	Hallucinations?	"Have you heard voices when no one is there?"
Cognition	Orientation, memory, concentration.	Orientated to time, place, and person?
Insight	Does the patient recognise they have a problem?	Full / partial / no insight.

Asking about suicidal ideation does not plant the idea. Failing to ask leaves the patient unassessed. Ask gradually and calmly:

"When things have been at their worst, have you ever felt that life wasn't worth living?"
"Have you had any thoughts of harming yourself?"
"Have you had any thoughts of ending your life?"
If yes: "Have you had any thoughts about how you might do that? Have you made any preparations?"
"Is there anything that has stopped you from acting on those thoughts?"
"Have you had any thoughts of harming anyone else?"

Check what they know: "What have you already been told? What do you understand so far?"
Check how much detail they want: "Some people like all the details — others prefer the main points. What would be most helpful?"
Explain in sections — chunk and check: What is it? Why does it matter? What happens next? What do they need to do? Pause and check after each section.
ICE: "I've given you quite a lot of information. Is there anything in particular that stood out as a concern for you?"
Shared decision-making where a choice exists.
Safety-net and close.

Point	What to Include
What it is and why	Plain language explanation and reason for starting.
How to take it	Dose, route, frequency, timing (with food, at night, etc.).
When it works	Set realistic expectations — many take days to weeks.
Common side effects	Most frequent ones and what to do if they occur.
Serious side effects	The ones to watch for and report immediately.
Monitoring	Blood tests, BP checks — how often and why.
Missed doses	Most drugs: skip and continue — do not double up.
Duration	Short course or indefinite?

Module 2: The Consultation Toolkit

Psychiatric history-taking and consultation stations both require structural adaptation. This lesson covers both.

Onset, duration, and progression of current symptoms.
Impact on function: sleep, appetite, work, relationships, daily activities.
Psychiatric history: previous episodes, admissions, psychiatric team or CMHT, what has helped before.
Premorbid personality: "How would you describe yourself before all of this started?"

Domain	What to Observe / Ask	Key Descriptors
Appearance & behaviour	How the patient looks and presents.	Dishevelled, agitated, slowed (psychomotor retardation)?
Speech	Rate, volume, form.	Pressured, slow, coherent, disorganised?
Mood	Subjective — what they report.	Depressed, elated, anxious, empty.
Affect	Objective — your observation.	Congruent with mood? Full / restricted / blunted / labile?
Thought	Form (logical?) and content.	Delusions, obsessions, flight of ideas.
Perception	Hallucinations?	"Have you heard voices when no one is there?"
Cognition	Orientation, memory, concentration.	Orientated to time, place, and person?
Insight	Does the patient recognise they have a problem?	Full / partial / no insight.

Asking about suicidal ideation does not plant the idea. Failing to ask leaves the patient unassessed. Ask gradually and calmly:

"When things have been at their worst, have you ever felt that life wasn't worth living?"
"Have you had any thoughts of harming yourself?"
"Have you had any thoughts of ending your life?"
If yes: "Have you had any thoughts about how you might do that? Have you made any preparations?"
"Is there anything that has stopped you from acting on those thoughts?"
"Have you had any thoughts of harming anyone else?"

Check what they know: "What have you already been told? What do you understand so far?"
Check how much detail they want: "Some people like all the details — others prefer the main points. What would be most helpful?"
Explain in sections — chunk and check: What is it? Why does it matter? What happens next? What do they need to do? Pause and check after each section.
ICE: "I've given you quite a lot of information. Is there anything in particular that stood out as a concern for you?"
Shared decision-making where a choice exists.
Safety-net and close.

Point	What to Include
What it is and why	Plain language explanation and reason for starting.
How to take it	Dose, route, frequency, timing (with food, at night, etc.).
When it works	Set realistic expectations — many take days to weeks.
Common side effects	Most frequent ones and what to do if they occur.
Serious side effects	The ones to watch for and report immediately.
Monitoring	Blood tests, BP checks — how often and why.
Missed doses	Most drugs: skip and continue — do not double up.
Duration	Short course or indefinite?