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Akathesia [ EPSE ]

Discussion in 'CASC - GENERAL STATIONS' started by Najeeb, Jan 25, 2017.

  1. Najeeb

    Najeeb New Member

    Well to me the akathisia station was very unclear...I mentioned that it could be akathisia and I asked her whether triflu was trifluperazine? And she said not sure...I wondered why gp would have prescribed trifluperazine for anxiety at work! (And since when do they prescribe antipsychotics and that too triflu) so I said I would like to get in touch with the surgery to get more information from the staff (gp was away) then she said what will you give me for now? I said I will give you something like promethazine LOL to calm her a bit and then discuss further definitive treatment when I am sure about what medication she took....a nightmare station for me which I think is an absolute goner! And I stood with her for a while and then I sat :-( TLE was another station, sounded more like complex partial seizures or just aura.
     
  2. Johnson

    Johnson Member

    Akathesia - I went through a brief history why it was started , when , any previous incidents like this,mentioned I would contact GP for more details, asked for all EPSE symptoms as per modified simpson angus scale
    http://keltymentalhealth.ca/sites/default/files/SAS.pdf,
    impact on life, other comorbidities, and discussed the treatment plan and I mentioned admission, physical examination, bloods and starting propranolol as medication[ they say no to procyclidine] and she caught me here and mentioned that she had previously propranolol for anxiety and did not help [ i think i missed the cue that it was for anxiety and I could have mentioned that we are treating the side effects now] but what i did ask was the dose [which she couldn't remember] and I told we could start on a higher dose........
    At the end she smiled when I almost finished close to 7 min as I mentioned I will stand but kept looking for the chair. The examiner appears to be serious ...
     
  3. Johnson

    Johnson Member

    September 2015 CASC station
    The patient was pacing having taken and antipsychotic medication
    So its most likely akathesia and its management ( oxford handbook of psychiatry p 946-47 3e )
    The below link is useful for EPSE examination
    https://cpnp.org/_docs/ed/movement-disorders/scale/msas.pdf
    Good explanation on glabellar tap.
    Please have a good knowledge on management of various presentation in EPSE
    (oxford handbook of psychiatry p 944-55 3e )
     
  4. Johnson

    Johnson Member

    CASC - Jan 2017
    We could share our failure and success as both can equally help us.
    I failed this station in spite of thinking I did well
    First of all I did not know this was a "history station" which seems very worrying for me, had I knew this was history station, I would have done it differently
    This is worrying because I am missing the task or the instructions are not very obvious because in many other stations I pass , so at least I should be doing something right

    On reflecting
    I should NOT have spoken about management
    I could have done risks [ not in detail]
    One important thing that comes to my mind is that in the instruction its says "YOU ARE A JUNIOR DOCTOR", hence I would verbalise that I would discuss with my senior colleague.. [ junior doctors take history , hmmmmm..]
    Perhaps team work might be checked
    BUT BE MINDFUL THAT STATIONS CAN BE TWEAKED

    Again these our my inferences who have failed CASC many times, so do take with a pinch of salt
     
    Last edited: Mar 3, 2017
  5. Johnson

    Johnson Member

    Recently had a 7 min practise session [proper casc like - 90 sec reading etc..] with a English consultant [ very nice person ] with casc teaching experiences and this is the best news, I was told that that if I pass casc, they would be very keen to employ me as a consultant in the future [only joking:)]

    Feedback
    Try not to shake hands with patients

    To take a sleek history [Psy , medical history, family history etc..]
    family history - Has anyone had a ???? in your family [consultants' phrases are excellent, more so such phrases could help with time management, what I do is that beat around the bush and waste time]
    Example- I was repetitive, but was told, to say " please could you do it"

    Other candidate's feedback was to explain to the examiner what we do, but consultant's feedback was EXPLAIN TO THE PATIENT as we do

    As I have not practised the station recently, I forgot to ask to raise the tongue to look for drooling and also tell the patient try not to blink while doing the glabellar tap [forehead]. But confirmed that while doing this that we ought to stand behind the patient or the patient does not see us...

    To give clear instructions [example I asked the patient [consultant] to walk, he walked and stood by the door, did not turn back]

    Avoid complex explanation/jargons - instead of EPSE, to tell signs of .......[ will ask]
     
    Last edited: Apr 24, 2017

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