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Akathesia

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. eadmin

    eadmin Administrator Staff 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

    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 ...
     
  4. 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 )
     
  5. 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

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