AHMED ELAGHOURYEgyptian & Arab Boards in Psychiatry

Abbassia Hospital for Mental Health, MOH

Cairo, Egypt

Psychiatry started as “inpatient” practice egKraepelin, Khalboum, Bleuler

Basic residency tasksNot available in many mental health facilities

in EgyptStill current practice is affected by “mind-

body” dualism, so psychiatrists may work inpoor-facility hospitals deprived from othermedical services / coverage ie depend ontheir skills in inpatient care

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1. Admission process

2. Working DD

3. Initial assessments / orders

4. Management plan

5. Followup / Progress notes

6. Psychopharmacology

7. Discharge plan / arrangement

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Type of admission according to Egyptian

MHA

Source / Through

Supervisor psychiatrist: responsible

Accurate record of date and time with clear

physician name

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

Phenomenology

Age of onset

OCD: onset, course, duration

Risk factors: 3Ps

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Byrne P & Byrne N: Psychiatry : clinical cases uncovered. 2008, Wiley-Blackwell

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ICD 10 symptom checklist, WHO 1994

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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Donnely T & Giza C: Differential diagnosis mnemonics. 2001, Hanley & Belfus, Inc

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All admitted pt to mental health hospitals should be assessed by:• Security / Nurse aide / Nurse

• Internal medicine

• Clinical psychology

• Social worker

Neuro exam: • Cognitive

• Gait

• Motor

• CNs: (2, 3, 4 , 6), 7, (9, 10, 11)

• DTRs: bi, tri, ankle, knee / Superficial: plantar

• Coordination

• Stretch signs

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Initial orders regards:• Vital signs

• Diet: regular / diabetic / cardiac / easy to chew &

swallow

• Elimination: stool & urine

Activity: with help / walking stick etc

Precautions against: Fall / Aspiration /

Seizures / VTE

ECG / Labs / Imaging

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Avoid crystalloids without I / O monitor

Avoid D5W without thiamine

PRN medications: as needed

STAT medications: you must attend

qHS medications: at bedtime

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Do NOT give conflicting order ( 2 connected orders in same phrase) eg• PRN Chlorpromazine 50mg IM if BP ≥ 90 / 60

• Monitor pt meals, except when sedated / confused

• [ - PRN Chlorpromazine 50mg IM – Notify if BP ≤ 90 / 60 ]

• [ - PRN haloperidol 10 IM – Do NOT exceed 50mg / d]

• [ - Notify if RBG ≥ 200 mg / dl]

• [-Monitor pt meals –Notify if pt is oversedated –Notify if meals are left as same]

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CBC, LFT, KFT, Chemistry, TFT

PRL

Vit D3 & B12

Hepatitis viral markers / HIV

Tumor markers

Immune profile

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Quick LabRef app. Nika Informatics, 2014

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Acute / Short term

Long term

Durations

Scales / outcome measures

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MSE is a part of followup note

Nurse’s observation

Ward behaviors toward staff / other pts

Side effects of medications

Trace initial target symptoms

Examples & discussion

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Oral

Parenteral: IM, IV

Enteral: NGT, G tube, PR

Inhalational

Sublingual

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Who?• Recently admitted without proper data regards

previous mental / medical / drug Hx

• Pt in other health facilities

• Drug naïve pt

What to do?• Avoid depot inj at start

• Avoid frequent daily dosing

• Avoid high doses

• Start low & go slow

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Poor Compliance is main indication

Start during inpatient stay: at least 2 wks

before discharge

Oral first

Challenge doses

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Try know cause: psychotic / notContainment & calming downFollow predetermined protocol: drugs & how

to after monitor?Eg Haloperidol , Olanzapine, Zuclopentixol injEg BZD injTry avoid IV inj esp in poor facility hospitals Keep alert to oversedation: dehydration,

hypoglycemia, aspiration, constipation etc

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Discharge summary

Final diagnosis

Drug treatment

OPD appointments

Special precautions to pt / family

Rehab arrangements

Keep contacts of critical pts, esp in poor-

record systems

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