Liaison

Question 1

Conversion disorder (history)

Answer 1

• HPC (onset, duration, ass Sx, previous events)
• Stressors
• La Belle Indifference (concern about Sx, relieved by Ix findings, family response)
• Comorbidity (moos, sleep, appetite, enjoyment, energy, psychosis, risk)
• Personal Hx (PPHx, FHx, PMHx, substance use)

Question 2

Conversion disorder (explanation)

Answer 2

• Summarise findings
• Explain diagnosis and cause
• Explain medication (antidepressant if indicated)
• Explain psychological Rx (CBT)
• Concerns and leaflets

Question 3

Health anxiety (history)

Answer 3

• HPC (onset, duration, exac/relieving factors, ass Sx, Ix, ICEs)
• Impact on functioning (research, family response, relationships, work)
• Personal history (PMHx, medications, recurrent childhood illness, family response, FHx)
• Comorbidities (mood, sleep, appetite, enjoyment, concentration, psychosis, risk)

Question 4

Health anxiety (management)

Answer 4

• Clarify diagnosis and understanding
• Explain cause (family culture, stress, genetic risk)
• Explain medication (antidepressant)
• Explain psych Rx (CBT)
• Questions and concerns

Question 5

Somatoform pain disorder (history)

Answer 5

• HPC (onset, duration, previous Rx, ICEs)
• Stressors (relationships, work, finances, medical)
• Impact on functioning
• Comorbidity (mood, sleep, appetite, concentration, enjoyment, psychosis, substances, risk)

Question 6

Traumatic brain injury (history)

Answer 6

• HPC (onset, duration, progression, injury)
• Personality change (premorbid, disinhibition, impulsive)
• Behavioural change (irritable, verbal/physical aggression)
• Judgement (attention, concentration, decision making, risk)
• Memory (short-term, long-term, planning, orientation TPP, word-finding)
• Functioning (washing, dressing, finances)
• Comorbidity (mood, sleep, appetite, enjoyment, abnormal behaviour, substances, risk)

Question 7

Traumatic brain injury (examination)

Answer 7

• Day/date/month/year
• Animals in 1 min
• Objects x3
• Clock drawing
• Objects recall
• Similarities (banana/orange, table/chair, tulip/rose/daisy)
• Programming (fist-edge-palm, x3 together then alone, 6 reps for 3 points)
• Cognitive estimates (elephants in London)
• Letter on the floor

Question 8

Post MI depression (history)

Answer 8

• HPC (admission, progress, treatment, medications, follow-up)
• Depressive Sx
• Current stressors (relationships, work, financial)
• Understanding (cardiac rehab, lifestyle changes)

Question 9

Post MI depression (d/w cons)

Answer 9

• Summary of case
• Prevalence (20%, 2-6x higher mortality)
• Medical Rx (sertraline - SADHART trial, avoid venlafaxine & tricyclics)
• Psychological Rx (CBT and lifestyle support)
• Liaise with cardiology

Question 10

Antidepressant induced sexual dysfunction (history)

Answer 10

• Clarify diagnosis, medication and onset S/Es
• Current depressive Sx & risk
• Explore sexual difficulties (interest, erection, orgasm, priapism, relationship in general)
• Other causes (PMHx, medication)
• Options (continue - timing of meds, sildenafil, drug holiday; switch meds; stop - relapse)
• Other Treatment (CBT, couples therapy)

Question 11

Antidepressant induced sexual dysfunction (d/w wife)

Answer 11

• Clarify diagnosis
• Wife’s perception of Sx (mood, sleep, appetite, risk)
• Explain depression vs side-effects
• Management plan (continue - timing of meds, sildenafil, drug holiday; switch meds; stop - relapse)
• Questions and concerns

Question 12

Post-concussion syndrome (history)

Answer 12

• HPC (injury, LOC, amnesia, admission, Ix)
• Ongoing neurology (weakness, headache, dizziness, tinnitus)
• Psych Sx (mood, anxiety, irritability, sensitivity to noise)
• Risk (falls, memory, self)
• Brief memory Ax (3 items, WORLD, recall, fluency)