Psychiatry
Psychiatry
Psychiatry tests recognition and first-line management of mental disorders in general and primary care, using the mental state examination (MSE) and mhGAP principles.
Core rules and concepts
- MSE components: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, and insight.
- Depression: at least 2 weeks of low mood or anhedonia plus four or more other symptoms; assess suicide risk directly.
- Psychosis: delusions, hallucinations, and disorganisation; duration and functional decline distinguish schizophrenia from brief psychotic disorder.
- mhGAP: assess, manage, and follow up common disorders at primary level; refer when risk is high.
- Alcohol withdrawal: tremor, sweating, seizures, and delirium tremens; use a structured scale (CIWA-Ar) and benzodiazepines.
Worked example
A 30-year-old woman has 3 weeks of low mood, anhedonia, early waking, weight loss, and passive suicidal ideation without plan or intent. This is a major depressive episode. Assess risk (access to means, past attempts, social support), screen for hypothyroidism and anaemia, provide psychoeducation, and start an SSRI with follow-up in 1–2 weeks. Do not dismiss the suicidal thoughts or start an antipsychotic.
Traps
- Missing organic causes of psychiatric symptoms.
- Overdiagnosing schizophrenia from a single episode.
- Not asking about suicide because of discomfort.
- Ignoring postpartum psychosis, which is an emergency.