Delirium and somatoform workup

[mcater2006]

Dear Premed101'ers:

 

If a psych OSCE station is about a person with delirium or somatoform (somati, pain, conversion, hypochond, body dysmorphic, factitious, malingering), what should be the questions I need to ask for the HPI in order to get all the check marks?

 

I feel that I can't come up with any good questions to ask for these cc's, especially the somatoform like malingering. And the materials I have (Toronto Notes, etc.) just gives me tables.

 

Thanks,

 

mcater2006

[peachy]

These aren't any different from any other DSM-IV disorder: you need to go through the DSM criteria. E.g. for somatoform, pain in four areas of the body, two GI symptoms, etc.

 

There's a very good cheap, small handbook that goes through the criteria for all of the DSM-IV disorders and gives sample questions for each criterion: http://www.amazon.com/Interview-Evaluating-Psychiatric-Disorders-Examination/dp/0963382136/ref=sr_1_2?ie=UTF8&s=books&qid=1298842808&sr=8-2

 

Malingering would be a very odd thing to have on an OSCE station, imho. After all, in an OSCE you are relying on the simulated patient to give you honest answers, and in malingering they are, by definition, lying! And malingering can look like anything at all. I wouldn't put much time into preparing for a "malingering" station, personally.

[Julie]

Delirium would be different as it's an organic disorder, I guess you would probably have an elderly pt who looks confused & disoriented, & could ask questions regarding orientation *3, hallucinations (esp. visual), med list, etc. Hopefully you would have a relative or someone other than the pt to provide hx, otherwise I doubt they would ask you hx only, as it may or may not be possible to obtain a complete one. If you do have a relative, then imo important things to ask would be about possible causes of delirium (meds, surgeries, etc etc), pattern of symptoms, and try to distinguish between dementia, depression & delirium.

 

Like peachy, I doubt they would put a station on malingering. In my experience, OSCEs tend to focus on the big, really common/dangerous to miss things : depression, suicidality and psychosis would be common ones, as well as ADHD for child psych.

 

Did you try uptodate as a resource? I really like it for things like this.

[mcater2006]

Thanks to both Peachy and Julie. I realized now that I probably shouldn't have asked about somatoform workup simply because the likelihood of them appearing on the OSCE is sooooooooooo low that the cost-benefit ratio analysis simply does not warrant me studying somatoform, especially malingering.

 

Thanks again.