BASIC SKILLS FOR

INPATIENT PSYCHIATRY
AHMED ELAGHOURY
Egyptian & Arab Boards in Psychiatry
Abbassia Hospital for Mental Health, MOH
Cairo, Egypt
 WHY?
Psychiatry started as inpatient practice
eg Kraepelin, Khalboum, Bleuler
Basic residency tasks
Not available in many mental health
facilities in Egypt
Still current practice is affected by mind-
body dualism, so psychiatrists may work
in poor-facility hospitals deprived from
other medical services / coverage ie
depend on their skills in inpatient care
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 Outline
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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 Admission process

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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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 Working DD

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

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 How to set a DD list?
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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 Psychotic ds & Mood ds present the
same

ICD 10 symptom checklist, WHO 1994

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 Delirium

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

BASIC SKILLS FOR INPATIENT PSYCHIATRY Cairo, Dec 2014

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

BASIC SKILLS FOR INPATIENT PSYCHIATRY Cairo, Dec 2014

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

BASIC SKILLS FOR INPATIENT PSYCHIATRY Cairo, Dec 2014

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

BASIC SKILLS FOR INPATIENT PSYCHIATRY Cairo, Dec 2014

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

BASIC SKILLS FOR INPATIENT PSYCHIATRY Cairo, Dec 2014

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

BASIC SKILLS FOR INPATIENT PSYCHIATRY Cairo, Dec 2014

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 Initial assessments /
orders

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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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 General tips
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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 Labs & Imaging

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 Common labs
CBC, LFT, KFT, Chemistry, TFT
PRL
Vit D3 & B12
Hepatitis viral markers / HIV
Tumor markers
Immune profile

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 CBC & BMP

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 QTc Interval

Quick LabRef app. Nika Informatics, 2014

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 Management plan

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 Acute / Short term
Long term
Durations
Scales / outcome measures

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Followup / Progress notes

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 MSE is a part of followup note
Nurses observation
Ward behaviors toward staff / other
pts
Side effects of medications
Trace initial target symptoms
Examples & discussion

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 Psychopharmacology

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 Route of drug delivery
Oral
Parenteral: IM, IV
Enteral: NGT, G tube, PR
Inhalational
Sublingual

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 Unknown pt
Who?
Recently admitted without proper data
regards previous mental / medical / drug Hx
Pt in other health facilities
Drug nave pt
What to do?
Avoid depot inj at start
Avoid frequent daily dosing
Avoid high doses
Start low & go slow

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 Depot injections
Poor Compliance is main indication
Start during inpatient stay: at least 2
wks before discharge
Oral first
Challenge doses

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 Agitated pt
Try know cause: psychotic / not
Containment & calming down
Follow predetermined protocol: drugs &
how to after monitor?
Eg Haloperidol , Olanzapine, Zuclopentixol
inj
Eg BZD inj
Try avoid IV inj esp in poor facility hospitals
Keep alert to oversedation: dehydration,
hypoglycemia, aspiration, constipation etc

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Discharge plan / arrangement

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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