Psychiatry Station 9

 

Station 9

Lithi-what?

 

Candidate Instructions

Setting:

Mr Ahmed was recently diagnosed with bipolar mood disorder. He has been prescribed lithium as part of his treatment plan and is attending this appointment to receive counselling about starting lithium therapy. Physical examination, ECG, and bloods are normal. Rahul has no other past medical history and no drug allergies.


Name: Rahul Ahmed


Tasks:

1. Counsel the patient on initiating treatment with Lithium.

2. Answer any patient questions.

You are not required to examine the patient or explain the diagnosis.

Simulated Patient Instructions

Briefing

Diagnosis: Bipolar requiring lithium
You are Rahul Ahmed, age 28
You are here to learn more about your recent prescription for Lithium.

Appearance and Behaviour

You appears nervous, but settle if the doctor is empathetic.

Opening statement

“The consultant recommended that I be started on Lithium, I have bipolar.”

Information to Give Freely

"I’ve heard lithium can have some serious side effects. Should I be worried?"

Ideas / Concerns / Expectation

Ideas - I’ve heard of Lithium, I don't know much else to be honest.
Concerns - You are quite reluctant for any potential side effects, but you're not sure what they are.
Expectations - You don’t want to embarrass yourself again during another manic episode, as a result you will accept the side effects if explained in an empathetic way.

History of presenting complaint

Struggled with low mood for 10 years
2 Manic episodes during this time, the last one was 1 month ago
Depressive symptoms - low mood, anhedonia, poor sleep, fatigue.
Manic symptoms (during episodes) - excess spending, sleeping just 4 hours per night.
Impact on life - very strained personal relationships, lost my last job due to odd behaviour at work during a manic episode.
Psychosis - no hallucinations or voices
Other symptoms - no compulsions

Risk Assessment

Self harm/suicide? - No
Police altercations? - No
Thought of harming others? - No

Past Medical History

Nil else

Drug History

Medications - None
Allergies - None

Social History

Smoking - No
Alcohol - No
Recreational drug use - No

Discussion

Ask any questions from the following list that the student hasn’t already covered.
  • "Will I need to be on Lithium for life?"
  • "Will I need to change my diet or lifestyle whilst on lithium?"
  • “How will I know if my lithium levels are too high or too low?”
  • “Will it completely solve my mood swings?”

    • At the end of the consultation, you agree to try the medication.

    Start the Timer and Begin

    Intro

     

    Gathering information

     

    Giving information

     
    Explaining the Indication:

    Explaining Mechanism of Action:

    Explains Practical Points:

    Explains Side Effects:
  • Severe tremors or ataxia
  • Confusion
  • Vomiting
  • Slurred speech
  • Change in vision
  • Seizures / Coma
  • Nausea
  • Diarrhoea / abdo cramps
  • Minor tremor
  • Increased thirst
  • Increased urination
  • Weight gain
  • Fatigue
  • Brain fog

    • Explains Lifestyle and Monitoring:
  • NSAIDs such as ibuprofen interact with Lithium
  • Do not drive if feeling drowsy on Lithium

    • Safety Netting

     

    Actor Questions

     
    Candidate correctly answers the patients questions (example answers below):

    ACTOR INSTRUCTIONS

     

    If not already answered please also ask the following questions;

    (marks already contained in the above mark scheme):

    1. “How does Lithium work?”

    2. “Will I need to change my diet or lifestyle while on lithium?”

    3. “How will I know if my lithium levels are too high or too low?”

    Conclusion

     

    Submit for Scoring

    Tags | Psychiatry | Counselling | Lithium | Lithium Counselling | Communication

    Station Written by: Dr Sara Pender

    Peer Reviewed by: Dr Benjamin Armstrong

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