Counselling, Crisis, Difficult pt + Disability

Question 1

Factors to consider when counselling pts

Answer 1

Set clear therapeutic goals
allow adequate time for assessment, identify context and pt’s understanding of problem, evaluate own skills, recognise when your beliefs may interfere with counselling
remain aware of risks of offering advice vs providing options
pay close attention to quality of therapeutic relationship
Recognise transference/ counter-transference

Question 2

What are the aspects of counselling to educate pt on

Answer 2

Expectations
Timing
Frequency
Costs
Duration
Homework

Question 3

Approach to pt in crisis

Answer 3

Acknowledge feelings + help de-escalate
Identify pt’s personal supports
Offer appropriate community resources
Assess suicidality

Question 4

How to manage difficult pt

Answer 4

Seek out info about pt’s life circumstances, context + functional status
Remain vigilant for new sx
Identify own attitude and contribution to situation
set clear boundaries

Question 5

What dz to look for in difficult pts

Answer 5

PDs

Question 6

When to end therapeutic relationship

Answer 6

take steps to end physician-patient relationship when it is in pt’s best interests to

Question 7

What to screen for in elderly for disability risks

Answer 7

falls, cognitive impairment, immobilization, decreased vision

Question 8

What are the spheres of function?

Answer 8

emotional, physical, social

Question 9

,approach to disability

Answer 9

orthotics, lifestyle mods, time off work, community support

Question 10

When to think about driving safety

Answer 10

after bad news, any new meds, flying, operating heavy machinery, cancer dx, cast/mobility, eye dz

Question 11

What strategies can you use for difficult pts?

Answer 11

Limit appointment duration + frequency, avoid polypharmacy w/ benzos, opioids, drugs of abuse, Z drugs, quetiapine, think about countertransference, consider terminating relationship, speak to CPSBC

Question 12

Dx criteria for schizotypal disorder

Answer 12

impairments in self functioning, self direction, interpersonal function, eccentricism, cognitive dysregulation, unusual beliefs, withdrawal

Question 13

What to cover in appt w/ disabled person

Answer 13

support and education for family, ensure FU, community engagement, monitoring for AE, monitoring for abuse

Question 14

What are the criteria for disability tax benefit?

Answer 14

Blindness, 1+ ADLs severely impaired, 2+ ADLs significantly impaired, needs life-sustaining therapy - must be ongoing x1yr

Question 15

What are the requirements for canada pension plan disability?

Answer 15

Mental or physical disability, prolonged and prevents any work

Question 16

What are registered disability savings plans?

Answer 16

Only if the person is eligible for disability tax credit, max age 59, not taxed on withdrawal

Question 17

Signs of abuse/ neglect in people w/ developmental disabilities?

Answer 17

Change in weight, noncompliance, aggression/ withdrawal, depression, avoidance, poor self esteem, sexualised behaviour, sleep or eating disorders, substance use

Question 18

What is often underdiagnosed in people w/ dev difficulties?

Answer 18

Vision + hearing impairment, dental dz

Question 19

What conditions are those with intellectual disability at risk of?

Answer 19

Vision impairment, hearing impairment, thyroid dz, resp dz, obesity, OP, AD, depression

Question 20

Aggressive patient management

Answer 20

name the emotion (I can see you’re angry), ask how you can help, consider other causes, safety first (suicidal, homicidal, weapons, kids)

Question 21

Causes of aggression

Answer 21

DIM FACES = drugs, dehydration, infection, metabolic, meds, failure, anemia/ alcohol, cardiac/ stroke, electrolyte, structural (brain tumor)

Question 22

Steps for trauma informed care

Answer 22

Bear witness to pt’s trauma experience
Create safe space and recognise emotional and physical safety
Include pt’s in healing process
Believe in pt’s strength and resilience