Essential Mental Models for a Psychiatrist – The Art of Complex Problem Solving

Posted on: February 27, 2019
Last Updated: March 1, 2019

Dr. Sanil Rege is a Consultant Psychiatrist and founder of Psych Scene, a platform to enhance psychiatry education and Vita Healthcare, providing high quality mental health care services to the public. He is a Fellow of the Royal Australian and New Zealand College of Psychiatrists and Member of the Royal College of Psychiatrists (UK). His clinical and research interests include psychosis, depression, anxiety, post-traumatic stress disorders, and personality disorders.

Author Quotes :

A family’s opinion can be disproved, but should never be ignored.

Think in terms of probabilities; there’s never one single conclusive diagnosis.

People present prodromally, and DSM-V has a specific statement which says–‘there will be patients who will not fulfil criteria but are still in need of treatment’ so that’s where understanding of neurophysiology, neuropharmacology and neuroanatomy becomes really important.

Summary : 

Good clinical practice is a bout translating academic knowledge into real world problem solving. The most important skills required for this are strategy development and implementation. These skills despite being crucial are not imparted in textbooks.

Clinical practice will never be the same after you master these mental models.

In this video, Dr. Sanil Rege covers the following topics:

1.How to minimise errors.

He talks about how to master your trade through performance improvement and the importance of insight,-“why is this patient not getting any better?”

Strategy is a set of guiding principles, which generates a roadmap for the clinician and their team to achieve a successful outcome for the patient.

2. Strategic problem-solving

Dr. Rege emphasises the importance of defining the outcome, the significance of recovery-oriented principles, prioritising and the principles of causality.

3. Thinking in terms of probabilities

He covers reverse causality and confounders, bias and chance, and talks about dual diagnosis in drug and alcohol cases where most errors are made. Drug-induced psychosis may be a result of self-medication.

4. Developing a formulation matrix.

5. Using the 6 domain management plan.

Concluding this tutorial, Dr. Rege presents an overview of the OSCE.

Take Home Messages : 

  1. Specific diagnostic criteria (DSM-IV/V) are intended as guidelines only –they should be informed by clinical judgement and not used in a cook book fashion.
  2. Organic disorders within mental health patients can directly contribute to the psychopathology of the patient.
  3. Checklists will make your life easier.

Quiz :

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