Year 4 PSYCH4: Psychiatry

Lecture: Personality Disorders

1. Explain the basics of how personality traits and disorders are defined and classified.
2. Outline the clinical features common to all personality disorders and the features which distinguish them.
3. Know how to elicit psychiatric symptoms and signs of a patient with a personality disorder.
4. Know the community resources required for the optimum rehabilitation and management of severe personality disorders.
5. Appreciate moral difficulties posed by serious personality disorder and for the care of those so affected.

Lecture: Psychotherapy

1. Understand principles of psychological management of common mental illnesses, especially depression, anxiety and OCD.
2. Know about cognitive behavioural therapy, computer-aided CBT, interpersonal therapy, counselling, motivational interviewing, group therapy, family therapy and psychodynamic therapy.
3. Recognise the importance of lifestyle on mental health and its impact on treatments including sleep hygiene, nutrition, social interaction, fitness, activity, education, occupation, and family and community involvement.

Lecture: Forensic Psychiatry

1. Be able to assess a patient's potential danger to self or others.
2. Know the main sections of Part III of the Mental Health Act 1983.
3. Have basic understanding of the interface between mental health and criminal justice systems.
4. Understand common legal defences (e.g. insanity, diminished responsibility).

Lecture: Perinatal Psychiatry

1. Understand the risks involved with perinatal mental illness.
2. Understand the presentation of mental illness in pregnancy and postnatal periods (including puerperal psychosis, pre-natal depression, post-natal depression, suicide risk).
3. Know the approach to appropriate prescribing of psychotropic medication during pregnancy and breastfeeding.
4. Know about pregnancy planning.
5. Understand the importance of parent-infant relationships.

Lecture: Child & Adolescent Psychiatry

1. Be able to consider how developmental factors affect the presentation of common adolescent psychiatric disorders.
2. Be aware of complex issues of capacity and consent in adolescence.
3. Be able to describe the management of important adolescent psychiatric disorders – depression, self-harm, substance misuse and psychosis.
4. Demonstrate an understanding of how common psychiatric disorders present in the Adolescent patient group: Depression; Psychosis; Bipolar Affective Disorder; OCD; Self Harm; PTSD; Substance Misuse.
5. Apply general principles of management of these disorders, with an understanding of when a situation is urgent.

Workshop: Learning Disabilities Workshop

1. Know the aetiology and prevalence of a learning disability
2. Know the aetiology, prevalence and presentation of mental illness and behavioural problems in people with learning disability
3. Know the definition of a learning disability
4. Understand the assessment of psychiatric disorders in people with learning disabilities
5. Understand the importance of community integration for people with learning difficulties
6. Understand the stigma and prejudice associated with learning disabilities
7. Understand the treatment of psychiatric disorders in people with learning disabilities
8. Know the community resources required for the optimum rehabilitation and management of learning disabilities in children and adults
9. Be able to communicate effectively with people with learning difficulties.
10. Know and appreciate the importance of valuing skills of people with learning disability
11. Know how to assess capacity to consent to treatment

Lecture: Social Psychiatry

1. Develop an integrative understanding of the Bio-Psycho-Social paradigm.
2. Know the importance of ‘social’ factors in aetiology, diagnosis and treatment of mental health disorders (e.g. family, culture, spirituality and society).
3. Aware of recent concepts of fundamental and applied research – new technologies, collaboration with social sciences, arts and humanities.
4. Know the public health importance of mental health in terms of personal, economic and social functioning.

Lecture: Medical Ethics in Psychiatry

1. Refresh knowledge about key ethical principles as applied to psychiatry.
2. Know some of the historical perspectives of psychiatric ethics and moral philosophies.
3. Appreciate specific ethical issues in psychiatry: diagnosis, confidentiality, consent, capacity, and compulsion.
4. Know of key legal directions – MHA, MCA, HRA
5. Integrate ethical theory with clinical experience.
6. Approach an ethical case analysis.

Lecture: Putting It All Together 1

Lecture: Putting It All Together 2

Lecture: Liaison Psychiatry

1. Understand the principles behind the mind-body relationship.
2. Understand the two-way links between Medical diseases and Psychiatric disorders.
3. Understand psychological aspects of physical disease.
4. Understand the main differences between the biomedical and biopsychosocial models of medicine.
5. Understand how to assess a patient with medical, unexplained or chronic symptoms and disability and to be able to outline the principles of treating such a patient.
6. Outline the clinical characteristics of somatization disorder, conversion disorder, body dysmorphic disorder, hypochondriasis and factitious disorder .

Lecture: Psychiatric Genetics

1. Understand the genetic factors involved in risk of major mental disorders including dementia, Alzheimer's disease, autism, learning disability, alcohol dependency, schizophrenia and mood disorders.

Lecture: Suicide & DSH

1. Know the difference between suicide and deliberate self-harm.
2. Know the epidemiology of suicide.
3. Know risk factors for suicide.
4. Be able to assess suicide risk.
5. Be able to identify and manage suicide risk in a general medical setting.
6. Be aware of national and local suicide prevention strategies.

Clinical Skills 1: Mental State Examination & History Taking

1. Achieve a balance between listening and interrupting. To orientate, guide and structure the interview within a time frame.
2. Communicate with patients who have psychiatric disorders: obtain information, provide reassurance and establish rapport
3. Deal with dilemmas of confidentiality and detaining patients.
4. To be able to screen for suicidality and to identify and manage suicide risk in a general medical setting
5. Establish the relationship and in particular to judge the distance both interpersonally and physically that is appropriate when interviewing patients with mental health problems.
6. Screen for psychiatric symptoms in a sensitive way
7. Show a non-judgemental attitude to patients with substance misuse problems
8. Demonstrate skills necessary for dealing with aggressive and uncooperative patients

Workshop 2: Alcohol & Substance Misuse Workshop

1. Alcohol Abuse: Describe the use of simple behavioural screening tests to recognise problematic alcohol use
2. Alcohol Abuse: Describe the structural and functional effects of alcohol on the cardiovascular system including cardiomyopathy
3. Alcohol Abuse: Describe the structural and functional effects on alcohol on the Gastrointestinal System, including Mallory-Weiss syndrome, gastritis, pancreatitis, alcoholic liver disease and the effect on nutrition
4. Alcoholic Withdrawal Syndrome: Know the management of alcohol withdrawal, including delirium tremens
5. Alcoholic Withdrawal Syndrome: Describe the management of the alcohol withdrawal syndrome and the Wernicke-Korsakoff syndrome
6. Alcoholic Withdrawal Syndrome: Describe the structural and functional effects on alcohol on the neuropsychiatric system including the alcohol withdrawal syndrome, Wernicke-Korsakoff syndrome, polyneuropathy, cerebellar degeneration and myopathy
7. Substance Abuse and Dependence: Describe the impact of alcohol and drug misuse and dependence on the family and society
8. Substance Abuse and Dependence: Describe the psychological effects of the misuse of alcohol and other illicit drugs
9. Substance Abuse and Dependence: Describe the range of individuals and services that are available to help the problem drinker and drug user and how to match the individual with the most appropriate service
10. Substance Abuse and Dependence: Know the community resources required for the optimum rehabilitation and management of substance misuse and dependence
11. Substance Abuse and Dependence: Know the investigations undertaken in cases of alcohol and substance misuse
12. Substance Abuse and Dependence: List the social and behavioural associations of alcohol and drug misuse and dependence
13. Substance Abuse and Dependence: Describe the pharmacological and metabolic effects of alcohol and other drugs of misuse.
14. Substance Abuse and Dependence: Show a non-judgemental attitude to patients with substance misuse problems.
15. Opioid Dependence: Describe the management of opioid dependence.

Lecture: Psychopharmacology of Psychosis

1. Know when and how to use antipsychotic drugs (oral and depot) and know their side effects.
2. Describe an appropriate course of treatment for a patient with schizophrenia including pharmacotherapy and psychosocial support.
3. Know the symptoms and management of movement disorders (Extra-Pyramidal Side Effects, Acute Dystonia, Akathisia, Tardive Dyskinesia).
4. Know the symptoms and management of Neuroleptic Malignant Syndrome.
5. To understand how to prescribe psychotropic medication safely, effectively and economically AND Plan which physical and psychosocial investigations should be carried out when patients present with psychiatric symptoms and when starting psychotropic medication.

Lecture: Psychopharmacology of Mood Disorders

1. Know when and how to use antidepressants and know their side effects.
2. To describe the treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance.
3. Know when and how to use antimanic agents and know their side effects.
4. Know the symptoms and management of Serotonin Syndrome.
5. Prescribe psychotropic medication (if appropriate) safely, effectively and economically AND Plan which physical and psychosocial investigations should be carried out when patients present with psychiatric symptoms and when starting psychotropic medication.

Self Directed Learning Session

1. To achieve a basic understanding of brain function and pathological processes
2. Give a differential diagnosis of common psychiatric disorders with supporting reasons.
3. Know the investigations used in psychiatry and be able to interpret their results.
4. To define correctly the term “psychosis”
5. To understand the two-way links between Medical diseases and Psychiatric disorders
6. Know the symptoms and management of Neuroleptic Malignant Syndrome
7. Know the symptoms and management of Serotonin syndrome
8. Know the symptoms and management of movement disorders including extra-pyramidal side effects; acute dystonia; akathisia and tardive dyskinesia
9. To gain an overview of recent scientific advances in the understanding of psychiatric disorders (molecular biology, neurobiology, pharmacology, genetics, neuro-imaging and cognitive neuroscience).

Clinical Teaching at Placements

1. Give a differential diagnosis of common psychiatric disorders with supporting reasons.
2. Know the investigations used in psychiatry and be able to interpret their results.
3. To understand the classification of mood disorders and distinguish between unipolar depression and bipolar disorder
4. Be able to elicit psychiatric symptoms and signs of a patient with an eating disorder
5. Be able to assess a patient's potential danger to self or others.
6. Be able to assess suicide risk.
7. Be able to elicit psychiatric signs and symptoms
8. Achieve a balance between listening and interrupting. To orientate, guide and structure the interview within a time frame.
9. To list the features that distinguish schizophrenia from a mood disorder with psychotic features
10. To summarise the signs and symptoms, differential diagnosis, course of illness, co-morbidity, prognosis and complications of mood disorders
11. To understand how to assess a patient with medical, unexplained or chronic symptoms and disability and to be able to outline the principles of treating such a patient.
12. Be able to assess the seriousness of a suicide attempt.
13. Communicate with patients who have psychiatric disorders: obtain information, provide reassurance and establish rapport
14. Be able to perform a cognitive assessment.
15. Deal with dilemmas of confidentiality and detaining patients.
16. To be able to screen for depressive symptoms
17. To be able to screen for suicidality and to identify and manage suicide risk in a general medical setting
18. Establish the relationship and in particular to judge the distance both interpersonally and physically that is appropriate when interviewing patients with mental health problems.
19. To be able to screen for manic and hypomanic symptoms
20. To describe the treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance
21. Describe an appropriate course of treatment for a patient with schizophrenia including pharmacotherapy and psychosocial support
22. Screen for psychiatric symptoms in a sensitive way
23. Be able to present the history and examination findings in a coherent and comprehensive format, both written and oral.
24. Know the general management of ANY psychiatric disorder over the first 24 hours of presentation
25. Be familiar with the role of the following professionals in the care of psychiatrically ill patients and be able to communicate effectively with each member of the multidisciplinary care team:- ward nurses, occupational therapists, social workers, genera
26. Demonstrate skills necessary for dealing with aggressive and uncooperative patients
27. To understand the differences between sadness and grief associated with life events and depressive disorders

Small Group Teaching at Placements

Lecture: Putting It All Together 3

Clinical Skills 2: Mental State Examination

Clinical Skills 4: History Taking & Differential Diagnosis

Clinical Skills 3: Risk Assessment and Challenging Situations

1. Understand and be able to perform a risk assessment
2. Gain insights in how to deal with challenging situations during patients encounters

Lecture: Neuropsychiatry

1. Understand the neuro-cognitive functions of the brain.
2. Know the neuropsychiatric assessment.
3. Appreciate the importance of neuropsychiatric conditions and their relevance across different medical specialties.
4. Be able to distinguish between ‘organic’ mental states from common mental disorders.
5. Understand the range of theoretical perspectives that underpin approaches in neuropsychiatry.

Lecture: Anxiety Disorders

1. Anxiety Disorders: To understand the difference between fear and anxiety and the importance of this distinction.
2. Anxiety Disorders: Be able to elicit psychiatric symptoms and signs of a patient with an anxiety disorder or obsessive compulsive disorder
3. Anxiety Disorders: Know when and how to use anxiolytic drugs and know their side effects.
4. Anxiety Disorders: To describe the treatment, both pharmacological and psychotherapeutic, for each of the anxiety disorders
5. Anxiety Disorders: To discuss the diagnosis and management of panic disorder, agoraphobia, social phobia and specific phobias.
6. Anxiety Disorders: To summarise current knowledge of the aetiology, pathophysiology and epidemiology of generalized anxiety disorder, panic disorder, social phobia, agoraphobia and other specific phobias
7. Obsessive-Compulsive Disorder: To summarise current knowledge of the aetiology, pathophysiology and epidemiology of obsessive-compulsive disorder.
8. Obsessive-Compulsive Disorder: To describe the treatment, both pharmacological and psychotherapeutic, of obsessive-compulsive disorder.
9. Obsessive-Compulsive Disorder: To discuss the diagnosis and management of obsessive-compulsive disorder.

Lecture: Psychiatric Emergencies

1. To have an overview of the major types of psychiatric emergencies
2. To know of risk factors and assessment of risk for psychiatric conditions
3. Understand the principles and practical application of the Mental Health Act in patient care
4. To know the differential diagnosis of psychiatric emergencies and strategies for treating them

SDL & CE

1. Know, as a non-specialist, how to treat a patient with a psychiatric illness
2. To understand the epidemiology of the psychiatric index conditions
3. Know the general management of ANY psychiatric disorder over the first 24 hours of presentation
4. Anxiety Disorders: Be able to elicit psychiatric symptoms and signs of a patient with an anxiety disorder or obsessive compulsive disorder
5. To understand the role of stress and social deprivation etc on mental health
6. To list the features that distinguish schizophrenia, delusional disorder, schizophreniform disorder, schizoaffective disorder and brief psychotic disorder from each other
7. Know when and how to use antipsychotic drugs (oral and depot) and know their side effects
8. To formulate a differential diagnosis for an individual presenting with psychosis
9. To understand the difference between fear and anxiety and the importance of this distinction
10. To state the moral difficulties posed by serious personality disorder for the care of those so affected
11. Anxiety Disorders: To summarise current knowledge of the aetiology, pathophysiology and epidemiology of generalized anxiety disorder, panic disorder, social phobia, agoraphobia and other specific phobias
12. To summarise the current knowledge concerning aetiology, pathogenesis and epidemiology of schizophrenia.
13. To understand the differences between depressive symptoms and depressive disorders and why the distinction is important

Lecture: Psychosis and Schizophrenia

1. To define correctly the term “psychosis”
2. To list the features that distinguish schizophrenia from a mood disorder with psychotic features.
3. To list the features that distinguish schizophrenia, delusional disorder, schizophreniform disorder, schizoaffective disorder and brief psychotic disorder from each other.
4. Know when and how to use antipsychotic drugs (oral and depot) and know their side effects
5. To formulate a differential diagnosis for an individual presenting with psychosis
6. Describe an appropriate course of treatment for a patient with schizophrenia including pharmacotherapy and psychosocial support
7. To understand the role of stress, social deprivation etc on mental health.
8. To summarise the current knowledge concerning aetiology, pathogenesis and epidemiology of schizophrenia.
9. To summarise the clinical features and course of schizophrenia.

Lecture: The Mental Health Act and Mental Capacity Act

1. Describe the key Sections of the Mental Health Act (including Section 2, Section 3, Section 5(2), with specific reference to admission, compulsory treatment.
2. Know how the structure of the Act is designed to try to protect the civil liberties of detained patients.
3. Know the conditions for detention of a patient Consider dilemmas of confidentiality and detaining patients.
4. Know the indications for, and appropriate steps to be taken when compulsory admission under the Mental Health Act into hospital is required.
5. Understand the Mental Capacity Act and its use in medical practice.

Lecture: Mood Disorders

1. To understand the classification of mood disorders and distinguish between unipolar depression and bipolar disorder
2. To list the features that distinguish schizophrenia from a mood disorder with psychotic features.
3. To summarise the signs and symptoms, differential diagnosis, course of illness, co-morbidity, prognosis and complications of mood disorders
4. To be able to screen for depressive symptoms
5. To be able to screen for suicidality and to identify and manage suicide risk in a general medical setting.
6. To be able to screen for manic and hypomanic symptoms
7. To describe the treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance
8. Know when and how to use antidepressants and know their side effects
9. Know when and how to use antimanic agents and know their side effects
10. To understand the differences between depressive symptoms and depressive disorders and why the distinction is important
11. To understand the differences between sadness and grief associated with life events and depressive disorders
12. Describe ECT as a treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance.