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Year 4 PSYCH4: Psychiatry

• Professor Ania Korszun
• a.korszun@qmul.ac.uk

Introduction

To achieve a level of competency in psychiatry to be able safely to carry out the duties of a Foundation Year 1 Doctor in any branch of medicine, and to have the necessary requirements to go on to further training in psychiatry if wished.

To promote respect and understanding of psychiatry as a medical discipline and its importance to other medical specialities.

To dispel attitudes which result in stigmatization of patients with psychiatric disorders.

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Index

• General Outcomes for Psychiatry
• Psychotic Disorders
• Anxiety Disorders
• Mood Disorders (inc. Depression)
• Delirium and Acute Confusion
• Dementia
• Personality Disorders
• Psychiatric Emergencies
• Somatoform and Factitious Disorders
• Eating Disorders
• Learning Disabilities
• Substance Abuse and Dependence
• Suicide and Self Harm

• General Outcomes for Psychiatry
  • Medical knowledge: PATHOLOGY
    • General
      1. To achieve a basic understanding of brain function and pathological processes
      2. To understand the two-way links between Medical diseases and Psychiatric disorders
  • Medical knowledge: EPIDEMIOLOGY
    • General epidemiology
      1. To understand the epidemiology of the psychiatric index conditions
  • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH
    • Lifestyle and Disease
      1. To understand the role of stress and social deprivation etc on mental health
  • Clinical skills: HISTORY and EXAMINATION
    • Taking a History
      1. Be able to obtain a full psychiatric history.
      2. Be able to elicit psychiatric signs and symptoms
      3. Achieve a balance between listening and interrupting. To orientate, guide and structure the interview within a time frame.
      4. Communicate with patients who have psychiatric disorders: obtain information, provide reassurance and establish rapport
      5. Deal with dilemmas of confidentiality and detaining patients.
      6. Establish the relationship and in particular to judge the distance both interpersonally and physically that is appropriate when interviewing patients with mental health problems.
      7. Screen for psychiatric symptoms in a sensitive way
      8. To know how to make a cultural formulation as part of a psychiatric assessment.
      9. Demonstrate skills necessary for dealing with aggressive and uncooperative patients
    • Mental State Examination
      1. Be able to perform a mental state examination
      2. Be able to assess suicide risk.
      3. Be able to assess a patient's potential danger to self or others.
      4. Be able to assess the seriousness of a suicide attempt.
      5. Be able to perform a cognitive assessment.
      6. Be able to present the history and examination findings in a coherent and comprehensive format, both written and oral.
  • Clinical skills: INVESTIGATION
    • Psychiatric Investigations
      1. Know the investigations used in psychiatry and be able to interpret their results.
  • Clinical skills: DIAGNOSIS and REASONING
    • General Outcomes for Psychiatric Diagnosis
      1. Give a differential diagnosis of common psychiatric disorders with supporting reasons.
  • Clinical skills: PATIENT MANAGEMENT
    • Management of Psychiatric Disorders
      1. Know, as a non-specialist, how to treat a patient with a psychiatric illness
      2. Know the general management of ANY psychiatric disorder over the first 24 hours of presentation
  • Professional issues: ETHICS and LAW
    • Ethics and Mental Illness
      1. Know the indications for, and appropriate steps to be taken when compulsory admission under the Mental Health Act into hospital is required
      2. To describe the key Sections of the Mental Health Act, with specific reference to admission, compulsory treatment and to provide a moral justification for them.
      3. The Mental Health Act for Section 2, Section 3, Section 5(2)
      4. The legislative requirements for compulsory admission
      5. Deal with dilemmas of confidentiality and detaining patients.
      6. To indicate how the structure of the Act is designed to try to protect the civil liberties of detained patients.
      7. To know the conditions for detention of a patient
      8. To specify the implications of serious mental disorder for the interpretation of the duties of clinical care.
• Psychotic Disorders
  • General Outcomes for Psychotic Disorders
    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. Describe an appropriate course of treatment for a patient with schizophrenia including pharmacotherapy and psychosocial support
    6. To formulate a differential diagnosis for an individual presenting with psychosis
    7. To understand the role stress, social deprivation etc on mental health
  • Schizophrenia
    1. To list the features that distinguish schizophrenia from a mood disorder with psychotic features
    2. To summarise the current knowledge concerning aetiology, pathogenesis and epidemiology of schizophrenia
    3. Describe an appropriate course of treatment for a patient with schizophrenia including pharmacotherapy and psychosocial support
    4. To summarise the clinical features and course of schizophrenia
• Anxiety Disorders
  • General Outcomes for Anxiety Disorders
    1. To summarise current knowledge of the aetiology, pathophysiology and epidemiology of generalized anxiety disorder, panic disorder, social phobia, agoraphobia and other specific phobias
    2. Be able to elicit psychiatric symptoms and signs of a patient with an anxiety disorder or obsessive compulsive disorder
    3. Know when and how to use anxiolytic drugs and know their side effects
    4. To describe the treatment, both pharmacological and psychotherapeutic, for each of the anxiety disorders
    5. To discuss the diagnosis and management of panic disorder, agoraphobia, social phobia and specific phobias
    6. To understand the difference between fear and anxiety and the importance of this distinction
  • Obsessive-Compulsive Disorder (OCD)
    1. To summarise current knowledge of the aetiology, pathophysiology and epidemiology of obsessive-compulsive disorder
    2. To discuss the diagnosis and management of obsessive-compulsive disorder
    3. To describe the treatment, both pharmacological and psychotherapeutic, of obsessive-compulsive disorder
• Mood Disorders (inc. Depression)
  • General Outcomes for Mood Disorders
    1. To understand the classification of mood disorders and distinguish between unipolar depression and bipolar disorder
    2. To summarise the signs and symptoms, differential diagnosis, course of illness, co-morbidity, prognosis and complications of mood disorders
    3. To list the features that distinguish schizophrenia from a mood disorder with psychotic features
    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. Know when and how to use antidepressants and know their side effects
    7. To be able to screen for manic and hypomanic symptoms
    8. To describe the treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance
    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
  • Bi-polar Disorder
    1. To understand the classification of mood disorders and distinguish between unipolar depression and bipolar disorder
    2. To be able to screen for manic and hypomanic symptoms
  • Electroconvulsive Therapy
    1. Describe ECT as a treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance
  • Pharmacological Management of Depression
    1. Know when and how to use antidepressants and know their side effects
• Delirium and Acute Confusion
  • General Outcomes for Delirium and Acute Confusion
    1. The common causes of delirium under the following headings – Sepsis, Iatrogenesis, Intracranial, metabolic.
    2. To understand the definition of delirium as a syndrome with many causes.
    3. To discuss the clinical features, differential diagnosis, evaluation and treatment of delirium.
    4. To be able to correctly describe the difference between delirium and dementia.
    5. To be able to correctly differentiate delirium from schizophrenia and depression.
• Dementia
  • Problems in old age
    1. Know and understand the principles of supporting patients’ wishes who are losing or who are deemed not to have capacity including legal power of attorney and court of protection
    2. Appreciate the principles of multi-disciplinary, complex discharge planning for an older patient with cognitive impairment.
    3. Know and understand the key therapeutic interventions used in patients with dementia (click to see list)
    4. Be able to take an appropriate, focussed history, and examine a patient presenting with delirium and / or dementia.
    5. Know and understand the principles of assessment of mental competency / capacity
    6. Know and understand the primary drug classes and members, their indications, contra-indications, common side effects and interactions; Including L-Dopa, DA agonists, COMT inhibitors, MAOI-B inhibitors, Apomorphine.
    7. Describe the pathology, presentation, investigation and management of dementia
    8. Be able to Perform a mental state examination – this should include a 10-point Abridged mental test score (AMTS) and be familiar with the 30-point Folstein mini-mental state examination (MMSE)
    9. Know when and how to use medications to treat dementia (including side effects)
  • General Outcomes for Dementia
    1. The common causes of dementia (click here for details)
    2. To know the epidemiology, pathology and pathophysiology of Alzheimer’s disease
    3. To recognise the clinical features of Alzheimer's disease and distinguish other types of dementia
    4. To understand the principles and reasons for investigation of dementia and list investigations of dementia in the over 65 year old age group
    5. To appreciate different kinds of management of dementia and principles of community based care, to understand the principles behind advances in modern neurogenetics, molecular biology, and mechanisms of disease in examples such as Huntington's disease
• Personality Disorders
  • General Outcomes for Personality Disorders
    1. Be able to elicit psychiatric symptoms and signs of a patient with a personality disorder
    2. Explain the basics of how personality traits and disorders are defined and classified
    3. Know the community resources required for the optimum rehabilitation and management of severe personality disorders
    4. Outline the clinical features common to all personality disorders and the features which distinguish them
    5. To state the moral difficulties posed by serious personality disorder for the care of those so affected
    6. To state the moral difficulties posed by serious personality disorder for the care of those so affected.
• Psychiatric Emergencies
  • General Outcomes for Psychiatric Emergencies
    1. Know the management of alcohol withdrawal, including delirium tremens
    2. Be able to assess a patient's potential danger to self or others
    3. Be able to assess suicide risk
    4. Be able to assess the seriousness of a suicide attempt
    5. Know the symptoms and management of Neuroleptic Malignant Syndrome
    6. Know the symptoms and management of Serotonin syndrome
    7. Know what to do in cases of patients with suicide risk or who pose a potential danger to self or others
    8. Know the symptoms and management of movement disorders including extra-pyramidal side effects; acute dystonia; akathisia and tardive dyskinesia
• Somatoform and Factitious Disorders
  • General Outcomes for Somatoform and Factitious Disorders
    1. To understand the principles behind the mind-body relationship
    2. To understand the main differences between the biomedical and biopsychosocial models of medicine.
    3. 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.
    4. Outline the clinical characteristics of somatization disorder, conversion disorder, body dysmorphic disorder and hypochondriasis.
    5. Outline the clinical characteristics of factitious disorder
    6. Be able to elicit psychiatric symptoms and signs
    7. To understand the two-way links between Medical diseases and Psychiatric disorders
• Eating Disorders
  • General Outcomes for Eating Disorders
    1. Be able to elicit psychiatric symptoms and signs of a patient with an eating disorder
    2. List the medical complications and indications for hospitalisation in patients with eating disorders
  • Bulimia Nervosa
    1. Summarise current knowledge of the aetiology, clinical features, epidemiology, course, co-morbid disorders, complications and treatment for bulimia nervosa
  • Anorexia Nervosa
    1. Summarise current knowledge of the aetiology, clinical features, epidemiology, course, co-morbidities, complications and treatment for anorexia nervosa
• Learning Disabilities
  • General Outcomes for Learning Disabilities
    1. Know the definition of a learning disability
    2. Know the aetiology and prevalence of a learning disability
    3. Know the aetiology, prevalence and presentation of mental illness and behavioural problems in people with learning disability
    4. Know how to assess capacity to consent to treatment
    5. Be able to communicate effectively with people with learning difficulties
    6. Understand the treatment of psychiatric disorders in people with learning disabilities
    7. Understand the assessment of psychiatric disorders in people with learning disabilities
    8. Understand the importance of community integration for people with learning difficulties
    9. Know the community resources required for the optimum rehabilitation and management of learning disabilities in children and adults
    10. Know and appreciate the importance of valuing skills of people with learning disability
    11. Understand the stigma and prejudice associated with learning disabilities
• Substance Abuse and Dependence
  • Alcoholic Withdrawal Syndrome
    1. Know the management of alcohol withdrawal, including delirium tremens
    2. Describe the management of the alcohol withdrawal syndrome and the Wernicke-Korsakoff syndrome
    3. 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
  • General Outcomes for Substance Abuse and Dependence
    1. Describe the impact of alcohol and drug misuse and dependence on the family and society
    2. Describe the psychological effects of the misuse of alcohol and other illicit drugs
    3. 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
    4. Know the community resources required for the optimum rehabilitation and management of substance misuse and dependence
    5. Know the investigations undertaken in cases of alcohol and substance misuse
    6. List the social and behavioural associations of alcohol and drug misuse and dependence
    7. Describe the pharmacological and metabolic effects of alcohol and other drugs of misuse.
    8. Show a non-judgemental attitude to patients with substance misuse problems
  • Opioid Dependence
    1. Describe the management of opioid dependence
  • Alcohol Abuse
    1. Describe the use of simple behavioural screening tests to recognise problematic alcohol use
    2. Describe the structural and functional effects of alcohol on the cardiovascular system including cardiomyopathy
    3. 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
• Suicide and Self Harm
  • General Outcomes for Suicide and Self Harm
    1. Be able to assess a patient's potential danger to self or others
    2. Be able to assess suicide risk
    3. Be able to assess the seriousness of a suicide attempt
    4. Know what to do in cases of patients with suicide risk or who pose a potential danger to self or others
    5. To be able to screen for suicidality and to identify and manage suicide risk in a general medical setting.

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