Modules

• Year 1
  • Introduction to Year 1 and Year Outcomes
  • Fundamentals of Medicine
  • Cardiorespiratory 1
  • Metabolism 1
  • Locomotor 1
  • Brain and Behaviour 1
  • Human Development 1
  • Medicine in Society 1
  • Clinical Communication Skills
  • Student Selected Component (SSC)
• Year 2
  • Introduction to Year 2 and Year Outcomes
  • Cardiorespiratory 2
  • Metabolism 2
  • Brain and Behaviour 2
  • Human Development 2
  • Human Sciences and Public Health 2
  • Locomotor 2
  • Cancer Week
  • Moving and Handling Training
  • Year 2 Lifesaver Programme
  • Clinical Communication Skills
  • Medicine in Society 2
  • Extended Patient Contact
  • Student Selected Component (SSC)
• Year 3
  • Introduction to Year 3 and Year Outcomes
  • Clinical Science and Professionalism (Weeks 1-3)
  • Cardiovascular, Respiratory and Haematology (CR3)
  • Gastroenterology and Cancer (MET3A)
  • Public Health
  • Endocrinology and Renal Medicine (MET3B)
  • General Practice and Community Care
  • Student Selected Component (SSC)
  • Clinical and Communication Skills
• Year 4
  • Introduction and Year 4 Outcomes
  • Obstetrics and Gynaecology
  • Child Health
  • HIV & Sexual Health
  • Musculoskeletal
  • Health Care of the Elderly
  • Neuroscience
  • Dermatology
  • General Practice and Community Care
  • Psychiatry
  • Ear, Nose and Throat
  • Global Health and Ethics
  • Ophthalmology
  • Clinical & Communication Skills
  • Student Selected Component (SSC)
• Year 5
  • Introduction to Year 5 and Year Outcomes
  • Teaching Week 1
  • Teaching Week 2
  • Anaesthesia & ITU (AN & ITU)
  • Breaking Bad News
  • Clinical Pharmacology & Therapeutics
  • Community Care
  • Doctors as Teachers and Educators (DATE)
  • Emergency Medicine (EMERG MED)
  • General (Internal) Medicine (G(I)M)
  • Immediate Life Support (ILS)
  • Student Assistantship
  • Simulation
  • Surgery
  • Student Selected Component (SSC)
• Year GEP 1
  • Cancer Week
  • Movement and Posture
  • Carriage of Oxygen
  • Human Sciences and Public Health
  • Digestion, Growth and Metabolism
  • Infection and Immunity
  • Ethics
  • Brain and Behaviour
  • Human Development
  • Clinical Communication Skills
  • Medicine in Society (GEP)

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Year 4 PSYCH4: Psychiatry

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

Teaching Material for this Module

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 the Whole Person
• General Outcomes for Psychiatry
• Psychotic Disorders
• Anxiety Disorders
• Mood Disorders (inc. Depression)
• Personality Disorders
• Psychiatric Emergencies
• Somatoform and Factitious Disorders
• Eating Disorders
• Learning Disabilities
• Substance Abuse and Dependence

• General Outcomes for the Whole Person
  • Professional issues: LEARNING (TD 21 a-d)
    • Learning - General
      1. Gain insights in how to deal with challenging situations during patients encounters
  • Professional issues: RISK MANAGEMENT and PATIENT SAFETY (TD 23 d)
    • Principles of Risk Management
      1. Understand and be able to perform a risk assessment
• General Outcomes for Psychiatry
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • 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
    • Accidents and Suicide
      1. To understand the epidemiology of the psychiatric index conditions
  • Medical knowledge: PUBLIC HEALTH and GLOBAL HEALTH (TD 11 a-j)
    • Lifestyle and Disease
      1. To understand the role of stress and social deprivation etc on mental health
  • Clinical skills: HISTORY (TD 13 a-b)
    • Taking a History
      1. Achieve a balance between listening and interrupting. To orientate, guide and structure the interview within a time frame.
      2. Be able to elicit psychiatric signs and symptoms
      3. Communicate with patients who have psychiatric disorders: obtain information, provide reassurance and establish rapport
      4. Deal with dilemmas of confidentiality and detaining patients.
      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. Demonstrate skills necessary for dealing with aggressive and uncooperative patients
  • Clinical skills: MENTAL STATE EXAMINATION (TD 13 d)
    • Mental State Examination
      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. Be able to perform a cognitive assessment.
      5. Be able to present the history and examination findings in a coherent and comprehensive format, both written and oral.
  • Clinical skills: PLANNING AND INTERPRETING INVESTIGATIONS (TD 14 c-d)
    • Psychiatric Investigations
      1. Know the investigations used in psychiatry and be able to interpret their results.
  • Clinical skills: MAKING A DIAGNOSIS and CLINICAL JUDGEMENT (TD 14 e-f)
    • General Outcomes for Psychiatric Diagnosis
      1. Give a differential diagnosis of common psychiatric disorders with supporting reasons.
  • Clinical skills: FORMULATING A TREATMENT PLAN (TD 14 g)
    • Management of Psychiatric Disorders
      1. Know the general management of ANY psychiatric disorder over the first 24 hours of presentation
      2. Know, as a non-specialist, how to treat a patient with a psychiatric illness
      3. Understand the principles and practical application of the Mental Health Act in patient care
    • Psychiatric Emergencies
      1. To know the differential diagnosis of psychiatric emergencies and strategies for treating them
  • Professional issues: ETHICS and LAW (TD 20 a-g)
    • Ethics in Psychiatry
      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.
• 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. 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
  • Schizophrenia
    1. To list the features that distinguish schizophrenia from a mood disorder with psychotic features
    2. Describe an appropriate course of treatment for a patient with schizophrenia including pharmacotherapy and psychosocial support
    3. To summarise the current knowledge concerning aetiology, pathogenesis and epidemiology of schizophrenia.
    4. To summarise the clinical features and course of schizophrenia.
• Anxiety Disorders
  • General Outcomes for Anxiety Disorders
    1. Anxiety Disorders: Be able to elicit psychiatric symptoms and signs of a patient with an anxiety disorder or obsessive compulsive disorder
    2. Anxiety Disorders: Know when and how to use anxiolytic drugs and know their side effects.
    3. Anxiety Disorders: To describe the treatment, both pharmacological and psychotherapeutic, for each of the anxiety disorders
    4. Anxiety Disorders: To discuss the diagnosis and management of panic disorder, agoraphobia, social phobia and specific phobias.
    5. 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
    6. To understand the difference between fear and anxiety and the importance of this distinction
  • Obsessive-Compulsive Disorder (OCD)
    1. Obsessive-Compulsive Disorder: To summarise current knowledge of the aetiology, pathophysiology and epidemiology of obsessive-compulsive disorder.
    2. Obsessive-Compulsive Disorder: To describe the treatment, both pharmacological and psychotherapeutic, of obsessive-compulsive disorder.
    3. Obsessive-Compulsive Disorder: To discuss the diagnosis and management 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 list the features that distinguish schizophrenia from a mood disorder with psychotic features
    3. To describe the treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance.
    4. To summarise the signs and symptoms, differential diagnosis, course of illness, co-morbidity, prognosis and complications of mood disorders
    5. Know when and how to use antimanic agents and know their side effects.
    6. To be able to screen for depressive symptoms
    7. To be able to screen for manic and hypomanic symptoms
    8. To be able to screen for suicidality and to identify and manage suicide risk in a general medical setting
    9. Know when and how to use antidepressants and know their side effects
    10. To describe the treatment for major depression and bipolar disorder (manic and depressive phases) for acute episodes and longer term maintenance
    11. Know when and how to use antimanic agents and know their side effects
    12. To understand the differences between depressive symptoms and depressive disorders and why the distinction is important
    13. 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
  • Pharmacological Management of Depression
    1. Know when and how to use antidepressants and know their side effects.
    2. Know when and how to use antidepressants and know their side effects
• Personality Disorders
  • General Outcomes for 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.
    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. To have an overview of the major types of psychiatric emergencies
    2. Be able to assess a patient's potential danger to self or others.
    3. To know of risk factors and assessment of risk for psychiatric conditions
    4. Alcoholic Withdrawal Syndrome: Know the management of alcohol withdrawal, including delirium tremens
    5. Know the symptoms and management of Neuroleptic Malignant Syndrome
    6. Know the symptoms and management of Serotonin syndrome
    7. 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 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.
• Eating Disorders
  • General Outcomes for Eating Disorders
    1. Be able to elicit psychiatric symptoms and signs of a patient with an eating disorder
• Learning Disabilities
  • General Outcomes for Learning Disabilities
    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
• Substance Abuse and Dependence
  • General Outcomes for Substance Abuse and Dependence
    1. Substance Abuse and Dependence: Describe the impact of alcohol and drug misuse and dependence on the family and society
    2. Show a non-judgemental attitude to patients with substance misuse problems
    3. Substance Abuse and Dependence: Describe the psychological effects of the misuse of alcohol and other illicit drugs
    4. 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
    5. Substance Abuse and Dependence: Know the community resources required for the optimum rehabilitation and management of substance misuse and dependence
    6. Substance Abuse and Dependence: Know the investigations undertaken in cases of alcohol and substance misuse
    7. Substance Abuse and Dependence: List the social and behavioural associations of alcohol and drug misuse and dependence
    8. Substance Abuse and Dependence: Describe the pharmacological and metabolic effects of alcohol and other drugs of misuse.
  • Alcohol Abuse
    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
  • Alcoholic Withdrawal Syndrome
    1. Alcoholic Withdrawal Syndrome: Know the management of alcohol withdrawal, including delirium tremens
    2. Alcoholic Withdrawal Syndrome: Describe the management of the alcohol withdrawal syndrome and the Wernicke-Korsakoff syndrome
    3. 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

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