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Wessex Core Psychiatry Course INTEGRATED PSYCHIATRY MODULE HANDBOOK PART A 2018-2019 Health Education England Wessex School of Psychiatry
Wessex Core Psychiatry Course
INTEGRATED PSYCHIATRY
MODULE HANDBOOK
PART A 2018-2019
Health Education England Wessex School of Psychiatry
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Integrated Psychiatry Module Handbook Contents
1. Introduction/Welcome
2. Aims
3. Objectives
4. Definitions
Facilitator
Lead facilitator
Learning set
Task
Topic
Presentation
5. Topic Timetable facilitator overview
6. Learning objectives for topics
7. Topic Task detailed plan
8. Contacts
9. Resources
IT/Library
Reading
Websites
Edition 8 12/09/2018
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Core Psychiatry Course 2018 / 2019 Integrated Psychiatry Module Handbook Introduction
Welcome to the Integrated Psychiatry Module: please read this handbook in conjunction with the Course Handbook.
Following the restructuring of the MRCPsych Course in 2009 we have endeavoured to keep ahead of the changing needs of our trainees in a rapidly changing educational environment and we have kept at the heart of any changes, the original aims of the course. While passing the MRCPsych is essential, we feel that it is a reflection of the overall aim of producing excellent psychiatrists.
The format of the first year of the Core Psychiatry Course is such as to try and develop essential psychiatric skills which will enable you to practice psychiatry safely and competently. We have also tried to encourage a ‘life-long approach’ to psychiatry and will be looking at a range of common psychiatric illnesses across the age spectrum.
We understand that there is often a steep learning curve at the introduction to the course. Some people have been exposed to similar models of learning as part of their undergraduate curriculum whereas for others it is a new style of learning. However we do know from our experience over the past few years that as individuals and groups become more familiar with the format their confidence and satisfaction with the course increases.
This handbook should be read in conjunction with various other handbooks available on the course website (Facilitator Handbook, Educational Supervisor Handbook and Course Handbook). The Core Psychiatry programme has been designed to address the changing needs of trainees in the light of recent changes in psychiatry training and the Royal College of Psychiatry curriculum (June 2017).
Course information and copies of the handbooks are available to download from the Postgraduate website: http://intranet.southernhealth.nhs.uk/all-about-me/postgraduate-centre/psychiatry-training/core-psychiatry/
A Competency Based Curriculum for Specialist Core Training in Psychiatry : http://www.rcpsych.ac.uk/traininpsychiatry/corespecialtytraining/curricula.aspx
The course runs from 09:00 to 16:45; you are expected to turn up on time and to attend each of the sessions, and for the whole day. You will be asked to ‘sign in’, and attendance records are kept. Course attendance is part of your professional work.
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Aims of the Integrated Psychiatry Module The aim of this module is in line with the overall aims of the Core Psychiatry Course:
To enable you to practice psychiatry across the age spectrum to the highest possible standard and to a level that is appropriate to your training.
To provide you with the essential skills and knowledge to communicate with a patient irrespective of their age to gain an understanding of their concerns and recognise psychiatric illness if it is present.
To have an appreciation of the different presentations of psychiatric illness across the age spectrum and some understanding of the current resources available to develop an appropriate treatment plan.
To enable you to develop an understanding of the college curriculum and relate this to day to day clinical practice.
Objectives of the Integrated Psychiatry Module
These are meant to be a guide rather than an exhaustive list.
We will focus on the day to day clinical skills you will need in everyday practice.
We will encourage you to try and make links with day to day practice and other parts of the educational system.
We will focus on some of topics relevant to MRCPsych exam Paper A and Paper B in conjunction with the relevance for everyday practice.
To take a full psychiatric history irrespective of the age of the individual.
To perform a Mental State Examination irrespective of the age of the individual.
To be able to construct a psychiatric Formulation based on the above.
To have an understanding of aetiology, epidemiology and presentation of common psychiatric illness.
To have an appreciation of the different presentations of common psychiatric illness across the age range.
To be able to understand the range of treatment options including biological, psychological and social strategies available for these illness across the age spectrum.
To have gained an awareness of the similarities and differences of these approaches across the age spectrum.
To have developed an understanding of the multidisciplinary nature of the management including non-statutory agencies.
To have a basic understanding of legal issues such as capacity and consent.
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Definitions
Many elements are linked in the training process
The roles of Educational and Clinical supervisors are outlined in the Course Handbook.
Trainees role
Take the lead as a professional and take an active part in their own development, setting objectives and developing a personal learning plan. They should be able to identify their learning needs and also to be able to recognise their own level of competence. These should form the basis of discussions within educational and clinical supervision. This should also include some discussions linking the Core Psychiatry course to clinical practice.
Facilitator
The facilitators will be experienced clinicians who work with the groups throughout the topic to support their learning. In this module the facilitators in each session will come from a range of clinical backgrounds reflecting the life span approach to this module. There will be a clear introduction to the topic and time to work with the facilitators to summarise the topic at the end of each session.
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Lead facilitator
There will be a named lead facilitator for each topic who will be present for that topic. It is their responsibility to:
ensure that a work plan is received from each group at the end of the initial session
ensure that the sessions run to time
To introduce the speaker and format of the Masterclass
To allow time for reflection at the end of the topic
To encourage trainees to complete the feedback forms.
Learning set
There will be 2 learning sets in this module. These will be allocated at the start of the year. We would encourage you to devise a way to communicate between sessions at an early stage. Within each session each learning set will have access to a laptop with access to the internet to enable you to research and develop how to approach your task
Topic
This is the theme of each 2 week cycle.
Task
Each learning set will be allocated a task to complete by the following session in 2 weeks’ time. The tasks will be discussed with the facilitators during the initial afternoon session for that topic. By the end of that session an individualised work plan detailing how the individuals in that group aim to approach the task needs to be handed to the lead facilitator.
The tasks as listed for respective topics are for guidance and may be changed nearer the time of the session. For each of those tasks we shall be developing and distributing case vignettes to help link the knowledge with practical issues of patient care. Trainees may wish to contribute their own case vignettes.
Presentation
Each learning set will meet together to share what you have learnt from the tasks you had agreed to deal with. You will gather your thoughts and prepare to present the learning to the whole group. The learning sets will then feedback to each other followed by discussion and including interactive clinical study. Timings will be as agreed with the facilitators for the morning. On the whole it should be one person presenting the Leaning Set feedback. If using PowerPoint no more than 2-3 slides should normally be used. You should also prepare a group handout to share key learning points with the other learning sets.
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Structure of the Integrated Psychiatry Module Summary timetable
Date Topic Facilitators
13 September 2018 12:45-14:45
Masterclass: History of Psychiatry Masterclass: Introduction to
Classification
Dr Shelly Hogg
Dr Mustafa Soomro
13 September 2018 pm / 27 September 2018 am
Phenomenology Dr Mustafa Soomro Dr Jerzy Strukowski Dr Theresa Davies
27 September 2018 pm / 11 October 2018 am
History Taking & Mental State Examination
Dr R Ramachandra Dr Theresa Davies
Dr David Dayson (Masterclass only)
11 October 2018 pm / 01 November 2018
Clinical Psychopharmacology Michele Sullivan
Dr R Ramachandra
01 November 2018 / 15 November 2018 am
Formulation Dr Carlos Hoyos
15 November 2018 pm Developmental Psychopathology Dr Carlos Hoyos
29 November 2018 am Human Development tbc
29 November 2018 pm / 13 December 2018 am
Schizophrenia & Psychosis across the Life Span
Dr Obed Bekoe SpR (OPMH) tbc SpR (CAMHS) tbc
13 December 2018 / 17 January 2019
Depressive Disorders across the Life Span
Dr Shelly Hogg Dr Wajid Iqbal
SpR (CAMHS) tbc
17 January 2019 / 31 January 2019
Anxiety Disorders across the Life Span
Dr Mustafa Soomro SpR (OPMH) tbc SpR (CAMHS) tbc
Prof David Baldwin (Masterclass only)
31 January 2019 / 07 March 2019
Bi-polar Disorder across the Life Span
Dr R Ramachandra Dr Balaji Wuntakal (OPMH)
SpR (CAMHS) tbc
07 March 2019 / 21 March 2019
Understanding and Managing Self-Harm across the Life Span
tbc
21 March 2019 / 04 April 2019
Cognitive Function across the Life Span
Dr Shelly Hogg (OPMH) Co-facilitator (OPMH)
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Learning Objectives for Topics
The learning objectives are meant to be a guide and are not exhaustive. Phenomenology a) to understand the basic concepts relating to symptoms of mental illness b) to learn more about thought disorders, perceptual abnormality and disorders of mood c) to understand the clinical relevance of these symptoms and to apply this knowledge to
clinical practice. History Taking a) to gain knowledge about comprehensive psychiatric history taking b) to use history taking as a tool to arrive at issues such as diagnosis and management c) to understand the variety of sources from which a history can be acquired.
Mental State Examination a) to gain a comprehensive understanding of the different components of the mental state
examination b) to understand how a mental state examination can be used to arrive at a diagnostic
formulation c) to be competent at assessing and recording a comprehensive mental state examination. Schizophrenia & Psychosis across the life span a) to understand concepts relating to developmental history of the term ‘schizophrenia ’
including the concept of paraphrenia b) to learn about aetiology, signs and symptoms and epidemiology of schizophrenia c) to learn about the differential diagnosis, and different management options in
schizophrenia. Depressive disorders across the life span a) to learn about signs and symptoms, aetiology and differential diagnosis b) to understand various management options in brief c) to learn about prognosis d) to understand relevant concepts pertaining to neurochemistry, genetics and
neurophysiology. Anxiety disorders across the life span a) to learn about presentations of different anxiety disorders including OCD b) to learn about various management options in anxiety disorders c) to learn about aetiology, prognosis and management of specified anxiety disorders such as
OCD. Bi-polar disorder across the life span a) to understand the signs and symptoms in bipolar disorder b) to learn about aetiology, epidemiology, physiology, neurochemistry and genetics in bipolar
disorder c) to understand the principles of diagnosis, including differential diagnosis and management
options.
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Understanding and managing self-harm across the life span. a) to understand the principles behind assessment of suicide and self-harm b) to learn about comprehensive risk assessment and risk management c) to look at various management options in repeated self-harm. Cognitive functions across the life span a) to understand the principles of how to assess cognitive function across the life span b) to gain an understanding of the broad range of psychiatric and physical illness that can
affect cognitive function including epidemiology and aetiology c) to gain a clear understanding of the differential diagnosis and the range of management
options.
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Detailed timetable
Date Time Part A Facilitators
A:1
Introduction to Integrated Psychiatry Module
13 September 2018
1245-1345 Masterclass: History of Psychiatry Dr Shelly Hogg
1345-1445 Masterclass: Introduction to Classification Dr Mustafa Soomro 1445-1500 Tea break Lead Facilitator 1500-1645 Plenary session: Introduction to topic
Phenomenology, masterclass and group work Dr Mustafa Soomro Co-facilitator:
Dr Jerzy Strukowski (ST5) Preparation for 27 September 2018
How can you develop your understanding of these topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1: Thought
Theories behind the origins of delusion
Can delusions be real?
Are overvalued ideas of clinical significance?
Different types of thought disorder
Diagnostic significance of various types of thought disorders
Concept 2: Perception
Characteristics of normal perception
When can hallucinations be normal?
What are the different types of perceptual abnormalities?
What are pseudo-hallucinations?
Diagnostic significance of various perceptual experiences
Concept 3: Mood
How to decide if a mood experience is pathological
Core experience of mood disturbances such as depression and mania
Other types of mood experience such as anxiety and panic
What are obsessions and compulsion?
Diagnostic significance of various mood disorders
Each Learning Set discusses the topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
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Date Time Part A Facilitators
27 September 2018
0900-0930 Phenomenology Learning sets meet to gather thoughts and prepare work agreed on 13 September for feeding back main points to whole group and preparation of summary / revision notes.
Lead Facilitator: Dr R Ramachandra Co Facilitator: Dr Theresa Davies (ST4)
0930-1145
Learning sets feedback and plenary discussions including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators
A:2
History Taking and Mental State Examination
27 September 2018
Plenary session: Introduction to topic History Taking and Mental State Examination
Lead Facilitator: Dr R Ramachandra
1245-1445 Group work and preparation for 11 October Detailed tasks to be advised by the facilitators
Co Facilitator: Dr Theresa Davies (ST4)
How can you develop your understanding of these topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1: What are the relevant features you would look for in relation to appearance, behaviour and speech when performing a mental state examination?
Concept 2: What are the relevant features you would look for in relation to mood, thought and perception?
Concept 3: What are the relevant features you would look for in relation to cognitive assessment and insight?
Each Learning Set discusses the topic and the
assigned group work, agrees individual tasks and writes a work plan. At the end of the session the learning set hands a copy of the plan to the Lead Facilitator.
How can you develop your understanding of these
topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1:
Essential aspects of psychiatric history taking, does psychiatric history taking differ from medical history?
What is a reasonable way to take a history to reduce the chances of omission of significant information?
What should be the focus of the history?
What is the time requirement for a reasonable history to be taken?
Bring a relevant example of a history to the group for discussion with a focus on history of present illness and diagnostic formulation
Concept 2:
What is the importance / relevance of developmental history, past history and family history?
Is it important to elicit history excluding symptoms / conditions (negative history)?
What would be the process of collecting information pertaining to the above?
How important is it to set aside time for
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preparation prior to history taking?
How does developmental, past and family history contribute to diagnostic formulation?
Concept 3:
Focus on specific aspects of history e.g. personal history, social history, pre-morbid history.
How to get a good account of history of pre-morbid personality
Is this different for children as compared to adults?
How do these things contribute to diagnostic formulation?
Each Learning Set discusses the topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator.
1315-1445 Masterclass: How to take a Mental State
Examination Speaker: Dr David Dayson
Date Time Part A Facilitators
11 October 2018
0900-0930 History Taking and Mental State Examination Learning sets meet to gather thoughts and prepare work agreed on 27 September for feeding back main points to whole group and preparation of summary/revision notes
Lead Facilitator: Dr R Ramachandra Co Facilitator: Dr Theresa Davies (ST4)
0930-1145
Learning sets feedback and plenary discussions including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators
A:3 Clinical Psychopharmacology Lead Facilitators: 11 October 2018
Plenary session: Introduction to topic Clinical Psychopharmacology See Appendix for Case Vignettes 1, 2, 3 and 4.
Dr R Ramachandra Michele Sullivan, Specialist MH Pharmacist
1245-1445 Group work and preparation for 01 November 2018 Masterclass: Trends in Psychopharmacology Speaker: Michele Sullivan
1445-1500 Tea break
Part Time Part A
1 November 2018
0900-0930 Clinical Psychopharmacology Learning sets meet to gather thoughts and prepare work agreed on 11 October for feeding back main points to whole group and preparation of summary/revision notes.
Lead Facilitators: Dr R Ramachandra Michele Sullivan, Specialist MH Pharmacist
0930-1145
Learning sets feedback and plenary discussions including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning sets feedback to each other and facilitators
– and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
Date Time Part A Facilitators
A:4
Formulation
1 November 2018 Plenary session: Introduction to topic Formulation Lead facilitator: Dr Carlos Hoyos
1245-1445 Group work and preparation for 15 November Tasks to be advised by the facilitator
1445-1500 Tea break
Date Time Part A Facilitators
15 November 2018
0900-1200 Formulation Plenary session: Recap of topic and tasks, clarification of programme for morning
Lead facilitator: Dr Carlos Hoyos
Group work, discussion within learning sets, preparation of work agreed on 01 November for feeding back main points to whole group and preparation of summary/revision notes
1200-1245 Lunch
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Date Time Part A Facilitators
A:5 15 November
Developmental Psychopathology / Human Development
Lead facilitator: Dr Carlos Hoyos
2018 1245-1445 Masterclass Plenary session: Introduction to topic
Developmental psychopathology and Human Development
Group work and preparation for 29 November Tasks to be advised by the facilitator
1445-1500 Tea break
Date Time Part A Facilitators
29 November 2018
0900-1200 Developmental Psychopathology / Human Development Plenary session: Recap of topic and tasks, clarification of programme for morning
Lead facilitator: tbc
Group work, discussion within learning sets, preparation of work agreed on 15 November for feeding back main points to whole group and preparation of summary/revision notes
1200-1245 Lunch
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Date Time Part A Facilitators
A:6 Schizophrenia & Psychosis across the Life Span Lead Facilitator: Dr Obed Bekoe
29 November 2018
Plenary session: Schizophrenia & Psychosis across the Life Span
Co Facilitator(s):
1245-1445 Group work and preparation for 13 December Tasks subject to amendment by the facilitators
SpR (OPMH) tbc SpR (CAMHS) tbc
How can you develop your understanding of these topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1: Research the history of the term ‘’schizophrenia’’ including the various concepts which were developed; illustrate all your findings with clinical cases
Concept 2: What is Recovery? Research the management of schizophrenia in presenting it in a recovery based way including all bio-psychosocial modalities
Concept 3: Research other psychotic disorders including schizoaffective disorder, delusional disorders and one or two others
Each Learning Set discusses the Topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
Masterclass: Speaker: tbc 1445-1500 Tea break
Date Time Part A Facilitators
13 December 2018
0900-0930 Schizophrenia & Psychosis across the Life Span Learning sets meet to gather thoughts and prepare work agreed on 29 November for feeding back main points to whole group and preparation of summary/revision notes
Lead Facilitator: Dr Obed Bekoe
Co-Facilitator(s): 0930-1145 Learning sets feedback and plenary discussions
including interactive clinical study. Timings to be agreed with facilitator.
SpR (OPMH) tbc SpR (CAMHS) tbc
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators
A:7
Depressive Disorders across the Life Span Lead Facilitator: Dr Shelly Hogg
13 December 2018
1245-1445 Plenary session: Introduction to Topic Depressive disorders across the life span
Co Facilitators:
Dr Wajid Iqbal (ST5) Group work and preparation for 17 January 2019
I am assuming basic knowledge of depression
What do you want to know
What we think you should know
The exam
Across the life span
Facilitators will work with you to develop The Concepts
Use clinical cases wherever possible
Group 1 Referral to Diagnosis
Who should diagnose it?
Need to be able to recognise it/exclude it
Need to have reasonable “systems enquiry”
Differential Diagnosis across all ages
How to diagnose it
Rating scales yes or no
Classifications system which one and why?
Guidelines helpful?
How to grade it/should we grade it?
Atypical depression
Personal burden
Economic burden Group 2 Post Diagnosis
How to treat
When to treat
How long to treat for
Broad principles Biological/sociological/psychological
Monitoring
Guidelines helpful or not
Evidence for treatment
Medication which one or combo?
Self help
Prophylaxis
SpR (CAMHS) tbc
Each Learning Set discusses the Topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
Masterclass: Depression Across The Lifespan Speaker: Dr Wajid Iqbal 1445-1500 Tea break
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Date Time Part A Facilitators
17 January 2019
0900-0930 Depressive Disorders across the Life Span Learning sets meet to gather thoughts and prepare work agreed on 13 December for feeding back main points to whole group and preparation of summary/revision notes.
Lead Facilitator: Dr Shelly Hogg Co Facilitator(s): Dr Wajid Iqbal (ST5)
SpR (CAMHS) 0930-1145
Learning sets feedback and plenary discussions including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators
A:8
Anxiety Disorders across the life span Lead Facilitator: Dr Mustafa Soomro
17 January 2019 Plenary session: Introduction to topic Anxiety Disorders across the Life Span
Co Facilitators:
Dr Balaji Wuntakal 1245-1445 Group work and preparation for 31 January
SpR (CAMHS) tbc
How can you develop your understanding of these topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1: Research History of Concepts related to
Anxiety, Classification and Differential Diagnosis: Some concepts you might want to consider are:
What are the signs and symptoms? How to you diagnose it?
What are the differential diagnosis of various anxiety disorders and related conditions? How does this vary dependant on age?
How common a problem is it?
The history of Neurosis and how it’s meaning has changed over time.
The increase in number of categories related to anxiety conditions over time. The influence in pharmaceutical influences on this.
Differentiation between OCD and germ / dirt phobia
Differentiation between OCD and impulse control disorders
Should OCD be part of anxiety disorders – or altogether a different category?
What is the relevance and significance of different types of attachment on anxiety in young people and throughout their lives?
What is the impact of abuse and neglect?
How much is anxiety learnt?
What is the genetic risk?
What is the importance of retirement, bereavement and life changes?
How do health problems affect anxiety disorders?
Consider both ICD 10 and DSM IV
Concept 2: Research Management of Anxiety Disorders:
What are the common management approaches across anxiety disorders?
What are the specific management approaches for various disorders?
How could a systemic approach to management be helpful?
Please consider all kinds of treatment and those with good evidence base.
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Concept 3: Research Aetiology, Epidemiology and Prognosis of Anxiety Disorders:
Consider common aetiological factors across anxiety disorders
What is the relevance and significance of different types of attachment on anxiety in young people and throughout their lives?
What are the effects of abuse and neglect?
What is the impact of parental mental health problems?
What is the importance of retirement, bereavement and life changes?
How do health problems affect anxiety disorders?
What is the prognosis for different anxiety disorders?
Do you grow out of anxiety?
How does anxiety change throughout a lifespan?
Consider both ICD 10 and DSM IV
Each Learning Set discusses the Topic and their assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
1400-1445 Masterclass: Evidence based pharmacological treatment of anxiety disorders
Speaker: Prof David Baldwin
1445-1500 Tea break
Resources for the topic:
Oxford Text books
College Seminar Series
Clinical Evidence BMJ
Cochrane Library
Evidence Based Mental Health – BMJ
Rutters Textbook of Child and Adolescent Psychiatry
Pubmed searches
Date Time Part A Facilitators
31 January 2019 Anxiety Disorders across the Life Span Lead Facilitator: Dr Mustafa Soomro 0900-0930
Learning sets meet to gather thoughts and prepare work agreed on 17 January for feeding back main point to whole group and preparation of summary / revision notes.
Co Facilitators: Dr Balaji Wuntakal SpR (CAMHS) tbc
0930-1145 Learning sets feedback and plenary discussions
including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators
A:09
Bi-polar Disorder across the Life Span Lead Facilitator: Dr R Ramachandra
31 January 2019 Plenary session: Introduction to topic Bi-polar disorder across the life span
Co Facilitator(s): 1245-1445 Group work and preparation for 7 March
Tasks subject to amendment by the facilitators
SpR (OPMH) SpR (CAMHS)
How can you develop your understanding of these topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1: Research the history, definition, aetiology, epidemiology and diagnosis of bipolar disorder Some questions you might want to consider are:
What is bipolar disorder?
What is the aetiology of bipolar disorder?
How common is it?
Is the incidence increasing?
Is it commoner in men or women?
What is the risk of bipolar disorder in the offspring?
What are the signs & symptoms? How do you diagnose it?
How does it differ from other conditions e.g. schizoaffective, delusional disorders, borderline personality disorder, substance misuse?
How did the term come about?
Is the term bipolar disorder appropriate?
Concept 2: Carry out some research on
investigation and management of bipolar disorder across bio-psychosocial concepts. Some questions you might want to consider are:
How do you manage bipolar disorder?
What are important aspects in risk assessment and management of patients with bipolar disorder?
What is the most appropriate drug treatment? For whom?
Which psychological treatments have proven to be effective?
Do people with bipolar disorder get well?
Is it a life-long condition requiring life-long treatment?
Concept 3: Carry out some research on the
prognosis and long-term outcome of bipolar disorder Some questions you might want to consider are: Is it a life long condition? Does it recur? What is the risk of relapse? What can patients do to improve prognosis? What are the prognostic indicators? Can the condition become chronic?
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Each Learning Set discusses the Topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
Masterclass Speaker: tbc 1445-1500 Tea break
Resources for the topic Text books:
Oxford textbook of Psychiatry
Companion to Psychiatric studies- Kendell and Zealley
Comprehensive textbook of Psychiatry
DSM-IV
ICD-10 Treatment Guidelines:
NICE
BAP –British Association of Psychopharmacology
APA- American Psychiatric Association Information Leaflets:
RCPsych website : information for patients and carers
Manic Depression Fellowship website Information on YouTube Famous people (some diagnoses more clear than others):
Stephen Fry
Dusty Springfield
Robbie Williams
Frank Bruno
Ruby Wax
Virginia Woolf Books:
Kay Redfield Jamison – An Unquiet Mind
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Date Time Part A Facilitators
7 March 2019
Bi-polar Disorder across the Life Span
Lead Facilitator: Dr R Ramachandra
0900-0930 Learning sets meet to gather thoughts and prepare work agreed on 31 January for feeding back main points to whole group and preparation of summary/revision notes.
Co Facilitator(s): SpR (OPMH) tbc SpR (CAMHS) tbc
0930-1145 Learning sets feedback and plenary discussions
including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators
A:11
Understanding and Managing Self Harm across the Life Span
Lead Facilitator: tbc
7 March 2019 Plenary session: Introduction to topic Understanding
and Managing Self Harm across the Life Span Co Facilitator(s): tbc
1245-1445 Group work and preparation for 21 March Tasks subject to amendment by the facilitators
How can you develop your understanding of these topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept for everyone – You do not have to feedback on this one but can if it helps to illustrate other tasks. Consider the clinical assessment of a patient who presents with self-harm. Questions you might want to research
What are the important features in history and examination?
Can you think of a patient you have recently seen?
Have you reflected on a clinical case with your educational / clinical supervisor?
Have you performed a WPBA?
Concept 1: Consider the wider social, moral and religious perspectives on self harm. Questions you might want to research
What is the legal framework regarding self-harm and suicide in the UK?
What is the view of the man on the street regarding self harm?
How does the view of self harm vary around the world?
Does this affect our clinical practice?
Concept 2: Consider the Psychological Processes and models that relate to self harm Questions you might want to research
Can psychiatric illness fully explain self harm?
What social factors influence self harm? (Hint - Durkheim)
How might personality, coping strategies, and childhood experiences affect risks of self harm?
Are the processes the same for all patients? Do they differ with different severity of self harm, self harm versus suicide?
Concept 3: Consider the Demographics of self harm Questions you might want to research. When asking and answering these questions consider similarities and differences between the elderly, children, patients with co-morbid physical illness, patients with substance misuse problems
Are self harm and suicide different?
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How common is self harm?
Who is vulnerable to self harm?
When is one vulnerable to self harm?
What is meant by static and dynamic risk factors?
Concept 4: Consider the assessment and treatments available to patients who present with self harm Questions you might want to research. . When asking and answering these questions consider similarities and differences between the elderly, children, patients with co-morbid physical illness, patients with substance misuse problems
What are the important features in history and examination?
Where might one find information regarding treatments and their effectiveness?
How do different treatments affect prognosis?
What psychological processes can help or hinder treatment?
Can one think of a case example that would illustrate either good outcomes or challenges (or both)?
Each Learning Set discusses the Topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
Masterclass : Speaker: tbc 1445-1500 Tea break
Date Time Part A Facilitators
21 March 2019
0900-0930 Understanding and Managing Self-harm across the Life Span Learning sets meet to gather thoughts and prepare work agreed on 7 March for feeding back main points to whole group and preparation of summary revision notes.
Lead Facilitator: Tbc Co Facilitator(s):
0930-1145
Learning sets feedback and plenary discussions including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Date Time Part A Facilitators A:12 Cognitive Function across the Life Span Lead Facilitator: Dr Shelly Hogg 21 March 2019
1245-1445 Plenary session: Introduction to topic Cognitive Functions across the Life Span. This is an introduction to a broad topic and a lot of it will be covered in more detail in Part B. I expect this to be an overview of the common dementias.
Co-Facilitator(s): tbc
Masterclass: Speaker: tbc Group work and preparation for 4 April How can you develop your understanding of these
topics? Describe it as per SIMS. You will be asked to generate tasks as a group.
Concept 1:
What do you understand by the term Vascular Dementia? Some questions you might want to consider are:
What are the diagnostic criteria?
What are the different types?
What are the important aetiological/epidemiological factors?
Rating scales?
Assessment and Investigations?
What treatment options are currently available?
Prognosis and monitoring?
Who should do what? / Role of OPMH
Concept 2:
What is Fronto-temporal dementia? Some questions you might want to consider are:
What are the diagnostic criteria?
Is there a classification system that you can understand?
What do all the different terms mean?
What are the important aetiological and epidemiological issues?
What assessment and Investigations?
Treatment strategies:
Sexual disinhibition
Concept 3:
What do you understand by the terms Senile dementia of Alzheimers type? (SDAT) Some questions you might want to consider are:
What are the important aetiological and epidemiological issues?
What is The Amyloid Hypothesis?
Is there a genetic component?
What are the diagnostic criteria?
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Assessment and Investigations?
To scan or not to scan ?
Treatment options
Monitoring
The NICE guidelines Concept 4: What is Lewy Body disease? (LBD) Some questions you might want to consider are:
What is the relationship to Parkinsons disease and SDAT
What are the diagnostic criteria?
Assessment and Investigations?
Why is diagnosis important?
Monitoring
Treatment options
NICE Guidelines
Each Learning Set discusses the Topic and their
assigned group work, agrees individual tasks, and writes a work plan. At the end of the session the Learning Set hands a copy of this plan to the Lead Facilitator
1445-1500 Tea break
Date Time Part A Facilitators
04 April 2019 Cognitive Function across the Life Span Lead Facilitator: Dr Shelly Hogg
0900-0930 Learning sets meet to gather thoughts and prepare
work agreed on 21 March for feeding back main points to whole group and preparation of summary / revision notes.
Co-Facilitator(s): tbc
0930-1145 Learning sets feedback and plenary discussions
including interactive clinical study. Timings to be agreed with facilitator.
1145-1200 Learning set feedback about how the topic has gone
to each other and facilitators – and vice versa. Each group to comment on two things the other learning set(s) have done well and one thing they would have liked to be included.
1200-1245 Lunch
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Reading list Gelder M, Harrison P and Cowen P (2006) Shorter Oxford Textbook of Psychiatry 5th Edition OUP
Oxford
Stein G and Wilkinson G (2007) Seminars in General Adult Psychiatry (2nd Edition) Royal College of Psychiatrists UK
Stephen Stahls Psychopharmacology (Latest Edition)
Andrew Sims Symptoms in the Mind (Latest Edition) regarding Psychopathology
Critical Appraisal (College Seminar Series) Royal College of Psychiatrists UK
ICD-10 Classification of Diseases (Chapter V on mental disorders)
Companion to Psychiatry Studies by Kendel and Zealley (latest edition)
Oxford Textbook of Old Age Psychiatry: Robin Jacoby et al
Psychiatry in the Elderly: Robin Jacoby and Catherine Oppenheimer
Assessment Scales in Old Age Psychiatry: Alistair Burns et al
Everything you need to know about Old Age Psychiatry: Robert Howard
Clinical Guidelines in Old age Psychiatry: Alistair Burns, Tom Denning & Brian Lawlor
Examination notes in Psychiatry: Peter Buckley, Del Prewette, Jonathan Bird & Glynn Harrison
Recent advances in Psychiatric treatment. Royal College of Psychiatrists CPD Journal
Rutters Child and Adolescent Psychiatry, 5th Edition
Child and Adolescent Psychiatry: A developmental Approach Turk J, Graham P, Verhulst F
Reference Gelder M, Andreasen N, Lopez-Ibor J and Geddes J (2009) New Oxford Textbook of Psychiatry
(2nd Edition) OUP Oxford
Comprehensive Textbook of Psychiatry by Kaplan and Sadock (latest edition)
Psychopathology by Fish
DSM-5 Classification of Mental Illnesses
Novels/Carers books Have the men had enough: Margaret Foster
Guppies for tea: Marika Cobbold
Iris: John Bayley
Iris and friends: John Bayley
I had a black dog: Matthew Johnstone
The Selfish Pigs guide to caring: Hugh Marriott
The Curious Incident of the Dog in the Night time: Mark Haddon
We need to talk about Kevin: Lionel Shriver
Useful Websites Alzheimers society: www.alzheimers.org.uk
Lewybody disease society: www.lewybody.org
Nice guidelines: www.nice.org.uk
Mental Health act/Mental Capacity act: www.directgov.uk
Information leaflets: www.rcpsych.ac.uk
College CPD On Line: www.rcpsych.ac.uk but need to be registered
Clinical guidelines: www.southernhealth.nhs.uk
This is not an exhaustive list, and facilitators will suggest references (which may include the above) to help trainees prepare for the tasks.
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Module leads for Integrated Psychiatry Module Adult Mental Health Leads Dr Raghavendra Ramachandra
Cannon House, Southampton [email protected] 023 8047 5588 / 023 8087 8040
Dr Mustafa Soomro St James Hospital, Portsmouth. [email protected]
023 8047 5588 / 023 9268 5000
Human Development Lead Dr Carlos Hoyos
The Orchard Centre, Western Community Hospital, Southampton. [email protected] 023 8029 6230 / 023 8084 0044
Older Persons Mental Health Lead Dr Shelly Hogg The Langstone Centre, St James Hospital, Portsmouth. [email protected] 023 9268 4684 / 023 9268 4681
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Library and IT facilities You will have access to Library facilities in your own local area and you will be able to use the library at Tom Rudd Unit on course days. You should ensure that you have a NHS Athens account: this is a username and password which allows you to use information resources paid for by the NHS. All NHS staff are entitled to an NHS Athens account. Teaching material may be made available to you after sessions, but please be mindful of intellectual property and do not reproduce without permission / acknowledging its source. Your Learning Set will have a laptop, with internet access, to use in the Education Room on course days. Some useful websites are:
http://www.library.nhs.uk/ and http://www.evidence.nhs.uk/ - locate libraries, search for articles / books / other publications, register for an Athens account, “My Library” facility
http://www.swims.nhs.uk - catalogue of what is available (books, journals, audiovisual, etc) in all libraries in the south west
http://www.medicalresearchservices.nhs.uk/ The Medical Search Initiative has developed electronic tools for use on the desktop, making it much easier for all NHS staff to check details while they are working. The tools created give easy access to reliable sources such as the British National Formulary, Medicines.org.uk and the National Library for Health
Basingstoke, Southampton, Winchester and South West Hampshire: http://www.hantshealthcarelibrary.nhs.uk/
Dorset: East Dorset NHS Library Service, Haven Road, Canford Cliffs, Poole [email protected]
Isle of Wight: http://www.iow.nhs.uk/index.asp?record=649 [email protected]
Portsmouth: http://www.porthosp.nhs.uk/library-services.html
Salisbury: Beechlydene, Fountain Way, Salisbury SP2 7EP Education Centre, Salisbury District Hospital, Salisbury SP2 8BJ [email protected]
Edition 8 (12/09/2018)
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APPENDIX
11 October 2018 / 02 November 2018
Clinical Psychopharmacology Dr R Ramachandra Michele Sullivan
Case Vignette 1 Clinical Psychopharmacology Dr R Ramachandra 11/10/18
You are seeing a 26-year-old man with a diagnosis of schizophrenia for the first time. He has second and third person auditory hallucinations, with derogatory content, and delusion of persecution. He believes that he is being targeted by some people who are playing mind games with him. He has been having these symptoms for approximately a year, but for the first 9 to 10 months, he did not disclose the symptoms to anybody. He was quite anxious and scared and it was only because his parents insisted that he went and saw his general practitioner who then referred him to the mental health services. He has already been seen for a generic assessment by a mental health nurse this person would need an assessment by a psychiatrist to discuss future medication treatment options. He is relatively well and fit, has no long-standing physical health problems, has no known allergies, is single but would like to get into a relationship in the near future, does not use alcohol or recreational drugs. 1) What are the different medication choices available to you? 2) How would you go about deciding on the choice of medication? 3) What are the different short-term and long-term treatment options? If medication is advised, what are the target symptoms? How long will you advise medication to be continued?
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Case Vignette 2 Clinical Psychopharmacology Dr R Ramachandra 11/10/18
You are seeing a 26-year-old man with a diagnosis of schizophrenia in your follow-up clinic. He has second and third person auditory hallucinations, with derogatory content, and delusion of persecution. He believes that he is being targeted by some people who are playing mind games with him. He had been having these symptoms for approximately a year, but for the first 9 to 10 months, he did not disclose the symptoms to anybody. He was quite anxious and scared and it was only because his parents insisted that he went and saw his general practitioner who then referred him to the mental health services. He has now been under the mental health services for nearly 6 months and has been treated with different antipsychotic medications, despite treatment he continues to have symptoms which are distressing. He has now started to feel relatively low and hopeless, does not think that he will ever get well, and believes that it would be much better for him to take his own life rather than be killed by his alleged persecutors. Since starting treatment it has also been noted that he has been putting some weight on, and he has also developed the habit of smoking tobacco. He does not use any recreational drugs. He does not consume any alcohol. He has also been less interested, less motivated and complains of sexual side effects with the medication. 1) What are the different medication choices available to you? 2) How would you go about deciding on the choice of medication? 3) How would you go about switching antipsychotic medications?
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Case Vignette 3 Clinical Psychopharmacology Dr R Ramachandra 11/10/18
You are seeing a 34-year-old Doctor for the first time. He has been recently diagnosed with bipolar disorder 2. He has had several hypomanic episodes as well as depressive episodes. When hypomanic he becomes quite impulsive, is not able to sleep well, becomes reckless, is unable to focus on concentrate, and has often been sent home from one as he becomes quite cavalier in his approach. He also has had caution from the police as he has driven recklessly. Such periods last approximately 2 to 3 months. When depressed he has become amotivated, withdrawn, takes himself to his bed, does not look after himself, sleeps a lot, comfort eats, and is unable to function. Such periods usually last between 3 to 4 months. He also has been absent from work on a number of occasions during such periods. He had been reluctant to accept this diagnosis and has only recently is started to consider the need for treatment. 1) What are the different medication choices available to you? 2) How would you go about deciding on the choice of medication? 3) Would you consider long term prophylactic medication for him? If so, what are your choices?
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Case Vignette 4 Clinical Psychopharmacology Dr R Ramachandra 11/10/18
You are seeing a 30 year old lady for the first time in your follow-up clinic with a diagnosis of bipolar disorder. She is on treatment with olanzapine and lithium. She has been well for the last two years. Prior to this, she had multiple episodes of mania and depression, and has also required hospitalisation on two occasions, once for a manic episode, and once when she was significantly depressed. She has been in a new relationship for the last six months and has decided that it would be an ideal time for her to start her family. She has come to you for advice. How do you proceed? She is quite keen to be on medication as she believes that medication has helped her remain well. She also believes that she needs long term prophylactic medication, as per the advice given to her by her consultant psychiatrist. 1) What are the different medication choices available to you? 2) How would you go about deciding on the choice of medication? 3) Would you advise her coming off all her medication, prior to her becoming pregnant?
