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2016-17 Phase I,Year 1

Psychological medicine

CONVENER DR DEAN MCMILLAN

Contents

Year 1

Psychological medicine Introduction Welcome to Psychological medicine Overview of the block Learning outcomes for the block Trigger material for the block

3 3 6 8

Learning outcomes for the trigger material Personal portfolio reflection

9 9

WEEK 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8

The brain and behaviour

WEEK 2

The interplay between behaviour, cognition, physical symptoms and emotions

Timetable for Week 1 Virtual patient: Eric Martin

11 12

Learning outcomes: Eric Martin Trigger material: Film clip – ‘Recovery’

13 14

Learning outcomes: Film clip – ‘Recovery’ Learning opportunities and their outcomes Clinical skills worksheet Personal portfolio reflection

15 16 19 31

2.1

Timetable for Week 2

33

2.2 2.3

Virtual patient: Daniella Shaw Learning outcomes: Daniella Shaw

34 35

2.4

Virtual patient: William Rowden

36

2.5 2.6

Learning outcomes: William Rowden Learning opportunities and their outcomes

37 38

2.7 2.8

Clinical skills worksheet Personal portfolio reflection

41 43

WEEK 3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8

Reactions to adversity, loss and illness Timetable for Week 3

45

Virtual patient: Jonathan Reid Learning outcomes: Jonathan Reid Virtual patient: Vikram Krishnan

46 47 48

Learning outcomes: Vikram Krishnan Learning opportunities and their outcomes

49 50

Clinical skills worksheet Personal portfolio reflection

53 61

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Contents

WEEK 4

How psychological conditions may manifest themselves in medicine

4.1

Timetable for Week 4

63

4.2

Virtual patient: Stella McNabb

64

4.3 4.4

Learning outcomes: Stella McNabb Virtual patient: Jeannette Wild

65 66

4.5 4.6

Learning outcomes: Jeannette Wild Learning opportunities and their outcomes

67 68

4.7

Personal portfolio reflection

71

ALL WEEKS Clinical placements Organisation of clinical placements in the Psychological medicine block CP1 Acute general ward placement CP2 Community psychiatry placement CP3 In-patient psychiatry placement CP4 Primary care placement

73 74 79 85 90

The contents of this guide are © copyright 2016 Hull York Medical School. The authors of the texts herein have asserted their rights under the Copyright, Design and Patents Act 1988 to be identified as the authors of this work. For enquiries, contact the Communications Office, HYMS, University of York, Heslington, York YO10 5DD. Cover photograph copyright 2016 ©iStockphoto.com/richardarno The case studies in this document are works of fiction and any resemblance to real persons, living or dead, is coincidental.

2

T H E H U L L YO R K M E D I C A L S C H O O L

Introduction

Block convener: Dr Dean McMillan

Welcome to the Psychological medicine block Welcome to Psychological medicine. A recurrent theme within the HYMS curriculum is the ability to appreciate the physical, psychological, and social aspects of health and illness. Psychology is a fascinating subject to study, and within this block we will explore some of the specific applications of psychology in relation to medicine. We will examine how psychology helps us appreciate how people stay healthy, why they become ill, and how they respond to illness and the care that is offered. The block convener is Dr Dean McMillan and enquiries about the block should be directed in the first instance him: [email protected]. As for the other blocks in Phase I, the learning outcomes for the Psychological medicine block are linked to the four HYMS themes; Applied life sciences, Clinical skills and reasoning, Health and society and Professionalism. We acknowledge the significant contribution made by the HYMS theme leads and Director of problem-based learning, as well as former HYMS colleagues to the Phase I study guides. We thank Jonathan Silverman for permission to use and adapt the Calgary-Cambridge framework in the HYMS curriculum.

Overview of Block 6 This block comprises four weeks: WEEK 1 The brain and behaviour WEEK 2 The interplay between behaviour, cognition, physical symptoms and emotions WEEK 3 Reactions to adversity, loss and illness WEEK 4 How psychological conditions may manifest themselves in medicine.

Study aids and resources for each week’s topics can be accessed in the HYMS Year 1 Psychological medicine 2016/17 block section on Blackboard.

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4

Overview of Psychological medicine – Summary Table

Week 2 The interplay between behaviour, cognition, physical symptoms and emotions

CLINICAL SKILLS

CLINICAL PLACEMENT

LECTURES

WORKSHOPS, BIOPRACTICALS AND RESOURCE SESSIONS

Eric Martin Comes to the surgery with his wife, who says he has become increasingly disturbed and distressed Film clip – ‘Recovery’ David Tennant plays Alan Hamilton, the head of a building firm, who is knocked down by a van sustaining head injuries that changes his behaviour and social boundaries

Becoming familiar with a mental health history • Explore psychological health in a consultation with a patient • Explore social and relationship consequences of psychological health • Learn how to use a genogram to record a patient’s family history Noticing and assessing a patient’s mental state • Learn to communicate with patients experiencing mental distress • Use non-verbal and verbal cues to inform assessments of mental state • Be able to ask a patient about their mental health

Groups rotate over 4 weeks w Acute general ward w Community psychiatry w In-patient psychiatry w Primary care

w Introduction to psychological medicine w Localisation of cortical function w Consciousness and brain activity

EEG (BP)

Daniella Shaw Friend and former colleague who comes to see you following several panicky episodes William Rowden 47-yr-old complaining of nausea and indigestion

Consultation review session

w w w w

Mental state examination Psychosis Basic principles of CNS biochemistry Memory and forgetting

Exposure treatment for phobias (WS – Hull)

w Physiology of stress and anxiety w Professionalism and fitness to practise w Stress, physical illness and coping

CBT for panic disorders (WS – Hull)

w Mechanisms of psychotropic drug action w Behavioural theories of anxiety and depression

Exposure treatment for phobias (WS – York)

Introduction

T H E H U L L YO R K M E D I C A L S C H O O L

Week 1 The brain and behaviour

PBL CASES

Week 4 How psychological conditions may manifest themselves in medicine

CLINICAL SKILLS

CLINICAL PLACEMENT

LECTURES

WORKSHOPS, BIOPRACTICALS AND RESOURCE SESSIONS

Daniella Shaw Friend and former colleague who comes to see you following several panicky episodes William Rowden 47-yr-old complaining of nausea and indigestion Jonathan Reid Visits you with psychological problems following his spinal injury. Vikram Krishnan Recently widowed and has experienced chest pain and palpitations during the last few weeks

Finish week 2 PBL Understanding different perspectives • Appreciate different perspectives towards an illness • Discuss the significance of empathy • Practise being empathic

Groups rotate over 4 weeks

w Stigma w Medically unexplained symptoms

CBT for panic disorders (WS – York)

Stella McNabb Stella and her daughter visit to discuss concerns about Stella’s behaviour Jeannette Wild Jeannette, who has Down’s Syndrome, is having problems following her mother’s death

One-to-one meeting with clinical skills tutor

w w w w

Acute general ward Community psychiatry In-patient psychiatry Primary care

w Loss and bereavement w Gender, ethnicity and mental health w Smoking cessation

Learning from evaluation Smoking Cessation (WS – York) Formative spotter

w Mechanisms of addiction w Motivational interviewing w Epidemiology of psychological disorders w Learning Disabilities

Motivational interviewing (WS) Smoking Cessation (WS – Hull)

Introduction

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Week 3 Reactions to adversity, loss and illness

PBL CASES

5

Introduction

Learning outcomes for Psychological medicine The tables below illustrate how the four themes in the HYMS curriculum combine to help you achieve the block learning outcomes. Learning outcomes for individual learning opportunities are provided in the sections for each week.

THEME Applied life sciences

BLOCK LEARNING OUTCOMES n Outline the basic principles of central nervous system (CNS) biochemistry n Outline the drug neurotransmitter targets in the central nervous system (CNS) n Outline the localisation of cortical function n Outline learning theory (operant and classical conditioning) n Outline the main theories of how we remember and forget n Outline what is meant by consciousness n Outline physiological and psychological reaction to adverse environmental and

social events n Outline the psychological and physiological mechanisms of addictive behaviour n Outline the interrelationship between physiological and psychological processes n Outline the mechanisms of psychotropic drug action n Describe the general principles of the aetiology, characteristic features and natural

history of mood and anxiety disorders n Outline how mood and anxiety disorders may be managed

THEME Clinical skills and reasoning

BLOCK LEARNING OUTCOMES n Explore patients’ psychological health and emotional issues n Communicate with patients in distress in a sensitive manner n Outline the characteristics of motivational interviewing n Outline the features of a normal electroencephalography (EEG) n Recognise normal and abnormal grief reactions

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T H E H U L L YO R K M E D I C A L S C H O O L

Introduction

THEME Health and society

BLOCK LEARNING OUTCOMES n Describe the biopsychosocial model of mental health and illness n Understand the application of epidemiology to establish the psychological and social

causes of common mental health problems n Outline the epidemiology of anxiety and depression n Outline the epidemiology of learning disabilities n Describe the iceberg phenomenon of disease n Describe ethnic and gender dimensions in mental health n Describe the concept of labelling and stigma n Describe the impact of definitions of mental health and illness on individuals n Understand the role of social adversity and ‘life events’ in determining psychological

wellbeing n Describe different ways in which individuals cope with adverse life events n Outline some of the specific needs of individuals with a learning disability n Describe how individuals react and adjust to loss n Understand and recognise ‘medically unexplained symptoms’ n Be aware of the costs to the NHS associated with ‘medically unexplained symptoms’ n Describe the organisation of mental health services n Be aware of service user involvement in provision of services n Be aware of the costs to the NHS and society of unrecognised mood disorders n Identify the role of random sampling and the implications of sampling variation n Interpret 95% confidence intervals n Understand the rationale and principles of qualitative research

THEME Professionalism

BLOCK LEARNING OUTCOMES n Recognise stress and ways of coping in students’ own personal and professional lives n Explain the procedures within HYMS and the medical profession for supporting and

promoting professionalism n Outline your duties as a doctor both when you encounter a sick colleague and when your

own level of functioning impairs your ability to perform your job n Describe the concept of labelling and stigma

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7

Introduction

Trigger material for Psychological medicine During this four week block you will be use the following trigger materials in PBL. n WEEK 1 Eric Martin Mr Martin has come to the surgery with his wife, who says he has become increasingly disturbed and distressed.

Film clip – ‘Recovery’ David Tennant plays Alan Hamilton, the head of a building firm, who is knocked down by a van sustaining head injuries that changes his behaviour and social boundaries.

n WEEK 2 Daniella Shaw Daniella is a friend and former colleague, and comes to see you following several panicky episodes.

William Rowden William is a 47-year-old man complaining of nausea and indigestion.

n WEEK 3 Jonathan Reid Jonathan, aged 37, is experiencing psychological problems following an injury to his spinal cord which has left him paralysed (see The CNS and normal neuromuscular and musculoskeletal function).

Vikram Krishnan Vikram is recently widowed and has experienced chest pain and palpitations during the last few weeks.

8

T H E H U L L YO R K M E D I C A L S C H O O L

Introduction

n WEEK 4 Stella McNabb Stella is a 48-year-old woman with indigestion. She visits you accompanied by her teenage daughter, who has further concerns about her mother.

Jeannette Wild Jeannette is a 36-year-old woman with Down’s Syndrome. She is having problems coping following her mother’s death.

Learning outcomes for the trigger material By now you should be thoroughly familiar with the PBL process which you need to employ for each patient. This is just a summary to remind you of the main features. w Identify any problems that the trigger material presents. There may be problems identified in

previous blocks carried forward. w Identify the learning outcomes which arise from the trigger material. w When you are given the learning outcomes identified by the course organisers at the end

of the session on Monday, compare them with the learning outcomes identified by your PBL group. w Ensure you cover all the course organisers’ list of learning outcomes. Your group may choose

to cover additional learning outcomes you have identified as a result of your discussions.

Personal portfolio reflection These pages are for personal notes on experiences from the week. While they remain private, you will need to draw on the content of these reflections in order to demonstrate progress on personal and professional development in your interviews with clinical placement supervisors and personal tutors at the end of each term. The aims of the HYMS Curriculum listed below are a starting point for reflection. They require that the student aims to: w possess the necessary attitudes and values to investigate patients as appropriate w be able to communicate effectively with patients and their relatives, their own colleagues and

other agencies w possess the attitudes and values that engender ethical understanding and behaviour; the

attributes of empathy, humanity, and social awareness w possess the skills and attitudes to ensure their own continuous professional development and

lifelong learning through reflective practice, and the self-awareness to recognise personal limitations and to seek help when appropriate.

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Introduction

10

T H E H U L L YO R K M E D I C A L S C H O O L

You should always check your e-timetable for an up to date version of the timetable as there may have been changes since the study guide was printed.

WEEK 1

The brain and behaviour 1.1 Timetable WEEK 1

9.00–10.00

Thursday 23 Feb 17

Friday 24 Feb 17

Monday 27 Feb 17

Tuesday 28 March 17

Wednesday 29 March 17

Lecture ALS

SDL

RS

Lecture ALS

SSIP

Intro to Psychological Medicine Dr D McMillan Localisation of Cortical Function Dr P Bazira

10.00–11.00

Basic Principles of CNS Biochemistry Dr A Kardasz

Lecture ALS

RS

SDL

Lecture ALS

Consciousness and Brain Activity Dr H Baseler

11.00–13.00

BP

Memory and Forgetting Dr B Jeffries

Lecture ALS

RS

EEG Hull and York MFL Hull M–Z York L–Z

Mental State Examination Dr A Blakeborough (11.00–11.50) Psychosis Dr S Wright (12.00–12.50)

PBL

BP

PBL

Eric Martin Film clip – ‘Recovery’

EEG Hull York (14.00–16.00)

Eric Martin Film clip – ‘Recovery’

Workshop HULL Exposure Treatments for Phobias Dr D McMillan

13.00–14.00

14.00–15.30

16.00–17.30

CSP

CSP

Becoming Familiar with a Mental Health History

Noticing and Assessing a Patient’s Mental State

ALS Applied Life Sciences BP Bio Practical CP Clinical Placement

Clinical Placement

HS Health and Society P Ethics and Professionalism PBL Problem-Based Learning

CSP Clinical Skills Practice

RS-H Resource Session (Hull only)

CSR Clinical Skills and Reasoning

RS-Y Resource Session (York only)

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Free

SDL Self-Directed Learning SSIP Scholarship and Special Interest Programme

11

WEEK 1 The brain and behaviour

1.2 Virtual patient Eric Martin Mr Martin, a 68-year-old retired plumber, comes to the surgery with his wife. She tells you that whilst he is usually very fit and well, he has become increasingly disturbed and distressed over the last three days and is becoming increasingly agitated.

his wife tells you she is exhausted as he has been up all night, pacing the house and looking for their children, who left home years ago.

During the day, Mrs Martin says that Eric has become intermittently drowsy, and at times appears confused when he is awake. From this description you wonder whether he may be having problems with consciousness.

On Examination • Pyrexia – 38 degrees

His wife tells you he has been searching the house all night looking for their children who left home years ago; she is exhausted. He has also accused his wife of hiding his glasses and keys and has been closing the curtains early saying that the neighbours are spying on him from the bushes. At interview, Mr Martin cannot concentrate on your questions and is easily distracted, picking up items on your desk. He does not know what day or date it is and thinks his wife has brought him to the po...