Goals & Objectives
AIM
At the end of the Mind Block, the student will be able to have a general body of knowledge of the normal and abnormal states of the mind, the epidemiological, biological, psychological and environmental factors leading to psychopathology associated with thinking, feeling, behaviour and cognition and their relationship to psychiatric disorders and syndromes in various stages of life cycle; acquire required skills; develop appropriate attitudes.
Knowledge:
- The student will have awareness of the broad categories of psychiatric disorders (Ref ICD-10 & DSM-IV).
- The student will demonstrate knowledge concerning biological sciences as applied to psychiatry namely neuroanatomy, neurophysiology, neurochemistry, neuroendocrinology, neuropharmacology, neuropsychoimmunology.
- The student will demonstrate knowledge concerning psychological sciences as applied to psychiatry, namely psychodynamic theory, learning theory, cognition, perception, language.
- The student will be aware of social sciences as applied to psychiatry.
- The student will demonstrate knowledge concerning psychiatric epidemiology
- The student should demonstrate knowledge of psychological factors in medical practice, eg:
- Physical illness which may present as psychological problems;
- Psychological problems that may present as physical illness (factitious disorder, somatisation disorders, hypochondriasis, conversion disorder, psychogenic pain);
- Psychological factors in coping with physical illness;
- Disorders of sleep and arousal as symptoms of disease.
- Student should describe normal and abnormal at various stages of growth and development and be aware of factors that contribute to child development, physical and psychosexual.
- The student will demonstrate knowledge of common psychiatric disorders associated with childhood and adolescence.
- The student will demonstrate knowledge of physical, psychological and socioeconomic changes that occur with aging, importance of previous personality coping mechanisms, incidence prevalence and presenting signs and symptom of common psychiatric conditions presenting in the elderly, role of family and potential for abuse and neglect, influence of aging on pharmacology and drug interactions.
- The student will demonstrate awareness of medicolegal and ethical aspects when dealing with psychiatric patients – namely involuntary commitment, informed consent, competency, confidentiality, protection for vulnerable people.
- The student will demonstrate awareness of importance of multidisciplinary team approach, early identification of population at risk and liaison with community resources, importance of preventive psychiatry and psychiatric rehabilitation.
Skills:
- The student will demonstrate the ability to recognize psychiatric symptomatology.
- The student will be able to elicit the basic components of psychiatric history and the conduct a mental status examination.
- The student will demonstrate ability to enquire about sensitive areas such as suicide, dangerousness, sexuality.
- The student will be able to demonstrate pathology and psychopathology associated with changes in thinking, feeling, behaviour and cognition.
- The student will define and elicit the clinical features of psychiatry disorders (Ref. list of problems) and differentiate normal from pathological processes and one disorder form another.
- The student will perform a child assessment and recognize its special aspect.
- The student will demonstrate and ability to produce a synthesis of the process of becoming ill that focuses on biological psychological and social factors and note the interplay of predisposing perpetuating and precipitating factors; leading to formulation of a treatment plan.
Attitudes:
The student will:
- Maintain professional nonjudgemental attitude, show respect and empathy for patients and their families.
- Respect confidentiality of information provided by patient.
- Identify important ethical issues relevant to the patients and families
- Value the importance of multidisciplinary team work.
- Value constructive nonjudgemental self evaluation, professional and personal and evaluation by peers.
Objectives for the Mind Block
The material provided in this handout is not meant to limit your study and knowledge in the field of psychiatry. Throughout your training in medicine you will be exposed to a vase amount of material that will complement these learning objectives. Additional material and clinical skills obtained through courseware, PBL, PSD, clinical and research electives should be integrated in your conceptualization of psychiatry and doctor-patient interaction. Through this integration we believe that you will be able to have a clear conceptualization of the brain-mind and its associated disorders.
Specific Learning Objectives
Week 1
History of Psychiatry:
- General overview of main trends through time
Psychiatric Assessment and Mental Status Examination
- Define DSM-IV-TR
- Describe the five axes of the DSM-IV-TR
- Explain how to do a psychiatric assessment including history taking, mental status and differential diagnosis for all age groups
Psychopharmacology
- Describe the mechanism of action, indications, therapeutic effects, side-effects and withdrawal symptoms for each of the following drug classes:
- Benzodiazapine/anti-convulsant
- Buspirone
- Anti-depressants
TCA
SSRI
SNRI
MAOI
RIMA
- Anti- psychotics
- Anti-parkinsonism
- Mood stabilizers/Anti-convulsant
- Stimulants
- Anti-cholinesterase
- Define pharmacologic phenomena including: addiction, dependence, tolerance, withdrawal, rebound, and relapse
Psychotherapeutic Interventions
- Define psychotherapies
- Define the following defense mechanisms:
denial, dissociation, splitting, idealization, devaluation, projection, acting out, projective identification, suppresion, repression, reaction formation, intellectualization, rationalization. - Describe the process of psychodynamic therapy including transference, countertransference and therapeutic alliance
- Describe the following psychotherapies:
- Psychoanalysis
- Psychodynamic
- Interpersonal
- Cognitive therapy
- Behavior therapy
- Supportive
Neurobiology of Emotions
- List the structures found in the limbic system, basal ganglia, cerebral cortex and cerebellum and their relationship to human emotions and mental disorders
- Describe the functions of catecholamines (dopamine and norepinephrine), serotonine and GABA
- Describe the noradrenergic, serotonergic and dopaminergic pathways
- Describe the mesolimbic dopaminergic pathway called reward pathway.
Anxiety Disorders
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of anxiety disorders including: panic disorder, social phobia, generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and specific phobia
- Describe anxiety disorders due to general medical conditions and substance induced
- Describe the presentation and management of anxiety disorders across the life span
- Describe the biopsychosocial interventions used for management of anxiety disorders including: panic disorder, social phobia, generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and specific phobia
Mood Disorders
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of mood disorders including: major depressive disorder, bipolar disorder, dysthymia and cyclothymia
- Describe mood disorders due to a general medical condition and substance induced
- Describe the presentation of mood disorders across the life span
- Distinguish bereavement from major depression
- Describe the biopsychosocial interventions used for the treatment of mood disorders including: major depressive disorder, bipolar disorder, dysthymia, cyclothymia
Suicide Assessment
- Describe the epidemiology, etiology and risk factors of suicide
- Compare and contrast suicide attempters versus suicide completers
- Describe the assessment of a suicidal patient
- Describe the difference between active and passive suicidal ideation
- Describe the management of a suicidal patient
Week 2
Psychoses: Diagnostic and Clinical Features
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of psychoses including schizophrenia, schizophreniform, schizoaffective, delusional, brief psychotic and shared psychotic disorders
- Describe psychotic disorders due to a general medical condition and substance induced
- Describe the presentation and management of psychoses across the life span
- Describe the biopsychosocial interventions used for the management of severe and persistent mental illness including schizophrenia, schizophreniform, schizoaffective, delusional, brief psychotic and shared psychotic disorder
Substance Abuse
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of substance abuse, dependence and withdrawal symptoms
- Describe the presentation and management of substance abuse across the life span
- Describe the biopsychosocial interventions used for management of substance abuse including alcohol, cannabis, tobacco, hallucinogens, stimulants, opiates and cocaine
- Describe the mesolimbic dopaminergic pathway (reward pathway) related to substance abuse disorder
- Define pharmacologic phenomena including: addiction, dependence, tolerance, withdrawal, rebound, and relapse
Somatoform Disorders
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of somatoform disorders including: somatization disorder, hypochondriasis, conversion disorder, body dysmorphic disorder, pain disorder.
- Describe the presentation and management of somatoform disorders due to a general medical condition and substance induced
- Describe the biopsychosocial interventions used for the management of somatoform disorders including: somatization disorder, hypochondriasis, conversion disorder, body dysmorphic disorder, pain disorder.
Factitious disorders and Malingering
- Describe the diagnostic criteria of factitious disorders: including with predominantly psychological signs and symptoms and physical signs and symptoms
- Describe the condition of Malingering
Eating Disorders
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of eating disorders including anorexia nervosa and bulimia nervosa
- Describe the presentation and management of eating disorders due to a general medical condition and substance induced
- Describe the biopsychosocial interventions used for the management of eating disorders inducing anorexia nervosa and bulimia nervosa
Dissociative Disorders
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of dissociative disorders including: dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization and derealization
- Describe the presentation and management of dissociative disorders due to a general medical condition and substance induced
- Describe the biopsychosocial interventions used for the management of dissociative disorders including: dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization and derealization
Personality Disorders
- Describe the general diagnostic criteria for a personality disorder
- Explain the categorical and dimensional perspective of diagnostic approach of personality disorder
- State the classification of personality disorder in three clusters
- Describe the main enduring pattern of each personality disorder type
- Explain the clinical relevance of comorbity of Axis I and Axis II disorders
Week 3
Geriatric Psychiatry
- Evaluation of mental illness in the elderly
- Describe signs and symptoms of anxiety, depression and suicidality in the elderly
Dementia
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of dementia including Alzheimer’s Disease, Vascular Dementia, Lewy Body and frontotemporal dementia
- Describe reversible dementias including pseudodementia and substance induced dementia
- Describe the biopsychosocial interventions used for the management of dementias including pharmacokinetic changes, polypharmacy and appropriate psychosocial interventions
Delirium
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis and differential diagnosis of delirium
- Describe the presentation and management of delirium due to a general medical condition and substance induced delirium
- Describe the biopsychosocial interventions used for the management of delirium
Managing Aggression and Challenging Behaviors
- Describe the mental disorders associated with aggressive behaviors
- List the biological, demographic, economic, social and developmental factors associated with violence and aggression
- Describe the pertinent factors in the recognition of the potential of aggressive behavior.
Self-Injurious Behavior
- Describe the mental disorders associated with self-injurious behaviors
- List the biological, demographic, economic, social and developmental factors associated with self-injurious behavior.
- Describe the pertinent factors in the recognition of the potential of self-injurious behavior.
Mental Health Act of Ontario & Related Issues
- Describe the following processes to obtain assessment under the Ontario Mental Health Act:
- application by a physician for psychiatric assessment (Form I)
- order for an examination by the Justice of the Peace for an assessment (Form 2)
- a certificate for involuntary admission (Form 3)
- consent to the disclosure, transmittal or examination of a clinical record (Form 14)
- Describe police jurisdiction under the Ontario Mental Health Act (Section ?)
- Describe recent changes pertaining to community treatment order under the Ontario Mental Health Act
- Describe the assessment of capacity to consent to treatment
CMPA – Ethics
Stigma of Mental Illness
- Understanding the management of mental disorders from the client and family perspective
- Describe the impact of mental illness on the individual and his/her family
Week 4
Normal Child & Adolescent Development
- Describe the normal development of childhood including infancy, pre-school latency and adolescent stages
- Describe the major developmental theories including Sigmund Freud, Erikson and Piaget
Pervasive Developmental Disorders and Developmental Disabilities
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis and differential diagnosis of pervasive developmental disorders including: Autism, Asperger ’s, Rett’s Syndrome and childhood psychosis.
- Describe the psychosocial interventions used for the management of pervasive developmental disorders including: Autism, Asperger’s, Rett’s Syndrome and childhood psychosis.
Attention Deficit/Oppositional/Conduct Disorders
- Describe the diagnostic criteria, epidemiology, etiology, course, prognosis, and differential diagnosis of disorders affecting children including: attention deficit hyperactivity disorder, oppositional defiance disorder and conduct disorder
- Describe the biopsychosocial interventions used for the management of disorders affecting children including: attention deficit hyperactivity disorder, oppositional defiance disorder and conduct disorder
Mental retardation
- Describe the characteristics of mental retardation.
- Describe the degree of severity according to the intelligence quotient.
Individual and Population Health
Theme: Social and Family Problems
Week 1: Suicide Prevention
The students will know and understand:
- risk factors for suicide and groups (e.g., adolescents, elderly, natives) at risk for suicide
- physician values/attitudes/beliefs about suicide
- community resources available for crisis intervention
- role of the physician in suicide prevention
- epidemiology of suicide in various age groups
- preventive strategies for suicide
- ethical issues around suicide and death
- personal feelings regarding suicide and death
- need to support family/friends who have lost an individual to suicide
Week 2: (a) Homelessness
The student will know and understand:
- size of the problem of homelessness; characteristics of homeless people
- reasons why homelessness exists in our community, particularly for those with mental illness
- health impact of being homeless in general and among those with mental illness
- community resources/services for those with chronic mental illness - money, housing, food, companionship/friendship, medical follow-up, transportation, recreation, vocation, case management
- role of the physician in working with homeless individuals
- how individual, community and health care professionals' attitudes influence people with chronic mental illness
- contribution of historical changes in mental illness services to homelessness
- tolerance for people with chronic mental illness; understanding the world from their perspective
- challenges homeless people face, need for respect and compassion
- need for physicians and other health care professionals to be advocates for homeless people coping with chronic mental illness
Week 2: (b) Child Abuse and Child Sexual Abuse
The student will know and understand:
- symptoms, including disguised presentations in a child, an adolescent or an adult abused as a child
- prevalence of child abuse and child sexual abuse
- risk factors
- requirement for reporting abuse in children
- key players in response to child abuse
- community resources for treatment of child, family, adults, victims, perpetrators
- community and hospital resources for children who have been abused and their families
- necessity for the physician to counter denial
- importance of sensitivity and avoiding an attitude of blame for the victim or perpetrator, while remaining clear about the responsibility of the adult
Week 3: Impact of Poverty on Child Health
The student will know and understand:
- scope of child poverty, characteristics of families who are poor and reasons for child poverty
- impact of child poverty on the physical, emotional and social health of child and family
- individual, family and community strategies to reduce child poverty and the impact of poverty on the child and family
- role of the physician and other health professionals in reducing child poverty and its impact on health
- challenges faced by children and families who are poor; need to show respect for people coping with poverty