Object Constancy

Object constancy is a principle of perceptual organization that refers to the ability of the brain to maintain a stable perception of an object, despite changes in its size, shape, orientation, or other aspects of its appearance. This ability allows us to recognize objects as the same, even when viewed from different angles or under different lighting conditions. Object constancy is important for navigating our environment and interacting with the world around us.

For example, imagine looking at a familiar object, such as a chair, from different angles. Despite the changes in its appearance, you can still recognize it as a chair and understand its purpose. This is because your brain is able to maintain a stable perception of the object, based on its learned knowledge of what a chair typically looks like.

Object constancy is a fundamental aspect of perception, and is essential for our ability to make sense of the world around us. It is also a key area of research in psychology and neuroscience, as it provides insights into how the brain processes and interprets sensory information.

Reference:

Brascamp, J. W., Knapen, T., & Blake, R. (2013). The dynamics of object perception. Trends in Cognitive Sciences, 17(2), 68-76.

Get Through MRCPsych CASC

Get Through MRCPsych CASC" is an excellent book for anyone preparing for the MRCPsych CASC examination. This book is written by a team of experienced authors who have a deep understanding of the examination format and the key competencies required to succeed.

The book is well-structured and covers all the major areas that are tested in the MRCPsych CASC exam. The content is presented in a concise and easy-to-read manner, with clear explanations and practical examples to illustrate key points.

One of the key strengths of this book is its focus on clinical scenarios, which are central to the MRCPsych CASC exam. The authors have included a wide range of scenarios, covering a variety of psychiatric disorders and clinical situations. Each scenario is accompanied by detailed guidance on how to approach the case, including tips on how to communicate effectively with patients and other healthcare professionals.

The book also provides helpful advice on how to manage time effectively during the exam, and how to deal with common challenges that may arise. The authors have included a range of practice questions and sample scenarios to help readers build their skills and confidence.

Overall, "Get Through MRCPsych CASC" is an invaluable resource for anyone preparing for this challenging exam. It is a well-written, comprehensive guide that covers all the key competencies and clinical scenarios that are tested in the MRCPsych CASC exam. I highly recommend it to anyone looking to pass the MRCPsych CASC exam.

MRCPsych CASC: Assessment of School Refusal

This MRCPsych CASC Sample Case assesses a child's refusal to attend school. It is important to consider several key factors when evaluating the situation.

First, it is crucial to determine the age of the child and whether they desired to attend the scheduled appointment. It is also important to determine who is currently responsible for their care and if they have any connections to CAMHS (Child and Adolescent Mental Health Services) or social services.

The duration of the child's refusal to attend school should also be considered, as well as the different perspectives on the cause of the refusal from the child, their parents, and the school. It is important to determine if the child is refusing other situations.

If the child is exhibiting signs of separation anxiety, it is important to note that they may have worries about the safety of their caregiver and follow them closely in all situations. It is also important to assess the potential risks to the child, to others, from others, and for neglect.

It is important to consider any history of drug and alcohol use and the impact of the school refusal on the child's life at home, at school (academically), and with their friends. A mental state examination should be performed, evaluating the child's mood (such as low mood) and any potential symptoms of psychosis. The child's level of anxiety should also be assessed, including any possible experiences of bullying, checking and washing behaviours, and any specific concerns they may have about the school or a teacher.

A comprehensive developmental and psychiatric history should be obtained, as well as any history of medication use. The child's past medical history and family history should also be considered.

The management of the child's refusal to attend school may involve a gradual return to school, liaison with the school to address any potential bullying, and involving an educational social worker and psychologist as necessary. Incentives for attending school may also be implemented, and group tutorials should be considered if the child falls academically behind.

Virtual Scenario

Psychiatrist: Good afternoon, thank you for coming in today. Can you tell me a little bit about your child and their recent refusal to attend school?

Parent: Yes, my son has been refusing to go to school for the past few weeks. He used to love going to school, but now he just refuses to leave the house in the morning.

Psychiatrist: I see. How old is your son?

Parent: He is 11 years old.

Psychiatrist: Is he refusing to attend any other activities or events besides school?

Parent: No, just school. He seems to have a lot of anxiety about it.

Psychiatrist: I understand. Have you or the school noticed any changes in his behavior, mood, or overall functioning?

Parent: He has become increasingly withdrawn and has been complaining of low mood. He used to have a lot of friends, but now he just wants to be alone all the time.

Psychiatrist: That's concerning. Has there been any history of bullying or other adverse events at school?

Parent: Not that we're aware of. The school hasn't mentioned anything, and my son hasn't talked about it.

Psychiatrist: I see. Can you tell me about his developmental and psychiatric history?

Parent: He has never had any major developmental or psychiatric issues. He's always been a happy and healthy child.

Psychiatrist: Okay, thank you. Can you tell me about any medications he is currently taking and his past medical history?

Parent: He is not currently taking any medications, and he has no significant past medical history.

Psychiatrist: Alright. And what about his family history, is there any history of mental illness or substance abuse in the family?

Parent: No, there is no history of mental illness or substance abuse in our family.

Psychiatrist: Okay, thank you. Based on what you've told me, it seems like there may be some anxiety or mood-related issues contributing to his school refusal. I would like to perform a mental state examination to get a better understanding of his current state.

Parent: Yes, of course.

Psychiatrist: After the examination, we can discuss potential management options, such as graded exposure to school, liaising with the school to address any potential bullying, and involving an educational social worker and psychologist as necessary. We may also consider using incentives for attending school and providing group tutorials if necessary.

Parent: That sounds like a good plan. Thank you for your help.

Psychiatrist: You're welcome. We'll work together to help your son get back to school and feel more comfortable.

Somatic Delusions

Introduction:

Somatic delusions are a delusion that can significantly impact a person's perception of their body and bodily functions. In this note, we will examine the definition, prevalence, causes, and treatment of somatic delusions.

Definition:

Somatic delusions are delusions in which an individual has a false belief or conviction about their body or bodily functions. The belief can manifest in various ways, such as a belief that the individual has a serious illness or medical condition, that parts of their body are missing or not functioning correctly, or infested with parasites or insects.

Prevalence:

Somatic delusions are commonly associated with psychiatric disorders such as schizophrenia, delusional disorder, or major depressive disorder with psychotic features. In addition, somatic delusions can also occur in medical conditions that affect the brain, such as dementia or traumatic brain injury.

Causes:

The precise cause of somatic delusions is not entirely clear. However, research suggests that factors such as genetics, environmental stressors, and abnormalities in brain function may contribute to the development of somatic delusions.

Treatment:

Treatment for somatic delusions typically involves a combination of medication and therapy, focusing on addressing the underlying psychiatric or medical condition causing the delusions. Cognitive-behavioral therapy (CBT) may also help address the patient's thought processes and beliefs about their body.

Conclusion:

Somatic delusions are a type of delusion that can have a significant impact on a person's perception of their body and overall well-being. Early detection and treatment can help individuals manage their symptoms and improve their quality of life.

References:

1. Somatic Delusions. Merck Manual. Retrieved from https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/somatic-delusions
2. Somatic Delusions. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/view/somatic-delusions
3. Yonkers, K. A. (2018). Management of somatic symptom disorder. New England Journal of Medicine, 379(14), 1373-1382.

MRCPsych CASC: Assessment of an aggressive Patient in the Emergency Department

Scenario:

A patient with a severe psychiatric disorder has become aggressive. You have been called to assess him in the psychiatric emergency department. 

Introduction 

Assessing a patient with a severe psychiatric disorder can be a challenging task, especially if the patient is aggressive. It is essential to approach the assessment with caution and to prioritize the safety of both the patient and the assessing psychiatrist. Here are the steps for assessing a patient with a severe psychiatric disorder:

Establish rapport: 

The first step is to establish a rapport with the patient. This can be done by introducing oneself and explaining the purpose of the assessment. For example, the trainee psychiatrist can say, "Hello, I am Dr. [Name]. I am here to talk to you and assess how you are feeling."

Gather information:

The next step is to gather information about the patient's current symptoms and past medical history. This can be done by asking open-ended questions, such as "Can you tell me about your symptoms?" or "What led you to come to the emergency department today?"

Assess the patient's level of agitation:

The trainee psychiatrist should assess the patient's level of agitation by observing their behavior, body language, and speech. This can help to determine the level of risk the patient poses and whether additional safety measures, such as restraints, are needed.

Assess for suicidal and homicidal ideation:

The trainee psychiatrist should also assess the patient for suicidal and homicidal ideation by asking questions such as "Have you been thinking about hurting yourself or others?" or "Do you have any plans to harm yourself or others?"

Conduct a mental status examination:

 
The trainee psychiatrist should conduct a mental status examination, which includes assessment of the patient's mood, affect, thought process, and cognitive functioning. This can help to diagnose any underlying psychiatric disorders and determine the patient's level of functioning.

Make a diagnosis:

Based on the information gathered, the trainee psychiatrist should make a diagnosis and develop a treatment plan.

Sample Conversation

Here is a sample conversation between the trainee psychiatrist and the patient:

Trainee psychiatrist: "Hello, I am Dr. [Name]. I am here to talk to you and assess how you are feeling."

Patient: "I don't want to talk to you. Just leave me alone."

Trainee psychiatrist: "I understand that you may not feel like talking, but it's important that I assess how you're feeling to determine the best course of treatment. Can you tell me what led you to come to the emergency department today?"

Patient: "I just can't handle it anymore. Everything is too much."

Trainee psychiatrist: "I'm sorry to hear that. Can you tell me more about what's been bothering you? Have you been having any thoughts of hurting yourself or others?"

Patient: "Yes, I have been thinking about hurting myself."

Trainee psychiatrist: "Thank you for telling me that. I am here to help. I am going to make sure you get the care you need to feel better."

This is just a sample conversation and the exact questions and responses will vary based on the specific patient and their situation. The trainee psychiatrist should adapt the conversation to fit the patient's needs and level of cooperation.

MRCPsych CASC: Emergency Assessment of an Angry or Anxious Patient or Relative

CASC Notes: Emergency Assessment of an Angry or Anxious Patient or Relative

As you enter the station, it is important to show your badge to the examiner and nod while saying a quiet "Thanks". When you meet the relative or patient, they may be standing up, so it's best to start by taking a seat yourself. You can say, "Hello, my name is Dr Waleed. Thank you so much for agreeing to see me today. Do you mind if I take a seat?"

Starting with a calm and friendly approach is crucial in building rapport with the patient or relative. You can say, "First of all, thank you so much for coming to see me today. Good communication between patients or relatives and the psychiatry team is very important to us, and we value it greatly."

You can also express your empathy and acknowledge their difficult situation by saying, "I can't imagine how difficult it must be as a mother/father/sister/carer to see your loved one suffering like this."

If the relative or patient is angry with another staff member for not caring or communicating, you can assure them that you will address the issue immediately. You can say, "I will talk with that member of staff straight after" or "Thank you for telling me. It is really important that we know this. We will look into it as soon as possible."

In case the patient or relative mentions side effects of medications, you can inform them that you have an official complaints procedure they can follow if they wish to take the matter further.

If the patient or relative says they are leaving, it's important not to block the exit, but you can try to calm them down and offer help by saying, "I can see that you're really anxious. Perhaps we could sit down and talk about it. I'm here to help. You're in a safe place now."

If the patient or relative says they are not mad, you can respond by saying, "I'm absolutely not suggesting you are mad, but I can see that you are suffering, and I'm here to help. It must be very distressing for you. Perhaps we can sit down and talk about it."

If the patient or relative asks to be removed from the section, you can explain the process and say, "I do understand your concerns, but the decision to remove the section is not just up to me. It's a team decision. I can assure you that as soon as the team feels that you no longer need to be on a section, it will be lifted. Have you been told how you can appeal against the section?"

If the patient or relative asks to speak to a male or female doctor, you can apologize for the unavailability of the preferred gender and ask if a nurse of the preferred gender can be present. You can also ask the reason for their discomfort and continue the interview by saying, "You seem quite distressed at the moment. Could I ask what's been troubling you?"

To increase empathy, it's important to lower the tone and volume of your voice and make eye contact with the patient or relative. This makes you sound more convincing. When wrapping up the station, it's best to come up with a short and concise summary of the important issues discussed and offer support and resources, such as psychology, carer's assessment, occupational therapy, and medication options. Don't forget to thank the patient or relative for talking to you.

Look at the examiner and nod while saying a quick "Thanks".

How to Prepare for the MRCPsych CASC Exam

Introduction

What is the MRCPsych CASC exam?

The MRCPsych CASC (Clinical Assessment of Skills and Competencies) exam is a competency-based examination that assesses the practical skills and knowledge of mental health professionals in the field of psychiatry. The exam is designed to test the ability of candidates to manage complex clinical cases and make appropriate decisions in a simulated clinical setting.

Why is it important for mental health professionals?

The MRCPsych CASC exam is a crucial step for mental health professionals who want to attain consultant level in the field of psychiatry. It is also a requirement for those who want to work in the UK National Health Service (NHS) as a consultant psychiatrist. Passing the MRCPsych CASC exam demonstrates that a mental health professional has the necessary skills and knowledge to provide high-quality care to patients.

Set Realistic Goals

Determine your current level of knowledge and skills

Before preparing for the MRCPsych CASC exam, it is essential to determine your current level of knowledge and skills in the field of psychiatry. This can be done by reviewing previous coursework, taking practice exams, or speaking with colleagues or mentors.

Set achievable goals based on your starting point

Based on your current level of knowledge and skills, set achievable goals that are realistic and attainable. This could include a certain number of hours of study per week, a certain number of practice cases to complete, or a specific date for taking the exam.

Break down your goals into manageable steps

Breaking down your goals into smaller, manageable steps can make the exam preparation process less overwhelming. For example, you could set a goal to complete a certain number of practice cases each week or to read a certain number of chapters from your study materials each day.

Develop a Study Plan

Choose a study method that works best for you

Everyone has a unique learning style, and it is important to choose a study method that works best for you. This could include self-study, group study, online courses, or attending review courses.

Allocate sufficient time for studying and practicing

To ensure that you are well prepared for the MRCPsych CASC exam, it is essential to allocate sufficient time for studying and practicing. This should include regular review of study materials, participation in mock exams, and practice with real-life cases.

Create a schedule and stick to it

Creating a study schedule and sticking to it is essential to ensure that you make steady progress towards your goals. Your schedule should include dedicated time for studying and practicing, as well as time for rest and relaxation.

Understand the Exam Format

Familiarize yourself with the exam structure and format

It is important to familiarize yourself with the exam structure and format, including the types of cases and scenarios that you may encounter. This information can be found on the Royal College of Psychiatrists website.

Read and understand the exam guidelines and regulations

Reading and understanding the exam guidelines and regulations is crucial to ensure that you are aware of the rules and expectations of the MRCPsych CASC exam. This information can also be found on the Royal College of Psychiatrists website.

Get a clear understanding of the types of cases and scenarios you may encounter

Getting a clear understanding of the types of cases and scenarios you may encounter during the MRCPsych CASC exam can help you to prepare more effectively. This includes understanding the types of clinical cases and situations you may face, as well as the types of questions that you may be asked.

Practice, Practice, Practice

Participate in mock exams to get a feel for the exam format

Participating in mock exams is a great way to get a feel for the exam format and to identify areas that you need to improve on. You can participate in mock exams with colleagues or through online resources.

Practice dealing with different cases and scenarios

Practicing dealing with different cases and scenarios will help you to develop your decision-making skills and to become more confident in your abilities. This can be done through role-playing, case simulations, or by working through practice cases.

Identify your strengths and weaknesses and focus on improving them

Identifying your strengths and weaknesses through practicing and taking mock exams will help you to focus your efforts on the areas that need improvement. This will ensure that you are well prepared and confident on the day of the exam.

Stay Focused and Positive

Stay motivated and positive throughout the exam preparation process

Staying motivated and positive throughout the exam preparation process is important to maintain your focus and to ensure that you are able to perform at your best on the day of the exam.

Surround yourself with positive and supportive people

Surrounding yourself with positive and supportive people, such as friends, family, or study partners, can provide encouragement and help to maintain a positive mindset.

Avoid negative self-talk and beliefs

Avoiding negative self-talk and beliefs is crucial to maintain a positive mindset and to ensure that you are able to perform at your best on the day of the exam. It is important to focus on your strengths and to believe in yourself.

Conclusion

Sum up the key points of the article

In this article, we have discussed the importance of the MRCPsych CASC exam for mental health professionals and the steps that can be taken to prepare for it. This includes setting realistic goals, developing a study plan, understanding the exam format, practicing and participating in mock exams, staying focused and positive, and surrounding yourself with positive and supportive people.

Reiterate the importance of preparing well for the MRCPsych CASC exam

It is important to take the MRCPsych CASC exam preparation process seriously and to allocate sufficient time and effort towards it. A well-prepared candidate is more likely to perform at their best and to pass the exam on their first attempt.

Wish the readers good luck on their exam

We wish all readers the best of luck on their MRCPsych CASC exam. Remember to stay focused, positive, and to believe in yourself. With the right preparation and mindset, you can achieve your goals and become a successful consultant psychiatrist.

Bibliography

1. MRCPsych CASC Guide, Royal College of Psychiatrists, https://www.rcpsych.ac.uk/traininpsychiatry/examinations/casc
2. MRCPsych CASC Exam Preparation Tips, Revisions in Psychiatry, https://revisionsinpsychiatry.com/mrcpsych-casc-exam-preparation-tips/.
3. The MRCPsych CASC Exam: What You Need to Know, The British Psychological Society, https://www.bps.org.uk/system/files/Public%20files/BPS%20Division%20of%20Clinical%20Psychology/Professional%20Development/CASC/CASC%20Exam%20Information/The%20MRCPsych%20CASC%20Exam%20What%20you%20need%20to%20know.pdf.
4. MRCPsych CASC Exam Success: How to Prepare, The Psychiatrist, https://thepsychiatrist.bmj.com/content/41/9/406.
5. Study Materials for MRCPsych CASC Exam, The Psychiatry Portal, https://www.psychiatryportal.com/examination-preparation/mrcpsych-casc/.
6. MRCPsych CASC Exam: Frequently Asked Questions, Royal College of Psychiatrists, https://www.rcpsych.ac.uk/traininpsychiatry/examinations/casc/mrcpsych-casc-exam-frequently-asked-questions.

These resources provide comprehensive information and guidance on the MRCPsych CASC exam, including the format, content, and preparation tips. They also offer helpful advice and suggestions on how to effectively prepare for the exam and increase your chances of success.

Attitude Change and Persuasive Communication

Attitude change is a common phenomenon that refers to modifying an individual's feelings, beliefs, and evaluations towards a particular object, person, or event. Attitude change can occur due to a variety of factors, including persuasive communication.

Persuasive communication refers to messages that are designed to influence an individual's attitudes, beliefs, or behaviors. Persuasion can take many forms, including advertising, political campaigns, and interpersonal communication. One of the key factors that contribute to the effectiveness of persuasive messages is the source of the message. Individuals are more likely to be influenced by messages from credible, trustworthy, and likable sources.

Another important factor that contributes to attitude change is the type of message. Messages that are argumentative and provide strong evidence and reasoning tend to be more effective at influencing attitudes than messages that simply express personal opinions or emotional appeals. Additionally, messages tailored to the target audience's specific beliefs and attitudes are also more likely to be effective at changing attitudes.

However, attitude change is not always easy to achieve, as individuals often have well-established attitudes and beliefs that are resistant to change. One approach to overcoming this resistance is to use social influence, by exposing individuals to messages from others who hold similar attitudes or beliefs. This can increase the perceived normative pressure to adopt a particular attitude, leading to attitude change.

References

1. Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. Advances in Experimental Social Psychology, 19, 123-205.
2. Eagly, A. H., & Chaiken, S. (1993). The psychology of attitudes. Fort Worth, TX: Harcourt Brace Jovanovich College Publishers.
3. Cialdini, R. B. (2001). Influence: Science and practice (4th ed.). Boston, MA: Allyn & Bacon.

Attitudes: Components and Measurement by Thurstone, Likert and Semantic Differential Scales

Introduction

Attitudes are complex psychological constructs that reflect an individual's positive or negative feelings, beliefs, and evaluations about a particular object, person, or event. Attitudes are crucial in shaping behaviour and influencing information processing and decision-making. To better understand attitudes, researchers have developed various frameworks and measurement tools to assess them.

Components and Measurement by Thurstone

One of the earliest frameworks for understanding attitudes was developed by Louis Thurstone, who identified seven primary attitudes that individuals hold: pleasure, displeasure, approval, disapproval, favourable, unfavourable, and neutral attitude. According to Thurstone, attitudes can be measured by determining the strength of an individual's feelings towards an object or event, with stronger attitudes indicating more intense feelings and evaluations.

Likert Scale

Another framework for understanding attitudes was developed by Rensis Likert, who introduced the Likert scale. The Likert scale is a type of rating scale that measures attitudes by asking individuals to rate their agreement or disagreement with a series of statements about an object or event. This type of scale is widely used in attitude research and is considered to be a reliable and valid measure of attitudes.

Semantic Differential Scale

Finally, the semantic differential scale is another measurement tool that is used to assess attitudes. The semantic differential scale measures attitudes by asking individuals to rate an object or event along a series of bipolar adjective pairs, such as good-bad, pleasant-unpleasant, and positive-negative. This type of scale is designed to capture the nuanced and complex nature of attitudes, as it takes into account the various dimensions and evaluations that individuals hold.

References

1. Thurstone, L. L. (1928). Attitudes can be measured. American Journal of Sociology, 33(6), 529-554.
2. Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 140, 1-55.
3. Osgood, C. E., Suci, G. J., & Tannenbaum, P. H. (1957). The measurement of meaning. Urbana, IL: University of Illinois Press.

Optimal Conditions for Observational Learning

Observational learning, also known as social learning or modelling, refers to the process of acquiring new information or behaviours through observing others. The following conditions have been identified as optimal for observational learning:

1. Attention: The observer must observe and learn from the modelled behaviour by paying attention. (Bandura, 1977)
2. Retention: The observer must be able to retain the information observed to use it in the future. (Bandura, 1977)
3. Reproduction: The observer must have the physical and cognitive abilities necessary to reproduce the observed behaviour. (Bandura, 1977)
4. Motivation: The observer must be motivated to perform the observed behaviour. This can include intrinsic motivation (e.g., personal interest in the behaviour) and extrinsic motivation (e.g., rewards or punishments associated with the behaviour). (Bandura, 1977)
5. Relevance: The observer must perceive the behaviour as relevant to their own life to be motivated to learn from it. (Bandura, 1977)

References:

1. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.

Leeds Dependence Questionnaire

Raistrick, Bradshaw, Tober, Weiner, Allison, Healey | 1994 

A self-report instrument called the Leeds Dependence Questionnaire (LDQ) assesses the level of dependence in people with substance use disorders. The questionnaire was created by a research team at the University of Leeds in the UK and released for the first time in 1994.

The LDQ has 20 questions that look at many aspects of drug dependence, such as how much a person's drug use gets in the way of their daily lives, how strong their need is, how important the drug is to them, and how much they can control how much they use.

Usually given as a self-report questionnaire, the LDQ takes between 10 and 15 minutes to complete. The responses are evaluated from "not at all" to "always." The overall score, which reflects the intensity of the reliance, is created by adding the scores from each item.

The LDQ has been used in numerous research to evaluate the degree of dependence in people with substance use disorders and has been shown to have strong reliability and validity. The questionnaire has also been utilised in international studies and translated into several languages.

To sum up, the Leeds Dependence Questionnaire can help people with substance use disorders figure out how much they depend on a substance. It is a reliable and valid tool that gives useful information about the type and severity of addiction and can help with treatment planning and making decisions.

Reference

Raistrick, D.S., Bradshaw, J., Tober, G., Weiner, J., Allison, J. & Healey, C. (1994) Development of the Leeds Dependence Questionnaire, Addiction, 89, pp 563-572. 

Hypofrontality in Schizophrenia

Hypofrontality, or reduced activity in the brain's frontal lobes, is a well-established feature of schizophrenia. The frontal lobes are responsible for various executive functions, such as planning, decision-making, working memory, and inhibitory control, which are often impaired in individuals with schizophrenia.

Proposed mechanisms

Several studies using neuroimaging techniques, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have shown reduced activation or metabolism in the frontal lobes of individuals with schizophrenia compared to healthy controls. This hypofrontality has been linked to the negative symptoms and cognitive impairments commonly observed in schizophrenia.

• reduced blood flow
• reduced dopaminergic activation
• reduced metabolism

However, it is important to note that hypofrontality's exact nature and causes in schizophrenia are not yet fully understood and require further research. Additionally, hypofrontality is not specific to schizophrenia and may also be present in other psychiatric conditions.

References

1. Lawrie, S. M., & Abukmeil, S. S. (1998). Brain abnormality in schizophrenia: a systematic and quantitative review of volumetric magnetic resonance imaging studies. British Journal of Psychiatry, 172(05), 110-120.
2. Peltier, S., & Casanova, M. F. (2015). The anatomy of schizophrenia: A review of structural brain imaging studies. Journal of the International Neuropsychological Society, 21(4), 235-255.

ICD-11 Criteria for Autism Spectrum Disorder

ICD-11 Criteria for Autism Spectrum Disorder (6A02)

Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.

Inclusions:              

• Autistic disorder

Exclusions:             

• Rett syndrome (LD90.4)

6A02.0     Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.1      Autism spectrum disorder with disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.2       Autism spectrum disorder without disorder of intellectual development and with impaired functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.3      Autism spectrum disorder with disorder of intellectual development and with impaired functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.5      Autism spectrum disorder with disorder of intellectual development and with absence of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is complete, or almost complete, absence of ability relative to the individual’s age to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires

6A02.Y        Other specified autism spectrum disorder

6A02.Z         Autism spectrum disorder, unspecified

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

Psychiatry Board Review: Pearls of Wisdom, Third Edition

Rebecca A. Schmidt

April 18, 2019

• 
  
• Pearls of Wisdom: Third Edition contains more than 2,300 quick-hit questions and answers addressing the most frequently tested topics on psychiatry board and in-service examinations. Only the correct answers are given, so only the correct answers can be memorized. The rapid-fire question-and-answer format with checkboxes to mark which questions to come back to lends itself to studying alone or with a partner. Every question in this edition has been carefully evaluated to make sure it is completely up-to-date. The new edition addresses four sections of major importance on the boards: General Information; Psychopathology (such as eating disorders and sleep disorders); Special Topics (such as substance abuse and child psychiatry); and Treatment Modalities.
• Market: Psychiatry Residents seeking certification in psychiatry (1,200 per year) Recertifying Psychiatrists (750 per year); recertification is required every ten years. Residents preparing for yearly in-service examinations (4,800 per year)
• Unique “flashcards in a book” format allows test-takers to quickly evaluate their knowledge of the content, and complements studying with a partner.
• The format complements other review material and works well with larger course books.

Psychiatry Board Review: Pearls of Wisdom, Third Edition

Publisher: McGraw Hill LLC

ISBN: 9780071549691

About the author (2009)

Rebecca A. Schmidt, MD, is a child and adolescent psychiatry consultant in Omaha, Nebraska.

Superego Cafe

The Critical Appraisal Company

For more than 22 years, healthcare professionals have enjoyed visiting Superego Cafe. Superego Cafe is a medical education startup, that offers online, in-person, and customised training programs for health. Superego Cafe, a trainee psychiatrist website, was launched in 1999. It expanded to include a critical appraisal, ongoing professional development, and MRCPsych exam preparation courses. The webmaster of PsychClub.com's Superego Cafe's MRCPsych Forum was Dr Gurpal Singh Gosall. This website, the top online resource for MRCPsych exam applicants, was created and is now run by him. The website has received positive reviews from the British Medical Journal and Hospital Doctor magazine. To address the demand for our distinctive training method in healthcare organisations and the pharmaceutical business, not just in the UK but also across the rest of Europe, the Middle East, and Australasia, a new subsidiary, The Critical Appraisal Company, was created in 2013.

The critical evaluation assessment has been added to different specialities' training curricula. Now that the company has developed, all medical and dental professionals can take advantage of our training programmes. They now provide virtual training sessions and online courses after launching fresh online content on their website. Please send us an email at office@criticalappraisal.com to learn more about the courses we offer.

The Critical Appraisal Company operates under the trading name Superego Café.

The Doctor’s Guide to Critical Appraisal (5th edition, 2020)

Written by two tutors of The Critical Appraisal Company and published by PasTest, The Doctor’s Guide to Critical Appraisal is a comprehensive and up-to-date review of clinicians' knowledge and skills to appraise clinical research papers.

This new edition expands on the award-winning third edition with a modified structure, new and updated chapters, new figures and scenarios, and more help with difficult topics. Also includes excerpts from real clinical papers to illustrate key concepts.

The Doctor’s Guide to Critical Appraisal is used worldwide by doctors, dentists, nurses, medical students and researchers. The book can help develop the knowledge and skills to appraise clinical research papers effectively. It provides essential reading for a range of postgraduate examinations, including MRCGP, MRCPsych, FCEM, FRCS, MRCOG, ISFE, MFPH and FPM.

This latest edition of the award-winning book is available at all good bookshops. It is also included with the Critical Appraisal Masterclass and Workshop.

MRCPsych CASC Notes

The Royal College of Psychiatrists' Clinical Assessment of Skills and Competencies (CASC) examination was created to evaluate the clinical competencies expected of trainees following 30 months of training. It is the last obstacle to clearing before becoming a full member of the College. This book aims to aid readers in passing what could seem to be a challenging examination by giving them the essential theory.

Reference Type:  Book

Record Number: 511

Author: Dutta, A. and Bhandary, N.M.

Year: 2010

Title: MRCPsych CASC Notes

Publisher: Lulu.com

Short Title: MRCPsych CASC Notes

ISBN: 9781445702032

URL: https://books.google.com.pk/books?id=ySnpAQAAQBAJ

Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations

"Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations" is a comprehensive guide to preparing for the clinical component of the MRCPsych exam. This book is specifically designed to help candidates prepare for the long case presentation component of the exam, which is an important aspect of the MRCPsych clinical examination.

Ace the MRCPsych Clinical Exam with 'Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations.' Your comprehensive guide to preparing for the long case presentation and other key components of the exam. Get ready to showcase your expertise in psychiatry and take your career to the next leve

The book provides a detailed overview of the MRCPsych clinical examination format and covers the key skills and knowledge that candidates need to demonstrate during the exam. The book is well-structured, with clear explanations of the examination process and helpful advice on how to prepare and perform well on the day of the exam.

One of the strengths of this book is its focus on the long case presentation, which is a unique and challenging aspect of the MRCPsych clinical examination. The book provides numerous examples of long case presentations, as well as practical tips on how to structure and present a compelling case study. This makes the book an essential resource for any candidate preparing for the MRCPsych clinical examination.

In addition to its comprehensive coverage of the long case presentation, the book also includes important information on other aspects of the MRCPsych clinical examination, including the short case presentation, the mental state examination, and communication skills. This makes the book an all-in-one resource for MRCPsych candidates, providing everything they need to know to prepare for and succeed on the clinical examination.

Overall, "Get Through MRCPsych Part 2: Clinical Exam: Long Case Presentations" is a well-written, comprehensive guide to the MRCPsych clinical examination. Whether you are a trainee psychiatrist, a consultant psychiatrist, or simply looking to enhance your knowledge and skills in psychiatry, this book is an essential resource for your MRCPsych exam preparation.

New MRCPsych Paper II Mock MCQ Papers

The Royal College of Psychiatrists has recently changed the format of its membership examination to adopt multiple-choice questions (MCQs). The book of mock MCQ papers includes 650 questions and answers covering all subjects of the Paper II curriculum. It is an essential aid for all candidates preparing for the MRCPsych Paper II, and will also be useful for those revising for the related Paper I and Paper III examinations.

Reference Type:  Book

Record Number: 510

Author: Badrakalimuthu, V.

Year: 2009

Title: New MRCPsych Paper II Mock MCQ Papers

Publisher: CRC Press

Short Title: New MRCPsych Paper II Mock MCQ Papers

ISBN: 9781846193958

The New MRCPsych Paper II Practice MCQs and EMIs

Clare Oakley, Oliver White

Published: 2008

The structure of the MRCPsych examination has changed significantly. This book is specifically written for the new exam, providing 250 practice best-of-five multiple choice questions (MCQs) and 100 extended matching item (EMI) questions for Paper II. It contains clear, concise answers to questions, along with explanatory notes and further reading for each topic. It gives practical advice on the format and content of the examination and techniques for answering questions. It is comprehensive and authoritative: both authors are members of the Psychiatric Trainees' Committee of the Royal College of Psychiatrists. This is an essential revision aid for candidates sitting Paper II of the MRCPsych examination.

• Reference Type:  Book
• Record Number: 509
• Author: Oakley, C. and White, O.
• Year: 2008
• Title: The New MRCPsych Paper II Practice MCQs and EMIs
• Publisher: Radcliffe Publishing
• Short Title: The New MRCPsych Paper II Practice MCQs and EMIs
• ISBN: 9781846192852

Cardiff CASC Training

Royal College CASC exam, since its advent in 2008, has posed a challenge for trainees which is evident in low pass percentages. There had been a need for structured and formal training for the CASC exam in Wales.

Cardiff CASC Training (CCT) has been formed in 2012, to lead the CASC training in Wales. It has got seven members, all in different sub specialties of psychiatry.

Training is organizing CASC examination practice sessions in the form of training days every year. The events are designed to boost the confidence of participants by replicating Royal College examination environment.

Cardiff CASC Training is a non-profit organization (Reg.no 08038178). We have links with Wales Deanery in terms of sponsorship and support. We also receive some contribution from pharmaceutical companies.

Contact

2 Narcissus Grove
Rogerstone
Newport
Gwent NP10 9LP

E: contact@cardiffcasctraining.co.uk

CCT Website

MRCPsych Paper I One-Best-Item MCQs: With Answers Explained

The past decade has seen several revisions to the MRCPsych examinations, but the latest changes have been the most radical. It is now a three-part written examination and a clinical assessment of skills and competencies. This has changed the focus of the 'new' MRCPsych Paper I, which now includes two thirds 'one-best-item-from-five' multiple choice questions (MCQs). This collection of 'one-best-item-from-five' style multiple choice questions mirrors the new format for the exam. Its companion volume Extended Matching Items for the MRCPsych Examinations Part 1 by Michael Reilly and Bangaru Raju remains relevant for the new format where EMIs make up one-third of the questions. Together, these two guides thoroughly prepare you for the revised format, incorporating the new areas of study such as basic ethics, philosophy and history of psychiatry, and stigma and culture. With varying degrees of question difficulty, a wide-range of styles and topics, and full explanations of answers overleaf, MRCPsych Paper I One-Best-Item MCQs is ideal for examination preparation and self-study.

Get Through MRCPsych Paper A2: Mock Examination Papers

Get Through MRCPsych Paper A2: Mock Examination Papers

The MRCPsych examinations, conducted by the Royal College of Psychiatrists, are the most important exams for the psychiatric trainees to achieve specialist accreditation.

Written by authors with previous exam experience and edited by the distinguished team behind Revision Notes in Psychiatry, Get Through MRCPsych Paper A: Mock Examination Papers provides candidates with the most realistic and up-to-date MCQ and EMIs, closely matched to themes appearing most often in the Paper A exam.

Get Through MRCPsych Paper A1: Mock Examination Papers

The MRCPsych examinations, conducted by the Royal College of Psychiatrists are the most important exams for psychiatric trainee to achieve specialist accreditation.

Written by authors with previous exam experience and edited by the distinguished team behind Revision Notes in Psychiatry, Get Through MRCPsych Paper A: Mock Examination Papers provides candidates with the most realistic and up-to-date MCQ and EMIs, closely matched to themes appearing most often in the Paper A exam.

Get Through MRCPsych Parts 1 and 2: 1001 EMIQs

Get Through MRCPsych Parts 1 and 2: 1001 EMIQs is an excellent and essential revision guide for all candidates taking the Membership examinations.

This is one of the first EMIQ books for the MRCPsych examinations. The Editor, Albert Michael, has written several successful MRCPsych texts and is a Consultant Psychiatrist. He and his team of 16 international contributors have created a unique selection of 1001 questions spread over the 200 themes which form the MRCPsych syllabus.

Topics featured include:

learning theory * diagnosis of eating disorders * uncommon syndromes * delerium * memory disorders * cognitive function tests * psychometry * couple therapy * drug dosing * mood stabilisers * dynamics of adverse effects * management of schizophrenia * child abuse * developmental syndromes * statistical concepts

Intermittent Explosive Disorder

Intermittent explosive disorder (IED) involved outbursts of impulsive aggression with no persistent mood disruption between the outbursts. It requires only 3 months for the total duration of two episodes every week on, average. There must have been At least three episodes with damage to property or injury to humans/animals within 12 months. It is diagnosed only if age is above 6 years. 

A man with explosive outburst depicted in a painting

See the ICD-11 Criteria for Intermittent explosive disorder here. 

Deficits in the prefrontal cortex on MRI have been associated with impulsivity (can aid diagnosis).¹

Findings of Etiological (but not necessarily diagnostic importance):

• Reduced prefrontal grey matter >> antisocial personality disorder.²
• Reduced amygdala volume has been associated with a lack of empathy.
• Increased amygdala responses to anger stimuli > Intermittent explosive disorder
• Elevated CSF testosterone >> aggressiveness interpersonal violence (men).³
• Low levels of CSF-5HIAA >> impulsive aggression, suicide victim.
• Reduced density of 5-HT transporter sites >> suicide victims.

Treatment

Psychotherapy is difficult; however, group psychotherapy may be helpful and family therapy is useful. A goal of therapy is to have the patient recognize and verbalize the thoughts or feelings that precede the explosive outbursts instead of acting them out. Anticonvulsants have long been used, with mixed results, in treating explosive patients: Lithium works. Carbamazepine, valproate or divalproex, and phenytoin have been reported helpful. Some clinicians have also used other anticonvulsants e.g., gabapentin. Benzodiazepines are sometimes used but have been reported to produce a paradoxical reaction of dyscontrol in some cases. Antipsychotics (e.g., phenothiazines and serotonin-dopamine antagonists) and tricyclic drugs have been effective in some cases. Still, clinicians must then question whether schizophrenia or a mood disorder is the true diagnosis. With a likelihood of subcortical seizure-like activity, medications that lower the seizure threshold can aggravate the situation. Selective serotonin reuptake inhibitors, trazodone, and buspirone are useful in reducing impulsivity and aggression. Propranolol (Inderal) and other β-adrenergic receptor antagonists and calcium channel inhibitors have also been effective in some cases. Some neurosurgeons have performed operative treatments for intractable violence and aggression. No evidence indicates that such treatment is effective. A combined pharmacological and psychotherapeutic approach has the best chance of success.

Bibliography

1. Sadock BJ, Sadock VA, Roiz P. Kaplan & Sadock Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters; 2015:1499.
2. Raine A, Lencz T, Bihrle S, LaCasse L, Colletti P. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Arch Gen Psychiatry. Feb 2000;57(2):119-27; discussion 128-9. doi:10.1001/archpsyc.57.2.119
3. Blair RJ. Neurobiological basis of psychopathy. Br J Psychiatry. Jan 2003;182:5-7. doi:10.1192/bjp.182.1.5

 

Obsession

An obsession is an intrusive thought or impulse that enters the mind despite efforts to exclude them. Most of the time, patients consider them false and totally against their own beliefs. For example, someone might think their hands are dirty and thus repeatedly wash their hands. But notice they clean their hands to reduce the distress of their intrusive thoughts. That is, they know their hands are clean, but due to the intrusive thoughts of dirt, they want to ensure that their hands are clean again. 

Delusion Definition and Types

A delusion is an unshakeable belief (we cannot change it with logical explanations or evidence) that is held on inadequate grounds (they do not have a valid explanation or evidence for their belief, and that is not a conventional belief that the person might be expected to hold given their educational, cultural, and religious background.  

Illusions are mostly but not always normal. Hallucinations are mostly but not always abnormal. But a delusion is something that is always abnormal. So, someone who believes to be possessed by the supernatural is not delusional because it’s a cultural common belief. In the west, many young girls become convinced that they need to be thin and take extreme measures, and their weight may reach life-threatening low levels and continue. And this is still not a delusion because they consider thinness socially desirable and they educate most people about the risks of obesity is dangerous and the need for thinness.

Persecutory delusions are the most common ones, in which they develop a belief that someone wants to harm them.

Common Types of Delusions

• Somatic delusions
• Grandiose delusions
• Bizzare delusion
• Capgras delusion
• Autochthonus delusion
• Cotard delusion
• Delusion of thought broadcasting
• Delusions of being controlled
• Delusions of reference
• Delusions of jealousy 
• Erotomanic delusions
• Foli a deux
• Fregoli delusion

A delusion may be primary or secondary. Primary delusions occur out of the blue, unexplainable by the patient's morbid experiences at the time. Secondary delusions arise occur against a background. For example, a patient with mania and grandiosity develops grandiose delusions. 

A delusional disorder is characterised by a single delusion or delusional system that persists for at least three months. Most of the time, these are persecutory delusions; delusions of jealousy, Foli a deux or Fregoli delusions may also occur.  In schizophrenia, delusions are more likely to be bizarre, primary, multiple and non-systematized. Grandiose delusion is more characteristic of mania. Patients with depression often have cotard delusions, delusions of poverty or hypochondriacal delusions.