MRCPsych Paper A Syllabus

PSYCHOTHERAPY   

State the characteristics and techniques of, and common indications for psychodynamic psychotherapy, psychoanalysis, supportive psychotherapy, cognitive and behavioural therapies, group therapies, couples and family therapies, and psychoeducational interventions.   

State the indications for and techniques of combining psychotherapy with psychopharmacology   

Describe behavioural interventions (e.g., relaxation training, assertiveness training, relapse prevention) and know for which problems they are indicated or contraindicated.  

Dynamic Psychotherapy: Development of psychodynamic concepts by Freud, the Neo-Freudians Klein, Jung, and Winnicott. An understanding of therapeutic alliance; transference; countertransference; resistance; negative therapeutic reaction; acting out; interpretation; insight; working through defence mechanisms. Indications for brief, long-term, and supportive psychotherapy. Therapeutic factors in groups.    

Family Therapy: Influence of General Systems Theory. Different models of family therapy: dynamic; structural; strategic; psychoeducational; behavioural. Goals of treatment.   

Cognitive-behavioural Therapies   

Behaviour Therapy. Understanding of systematic desensitisation, operant conditioning, graded and cue exposure, habituation, and social skills training. How to conduct a functional analysis, formulate a treatment plan, and use measurement to assess change.   

Cognitive Therapy. The cognitive model for non-psychotic disorders. The importance of schema, negative automatic thoughts, and maladaptive assumptions. These will need to be considered in relevant cultural contexts. 

Other Therapeutic Models: Awareness of Interpersonal Therapy, Cognitive Analytical Therapy, Dialectic Behavior Therapy, Gestalt Therapy, Client-Centred Therapy, Transactional Analysis, and Mentalisation.  

Effectiveness of Psychotherapy: Difficulties in defining the outcome, understanding of effect size and meta-analysis, specific and non-specific effects in psychotherapy, and be aware of contemporary guidelines. Research on outcomes in psychotherapy.  

Group Therapy 

Psychodynamic.  Historical roots of group therapy; group process; different models of analytic/dynamic group therapy (e.g. Bion, Foulkes, Yalom).   Therapeutic factors in groups.  

Other therapeutic group models. Cognitive Behavioral groups, Expressive therapies, support groups, psychoeducational groups, and Skills  

Learning Disability

The topics suggested should complement those topics which will be covered in other areas of psychiatry, particularly neuropsychiatry and child psychiatry.

Services

1. Normalisation and related social theories and their influence on service development of people with an intellectual disability.  
2. Change from an institutional to an individualised, needs-led approach.
3. The provision of specialist psychiatric services for people with intellectual disability.

Epidemiology

1. The prevalence/incidence of intellectual disability in the general population. 
2. The prevalence/incidence of superadded behavioural, psychiatric, and other impairments within this group. 
3. The factors which might account to the observed high rates of psychiatric behavioural disorders in this group.

Aetiology

Biological causes of intellectual disability, including genetic and environmental effects, and the clinical characteristics of common biological conditions associated with an intellectual disability such as 

1. Down Syndrome
2. Fragile-X syndrome
3. Foetal alcohol syndrome. 

The influence of psychological and social factors on intellectual and emotional development in people with intellectual disability, including the concept of secondary handicap.

Clinical

1. Assessment and communication with people with intellectual disability.
2. The presentation and diagnosis of psychiatric illness and behavioural disorder in people with intellectual disability, including the concept of diagnostic overshadowing
3. Psychological methods of assessment and an understanding of psychological theories as to the cause of problem behaviours. An understanding of the relevant behavioural modification techniques.
4. The application of psychiatric methods of treatment in intellectual disability including psychotherapy, drug treatments, behaviour therapy and cognitive therapy.
5. The application of a multidisciplinary approach to the management of mental health problems in people with intellectual disability
6. Specific syndromes and their association with psychiatric or behavioural disorders (behavioural phenotypes).
7. The assessment and management of offenders with Intellectual disability