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Syllabus: For MRCPsych Part 1 and 2 exams

Author: tegs, Posted on Wednesday, June 11 @ 03:48:27 IST by RxPG  

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MRCPsych Part 1

* indicates topics covered in the MRCPsych Part I Examination 1. *Psychology
i) Basic Psychology
a) Learning theory: classical, operant, observational and cognitive models. The
concepts of extinction and reinforcement. Learning processes and aetiological
formulation of clinical problems, including the concepts of generalisation, secondary

incubation and stimulus preparedness. Escape and avoidance
conditioning. Clinical applications in behavioural treatments: reciprocal inhibition,
habituation, chaining, shaping, cueing. The impact of various reinforcement
schedules. The psychology of punishment. Optimal conditions for observational
b) Basic principles of visual and auditory perception: figure ground differentiation,
object constancy, set, and other aspects of perceptual organisation. Perception as an
active process. The relevance of perceptual theory to illusions, hallucinations and
other psychopathology. The development of visual perception as an illustration of
constitutional/environmental inter- action.
c) Information processing and attention. The application of these to the study of
d) Memory: influences upon and optimal conditions for encoding, storage and
retrieval. Primary working memory storage capacity and the principle of chunking.
Semantic episodic and skills memories and other aspects of long-term/secondary
memory. The process of for- getting. Emotional factors and retrieval. Distortion,
inference, schemata and elaboration in relation. The relevance of this to memory
disorders and theatre assessment.
e) Thought: the possible relationship with language. Concepts, prototypes and cores.
Deductive and inductive reasoning. Problem-solving strategies, algorithms and
f) Personality: derivation of nomothetic and idiographic theories. Trait and type
approaches and elementary personal construct theory. Resume of principles
underlying psychoanalytic and humanistic approaches. The interactionist approach.
Construction and use of inventories, rating scales, grids and Q-sort.
g) Motivation: needs and drives. Extrinsic theories (based on primary and secondary
drive reduction) and homeostasis. Hypothalamic systems and satiety. Intrinsic
theories, curiosity and optimum levels of arousal. Limitations of approach and
attempts to integrate. Cognitive consistency. Need for achievement (nAch). Maslow’s
hierarchy of needs.
h) Emotion: components of emotional response. Critical appraisal of James-Lange
and Can- non-Bard theories. Cognitive appraisal, differentiation and the status of
primary emotions. Emotions and performance.
i) Stress: physiological and psychological aspects. Situational factors: life events,
daily hassles/uplifts, conflict and trauma. Vulnerability and invulnerability, type A
behaviour theory. Coping mechanisms. Locus of control, learned helplessness and
learned resourcefulness.
j) States and levels of awareness: levels of consciousness and evidence for
unconscious processing. Arousal, attention and alertness. Sleep structure and
dreaming. Parasomnias. Bio-rhythms and effects of sleep deprivation. Hypnosis and
suggestibility. Meditation and trances.
ii) Social Psychology
a) Attitudes: components and measurement by Thurstone, Likert and semantic
differential scales. Attitude change and persuasive communication. Cognitive
consistency and dissonance. Attitude-behaviour relationships.
b) Self psychology: self-concept, self-esteem and self-image. Self-recognition and
personal identity.
c) Interpersonal issues: person perception, affiliation and friendship. Attribution
theory, ‘naive psychology’ and the primary (fundamental) attribution error. Social
behaviour in social interactions. ‘Theory of mind’ as it might apply to pervasive
developmental disorders. El- emental linguistics as applied to interpersonal
d) Leadership, social influence, power and obedience. Types of social power.
Influence oper- ating in small and large groups or crowds: conformity, polarisation
and ‘groupthink’, deindividuation. Communicative control in relationships.
e) Intergroup behaviour: prejudice, stereotypes and intergroup hostility. Social
identity and group membership.
f) Aggression: explanations according to social learning theory, operant conditioning,
ethnol- ogy, frustration and arousal concepts. The influence of television and other
media. Family and social backgrounds of aggressive individuals.
g) Altruism, social exchange theory and helping relationships. Interpersonal cooperation.
iii) Neuropsychology
Brain organisation in relation to memory, language, perception, visuo-spatial ability
and frontal lobe functions.
iv) Psychological Assessment
a) Principles of measurement: scaling, ratios, norm-referenced and criterionreferenced
b) Intelligence: definition and components (general and specific abilities), concept of
IQ and its stability, measurement of intelligence using specific tests. Cultural
c) Overview of techniques in neuropsychological assessment with particular reference
to clinical practice.
*2. Human Development
i) Basic frameworks for conceptualising development: nature and nurture, stage
theories, maturational tasks. Possible definitions of maturity. Examination of geneenvironment
interactions with specific reference to intelligence. Relative influence of
early versus later adversities. The relevance of developmental framework for
understanding the impact of specific adversities such as traumata. Very brief mention
of historical models: Freud and general psychoanalytic, social-learning, Piaget.
ii) Methodology for studying development: cross sectional, cohort and individual
studies. Identification and evaluation of influences.
iii) Bowlby attachment theory and its relevance to emotional development, affect
regulation and human relationships in childhood and later on. Conditions for secure
attachment. Types and clinical relevance of insecure attachment. Early separation and
its consequences. Consequences of failure to develop selective attachments. Brief
consideration of neonatal maternal ‘bonding’.
iv) Other aspects of family relationships and parenting practice. The influence of
parental attitudes compared with parenting practices. Some aspects of distorted family
function: e.g. discord, overprotection, rejection, enmeshment. The impact of
bereavement, parental divorce and intrafamilial abuse on subsequent development of
the child. Brief mention of relevance or otherwise of non-orthodox family structure.
v) Individual temperamental differences and their impact on parent-child
relationships. Origins, typologies and stability of temperament and the evolution of
character and personality. Childhood vulnerability and resilience with respect to
mental health.
vi) Cognitive development with critical reference to Piaget’s model. The relevance of
pre-operational and formal operational thought to communication with children and
vii) Basic outline of language development in childhood with special reference to
environmental influ- ences and communicative competence.
viii) Development of social competence and relationships with peers: acceptance,
group formation, co- operation, friendships, isolation and rejection. The components
of popularity.
ix) Moral development with critical reference to Kohlberg’s stage theory.
Relationship to development of social perspective taking.
x) Development of fears in childhood and adolescence with reference to age. Possible
aetiological and maintenance mechanisms.
xi) Sexual development including the development of sexual identity and preferences.
xii) Adolescence as a developmental phase with special reference to pubertal changes,
task mastery, conflict with parents and authority, affective stability and ‘turmoil’.
Normal and abnormal adoles- cent development.
xiii) Adaptations in adult life, such as pairing, parenting, illness, bereavement and
xiv) Pregnancy and childbirth and their stresses both physiological and psychological.
xv) The development of personal (ego-) identity in adolescence and adult life. Work,
ethnic, gender and other identities. Mid-life ‘crises’. Adaptations in adult life,
especially to illness.
xvi) Normal ageing and its impact on physical, social, cognitive and emotional
aspects if individual func- tioning. Social changes accompanying old age.
xvii) Disability and pain.
xviii) Death and dying.
3. Principles of Evaluation and Psychometrics
i) Basic structuring of research: individual, population, case-control, whole and
intervention studies, clinical trials etc. as before.
ii) Concepts of scale of measurement, sampling methods, frequency and probability
distributions. Summary statistics and graphs, outliers, stem-and-leaf plots, Bos plots,
scattergrams. Types of data e.g. categorical, ordinal, continuous.
iii) Descriptive and Inferential Statistics. Significance tests, estimation and confidence
intervals. The advantage of confidence intervals over p values.
iv) Specific tests, particularly t-test, chi-square test, Mann-Whitney U test, confidence
intervals for difference between means, proportions and medians.
v) Clinical trials - the advantages of randomised trials and the problems with
alternatives such as his- torical controls.
vi) A brief introduction to more complex methods such as factor analysis - no more
than a description of what the techniques aim to achieve.
vii) Problems of measurement in psychiatry, latent traits (constricts) and observed
indications (symp- toms). Type I and type II errors.
viii) Ideas of reliability and validity. Sensitivity, specificity and predictive values of
research measures. Bias.
ix) Diagnostic agreement measured by Kappa and intra-class correlations. Cronbach’s
x) Metanalysis, survival analysis, logistic regression.
4. Social Sciences
i) Descriptive terms: social class, socio-economic status and their relevance to
psychiatric disorder and health care delivery.
ii) The social roles of doctors. Sick role and illness behaviour.
iii) Family life in relation to major mental illness (particularly the effects of high
Expressed Emotion).
iv) Social factors and specific mental health issues, particularly depression,
schizophrenia and addic- tions. Life events and their subjective, contextual evaluation.
v) The sociology of residential institutions.
vi) Basic principles of criminology and penology.
vii) Stigma and prejudice.
viii) Ethnic minorities, adaptation and mental health.
ix) Methodology, particularly surveys, social anthropological and ethnological
x) Interrelationships between professional groups involving patient care. The
characteristics of profes- sions.
*5. Psychopathology
i) Descriptive psychopathology.
ii) The psychoanalytic theories of Freud, Jung, Klein and Winnicott with special
reference to the struc- ture of the mind, the process of development and responses to
iii) Defence mechanisms in intrapsychic and interpersonal terms.
6. Neuroanatomy
i) The general anatomy of the brain and the functions of the lobes and some of the
major gyri including the prefrontal cortex, cingulate gyrus and limbic system. Basic
knowledge of the cranial nerves and spinal chord.
ii) The anatomy of the basal ganglia.
iii) The internal anatomy of the temporal lobes, i.e. hippocampal formation and
iv) The major white matter pathways, e.g. corpus callosum, fornix, Papez’s circuit and
other circuits relevant to integrated behaviour (see neurophysiology section).
v) The types of cell found within the nervous system.
vi) The major neurochemical pathways, including the nigrostriatal, mesolimbic and
mesocortical dopamine pathways, the ascending noradrenergic pathway from the
locus coeruleus, the basal forebrain cholin- ergic pathway, the brain stem cholinergic
pathway, the corticofugal glutamate system and serotonin pathways.
7. Neuropathology
i) a) The neuropathology of organic disorders, including detailed knowledge of the
b) The neuropathology of schizophrenia.
c) Conditions associated with mental retardation, including autism.
d) Movement disorders including detailed knowledge of Parkinson’s disease,
Huntington’s dis- ease and the neurochemical pathology of the tardive dyskinesias.
e) Association between the localisation of gross cerebral lesions and clinical signs.
ii) Neuroimaging techniques: X-ray, CT, PET, SPECT and MRI.
8. Neurophysiology
i) The basic concepts in the physiology of neurones, synapses and receptors, including
synthesis, re- lease and uptake of transmitters. A basic knowledge of action potential,
resting potential, ion fluxes and channels etc.
ii) The physiology and anatomical pathways of the neural and endocrine systems
involved in integrated behaviour including perception, pain, memory, motor function,
arousal, drives (sexual behaviour, hunger and thirst), motivation and the emotions,
including aggression, fear and stress. Knowledge of disturbances of these functions
with relevance to organic and non-organic (functional) psychiatry.
iii) The development and localisation of cerebral functions throughout the life span
from the foetal stages onwards and their relevance to the effects of injury at different
ages to the brain and to mental function. An understanding of neurodevelopmental
models of psychiatric disorders and of cerebral plasticity.
iv) An understanding of the neuroendocrine system, in particular the control of the
secretion of hypothalamic and pituitary hormones (by releasing factors and by
feedback control) and posterior pituitary function. The main hormonal changes in
psychiatric disorders. A basic understanding of neuroendocrine rhythms and their
disturbance in psychiatric disorders.
v) A basic knowledge of the physiology of arousal and sleep and with particular
reference to noradrenergic activity and the locus coeruleus.
vi) The normal EEG (including frequency bands) and evoked response techniques.
The applications to investigation of cerebral pathology, seizure disorders, sleep and
psychiatric disorders. The effects of drugs on the EEG.
9. Neurochemistry
i) Transmitter synthesis, storage and release. Ion channels and calcium flux in relation
to this.
ii) Knowledge of receptor structure and function in relation to the transmitters listed
below. Pre-synaptic and post-synaptic receptors.
iii) Basic pharmacology of noradrenaline, serotonin, dopamine, GABA, acetylcholine,
excitatory amino acids.
iv) Elementary knowledge of neuropeptides, particularly corticotrophin releasing
hormone and cholecystokinim and the encephalins/endorphins.
10. Psychopharmacology
*i) General Principles
A brief historical overview of the development of psychotropic drugs. Their
classification. Optimising patient compliance. Knowledge of the placebo effect and
the importance of controlling for it. The principles of rational prescribing of
psychoactive drug.
*ii) Pharmacokinetics
a) General principles of absorption, distribution, metabolism and elimination.
Particular refer- ence to a comparison of oral, intramuscular and intravenous routes of
administration as they affect drug availability, elimination as it affects the life of the
drug in the body and access to the brain through the ‘blood-brain barrier’.
Applications of these to choice of administrative route and timing of doses.
b) Relationships between plasma drug level and therapeutic response: the possibilities
and limi- tations of this concept with specific examples such as lithium,
antidepressants and anticonvulsants.
*iii) Pharmacodynamics
a) Synaptic receptor complexity, main receptor sub-types, phenomena of receptor up-
and down- regulation.
b) The principal CNS pharmacology of the main groups of drugs used in psychiatry
with par- ticular attention to their postulated modes of action in achieving therapeutic
affect: at both molecular/synaptic and systems levels. These groups would include
‘anti-psychotic’ agents, drugs used in the treatment of affective disorder (both mood
altering and stabilising), anxiolytics, hypnotics and anti-epileptic agents.
c) Neurochemical affects of ECT.
*iv) Adverse Drug Reactions (ADRs)
a) Understanding of dose-related as distinct from ‘idiosyncratic’ ADRs.
b) The major categories of ADRs associated with the main groups of drugs used in
psychiatry and those associated with appropriate corrective action.
c) The importance of assessing risks and benefits for every individual patient in
relation to his medication. Risks and benefits of psychotropic drugs in acute, short-
and long-term use including effects of withdrawal. Where appropriate, knowledge of
official guidance on the use of particular drugs (e.g. the Royal College Guidelines on
the use of Benzodiazepines).
d) The information database for adverse drug reactions and how to report them.
e) Prescribing of controlled drugs.
v) Evaluation of Drugs
Research methodology for drug trials including principles of design, randomisation,
blindness, statis- tical power, duration, rating scales, exclusion criteria.
11. Genetics
i) Basic concepts: chromosomes, cell division, gene structure, transcription and
translation, structure of the human genome, patterns of inheritance.
ii) Traditional techniques: family, twin and adoption studies.
iii) Techniques in molecular genetics: restriction enzymes, molecular cloning and
gene probes, Southern blotting, restriction fragment length polymorphisms,
iv) Distinction between direct gene analysis and gene tracking. Genetic markers,
linkage studies, lod scores.
v) Conditions associated with chromosome abnormalities.
vi) Principal inherited conditions encountered in psychiatric practice and the genetic
contribution to specific psychiatric disorders.
vii) Prenatal identification. Genetic counselling. The organisation of clinical genetic
services, DNA banks.
viii) Molecular and genetic heterogeneity. Phenotype/genotype correspondence.
12. Medical Ethics and Principles of Law
i) Legal principles, consent, restraint, legal responsibilities and protection.
ii) Powers of attorney, enduring powers of attorney, management of property,
testamentary capacity.
iii) Effect of psychiatric disorders on driving capability.
13. Epidemiology
i) Concepts of incidence (inception), prevalence and population at risk.
ii) Sampling techniques, case identification, case registers, mortality and morbidity
iii) Epidemiology of specific psychiatric disorders.
All psychiatrists undergo the same basic training before entering for the MRCPsych
Examinations. Only after this common basic training do trainees specialise in
particular aspects of psychiatry as Senior Regis- trars. In this document, the core
knowledge and clinical skills are identified which must be possessed by all
psychiatrists. General Adult Psychiatry is at the core of basic psychiatric training
although all trainees are expected to gain some experience in the specialities of
psychiatry. For this reason, this document includes all the specialities in some detail;
trainees and trainers should bear in mind that knowledge to such depth would not
normally be expected in all. This document is therefore a guide to studies, both
theoretical and practical, but care should be taken not to interpret it too narrowly.
Areas of Competence which will be required
1. Theoretical Knowledge
Trainees will be expected to have a theoretical knowledge of the aetiology,
assessment, diagnosis, classification, management (including pharmacological,
physical and psychological approaches) and prognosis of psychiatric disorders. The
level of knowledge of General Adult Psychiatry required should be that which would
be sufficient for a candidate, who may subsequently specialise, to exam- ine and
assess any patient. The theoretical knowledge is likely to be that found in basic
postgraduate textbooks. Knowledge about the specialities should include that which
all psychiatrists might be expected to know in order to identify special needs of
patients in the specialities. Trainees may wish to read about some topics in greater
detail, but this should not be at the expense of breadth of knowl- edge.
2. Clinical Skills
All trainees will be expected to be competent in history taking, examination of the
mental state, physical assessment, the taking of accounts from informants, the
consideration of diagnosis and aetiological factors, the identification of further
investigations required, the preparation of schemes of management and the practice of
treatment under supervision. Trainees should be able to work with and contribute
appropriately to a multidisciplinary team, and to be able to direct and supervise the
work of others as appropriate. The level of skill required is that of someone who is
able to work independently with access to Consultant advice.
3. Physical Disorders
It is important that as the medical members of multidisciplinary teams, psychiatrists
are able to deal with the medical aspects of psychiatric disorder and with physical
disease in psychiatric practice. Trainees will be expected to have the necessary
medical knowledge and clinical skills to do this and to integrate the physical and
psychiatric assessments.
4. Legal Aspects of Psychiatric Care
A knowledge of the legal aspects of psychiatric practice in different settings is
required. Trainees will be required to know the history and concept of mental health
legislation in relation to admission, detention and treatment of psychiatric patients,
consent to treatment as it applies to psychiatric pa- tients, including those who are
incompetent, and compulsory care in the community. They will not be expected to
have detailed knowledge of mental health legislation or psychiatric defences in more
than one jurisdiction. They should be able to describe the principles upon which the
mental health legislation and psychiatric defences of one particular jurisdiction
(England and Wales, Ireland, Northern Ireland and Scotland) is based. Knowledge of
the Misuse of Drugs legislation and notification of addicts as this relates to doctors.
5. Ethical Considerations
Candidates must understand the general and particular ethical considerations which
arise in medical practice and in psychiatric practice in particular. These include the
principles of the doctor/patient relationship, confidentiality, consent to treatment and
an understanding of institutional factors that can have an effect on professional
practice. Knowledge is expected of the organisation and provision of services
including planning, management, audit and budgeting. Candidates should be aware of
the factors to be considered in providing psychiatric service to a community. These
will include the epidemiology of psychiatric disorder, methods of assessing need for
services and the evaluation of psychiatric services.
Objectives of the Examination in General Adult Psychiatry
Candidates should be able to integrate knowledge of basic sciences relative to
psychiatry, general medicine (especially neurology and endocrinology) and clinical
psychiatry. They should be able to apply such knowledge to the assessment and
treatment of patients with a psychiatric disorder and their relatives in a range of
settings in which such disorders are present - the community, general hospital, the
psychiatric hospital, primary care and in forensic settings.
The scope of General Adult Psychiatry includes all major syndromes in the
classificatory systems of ICD-10 and DSM-IV. In particular, candidates should have a
detailed knowledge of the following:
i) the aetiology, presentation, clinical course, outcome and prognosis of psychiatric
ii) psychiatric epidemiology;
iii) a working knowledge of ICD-10 and detailed knowledge of either ICD-10 or
DSM-IV classification and diagnostic systems;
iv) the various biological, psychological and social factors involved in the
predisposition to and onset, and maintenance of psychiatric disorder;
v) the nature and process of psychiatric treatment, including the application of
multidisciplinary ap- proaches, the special role of the psychiatrist in treatment and the
co-ordination of the various treat- ment processes involved. Physical, psychological
and social treatments and their relevance to the management and treatment of
psychiatric disorders;
vi) preventative strategies in psychiatric disorder, where these exist;
vii) the presentation of psychiatric disorder in a range of cultural settings, especially
those likely to be encountered in the United Kingdom or the Republic of Ireland;
viii) the assessment of need for psychiatric services within a community and how to
set up and administer such services, including some idea of the costs of major
elements of such service provision;
ix) rehabilitation.
Hospital Liaison Psychiatry
i) Psychiatric assessment of patients with physical illness.
ii) Assessment and management of patients who have harmed or threatened to harm
iii) Advice to special medical services, such as endocrinology, neurology and
neurosurgery, cardiothoracic surgery, nephrology, intensive care wards, special care
baby wards, accident and emergency depart- ments, HIV infection, haematology,
iv) Clinical and theoretical aspects of pain and its management.
v) Substance misuse related complications and management of dependence.
vi) Clinical and theoretical aspects of hypochondriasis and disorders presenting with
symptoms of physi- cal disease.
vii) Care of the dying and the bereaved.
viii) Knowledge of staff interaction in general hospital services and of advising on
this matter.
i) The psychiatric consequences and associations of brain disease, damage and
ii) A working knowledge of neurology including physical examination, diagnosis,
investigation and treatment of common conditions.
iii) Knowledge of psychiatric aspects of head injury and stroke, and of rehabilitative
iv) Imaging of the nervous system.
Human Immunodeficiency Virus
i) Basic knowledge of the recognition and management of medical conditions
associated with HIV infection and hepatitis B infection. Knowledge of the psychiatric
presentations of HIV infection.
Medicine Especially Relevant to Psychiatry
i) Endocrinology as relevant to psychiatry.
ii) General medicine and geriatric medicine as relevant to psychiatry, e.g. elucidation
of causes of toxic states.
iii) Paediatrics relevant to studies in Child and Adolescent Psychiatry.
Candidates should be able critically to examine the design, methodology, results and
appraisal of published research, with reference to the following areas.
i) Principles and criteria for literature reviews: meta-analysis.
ii) Study design: case studies; case series; retrospective studies; case control designs;
prospective con- trolled trials. Sample size. Randomisation. Bias. Hypotheses and
predictions. Appropriateness of controls in various study designs.
iii) Ethical issues.
iv) Measurement instruments in psychiatry: rating scale characteristics.
v) Data analysis and statistics (cf. Part 1). Type 1 and 2 errors, p values and
confidence intervals. Non- parametric and parametric tests.
vi) Interpreting results. Inferring cause and effect. Confounding factors.
1. Old Age Psychiatry
i) Neurobiology of ageing. Psychology of ageing; cognition and age, importance of
loss, personality changes with ageing.
ii) Social and economic factors in old age; attitude, status of the elderly, retirement,
income, accommodation, socio-cultural differences.
iii) Psychopharmacology of old age; pharmacokinetics, pharmacodynamics, drug
interactions, practical considerations. Drugs affecting mental functioning.
iv) Demographic changes. Epidemiology.
v) District service provision; need for specialisation, principles of service provision,
multidisciplinary working with reference to needs of an older population,
relationships with and provision by social services and voluntary bodies. Liaison with
geriatricians. Attention to the needs of carers. Appropriate legislation.
vi) Assessment of a referral; psychiatric, physical, psychological and social. O.T.
investigation including use of EEG and brain imaging. Use of home visits.
vii) Psychological aspects of physical disease; particular emphasis on possible
psychiatric sequelae of Parkinson’s disease, cerebrovascular disease, sensory
impairment. Emotional reaction to illness and to chronic ill health. Reversible
dementias. Delirium.
viii) Epidemiology, clinical features, differential diagnosis, aetiology, management
and prognosis of the following:
dementia disorders; affective disorders in old age; late paraphrenia and paranoid
states; anxiety disorders.
ix) Suicide and attempted suicide in old age.
x) Psychiatric aspects of personality in old age.
xi) Psychotherapy with older adults: adaptations and difference in therapy.
Transference - counter- transference issues. Common themes.
xii) Bereavement and adjustment disorders.
xiii) Sleep disorder in later life.
xiv) Alcohol and drug problems in the elderly.
xv) Psychosexual disorders in old age; including sexuality in physically ill/disabled
people, sexuality in institutionalised elderly.
xvi) Medico legal issues in old age psychiatry; abuse of the elderly. Management of
property. Testamen- tary capacity. Driving.
2. Addictions
i) Classification of disorders associated with the use and abuse of alcohol and other
psychoactive sub- stances.
ii) Basic pharmacology and epidemiology of: alcohol; cannabis: the stimulants
(amphetamine, cocaine, phentermine, diethylpropion, pemoline etc.); hallucinogens;
solvents and nitrites; Ecstasy and related substances, benzodiazepines and
barbiturates; opiates.
iii) The restrictions imposed on doctors by the Misuse of Drugs Act and Regulations.
Awareness of the arguments for and against the various types of prescribing and
treatment modalities.
iv) Cause, consequences and recognition of heavy drinking: the concept of ‘problem
drinking’; the components of the alcohol dependence syndrome; the nature of alcoholrelated
disabilities; detoxification procedures for in-patients and out-patients.
v) Who uses which drugs and why; reasons for initiating and continuing drug use;
how to recognise drug use; the concept of problem drug use; patterns of dependence
on different drugs; detoxification procedures for inpatients and outpatients.
vi) The interaction of drug and alcohol use with psychiatric illness.
vii) Basics of the biological, psychological and socio-cultural explanations of drug
and alcohol dependence.
viii) The assessment and management of drug and alcohol misusers.
ix) strategies for the prevention of drug and alcohol abuse.
x) The assessment and management of non-substance addictive behaviours and
related syndromes.
xi) Dual diagnosis and co-morbidity (classificatory systems).
xii) Recognition of substance misuse related medical, psychiatric and social
complications and their im- pact on Public Health.
3. Child and Adolescent Psychiatry
i) The effects of adult mental illness on children. The effect of depression and other
psychiatric symp- tomatology on parental functioning, and the impact of this on child
development and functioning.
ii) The effects of early and continuing experience on later child, adolescent, and adult
development and functioning. Long-term implications of early insecure attachment.
Short and long-term effects of other negative life events on development and
functioning e.g. maternal loss, child abuse, chronic or life-threatening illness.
iii) Classification and epidemiology of child and adolescent psychiatric disorder.
iv) Aetiology of child psychiatric disorder. Individual and family factors, social and
environmental influences e.g. school and neighbourhood. Genetic influences. v) Child
protection. The needs of developing children and how these change with time. Types
of child abuse and their aetiology, recognition and outcome.
vi) Interaction between psychiatric disorder and physical illness. Physical presentation
of psychiatric disorder.
vii) Knowledge of the prevalence, aetiology, presentation, treatments and outcome of
the following condi- tions:
· common pre-school problems - oppositional behaviour, temper tantrums, sleeping
difficulties, feeding difficulties; · conduct disorder; · hyperactivity disorders; · school
attendance problems; · emotional disorders specific to childhood; · depression, OCN
and schizophrenia in adolescence; · anorexia nervosa; · deliberate self-harm in
adolescence; · substance misuse; · generalised mental handicap, specific delays in
speech, language, reading, perva- sive developmental disorders e.g. autism and
Asperger’s Syndrome; · enuresis and encopresis; · tic disorder; · family conflict
viii) Continuities of childhood psychiatric disorder into adult life.
ix) Treatment. The basic range of treatment methods: description, indications and
contra-indications for different treatment interventions, outcomes. Indications for inpatient
and day patient care.
x) Description of a typical child psychiatric service. Basic information on different
agencies involved in the care of children and their function.
Particular Skills Relevant to This Speciality
The ability to take a developmental history. The ability to carry out a conjoint family
assessment and take a history concerning one member of the family whilst involving
all members. The ability to communicate with children at a developmentally
appropriate level.
4. Forensic Psychiatry
i) Relationship between crime and mental disorder
Knowledge of the range of offences committed by mentally disordered offenders;
specific crimes and their psychiatric relevance particularly homicide, other crimes of
violence, sex offences, arson, shop- lifting and criminal damage. The relationship
between specific illnesses and crime. Special syn- drome: morbid jealousy,
erotomania, Munchausen and Munchausen by proxy. Mental disorders and offending
in special groups: young offenders, females, ethnic minorities; substance misuse and
crime; offenders with brain damage, epilepsy, deafness and other physical disabilities.
ii) Psychiatry and the criminal justice system
An outline of the procedures of arrest, prosecution and sentencing. Role of police in
arrest of men- tally disordered offenders, the assessment of defendants at police
stations, false confessions.
iii) # Psychiatric defences
Fitness to plead, mutism and deafness, criminal responsibility, diminished
responsibility, infanticide, amnesia and automatism. Psychiatric disposals after
# Candidates will not be expected to have detailed knowledge of mental health
legislation or psychiatric defences in more than one jurisdiction. They should be able
to describe the principles upon which the mental health legislation and psychiatric de-
fence of one particular jurisdiction is based.
iv) Writing reports and giving evidence
Principles of assessing a defendant for the court and preparing a psychiatric court
report in a criminal case.
v) Facilities and treatment
Elements of a Forensic Psychiatry service, their relationship to each other. The use of
security in the treatment of psychiatric patients and the arguments for and against
seclusion. The long-term man- agement of patients on restriction orders. Care in the
community for previously violent patients.
vi) Dangerousness
The concept, definitions and situations where assessment is required. Problems in
vii) Psychiatry in prisons
Knowledge of the prevalence of psychiatric disorder in prison populations, suicide in
prisoners, psychiatric treatment in prison settings.
viii) Victims
The psychological sequelae of victimisation, especially anxiety states, anger and
aggressive behav- iour. Compensation and other medico-legal issues.
ix) Civil matters
Psychiatric disorder and civil rights including marriage, divorce, custody of children
and manage- ment of property and affairs. Ethical issues including confidentiality and
the implications of ‘duty to warn’. Claims of psychiatric damage, for example post
traumatic stress disorder.
5. Learning Disability
The topics suggested should complement those topics which will be covered in other
areas of psychiatry, particularly neuropsychiatry and child psychiatry.
i) The neurobiology of brain development and the effects of genetic and
environmental factors.
ii) More common mental handicapping disorders. For example, Down’s Syndrome,
fragile-X syndrome, foetal alcohol syndrome and the developmental problems of very
low birth weight babies.
iii) Specific disorders of development including autism and Asperger’s syndrome.
iv) The influence of social factors on intellectual and emotional development.
Classification and Epidemiology
i) An historical perspective to methods of classification.
ii) Modern systems of classification including ICD-10 and the WHO classification of
impairments, disabilities and handicaps. A working knowledge of ‘statementing’ for
special needs education.
iii) The prevalence of intellectual impairment in the general population. The
prevalence of superadded behavioural, psychiatric and other impairments within this
group. The factors which might account to the observed high rates of psychiatric
behavioural disorders in this group.
i) The characteristics of learning disability and mental handicap. The ability to take a
good develop- mental and relevant family history, and basic knowledge about
possible aetiological factors giving rise to the handicap. ii) The presentation,
diagnosis and treatment of psychiatric illness and behavioural disorder in people with
a learning disability (mental handicap).
iii) Psychological methods of assessment and an understanding of psychological
theories as to the cause
of problem behaviours. An understanding of relevant behavioural modification
iv) The application of psychiatric methods of treatment in learning disability (mental
handicap) includ- ing psychotherapy, drug treatments, behaviour therapy and
cognitive therapy.
v) Specific syndromes and their association with particular psychiatric or behavioural
disorders (behav- ioural phenotypes).
vi) The impact of disability on the family and the psychological consequences of
having a child with a disability. vii) The assessment, management and treatment of
offenders with a learning disability (mental handicap).
i) A broad understanding of legislation which may be of importance, for example
relating to common law, mental health, sexual offenders, community care etc. General
principles rather than details would be required.
ii) Normalisation and service development for people with a learning disability
(mental handicap). The change from an institutional to an individualised, needs led
iii) The provision of specialist psychiatric services for people with a learning
disability (mental handicap).
6. Psychotherapy
i) Dynamic Psychotherapy
Development of psychodynamic concepts by Freud, the Neo-Freudians Klein and
Winnicott. An understanding of the following: 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.
ii) Family Therapy
Influence of General Systems Theory. Different models of family therapy: dynamic;
structural strategic; psychoeducational; behavioural. Goals of treatment.
iii) 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 schemes, negative automatic thoughts and maladaptive assumptions.
iv) Effectiveness of Psychotherapy
Difficulties in defining outcome, understanding of effect size and meta-analysis,
specific and non- specific effects in psychotherapy.

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