FFP 1 Introduction to Psychiatry PDF Sep 23

25th September 2023 FFP1 Introduction to Psychiatry Dr Caragh Behan Senior Clinical Lecturer Department of Psychiatry  Professor Charlotte Kamel, FRCPsychUK Head of Department of psychiatry RCSI-Bahrain FFP1 LEARNING OUTCOMES 1. Use effective strategies (e.g...

25th September 2023 FFP1 Introduction to Psychiatry Dr Caragh Behan Senior Clinical Lecturer Department of Psychiatry  Professor Charlotte Kamel, FRCPsychUK Head of Department of psychiatry RCSI-Bahrain FFP1 LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation FFP1 LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation  “Without mental health there can be no true physical health” Dr Brock Chisholm 1st Director-General of the World Health Organisation 1953 ACTIVITY LEARNING OUTCOMES 1. Describe common psychiatric disorders that can present as physical illnesses with reference to conditions taught in FFP1 2. Develop an appreciation of where psychiatry interfaces with conditions taught in FFP1 3. Outline the impact of the individual's environment or system on their physical and mental health using the biopsychosocial approach 4. Describe how health anxiety is useful in maintaining health and where health anxiety becomes pathological (psychology) Outline the components of a mental state examination 5. Describe how engaging effectively with patients, colleagues and communities requires managing the self and self-care, using a biopsychosocial approach with specific reference to stress 6. Describe combined disease burden and outcomes in INTEGRATING MENTAL HEALTH WITH OTHER NON-COMMUNICABLE DISEASES 1. Mental health and wellbeing are central to reducing the global burden of non-communicable diseases (NCDs) 2. WHO Mental Health Action Plan for 2013-20 3. Previously the “Big Four” NCDs – cardiovascular disease, diabetes, cancer and respiratory diseases 4. Expanded to a 5 x 5 approach including mental disorders and environmental contributors 2018 INTEGRATING MENTAL HEALTH WITH OTHER NON-COMMUNICABLE DISEASES 1. Cardiovascular diseases, diabetes, cancer and respiratory diseases commonly co-occur with common mental disorders and severe mental illnesses 2.Common mental disorders- include depression and anxiety 3.Severe mental disorders – include schizophrenia and bipolar disorder 4. Risk factors for NCDs common to both and cluster in people with mental illness 5.Risk factors include – tobacco, unhealthy diet, physical inactivity and harmful alcohol use, environmental risk factors (including adverse INTEGRATING MENTAL HEALTH WITH OTHER NON-COMMUNICABLE DISEASES 1.Collaborative care – evidence supports integration of mental health treatment into primary care 2.Awareness of mental illness and physical illness comorbidity at secondary care level – improves outcomes, reduces costs 3.Professionalism – multidisciplinary team work 4.Inclusion in medical curriculum at an early stage - spiralling SO… 1. Today FFP 1: focus on introduction and awareness 2.Common mental disorders 3.Awareness of the presence of these in a consultation in primary care 4. FFP 2: introduction to more mental disorders 5. Spiralling to later years – comorbidity of mental illness and cardiovascular disease, endocrine disease, respiratory disease 6.Spiralling to later years - treatment and management of mental disorders – psychiatry in year 4 ALO 1 AND ALO2 1. Describe common psychiatric disorders that can present as physical illnesses with reference to conditions taught in FFP1 2. Develop an appreciation of where psychiatry interfaces with conditions taught in FFP1, namely anaemia, breast feeding, immunology and inflammation COMMON MENTAL DISORDERS 1. Depression 2. Anxiety 3. Managed primarily in primary care (mild, stable) 4. How are these relevant to conditions like anaemia or inflammation or sepsis? 5. How would these be recognised in a primary care consultation? COMMON MENTAL DISORDERS - DEPRESSION 1.Low mood – persistent, most of the day, more days than not 2. Associated with biological symptoms 3.Disrupted sleep, low energy, altered appetite, low energy, altered cognition 4. Also in more severe forms – altered thinking including suicidal thoughts 5.Depressed mood, dysphoric mood, dysthymic mood COMMON MENTAL DISORDERS - DEPRESSION How is depression relevant to conditions like anaemia or inflammation or sepsis? 1. Presenting symptoms of conditions you learn about in FFP1 can mimic depression and vice versa 2. Depression is associated with anaemia 3. Low Iron – basal ganglia – responds to changing iron levels 4. Basal ganglia – responsible for movement but also shapes the processing of emotional stimuli 5. Low energy and altered cognition – hypoxia – physical , cognitive and mental health symptoms including fatigue, weakness, dizziness, mood changes, cognitive impairment (trouble remembering, learning, concentrating, making decisions) COMMON MENTAL DISORDERS - DEPRESSION How is depression relevant to conditions like anaemia or inflammation or sepsis? 1. Depression is associated with sepsis – inflammation, post viral symptoms, post COVID (learn more about this later) 2. Low energy and altered cognition – hypoxia – physical , cognitive and mental health symptoms including fatigue, weakness, dizziness, mood changes, cognitive impairment (trouble remembering, learning, concentrating, making decisions) 3. Acute sepsis – encephalopathy - fluctuating mental state changes, inattention, disorganised thinking (delirium – more later) COMMON MENTAL DISORDERS - DEPRESSION How is depression relevant to conditions like anaemia or inflammation or sepsis? 1. Presenting symptoms of conditions like anaemia, thyroid dysfunction, post viral symptoms can mimic anxiety/depression and vice versa 2. Depression is associated with a chronic low grade inflammatory response, activation of cell-mediated immunity 3. Range of common risk factors for depression and inflammation – psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut permeability, atopy, dental cares, sleep and Vitamin D deficiency COMMON MENTAL DISORDERS - ANXIETY 1. Feelings of anxiety or worry – persistent or intermittent, generalised or specific 2. Associated with biological symptoms 3. Disrupted sleep, easily fatigued, irritable, restlessness, wound up increased appearance of energy, altered cognition (difficulty concentrating, paying attention, memory, feeling of impending danger or doom) 4. Associated with physical feelings live headaches, muscle aches, stomach aches, unexplained pains, rapid heart beat, breathing rapidly, sweating, trembling, feeling week, pins and needles in extremities COMMON MENTAL DISORDERS - ANXIETY How is anxiety relevant to conditions like anaemia or inflammation or sepsis? 1. Presenting symptoms of many conditions can mimic anxiety and vice versa 2. Bidirectional association between anxiety and anaemia 3. Iron deficiency anaemia 4. Low energy and altered cognition – hypoxia – physical , cognitive and mental health symptoms including fatigue, weakness, dizziness, mood changes, cognitive impairment (trouble remembering, learning, concentrating, making decisions) 5. Sepsis – more in FFP2 and Year 2 HOW WOULD THESE CONDITIONS BE RECOGNISED IN A PRIMARY CARE CONSULTATION? ALO 4 Outline the components of a Mental State Examination (MSE) MENTAL STATE EXAMINATION 1.Back to your lecture on the consultation in primary care 2.Calgary communication model COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview MENTAL STATE EXAMINATION 1. Snapshot of a patient’s thoughts, emotions and behaviour at the time of observation 2. Helps identify the presence and severity of any mental condition 3. Helps identify the presence of risk to self or others (LATER, not Year 1) 4. Structured format when written down but done during the interview while the patient is talking MENTAL STATE EXAMINATION CONTENT 1. Appearance 8.Cognition 2.Behaviour 9. Insight and 3.Speech Judgment 4.Mood and Affect 10.Risk 5.Thought form assessment 6.Thought content MENTAL STATE EXAMINATION CONTENT 1. Appearance 8.Cognition 2.Behaviour 9. Insight and 3.Speech Judgment 4.Mood and Affect 10.Risk 5.Thought form assessment 6.Thought content BIOPSYCHOSOCIAL APPROACH Refer back to psychology lecture 4th October 2022 Essentially we are concerned about where the patient sits within their system - Physical environment - Social environment - Psychological factors Complex interplay of conditions ALO6 Describe combined disease burden and outcomes in comorbid physical and mental illness BURDEN OF DISEASE WHO 1.1 in 8 people in the world live with a mental disorder 2.There was a 26% increase in anxiety disorders and a 28% increase in depressive disorders in one year 2’ to the pandemic (2020) 3. Depression and anxiety ranked 13th and 24th leading causes of Disability adjusted Life Years (DALYs) EFFECT OF COMORBIDITY 1.People living with a chronic physical health condition are 2x as likely to have poor mental health 2.People with a severe mental illness have earlier morbidity and mortality than their peers 3.Worse outcomes and increased cost 4. Under recognised and treated  ACTIVITY LEARNING OUTCOMES 1. Describe common psychiatric disorders that can present as physical illnesses with reference to conditions taught in FFP1 2. Develop an appreciation of where psychiatry interfaces with conditions taught in FFP1, namely anaemia, breast feeding, immunology and inflammation 3. Outline the impact of the individual's environment or system on their physical and mental health using the biopsychosocial approach: refer back to psychology lecture slides 11-13 4th October 22 4. Describe how health anxiety is useful in maintaining health and where health anxiety becomes pathological 4. Outline the components of a mental state examination 5. Describe how engaging effectively with patients, colleagues and communities requires managing the self and self-care, using a biopsychosocial approach with specific reference to stress – we will touch upon this ALO in the mental health symposium next week 6. Describe combined disease burden and outcomes in comorbid physical and mental illness MENTAL STATE EXAMINATION 1.https://www.youtube.com/watch?v=u uBYeNwkCvQ Video of a doctor interviewing a patient (6 minutes, stop around 4 minutes) QUESTIONS? This Photo by Unknown Author is licensed under CC BY-SA RESOURCES https://psychcentral.com/depression/anemia-a nd-depression#mental-health article on the association between depression and anaemia https://www.bmj.com/content/bmj/364/bmj.l29 5.full.pdf Integrating mental health and other NCDs https://psychscenehub.com/psychinsights/ten- point-guide-to-mental-state-examination-mse-i n-psychiatry/ Longer article going into the MSE in detail (for interest, but only with reference to the ones I circled in this talk) https://youtu.be/ZGR4Lnn8VCw how to