Psychiatry
see also
Objectives for the Psychiatric Component of General Practice Vocational
Training
These objectives have been developed from those of the
joint working party of the Royal College of General Practitioners and the Royal
College of Psychiatrists published in 1978 Those marked with an asterisk (*)
will need a substantial contribution from training in the setting of primary
care if they are to be achieved.
Vocational training should enable future general
practitioners to be able to:
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understand the doctor patient
relationship and its therapeutic value;
-
acquire skills in the consultation
and particularly in listening, in recognising clues and in providing
explanations, video feedback may be useful for developing consultation skills;
-
*have knowledge of the emotional,
intellectual and social development of the individual development, from
infancy to senescence;
-
*understand the psychological
causes and consequences of physical illness, as well as individual
development, in terms of the patients' interpersonal relationships and of
their social group membership and of their family;
-
be aware of the factors that are
conducive to or destructive of mental health and epidemiological matters
important for understanding the relationship of general practice and
psychiatry;
-
*have knowledge of the interactions
of medical practice with the social and educational services in the assessment
of many mental disorders, especially concerning the involvement of the family;
-
understand the roles of other
professional groups involved in the care of patients with mental disorder and
behaviour problems, and in particular knowledge of and ways of dealing with
voluntary agencies and local authority social services departments and how to
deal with psychiatric emergencies;
-
develop the clinical skills needed
in the recognition, elucidation and management of mental and emotional
disorder including:
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taking a psychiatric history; |
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making an accurate diagnosis
through a formal mental state examination; |
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formulating the psychodynamics of
a case, and their relationship to assessment and management, including a
care programme approach when discharging patients. |
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prescribing drug treatment; |
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advising relatives, sometimes in
very difficult and deteriorating circumstances; |
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planning interviews to modify
behaviour; |
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referral for specialist advice; |
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to ascertain what further
investigation is required to make an accurate diagnosis. |
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be aware of the Mental Health Act
1989 and the Children Act 1989 and their implications for general practice,
and the Misuse of Drugs (Notification of and Supply to Addicts) Regulations
1973.
(Not all these skills will necessarily apply in every case). |
have knowledge and understanding of
mental and emotional disorder and in particular:
|
acute disorders that are
threatening life:
 |
of the sufferer, e.g. suicidal
depression; |
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of others, e.g. aggressive
reactions in the psychopathic patient; |
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and appropriate management of
such psychiatric emergencies. |
|
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*disorders which if recognised
early may be managed or whose complications may be reduced - e.g. school
refusal, early depression presenting with somatic complaints, postnatal
mental illness, including depression, or dementia; |
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*disorders not normally
themselves dangerous which become dangerous in certain situations, e.g.
mono-symptomatic phobias; |
|
*common conditions unlikely to
require referral to a specialist or admission to hospital - e.g. temper
tantrums, enuresis; |
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*the effects of bereavement and
loss and their complications; |
|
continuing care of chronic
conditions - e.g. manic-depressive illness or mental handicap; |
|
the pharmacology of drugs used in
psychiatry, their indications, their side effects and their interactions
with other drugs; |
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early recognition and management
of substance misuse; |
|
the impact on children of
parental mental illness. |
*have knowledge of the
psychological aspects of physical illnesses and of medical and surgical
treatments. Examples which illustrate the wide range of these include:
|
post myxoedema, influenzal
depression, asthma and peptic ulcer; |
|
the effects on a young child of
admitting the mother to hospital; |
|
surgical operations in general; |
|
the results of mutilating
operations or of chronic physical disease such as rheumatoid arthritis. |
*be able to recognise deviations
from the expected norms of development, such as mental handicap, dyslexia,
behaviour disorders and personality disorders;
be aware of the wide variety of
non-pharmacological methods of treatment available for psychiatric disorders,
for example counselling, family therapy, psychodynamic psychotherapy,
cognitive therapy and behavioural therapy;
be aware of the effects of the
attitudes of the doctors and those who work with him upon the patient and the
management of the illness;
understand the placebo effects of
drugs;
appreciate the different models of
working together between general practitioners and psychiatrists, including;
The Patient in the Community Act (1995) and The NHS and Community Care Act
(1990).
Learning experience in the subject
Consultation skills.
 | Taking a psychiatric history |
| Understanding psychodynamics of a case |
| Advising relatives |
| Recognise need for referral |
Diagnosis and management
a) Psychiatric emergencies:
| Suicide/ Parasuicide |
| Acute psychoses |
| Acute confusional state |
| Mental Health ACT |
b) Serious conditions
| Neuroses·: Anxiety states, Phobias, Obsessive disorders |
| Affective disorders: Depression, Mania |
| Psychoses: Schizophrenia, Manic (bipolar) depression, Paranoid |
| Psychopathy |
| Eating disorders: Bulimia, Anorexia nervosa |
| Post natal problems |
| Psychosexual problems |
| Bereavement |
| Personality disorder |
| Marital / relationship breakdown |
| Addictions: drugs, tobacco, alcohol, substance abuse, Gambling |
| Old Age: Alzheimer's disease, Dementia presenting as depression, Depression |
| Children: Behaviour problems, Autism, Neurotic disorders, Hyperactivity. |
| Learning disabilities |
| Psychiatric manifestations of systemic disease. |
Understanding treatment options
| Psychotherapy, counselling |
| Medication |
| Community psychiatric support |
| ECT |
| Physical, social, psychological side to medicine |
| Doctor patient relationship and therapeutic value |
| |
Source: D Rapley
Surviving GP Training (Download Word version)
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