
Contents
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First principles First principles
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Mental illness Mental illness
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Empathy Empathy
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Suspending judgement Suspending judgement
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Recovery Recovery
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Psychiatric skills: an introduction Psychiatric skills: an introduction
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Psychiatric history
Psychiatric history
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Presenting symptoms Presenting symptoms
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The present The present
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Birth and development Birth and development
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Premorbid personality Premorbid personality
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Relevant past history Relevant past history
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Mental state examination
Mental state examination
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Appearance Appearance
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Behaviour Behaviour
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Speech Speech
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Mood Mood
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Perception Perception
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Thought Thought
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Risk and suicidal ideation Risk and suicidal ideation
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Cognition Cognition
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Insight Insight
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Risk assessment Risk assessment
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Predicting the future Predicting the future
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Approaches to risk assessment Approaches to risk assessment
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Risk factors Risk factors
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Focusing on risk Focusing on risk
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Confidentiality Confidentiality
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Breaking confidentiality Breaking confidentiality
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Physical examination
Physical examination
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Medically unexplained symptoms Medically unexplained symptoms
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Descriptive psychopathology Descriptive psychopathology
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Delusions Delusions
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Specific delusions Specific delusions
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Ideas of reference Ideas of reference
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Descriptive psychopathology Descriptive psychopathology
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Hallucinations Hallucinations
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Auditory hallucinations Auditory hallucinations
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Visual hallucinations Visual hallucinations
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Non-pathological hallucinations Non-pathological hallucinations
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Organic disorders Organic disorders
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Obsessional thoughts Obsessional thoughts
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Descriptive psychopathology Descriptive psychopathology
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Conventional thought processes Conventional thought processes
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Major thought disorder Major thought disorder
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Disorders of thought stream Disorders of thought stream
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Disorders of thought content Disorders of thought content
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Disorders of thought form Disorders of thought form
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Disorders of thought possession Disorders of thought possession
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Classification of disorders Classification of disorders
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Multiaxial classification Multiaxial classification
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Strengths and weaknesses Strengths and weaknesses
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How to look after your own mental health How to look after your own mental health
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Community care Community care
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Schizophrenia: diagnosis
Schizophrenia: diagnosis
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Schizophrenia Schizophrenia
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Incidence: Incidence:
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Prevalence: Prevalence:
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Diagnostic guidelines for schizophrenia Diagnostic guidelines for schizophrenia
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Prodromal symptoms Prodromal symptoms
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Other ‘schizophrenia’ disorders Other ‘schizophrenia’ disorders
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Schizophrenia: management
Schizophrenia: management
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Psychosis and schizophrenia Psychosis and schizophrenia
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Frequent symptoms: Frequent symptoms:
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Frequent behaviours: Frequent behaviours:
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Medication Medication
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Psychological interventions Psychological interventions
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Social support: Social support:
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Aftercare Aftercare
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Prognosis Prognosis
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Suicide rates: Suicide rates:
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Schizophrenia: which antipsychotic? Schizophrenia: which antipsychotic?
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Advice and monitoring Advice and monitoring
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Antipsychotic medication Antipsychotic medication
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Comparing efficacy Comparing efficacy
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Clozapine Clozapine
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Treating EPSE: Treating EPSE:
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Main lifestyle issues Main lifestyle issues
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Failure to respond Failure to respond
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Depression: diagnosis
Depression: diagnosis
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Diagnosis Diagnosis
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Classification Classification
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Aetiology Aetiology
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Differentials Differentials
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Depression: management
Depression: management
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Mild depression Mild depression
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Moderate depression Moderate depression
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Severe depression Severe depression
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Recurrent depression Recurrent depression
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Lifestyle changes Lifestyle changes
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Follow-up Follow-up
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St John’s wort St John’s wort
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Depression: which antidepressant? Depression: which antidepressant?
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NICE guidance NICE guidance
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First line: First line:
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Second line: Second line:
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Third line: Third line:
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Fourth line: Fourth line:
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Mania and bipolar affective disorder Mania and bipolar affective disorder
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Prevelance Prevelance
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Signs of mania Signs of mania
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Mood: Mood:
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Cognition: Cognition:
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Behaviour: Behaviour:
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Psychotic symptoms: Psychotic symptoms:
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Causes Causes
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Medication: Medication:
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Physical: Physical:
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Assessment Assessment
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Do: Do:
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Treating acute mania
Treating acute mania
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Assess: Assess:
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Prophylaxis Prophylaxis
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Psychosocial interventions Psychosocial interventions
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Risk Risk
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Anxiety: neurosis
Anxiety: neurosis
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Neurosis Neurosis
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Symptoms of anxiety Symptoms of anxiety
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Cognitive: Cognitive:
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Somatic: Somatic:
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Behaviours: Behaviours:
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Children’s symptoms: Children’s symptoms:
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Causes Causes
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Treatment Treatment
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Symptom control: Symptom control:
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Prognosis Prognosis
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Anxiety: OCD and phobic disorders Anxiety: OCD and phobic disorders
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Obsessive–compulsive disorder (OCD) Obsessive–compulsive disorder (OCD)
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Pathophysiology: Pathophysiology:
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Treatment: Treatment:
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Phobic disorders Phobic disorders
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Anxiety: post-traumatic stress disorder Anxiety: post-traumatic stress disorder
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Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD)
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Pathophysiology: Pathophysiology:
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Treatment: Treatment:
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Prognosis: Prognosis:
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Prevention: Prevention:
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Anxiety: depersonalization, derealization, and dissociation Anxiety: depersonalization, derealization, and dissociation
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Depersonalization Depersonalization
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Derealization Derealization
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Dissociation Dissociation
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℞: ℞:
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Follow-up Follow-up
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Treatment Treatment
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Seeking a physical cause Seeking a physical cause
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Withdrawing psychotropics Withdrawing psychotropics
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Withdrawing benzodiazepines Withdrawing benzodiazepines
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Withdrawing antidepressants: Withdrawing antidepressants:
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Suicide and suicidal ideation
Suicide and suicidal ideation
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Understanding suicide Understanding suicide
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Risk Risk
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Assessment Assessment
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Summary: Summary:
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After the assessment, there are four stages in trying to help survivors After the assessment, there are four stages in trying to help survivors
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Deliberate self-harm
Deliberate self-harm
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Prevalence Prevalence
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Why do people self-harm? Why do people self-harm?
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Risk factors Risk factors
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Witnessed DSH: Witnessed DSH:
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Biological: Biological:
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Developmental: Developmental:
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Peer relations: Peer relations:
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Psychological: Psychological:
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Antisocial behaviour: Antisocial behaviour:
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Management Management
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Discharge against medical advice Discharge against medical advice
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Prognosis Prognosis
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Crisis intervention Crisis intervention
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Therapeutic strategy Therapeutic strategy
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Urgent psychiatric situations
Urgent psychiatric situations
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Severe behavioural disturbances Severe behavioural disturbances
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Organic: Organic:
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Intoxication: Intoxication:
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Psychiatric: Psychiatric:
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Personality: Personality:
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Intoxication Intoxication
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Self-harming behaviour Self-harming behaviour
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Safeguarding Safeguarding
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Neuroleptic malignant syndrome Neuroleptic malignant syndrome
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Symptoms: Symptoms:
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Management: Management:
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Mortality: Mortality:
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Delirium Delirium
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Differential diagnosis Differential diagnosis
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Causes Causes
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Investigations Investigations
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Management Management
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Dementia Dementia
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Investigations Investigations
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Management Management
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Alzeimer’s disease (as an example of dementia) Alzeimer’s disease (as an example of dementia)
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Presentation: Presentation:
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Mean survival: Mean survival:
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Pharmacological treatment: Pharmacological treatment:
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Prevention/protection: Prevention/protection:
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Child and adolescent psychiatry: depression Child and adolescent psychiatry: depression
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Depression in children and adolescents Depression in children and adolescents
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Clinical features Clinical features
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Assessment Assessment
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Treatment Treatment
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Specific drugs to avoid if <18yrs old, if possible (BNF): Specific drugs to avoid if <18yrs old, if possible (BNF):
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Recovery Recovery
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Child and Adolescent Psychiatry: Psychosis Child and Adolescent Psychiatry: Psychosis
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Assessment Assessment
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Symptoms Symptoms
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Causes of odd ideas Causes of odd ideas
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Management Management
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Prognosis Prognosis
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Behavioural difficulties in young people Behavioural difficulties in young people
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Attachment Attachment
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Behavioural disorders Behavioural disorders
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Conduct disorder (CD) Conduct disorder (CD)
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Diagnosis: Diagnosis:
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Treatment: Treatment:
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Prognosis: Prognosis:
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School refusal School refusal
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Setting: Setting:
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Treatment: Treatment:
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Sleep disorders Sleep disorders
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Not falling asleep Not falling asleep
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Waking at 3am Waking at 3am
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Other sleep disturbances Other sleep disturbances
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Sleepwalking & parasomnias Sleepwalking & parasomnias
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Antiparasomniacs: Antiparasomniacs:
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Sleep hygiene Sleep hygiene
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Autism spectrum disorders (ASDS) Autism spectrum disorders (ASDS)
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Cause Cause
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Diagnosis Diagnosis
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Clinical features Clinical features
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1. Impaired reciprocal social interaction 1. Impaired reciprocal social interaction
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2. Impaired imagination 2. Impaired imagination
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3. Poor range of activities and interests 3. Poor range of activities and interests
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Management Management
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Parent training: Parent training:
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Support: Support:
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Diet: Diet:
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Benefits: Benefits:
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Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD)
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Attention deficit hyperactivity disorder (ADHD) Attention deficit hyperactivity disorder (ADHD)
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Associations: Associations:
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Treatment:
Treatment:
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Substance misuse psychiatry Substance misuse psychiatry
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Epidemiology of drug addiction Epidemiology of drug addiction
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Causes Causes
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Suspect drug addiction if: Suspect drug addiction if:
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Clinical presentation Clinical presentation
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Acute intoxication: Acute intoxication:
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Harmful use: Harmful use:
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Opiate detoxification and methadone maintenance Opiate detoxification and methadone maintenance
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Psychological support: Psychological support:
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Relapse prevention Relapse prevention
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Alcohol-related problems Alcohol-related problems
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Assessment Assessment
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Screening questions Screening questions
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Withdrawal signs Withdrawal signs
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℞ treatment: ℞ treatment:
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Management Management
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Alcohol & organ damage Alcohol & organ damage
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Alcohol and drug levels Alcohol and drug levels
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Intellectual disability Intellectual disability
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Definition Definition
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Epidemiology Epidemiology
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The patient The patient
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Physical: Physical:
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Psychiatric: Psychiatric:
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Causes Causes
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Chromosomal abnormalities: Chromosomal abnormalities:
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Antenatal causes: Antenatal causes:
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Perinatal causes: Perinatal causes:
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Post-natal causes: Post-natal causes:
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Forensic issues Forensic issues
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Assessing a person with an intellectual disability Assessing a person with an intellectual disability
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Care of people with an intellectual disability Care of people with an intellectual disability
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Treatment of psychiatric disorders Treatment of psychiatric disorders
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Personality disorders Personality disorders
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Personality disorders Personality disorders
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Classification Classification
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Management Management
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Prognosis Prognosis
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Personality disorder clusters Personality disorder clusters
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Eating disorders
Eating disorders
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Anorexia nervosa Anorexia nervosa
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Diagnostic criteria: Diagnostic criteria:
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Epidemiology: Epidemiology:
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Prevalence: Prevalence:
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Incidence in primary care: Incidence in primary care:
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Cause: Cause:
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Signs: Signs:
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SCOFF questionnaire: SCOFF questionnaire:
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ΔΔ: ΔΔ:
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Red flags—risk↑↑ if: Red flags—risk↑↑ if:
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Treatment: Treatment:
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Prognosis: Prognosis:
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Re-feeding syndrome Re-feeding syndrome
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Signs: Signs:
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Treatment: Treatment:
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Psychosexual disorders Psychosexual disorders
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Sexual history Sexual history
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Common triggers for sexual problems Common triggers for sexual problems
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Psychological: Psychological:
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Environmental: Environmental:
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Physical: Physical:
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Factors related to the partner: Factors related to the partner:
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Prescribed medication Prescribed medication
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Psychosexual therapeutic interventions Psychosexual therapeutic interventions
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Talking about sex Talking about sex
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Asking about sexual abuse Asking about sexual abuse
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Confidentiality Confidentiality
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Perinatal psychiatry Perinatal psychiatry
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Baby blues Baby blues
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Postnatal depression Postnatal depression
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Natural history Natural history
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Consider these facts: Consider these facts:
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Management of postnatal depression Management of postnatal depression
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Postpartum psychosis Postpartum psychosis
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Prevention: Prevention:
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New cases: New cases:
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Validity Validity
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The psychotherapies
The psychotherapies
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Cognitive therapies Cognitive therapies
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Behavioural therapies Behavioural therapies
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Psychodynamic therapies Psychodynamic therapies
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Group therapies Group therapies
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Play and art therapies Play and art therapies
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Which psychotherapy is most successful? Which psychotherapy is most successful?
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Comparing therapies Comparing therapies
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Westen’s dictum Westen’s dictum
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Principal recommendations and levels of evidence Principal recommendations and levels of evidence
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Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT)
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CBT CBT
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Key concepts Key concepts
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Technique Technique
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Refresher courses Refresher courses
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Indications Indications
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Caution Caution
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Modalities Modalities
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Behavioural therapy Behavioural therapy
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Relaxation training Relaxation training
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Indication: Indication:
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Technique: Technique:
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Systematic desensitization Systematic desensitization
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Indications: Indications:
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Technique: Technique:
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Response prevention Response prevention
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Indications: Indications:
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Technique: Technique:
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Exposure/flooding/implosion Exposure/flooding/implosion
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Indication: Indication:
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Technique: Technique:
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Thought stopping Thought stopping
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Indications: Indications:
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Technique: Technique:
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Aversion therapy/covert sensitization
Aversion therapy/covert sensitization
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Indications: Indications:
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Technique: Technique:
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Cautions: Cautions:
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Social skills training Social skills training
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Indications: Indications:
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Technique: Technique:
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Token economy Token economy
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Indications: Indications:
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Technique: Technique:
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Problems: Problems:
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Modelling and role play Modelling and role play
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Technique: Technique:
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Indications: Indications:
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Dynamic psychotherapy Dynamic psychotherapy
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Key concepts Key concepts
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Assessing suitability Assessing suitability
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Psychological understandibility: Psychological understandibility:
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Psychological mindedness: Psychological mindedness:
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Motivation: Motivation:
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Intelligence and verbal fluency: Intelligence and verbal fluency:
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Introspectiveness: Introspectiveness:
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Dreams: Dreams:
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Ego strength: Ego strength:
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Capacity to form relationships: Capacity to form relationships:
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Specific indications Specific indications
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Technique Technique
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Systemic/family therapy Systemic/family therapy
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Family therapy sessions Family therapy sessions
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Family therapy models Family therapy models
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Counselling and supportive psychotherapies Counselling and supportive psychotherapies
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Indications Indications
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Technique Technique
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Caution Caution
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Randomized trial evidence Randomized trial evidence
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Group psychotherapy Group psychotherapy
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General indications General indications
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Specific indications Specific indications
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Contraindications Contraindications
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Technique Technique
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Play therapy Play therapy
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Play therapy Play therapy
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Technique (non-directive) Technique (non-directive)
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The basic 10 rules are: The basic 10 rules are:
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Evidence Evidence
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Play as a diagnostic tool Play as a diagnostic tool
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Art therapy Art therapy
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Compulsory treatment
Compulsory treatment
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Procedures governing use of compulsory powers (2007) Procedures governing use of compulsory powers (2007)
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Stage 1—preliminary examination: Stage 1—preliminary examination:
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Stage 2—formal assessment/initial treatment under compulsory powers: Stage 2—formal assessment/initial treatment under compulsory powers:
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Stage 3—care and treatment order: Stage 3—care and treatment order:
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Compulsory hospitalization
Compulsory hospitalization
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Section 2: admission for assessment (for ≤28 days) Section 2: admission for assessment (for ≤28 days)
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Section 3: admission for treatment (for ≤6 months) Section 3: admission for treatment (for ≤6 months)
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Section 4: emergency treatment (for ≤72 hours) Section 4: emergency treatment (for ≤72 hours)
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Section 5(2): detention of a patient already in hospital (≤72 hours) Section 5(2): detention of a patient already in hospital (≤72 hours)
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Nurses’ holding powers: section 5(4) (for ≤6 hours) Nurses’ holding powers: section 5(4) (for ≤6 hours)
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Sections 7 and 8: guardianship (for 6 months) Sections 7 and 8: guardianship (for 6 months)
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Section 17: leave of absence from hospital Section 17: leave of absence from hospital
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Section 117: aftercare & the Care Programme Approach (CPA) Section 117: aftercare & the Care Programme Approach (CPA)
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Mental Health Act law and consent Mental Health Act law and consent
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Section 57: treatments requiring consent and a 2nd opinion Section 57: treatments requiring consent and a 2nd opinion
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Section 58: treatments requiring consent or a 2nd opinion Section 58: treatments requiring consent or a 2nd opinion
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Section 62: urgent treatment Section 62: urgent treatment
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Capacity
Capacity
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Mental Capacity Act (2005) Mental Capacity Act (2005)
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Cite
Abstract
This chapter discusses psychiatry. It outlines psychiatric history skills (principles, mental state exam, risk assessment, confidentiality, and physical ecamination), assessment of psychiatric symptoms (descriptive psychopathology, classification of disorders (ICD-10, DSM-V)), community psychiatry (community care, schizophrenia, depression, bipolar affective disorder, anxiety, OCD, and PTSD, and the withdrawal of psychotropics), emergency department psychiatry (suicide and suicidal ideation, deliberate self-harm, crisis intervention, urgent psychiatry situations, and managing violence), liaison psychiatry and organix illness (delirium and dementia), child and adolescent psychiatry (depression, psychosis, behavioural difficulties, sleep disorders, ASD, and ADHD), psychiatric subspecialties (substance and alcohol misuse, intellectual disability, personality disorders, eating disorders, psychosexual disorders, and perinatal disorders), psychological treatment and psychotherapy (cognitive therapy, behavioural therapy, dynamic psychotherapy, systemic/family therapy, counselling and supportive psychotherapy, group psychotherapy, play and art therapy), and mental health and the law (compulsory hospitalisation, consent, capacity, and the Mental Health Act).
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