Clare Oakley

Medical students' views about an undergraduate curriculum in psychiatry before and after clinical placements

BackgroundIt has been suggested that medical students wish to focus their learning in psychiatry on general skills that are applicable to all doctors. This study seeks to establish what aspects of psychiatry students perceive to be relevant to their future careers and what psychiatric knowledge and skills they consider to be important. It is relevant to consider whether these expectations about learning needs vary prior to and post-placement in psychiatry. To what extent these opinions should influence curriculum development needs to be assessed.MethodsA questionnaire was distributed to medical students before they commenced their psychiatry placement and after they had completed it. The questionnaire considered the relevance of psychiatry to their future careers, the relevance of particular knowledge and skills, the utility of knowledge of psychiatric specialties and the utility of different settings for learning psychiatry.ResultsThe students felt skills relevant to all doctors, such as assessment of suicide risk, were more important than more specialist psychiatric skills, such as the management of schizophrenia. They felt that knowledge of how psychiatric illnesses present in general practice was important and it was a useful setting in which to learn psychiatry. They thought that conditions that are commonly seen in the general hospital are important and that liaison psychiatry was useful.ConclusionTwo ways that medical students believe their teaching can be made more relevant to their future careers are highlighted in this study. Firstly, there is a need to focus on scenarios which students will commonly encounter in their initial years of employment. Secondly, psychiatry should be better integrated into the overall curriculum, with the opportunity for teaching in different settings. However, when developing curricula the need to listen to what students believe they should learn needs to be balanced against the necessity of teaching the fundamentals and principles of a speciality.

Childhood adversity and conduct disorder: a developmental pathway to violence in schizophrenia

BACKGROUND Both childhood adversity and conduct disorder are over-represented among adult patients with schizophrenia and have been proposed as significant factors that may increase the risk of violence. It is not known how childhood adversity and conduct disorder might interact to contribute towards an increased risk of violence in schizophrenia. This study aimed to explore the relationships between childhood adversity, conduct disorder and violence among men with schizophrenia. METHODS 54 male patients with schizophrenia from a range of inpatient and outpatient mental health services were assessed for exposure to a variety of childhood adversities, conduct disorder before the age of 15 and later violent behaviour in adulthood. RESULTS Exposure to domestic violence during childhood was associated with an increased propensity to violence in adulthood. Symptoms of conduct disorder were associated both with cumulative exposure to childhood adversities and with later propensity to violence. The cumulative number of childhood adversities was associated with adult propensity to violence. This association was significantly attenuated by inclusion of conduct disorder in the model. CONCLUSIONS This is the first study to demonstrate an association between childhood exposure to domestic violence and later violent behaviour in schizophrenia. Conduct disorder may mediate the association between cumulative childhood adversities and adult propensity to violence, indicating an indirect pathway. These results indicate a complex interplay between childhood adversity, conduct disorder and later violent behaviour in schizophrenia, and suggest that there may be shared aetiological risk factors on a common developmental pathway to violence.

A right to be fat? A survey of weight management in medium secure units

Obesity is a significant problem among patients in mental health services, with implications for morbidity and mortality. This is particularly challenging in forensic services where patients often remain in hospital for prolonged periods, may be on higher doses of medication and often have less access to exercise opportunities. This survey was conducted to investigate weight management strategies in medium secure units (MSUs) and to identify potential barriers to effective prevention and management of obesity. More than half of the MSUs do not currently have an effective strategy for managing obesity, although most have a reasonable range of weight management options available. There is dissonance among clinicians about the ethics of restricting patients’ access to food in order to reduce obesity. Whilst more coercive strategies may prove challenging in terms of maintaining the balance with human rights, it is clear that hospitals need to rigorously pursue education and health promotion.

The evolution of secure and forensic care

Forensic psychiatry in the UK has recently been castigated as a rigid, counter-therapeutic, self-perpetuating institution which inhibits the development of wider systems of support for mentally disordered offenders (Wilson, James, & Forrester, 2011). Medium secure care is caricatured as a financially unsustainable ‘juggernaut’, ‘moving forward under its own momentum irrespective of the needs of patients or the realities of health-care funding’. Secure care is undeniably an expensive part of mental health provision, and in the current financial climate is under pressure to develop more efficient models of care. But how do we make this happen? What can we learn from the past, and what innovations are emerging to help us?

IDENTIFYING PSYCHOLOGICAL FACTORS ASSOCIATED WITH VIOLENCE IN PATIENTS WITH SCHIZOPHRENIA

Background: Cardiovascular and metabolic problems combined with a bad lifestyle are a major cause of a shortened life expectancy in chronic psychotic disorders. While the incidence of cannabis use is twice as high in psychosis compared to the general population, use of cannabis has been associated with better outcomes on cardiometabolic risk factors. This study investigates whether this effect is mediated by the AKT1 gene, as activation of the related enzyme by cannabis may cause changes in metabolism. Methods: Patients with a recent onset psychosis (n=623) were included from a cohort study (GROUP). Cannabis use, based on self-report and urine screening, was related to Body Mass index (BMI). Next the mediating effects of six AKT1 polymorphisms (rs1130214, rs1130233, rs2494732, rs2498784, rs3730358 and rs3803300) were investigated. Results: There was a strong, negative association between BMI and cannabis use. Moreover, two SNPs (rs1130233 and rs2494732) showed an association with cannabis use, but did not mediate the effect of cannabis on BMI. Conclusion: In conclusion, cannabis use results in a lower body weight in patients with a psychosis. While AKT1 is related to cannabis use, it does not affect body mass via AKT1. Instead, AKT1 risk alleles may increase the incidence of cannabis use. Future studies may investigate whether other genes mediate the effect between cannabis and metabolic risk factors.

P-1140 - A survey from the WPA early career Psychiatrists council: what about training and practice of psychotherapy across Europe?

There are some doubts as to whether psychotherapy will remain in the armamentarium of future psychiatrists. Few studies have explored early career psychiatrists’ views and their experience with psychotherapy training. The Early Career Psychiatrists’ Council of the WPA carried out an online survey on training and practice in psychotherapy in 13 European countries in order to assess: 1) main characteristics of psychotherapy training in the partecipating countries; 2) organizational and clinical differences of psychotherapy training; 3) trainees’ satisfaction and confidence in the use of psychotherapy. An online survey was conducted through the use of a questionnaire specifically developed for the purposes of this study.Responders were required to collect their opinions on the basis of their own experience. Different aspects of psychotherapy training, such as compulsoriness, payment and supervision, as well as satisfaction with received training and confidence in the use of psychotherapy have been investigated. Results show that training in psychotherapy is mandatory in all countries, except Belgium and France, but most of early career psychiatrists have to pay for it. European trainees are satisfied (70%) with received training, and feel confident to treat patients in psychotherapy settings. Psychodynamic and cognitive-behavioural techniques are more common than systemic, interpersonal, supportive and psychoeducational ones. In 3 countries out of 12 it is not compulsory to attend a psychotherapy training, and only psychodynamic and cognitive-behavioural approaches are widely spread in all countries.This survey is a starting point to improve training and practice of psychotherapy across Europe and to enhance early career psychiatrists’ psychotherapeutic skills and knowledge.

Get Through Workplace Based Assessments in Psychiatry (2nd edn)

The introduction of workplace-based assessments (WPBA) in postgraduate medical education represents a significant shift in the culture of assessing trainees. Trainees are keen to obtain clear and detailed information about how to undertake WPBA and what is expected of them. There is also an