PSY605 — Tutorial and Seminar in Psychiatry: Lecture Note

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: PSY 605 Course title: Tutorial and Seminar in Psychiatry Course credit load: 1 Unit Series 1: Tutorial and Seminar Foundations: Psychiatric Assessment and Core Competencies • Part 1.1: Foundations and History of Psychiatry o Sub Part 1.1.1: Historical milestones in psychiatry o Sub Part 1.1.2: Aetiological factors in psychiatric disorders o Sub Part 1.1.3: Classification of psychiatric disorders: ICD and DSM • Part 1.2: Psychiatric Assessment Skills o Sub Part 1.2.1: History taking in psychiatry o Sub Part 1.2.2: Mental state examination o Sub Part 1.2.3: Physical examination and psychological assessment in psychiatry • Part 1.3: Ethics and Core Competencies in Clinical Practice o Sub Part 1.3.1: Principles of medical ethics in psychiatry o Sub Part 1.3.2: Interview technique in emergency and general practice settings o Sub Part 1.3.3: Must-know competencies for tutorial and seminar teaching Introduction A tutorial is only as strong as the foundation it builds on. This opening Series of Tutorial and Seminar in Psychiatry revisits the essential groundwork from earlier courses, the history and classification of psychiatry, core assessment skills, and the ethics and competencies every trainee must carry into clinical teaching. The aim of this Series is to consolidate your understanding of the historical and classificatory foundations of psychiatry, psychiatric assessment skills, and the ethical principles and core competencies that underpin sound clinical teaching and practice.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS This Series opens with the foundations and history of psychiatry, moves to psychiatric assessment skills, and closes with ethics and core competencies in clinical practice. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: illustrate milestones in the historical development of psychiatry • SLO 1.2: list factors and hypotheses in the causation of mental illness, and apply ICD and DSM in classifying mental disorders • SLO 1.3: describe the components of psychiatric history taking and the mental state examination • SLO 1.4: describe physical examination and psychological assessment in psychiatry • SLO 1.5: explain the application of principles of medical ethics in psychiatry • SLO 1.6: describe interview technique in emergency and general practice settings, and identify must-know competencies for clinical teaching 1.1 Foundations and History of Psychiatry 1.1.1 historical milestones in psychiatry From moral treatment to modern classification Psychiatry developed through several distinct eras, moving from early moral treatment reforms that replaced restraint with humane asylum care, through the emergence of descriptive psychopathology in the nineteenth century, to the biological and pharmacological advances of the twentieth century that transformed treatment options. Key milestones include the introduction of the first effective antipsychotic medication in the 1950s, the development of structured diagnostic classification systems, and the more recent shift towards community-based and biopsychosocial models of care, each reshaping how psychiatric illness is understood and treated. Fill in the blank: Early moral treatment reforms replaced restraint with humane ________ care.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1.2 aetiological factors in psychiatric disorders Biological, psychological, and social contributions Aetiological factors in psychiatric disorders are generally understood through a biopsychosocial framework, encompassing genetic vulnerability and neurochemical factors, psychological factors such as early attachment and cognitive style, and social factors including adverse life events and socioeconomic circumstances. No single factor typically explains a psychiatric disorder in isolation, and clinical teaching emphasises that most conditions arise from an interaction between predisposing vulnerability and precipitating stress, a distinction useful for both diagnosis and management planning. Fill in the blank: Most psychiatric disorders arise from an interaction between predisposing vulnerability and ________ stress. 1.1.3 classification of psychiatric disorders: icd and dsm Two parallel diagnostic systems The ICD and DSM are the two major classification systems used in psychiatry, both organising disorders into categories based on defined symptom criteria. The ICD is published by the World Health Organization and used globally, while the DSM is published by the American Psychiatric Association and widely used in research and North American practice. Both systems undergo periodic revision to reflect advancing evidence, and while their criteria are broadly aligned, subtle differences exist that trainees must be aware of, particularly when interpreting research literature or working across settings that use different systems. Fill in the blank: The ICD is published by the World Health ________ and used globally.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Figure 1.1: A historic asylum ward from the era of moral treatment reform. Pilot questions 1.1 1. Describe one milestone in the historical development of psychiatry. (Linked to SLO 1.1) 2. Explain the shift from moral treatment to modern classification. (Linked to SLO 1.1) 3. List the three domains of the biopsychosocial framework. (Linked to SLO 1.2) 4. Distinguish predisposing from precipitating factors. (Linked to SLO 1.2) 5. Distinguish the ICD from the DSM. (Linked to SLO 1.2) 1.2 Psychiatric Assessment Skills 1.2.1 history taking in psychiatry A structured, comprehensive clinical narrative Psychiatric history taking follows a structured format covering the presenting complaint, history of presenting illness, past psychiatric and medical history, family history, personal and social history, and a systematic review of relevant symptoms, building a comprehensive picture of the patient's difficulties in context.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Effective history taking requires both structured questioning and open, empathic listening, since rigid adherence to a checklist can miss important spontaneous disclosures, while purely open interviewing risks missing essential diagnostic detail. Fill in the blank: Psychiatric history taking requires both structured questioning and open, ________ listening. 1.2.2 mental state examination A structured snapshot of current mental functioning The mental state examination systematically assesses appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, and insight, providing a structured snapshot of the patient's current mental functioning independent of the history. Unlike the history, which covers the patient's past, the mental state examination reflects the clinician's direct observations and findings at the time of assessment, and the two together form the core evidence base for psychiatric diagnosis. Fill in the blank: The mental state examination reflects the clinician's direct observations at the time of ________. 1.2.3 physical examination and psychological assessment in psychiatry Complementary sources of clinical evidence Physical examination remains essential in psychiatric assessment to identify or exclude medical causes of presenting symptoms, and psychological assessment, including neuropsychological, cognitive, behavioural, and personality assessment, adds structured, standardised evidence beyond clinical interview alone. Together these complementary sources of evidence strengthen diagnostic confidence, particularly in complex presentations where interview findings alone may be ambiguous or where an underlying medical or neurocognitive contribution is suspected. Fill in the blank: Physical examination helps identify or exclude ________ causes of presenting psychiatric symptoms. Table 1.1: Comparing history, mental state examination, and psychological assessment

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Component Time frame Primary source History Past and background Patient and informant report Mental state examination Present, at time of assessment Clinician observation Psychological assessment Structured, standardised Formal testing instruments Pilot questions 1.2 1. List the components of a psychiatric history. (Linked to SLO 1.3) 2. Explain why both structured and open interviewing matter in history taking. (Linked to SLO 1.3) 3. List the domains assessed in a mental state examination. (Linked to SLO 1.3) 4. Distinguish the mental state examination from the history. (Linked to SLO 1.4) 5. Explain the value of psychological assessment alongside clinical interview. (Linked to SLO 1.4) 1.3 Ethics and Core Competencies in Clinical Practice 1.3.1 principles of medical ethics in psychiatry Four principles applied to psychiatric care The four core principles of medical ethics, autonomy, beneficence, non-maleficence, and justice, apply directly to psychiatric practice, though psychiatry raises particular tension around autonomy when a patient's capacity is affected by their mental disorder. Confidentiality, informed consent, and the careful use of compulsory treatment powers where legally permitted are recurring ethical considerations in psychiatric practice, each requiring the clinician to balance the patient's rights against genuine risk of harm. Fill in the blank: The four core principles of medical ethics are autonomy, beneficence, non-maleficence, and ________. 1.3.2 interview technique in emergency and general practice settings Adapting technique to context and time pressure Interview technique must adapt to context: emergency settings demand a rapid, focused assessment prioritising immediate risk and safety, while general practice settings allow a more extended, exploratory interview building rapport over potentially several consultations.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS In both settings, empathic communication remains essential, since a rushed or dismissive manner can undermine trust and reduce the accuracy of information gathered, regardless of how limited the available time may be. Fill in the blank: Emergency interview technique prioritises immediate risk and ________. 1.3.3 must-know competencies for tutorial and seminar teaching What every trainee should be able to demonstrate Must-know competencies for tutorial and seminar teaching include accurate history taking

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