NORTHERN DEANERY REGIONAL
MRCPsych COURSE
Psychosis and Substance Misuse Module
Year II
Module Leader: Dr Niraj Ahuja
March – May 2012
Location:
Jubilee Theatre, St. Nicholas Hospital
1
CONTENTS
Page
1.
2.
3
4
5
Introduction
3
List of Teachers
4
Timetable
5
Psychosis: Psychosocial and Legal Aspects
1.1
Stigma and Social Exclusion
1.1.1 Module Objectives
1.1.2 Reading List
1.1.3 Lesson Plan 1
1.2
User and Carer Perspective
1.2.1 Module Objectives
1.2.2 Reading List
1.2.3 Lesson Plan 2
1.3
Principles of Mental Health Legislation
1.3.1 Module Objectives
1.3.2 Reading List
1.3.3 Lesson Plan 3
Patient-Level Interventions in Psychosis
2.1
Cognitive Behaviour Therapy in Psychosis
2.1.1 Module Objectives
2.1.2 Reading List
2.1.3 Lesson Plans 4, 5 and 6
Neuropsychology, Recovery and Models of Community Provision
3.1
Neuropsychology of Schizophrenia
3.1.1 Module Objectives
3.1.2 Reading List
3.1.3 Lesson Plan 7
3.2
The Course, Outcome and Recovery
3.2.1 Module Objectives
3.2.2 Reading List
3.2.3 Lesson Plan 8
3.3
The Models of Community Provision for Psychoses
3.3.1 Module Objectives
3.3.2 Reading List
3.3.3 Lesson Plan 9 and 10
Substance Misuse
4.1 Prevalence and Patterns of Use
4.1.1 Module Objectives
4.1.2 Reading List
4.1.3 Lesson Plan 11
4.2 Assessment of Drug and Alcohol Use
4.2.1 Module Objectives
4.2.2 Reading List
4.2.3 Lesson Plan 12
4.3 Treatment Interventions
4.3.1 Module Objectives
4.3.2 Reading List
4.3.3 Lesson Plan 13
Co-morbid Psychosis and Substance Misuse
5.1 Co-morbidity
5.1.1 Module Objectives
5.1.2 Reading List
5.1.3 Lesson Plan 14
5.2 Formulation Workshop
5.2.1 Module Objectives
6
6
7
9
11
12
13
14
15
15
17
18
2/19
Lesson plan 15INTRODUCTION
Overall Aims
Module Objectives
The module objectives for each session are listed in terms of Aims and the desired learning
outcome(s). Our overall intention is to briefly review material on schizophrenia, psychosis
and substance misuse that has not been covered by the previous teaching earlier in the
course. You will have the opportunity to evaluate this module in terms of these learning
outcomes in the final session of the module as well as at the end of each section of teaching.
MRCPsych Curriculum
Please refer to the new curricula issued by the Royal College of Psychiatrists, available on
the College website; http://www.rcpsych.ac.uk/training/curriculum2010.aspx.
Reading Lists
We recommend that the essential reading be done prior to and during the weeks of teaching,
for you to get the most out of the teaching programme. The Reading Lists include material
that is part of the MRCPsych curriculum but not necessarily being covered in this module.
Lesson Plans
The lesson plans detail the material to be covered in the Module and the variety of teaching
methods to be used. Lesson plans for each session are indicated in a tabular format
describing the subject matter, teaching methods and the teacher(s). Please be prepared to
join in the discussion and group exercises where indicated. The more you participate, the
more you will gain from the course.
Local Hospital Teaching
The MRCPsych course is not a comprehensive programme of psychiatric teaching. It is
designed to supplement educational experience gained in your local hospital, i.e. your own
clinical experience, educational and clinical supervision from your consultant(s), and your
local postgraduate teaching programme.
Self-directed Learning
It is obvious that you will not pass the MRCPsych merely by attending the MRCPsych course
and your local teaching programme though it they should help you to structure your reading
and also help participate in useful interactive discussion. The reading lists indicate additional
sources of information to facilitate self-directed learning.
3/19
LIST OF TEACHERS
AC
Andrew Cole
Assistant Medical Director, Consultant Psychiatrist and Honorary
Lecturer, North Tyneside General Hospital, North Tyneside
AH
Andrea Hearn
Consultant Psychiatrist, Regional Drug and Alcohol Service, Plummer
Court, Newcastle
AL
Adrian Lloyd
Consultant Psychiatrist, North Tyneside General Hospital, North
Tyneside; Senior Lecturer, Academic Psychiatry, NGH; Training
Programme Director (CT4-6), School of Psychiatry
JH
John Horne
Teaching Fellow, School of Law, Northumbria University; Former Mental
Health Act Commissioner; Part-time Legal Member of the Mental Health
Review Tribunal service
NA
Niraj Ahuja
Consultant Psychiatrist and Honorary Lecturer, Wallsend CMHT, Sir GB
Hunter Memorial Hospital, Wallsend
PK
Patrick Keown
Consultant Psychiatrist, Rehabilitation Psychiatry, and Senior Lecturer,
Newcastle University
SG
Stephen Galvin
Consultant Clinical Psychologist
Landsdowne Clinic, Newcastle
SM
Steve Moorhead
Consultant Psychiatrist, Regional CBT Centre, Plummer Court and Early
Intervention Services, Newcastle & North Tyneside
ST
Sarah Troughton
Associate Specialist, Regional Drug and Alcohol Service, Plummer
Court, Newcastle
4/19
TIMETABLE
Programme for 28 March 2012
1.
Stigma and Social Exclusion
PK
09:30 – 10:00
2.
User and Carer Perspective
PK
10:00 – 11:00
3.
Course, Outcome and Recovery in Psychosis
NA
11:00 – 13:00
4.
CBT in Psychosis – I. Background
SM
13:30 – 14:00
5.
CBT in Psychosis – II. Formulation and Treatment
SM
14:00 – 14:45
6.
CBT in Psychosis – III. The Evidence
SM
14:45 – 15:30
7.
Neuropsychology of Schizophrenia
SG
15:30 – 16:30
Programme for 25 April 2012
8.
Psychosis and principles of Mental Health Legislation JH/PK 09:30 – 11:30
9.
Models of Community Provision – I
AC
11:30 – 12:30
10.
Models of Community Provision – II
AC
12:30 – 13:30
11.
Substance Misuse: Patterns of Use
AH
14:00 – 14:45
12.
Substance Misuse: Assessment
AH
14:45 – 15:30
13.
Substance Misuse: Treatment/Intervention
AH
15:30 – 16:30
AH
09:30 – 10:30
Programme for 09 May 2012
14.
Co-morbidity
15.
Formulation Workshop
16.
Module Evaluation
AL/AH/NA/ST
NA
10:45 – 12:45
12:45 – 13:15
5/19
1. PSYCHOSIS: PSYCHOSOCIAL AND LEGAL ASPECTS
1.1. Stigma and Social Exclusion
1.1.1. Module Objectives
Aims



Describe origin(s) of stigma.
Identify experience of social exclusion for people with mental health problems.
Discuss ways of reducing stigma and promoting social inclusion.
Learning Outcome
 Gain an understanding of the importance of stigma in influencing the use of services and the
quality of life for people with mental health problems.
1.1.2. Reading List
1. Biernat M, Dovidio JF (2000). Stigma and stereotypes. In: Eds. Heatherton TF, Kleck RE,
Hebl MR, et al. The Social Psychology of Stigma, pp.88-125, Guilford Press, New York.
2. Sartorius N, Schulze H (2005). Reducing the Stigma of Mental Illness: A Report from a Global
Programme of the World Psychiatric Association. Cambridge University Press, Cambridge.
1.1.3. Lesson Plan 1
Session 1
Subject Matter
Teaching
Methods
Handout
Teacher(s)
Interactive session: accounts of experience
of stigma and social exclusion by people
with mental health problems
Small group
discussion
PK
Discuss ways of reducing stigma and
promoting social inclusion
Small group
discussion
PK
Total = 30 minutes
Describe origin(s) of stigma
PK
1.2. User and Carer Perspective
1.2.1. Module Objectives
Aims


To learn about user/carer perspectives on psychiatric service provision through training by
users/carers.
Demonstrate both similarities and differences in the views of users, carers and professionals
with regard to identification of need and provision of services for people with serious mental
illnesses.
Learning Outcome
 Understand the important of user and carer involvement in planning, running and monitoring
services.
 Understand the importance of collaborative working with users and carers in determining
outcomes relating to recovery, function and quality of life.
1.2.2. Reading List
6/19
1. Barker P, Campbell P, Davidson B (1999). From the Ashes of Experience: Reflections on
Madness, Survival and Growth. Whurr Publishers, London.
2. Livingston G, Cooper C (2004). User and carer involvement in mental health training.
Advances in Psychiatric Treatment 10: 84-91.
3. Rose D (2001). Users’ Voices: The Perspective of Mental Health Service Users on
Community and Hospital Care. Sainsbury Centre for Mental Health, London.
1.2.3. Lesson Plan 2
Session 2
Teaching
Methods
Presentation by users and/or carers
Discussion
Subject Matter
Demonstrate similarities/differences in
views of users, carers and professionals
with regard to identification of need and
provision of services. Pay particular
attention to what users and carers find
helpful and unhelpful about contact with
psychiatrists.
Small group
discussion
Teacher(s)
Users and carers of
services
40 minutes
PK
20 minutes
1.3. Principles of Mental Health Legislation
1.3.1. Module Objectives
Aims

Provide an overview of issues relating to the Mental Capacity Act (MCA) and the revised
Mental Health Act (MHA), including mental capacity, consent to treatment, and community
treatment orders, as applied to psychosis and substance misuse.
Learning Outcome
 Able to identify key issues relating to assessing mental capacity, obtaining informed consent
to treatment and application of MCA and MHA to clinical practice in psychosis and substance
misuse.
1.3.2. Reading List
1. BMA/Law Society (2010). Assessment of Mental Capacity: A Practical Guide For Doctors and
Lawyers. The Law Society/BMA.
http://www.bma.org.uk/ethics/consent_and_capacity/assessmentmentalcapacity.jsp
2. Barber P, Brown R, Martin D (2009). Mental Health Law in England and Wales: A Guide for
Mental Health Professionals. Learning Matters.
3. CQC (2010). 'Monitoring the use of the MHA in 2009/2010'. The Stationary Office.
4. Department of Health Consent Documents
http://www.dh.gov.uk/en/Publichealth/Scientificdevelopmentgeneticsandbioethics/Consent/Co
nsentgeneralinformation/index.htm
7/19
5. General Medical Council: Confidentiality: Protecting and Providing Information.
http://www.gmc-uk.org/guidance/current/library/confidentiality.asp
6. General Medical Council: Seeking patients’ consent.
http://www.gmc-uk.org/guidance/current/library/consent.asp
7. Royal College of Psychiatrists (2004). Council Report CR125. Good Psychiatric Practice. II
Ed. http://www.rcpsych.ac.uk/files/pdfversion/cr125.pdf
8. Royal College of Psychiatrists (2006). Council Report CR133. Good Psychiatric Practice:
Confidentiality and Information sharing. http://www.rcpsych.ac.uk/files/pdfversion/cr133.pdf
9. DoH (2007). The Mental Capacity Act 2005: The Code of Practice. The Stationary Office.
www.justice.gov.uk/docs/mca-cp.pdf
10. DoH (2008). The Mental Health Act 1983: The Code of Practice. The Stationary Office.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_4005756
11. DoH (2008). The Reference Guide to MHA 1983. The Stationary Office.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_088162
12. The Mental Health Act Commission http://www.mhac.org.uk/
1.3.3. Lesson Plan 3
Session 6
Teaching
Methods
Case discussion (as relevant to psychosis Discussion
and substance misuse), with an overview of interspersed
issues relating to MCA and MHA, including with didactic
consent, capacity and community treatment teaching
orders.
Subject Matter
Teacher(s)
PK/JH
120 minutes
Interactive
8/19
2. PATIENT LEVEL INTERVENTION IN PSYCHOSIS
2.1. Patient Level Intervention
2.1.1. Module Objectives
Aims




Present a format for comprehensive needs assessment in a community mental health setting.
Discuss the concept of stress vulnerability models in psychosis.
Provide a model for bio-psycho-social formulation of case material in psychosis.
Provide a framework to understand the place of psychosocial interventions, particularly CBT,
in the management of psychosis.
Learning Outcome
 To describe a stress vulnerability model for the development of psychosis.
 To organise clinical case material into a broad bio-psycho-social as well as CBT formulation.
 Understand the theoretical basis for CBT interventions in psychosis.
 Understand the evidence base for effectiveness of psychosocial interventions in psychosis,
particularly CBT.
 Use a bio-psycho-social formulation to generate a multi-modal management plan.
2.1.2. Reading List
1. Barrowclough C, Tarrier N (1997). Families of schizophrenic patients: Cognitive-behavioural
interventions. II Ed. Cheltenham, Stanley Thornes.
2. Freeman D, Garety P (2006). Helping patients with paranoid and suspicious thoughts: A
cognitive–behavioural approach. Advances in Psychiatric Treatment 12: 404-415.
3. Kingdon D, Turkington D (2002). The Case Study Guide to Cognitive Behaviour Therapy of
Psychosis. Chichester, Wiley.
4. Morrison A, Renton JC, Dunn H, Williams S, Bentall RP (2003). Cognitive Therapy for
Psychosis: A Formulation-Based Approach. Brunner-Routledge, New York.
5. Romme M, Escher S (1996). Empowering people who hear voices. In: Haddock G, Slade P.
Eds. Cognitive Behavioural Interventions with Psychotic Disorders. Routledge.
6. Zubin J, Spring B (1977). Vulnerability: a New View of Schizophrenia. Journal of Abnormal
Psychology 86: 103-126.
2.1.3. Lesson Plans 4-6
Session 4
Patient Level Intervention – I – Background
Subject Matter
Teaching
Teacher(s)
Methods
Theoretical stress vulnerability models
Didactic
SM
30 minutes
Theory of CBT and other psychosocial
interventions in psychosis
Didactic
SM
30 minutes
9/19
Session 5
Patient Level Intervention – II – Formulation and Treatment
Subject Matter
Teaching
Teacher(s)
Methods
CBT Formulation and Treatment
Discussion
SM
30 minutes
Session 6
Patient Level Intervention – II – The Evidence
Subject Matter
Teaching
Teacher(s)
Methods
Critical Appraisal of the Evidence Base for
Didactic
SM
CBT interventions in psychosis
30 minutes
Discussion
SM
15 minutes
10/19
3. NEUROPSYCHOLOGY, RECOVERY AND MODELS OF COMMUNITY PROVISION
3.1.
Neuropsychology of Schizophrenia
3.1.1. Module Objectives
Aims



Present summary of work in neuropsychology of schizophrenia
Present how neuropsychological studies link with clinical and brain imaging studies
Present clinically useful intervention models to address neuropsychological deficits in
schizophrenia
Learning Outcome
 Understand the findings of neuropsychological studies in schizophrenia
 Describe clinical relevance of neuropsychological deficit in schizophrenia
 Understand and describe current limitations in neuropsychological studies
3.1.2. Reading List
1. Bilder RM (2009). The Neuropsychology of Schizophrenia Circa 2009. Neuropsychological
Review 19: 277-279.
2. Heinrichs RW, Zakzanis KK (1998). Neurocognitive deficit in schizophrenia: a quantitative
review of the evidence. Neuropsychology 12: 426-445.
3. Hogarty GE, et al (2004). Cognitive enhancement therapy for schizophrenia: effects of a 2year randomized trial on cognition and behavior. Arch Gen Psychiatry 61: 866-876.
4. Mesholam-Gately, et al (2009). Neurocognition in first-episode schizophrenia: A meta-analytic
review. Neuropsychology 23: 315-336.
5. Thompson PM, et al (2001). Mapping adolescent brain change reveals dynamic wave of
accelerated gray matter loss in very early-onset schizophrenia. Proc Natl Acad Sci U S A.
98(20): 11650-11655.
6. Tsuang MT, Stone WS, Faraone SV (2002). Understanding predisposition to schizophrenia:
toward intervention and prevention. Can J Psychiatry 47: 518-526.
7. Wood SJ, Allen SB, Pantelis C (2009). Eds. The Neuropsychology of Mental Illness. I Ed.
Cambridge University Press.
3.1.3. Lesson Plan 7
Session 7
Teaching
Methods
Introduction to neuropsychology
Didactic
Subject Matter
Teacher(s)
Neuropsychological studies in
schizophrenia
Didactic
Discussion
SG
15 minutes
SG
30 minutes
Treatment options for
neuropsychological deficits
Didactic
Discussion
SG
15 minutes
11/19
3.2. The Course, Outcome and Recovery in Schizophrenia and other Psychoses
3.2.1. Module Objectives
Aims




Present models of understanding the course and outcome in schizophrenia that go beyond
the medical model.
Present schizophrenia as a bio-psycho-social construct.
Summarise data pertaining to outcome in schizophrenia.
Present a brief critique of the recovery model of schizophrenia.
Learning Outcome
 Understand the factors affecting outcome and prognosis in schizophrenia.
 Describe the limitations of the medical rationale guiding treatment of schizophrenia.
 Describe the limitations of psychiatric practice and emergence of the concept of recovery.
3.2.2. Reading List
1. Bentall RP (1992). Reconstructing Schizophrenia. Routledge.
2. Bentall RP (2004). Madness Explained: Psychosis and Human Nature. Penguin.
3. Care Services Improvement Partnership, Royal College of Psychiatrists & Social Care
Institute for Excellence (2007). A Common Purpose: Recovery in Future Mental Health
Services (Joint Position Paper 08). Social Care Institute for Excellence.
www.scie.org.uk/publications/positionpapers/pp08.pdf
4. Davidson L (2003). Living Outside Mental Illness: Qualitative Studies of Recovery in
Schizophrenia. New York University Press, New York.
5. Hopper K, Harrison G, Janca A, Sartorius N (2007). Recovery from Schizophrenia: An
International Perspective. Oxford University Press, New York.
6. Warner R (2003). Recovery from Schizophrenia; Psychiatry and Political Economy. III Ed.
Routledge.
3.2.3. Lesson Plan 8
Session 8
Teaching
Methods
Introduction to Recovery Model
Didactic
Subject Matter
Teacher(s)
Outcome and Prognosis in
schizophrenia
Didactic
Discussion
NA
15 minutes
NA
30 minutes
Factors influencing the Course and
Outcome of schizophrenia
Didactic
Discussion
NA
30 minutes
12/19
3.3.
The Models of Community Provision for Psychosis
3.3.1. Module Objectives
Aims



Describe the focus of service delivery
Describe the evolution of community psychiatry from de-institutionalism, to current provision
and looking at current/future trends.
Examine the evidence-base for current and proposed community psychiatry models.
Learning Outcome
 Understand the context and rationale of developments.
 Be able to critically appraise these developments.
3.3.2. Reading List
1. Birchwood M, McGorry P, Jackson H (1997). Early Intervention in Schizophrenia. Br J
Psychiatry 170: 2-11.
2. Hoult J, Reynolds I, et al (1983). Psychiatric hospitalisation vs. community treatment; the
results of a randomised controlled trial. Aust NZ J Psychiatry 17: 160-167.
3. Spencer E, Birchwood M, McGovern D (2001). Management of First Episode Psychosis.
Advances in Psychiatric Treatment 7: 133-140.
4. Thornicroft G, Szmukler G (2001). Textbook of Community Psychiatry. Oxford University
Press.
3.3.3. Lesson Plans 9-10
Session 9
Subject Matter
Teaching
Methods
Events leading to deinstitutionalisation
Didactic
Development of Sector Psychiatry and Didactic
Community Mental Health Teams
Description of role and function of Didactic
Specialised Teams
Discussion
 Assertive Outreach
 Crisis Assessment and Treatment
 Early Intervention in Psychosis
Subject Matter
Advantages and
specialisation
Session 10
Teaching
Methods
disadvantages of Didactic
Discussion
Changing role of Psychiatrist
Didactic
Critical appraisal of the evidence base
Didactic
Teacher(s)
AC
15 minutes
AC
15 minutes
AC
30 minutes
Teacher(s)
AC
60 minutes
13/19
14/19
4. SUBSTANCE MISUSE
4.1 Prevalence and Patterns of Use
4.1.1. Module Objectives
Aims

To describe epidemiology, nature and effects of alcohol and main drugs of abuse.
Learning Outcome
 An understanding of the nature of different drugs of abuse with respect to the context of use
from recreation to dependence and direct and indirect consequences of this.
4.1.2. Reading List
1. Ghodse H (1995). Drugs and addictive behaviour: A guide to treatment. Oxford: Blackwell
Science.
2. Lishman WA (1997). Toxic Disorders. In: Organic Psychiatry. III Ed. Oxford: Blackwell
Science.
3. Winger G, Woods JH, Hofmann FG (2004). A Handbook on Drug and Alcohol Abuse: The
Biomedical Aspects. Oxford University Press.
4. Nutt D (1996). Addiction: Brain Mechanisms and their treatment implications. Lancet 347: 3136.
5. Farrel M, Finch E (1999). Aspects of drug use and dependence: Drugs of abuse and
addiction. Neurobehavioral Toxicology. Chapter 1: 3-22.
6. http://www.niaaa.nih.gov/ (National Institute on alcohol abuse and alcoholism)
7. NTA (2010). Substance abuse among young people: the 2009-2010 data.
http://www.nta.nhs.uk/uploads/nta_substance_misuse_among_yp_0910.pdf
8. NTA (2010). Drug treatment in 2009-2010.
http://www.nta.nhs.uk/uploads/nta_annualreport_0910.pdf
4.1.3. Lesson Plan 11
Session 11
Subject Matter
Incidence/prevalence/definitions
Nature and effects of drug/alcohol
Consequences of drug use, direct and indirect
Context of use: occasional, experimental,
dependence
Specific effects e.g. drug induced psychosis /
DTs / Alcoholic hallucinosis
Teaching
Methods
Didactic
Discussion
Teacher(s)
AH
45 minutes
15/19
4.2.
Assessment of Drug and Alcohol Use
4.2.1. Module Objectives
Aims

To describe the factors relevant to a comprehensive assessment of drug and alcohol
problems.
Learning Outcome
 To be able to adequately assess a patient presenting with drug and/or alcohol misuse with
special reference to risk assessment.
4.2.2. Reading List
1. Department of Health (2007). Drug Misuse and Dependence: UK Guidelines on Clinical
Management. London.
http://www.nta.nhs.uk/areas/clinical_guidance/clinical_guidelines/docs/clinical_guidelines_200
7.pdf
2. Driver and Vehicle Licensing Agency (2005). At a glance guide to medical aspects of fitness
to drive. Swansea, DVLA. http://www.dvla.gov.uk/at_a_glance/AAG.SEPT.2005.Final.V2.pdf
3. Heather N, Peters TJ, Stockwell T (2001). Eds. Alcohol Dependence and Problems. Wiley.
4.2.3. Lesson Plan 12
Session 12
Teaching
Methods
Drug and alcohol history
Didactic
Confirmation of history (physical,
Discussion
biochemical, corroboration)
Psychiatric/forensic history
Family/social history including (child-care
issues, protection, etc.)
Subject Matter
Teacher(s)
AH
45 minutes
Risk Assessment
1. To self (drug use practices, overdose
risk, DSH / suicide, intoxication)
2. To others (domestic violence, child
protection issues, property, driving,
workplace)
Special situations, e.g. pregnancy
4.3. Treatment Interventions
4.3.1. Module Objectives
Aims

To describe the main treatment interventions used in the field of addiction psychiatry.
Learning Outcome
 To gain an understanding of the main treatment interventions used in addiction psychiatry and
the evidence base behind these.
16/19
4.3.2. Reading List
1. Department of Health (2007). Drug Misuse and Dependence: UK Guidelines on Clinical
Management. London.
http://www.nta.nhs.uk/areas/clinical_guidance/clinical_guidelines/docs/clinical_guidelines_200
7.pdf
2. Miller WR, Heather N (1998). Eds. Treating Addictive Behaviours. II Ed. Plenum Press, New
York.
3. Miller W (1983). Motivational Interviewing with Problem Drinkers. Behavioural Psychotherapy
11: 147-172.
4. Ward J, Hall W, Mattick RP (1999). Role of maintenance treatment in opioid dependence.
Lancet 353: 221-226.
5. http://www.nta.nhs.uk/ (National Treatment Agency)
6. http://drugs.homeoffice.gov.uk/ (tackling drugs)
7. NTA (2010). Routes to recovery: Psychosocial interventions for drug misuse. A framework
and toolkit for implementing NICE-recommended treatment interventions.
http://www.nta.nhs.uk/uploads/psychosocial_toolkit_june10.pdf
4.3.3. Lesson Plan 13
Session 13
Subject Matter
Teaching
Methods
Recognising the problem/engagement
Didactic
Pharmacotherapy, including detoxification, Discussion
maintenance treatment, relapse prevention,
brief interventions, MET, CBT, 12 step
facilitation, relapse prevention etc.
Teacher(s)
AH
60 minutes
17/19
5. CO-MORBID PSYCHOSIS AND SUBSTANCE MISUSE AND FORMULATION WORKSHOP
5.1. Co-morbidity
5.1.1. Module Objectives
Aims


Define co-morbidity / dual diagnosis.
Discuss how it should be managed and treatment options, with respect to current policy.
Learning Outcome
 Describe the relationship between mental illness and drug and alcohol misuse
 Understand the various treatment models in co-morbidity.
5.1.2. Reading List
1. Cleary M, Hunt G, Matheson S, et al (2008). Psychosocial interventions for people with both
severe mental illness and substance misuse. Cochrane Database of Systematic Reviews,
Issue 1.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001088/pdf_fs.html
2. Department of Health (2006). Dual diagnosis in mental health inpatient and day hospital
settings: Guidance on the assessment and management of patients in mental health inpatient
and day hospital settings who have mental ill-health and substance use problems.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_062649
3. Department of Health (2007). Drug Misuse and Dependence: UK Guidelines on Clinical
Management. London.
http://www.nta.nhs.uk/areas/clinical_guidance/clinical_guidelines/docs/clinical_guidelines_200
7.pdf
4. Ley A, Jeffrey DP, McLaren S, Seigfried N (2000). Treatment Programmes for people with
both severe mental illness and substance misuse (Cochrane Review), in the Cochrane Library
1, Oxford.
5. NTA – Models of Care. http://www.nta.nhs.uk/
6. Rorstad P, Checinkski K, McGeachy O, Ward M (1996). Eds. Dual Diagnosis; Facing the
Challenge. Kenley. Wynne Howard Publishing.
5.1.3. Lesson Plan 14
Session 14
Subject Matter
Definitions
Diagnosis / formulation
Models of disease (social, biological,
psychological, context)
Care planning and management
Co-working / service settings
Current policies (DoH and RCPsych)
Implications of new MHA
Teaching
Methods
Didactic
Teacher(s)
AH
60 minutes
18/19
5.2. Formulation Workshop
5.2.1. Module Objectives
Aims


To integrate skills regarding assessment and management of substance misuse and other
psychiatric disorders with an emphasis on psychoses.
To facilitate practice at complex formulation skills using case examples that have been
developed throughout the psychosis and substance use module.
Learning Outcome
 To improve skills in constructing a broad formulation leading to a comprehensive plan of
management.
 To gain additional understanding of the inter-relationship of substance misuse and psychiatric
disorders and to be able to plan further assessment and management of patients with dual
diagnosis with increased confidence
5.2.2. Lesson Plan 15
Session 15
Teaching Methods
Case discussions
building on material
Issues on assessment and from previous
management of problems of dual teaching
diagnosis
Subject Matter
Advancing case formulation skills
Teacher(s)
AL/AH/NA/ST
120 minutes
5.2.3. Reading List
1. Abou-Saleh MT (2004). Dual diagnosis: Management within a psychosocial context.
Advances in Psychiatric Treatment 10: 352-360.
2. Crome IB, Myton T (2004). Pharmacotherapy in dual diagnosis. Advances in Psychiatric
Treatment 10: 413-424.
3. Department of Health (2006). Dual diagnosis in mental health inpatient and day hospital
settings: Guidance on the assessment and management of patients in mental health inpatient
and day hospital settings who have mental ill-health and substance use problems.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_062649
4. Department of Health (2007). Drug Misuse and Dependence: UK Guidelines on Clinical
Management. London.
http://www.nta.nhs.uk/areas/clinical_guidance/clinical_guidelines/docs/clinical_guidelines_200
7.pdf
5. Macleod J (2007). Cannabis use and psychosis: the origins and implications of an
association. Advances in Psychiatric Treatment 13: 400-411.
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