NORTHERN DEANERY REGIONAL
MRCPsych COURSE
Integrated Adult Psychiatry and Psychotherapy
Schizophrenia Update Module
For Year III
Module Leaders:
Dr Niraj Ahuja
Dr Adrian Lloyd
06 December 2011
Longbenton CMHT, Hartside@SNH and
Academic Psychiatry, Newcastle University
CONTENTS
Page
Introduction
3
List of Teachers
4
Module Objectives
5
Lesson Plan
6
Reading List
7
2
INTRODUCTION
Overall Aims
The aim of this Update is to support your learning for the relevant parts of the new MRCPsych
Part III examination. Our intention is to briefly review material on Schizophrenia and Psychosis
that has not been covered by the previous teaching earlier in the course.
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/curriculum2009.aspx.
Module Objectives
These state the aims of the module and the learning outcomes expected at this stage of the
course. You will have the opportunity to evaluate this module in terms of these learning
outcomes in the final session of the module.
Reading List
A reading list is provided on Pages 8-9. This list provides update on recent articles on Psychosis
and Schizophrenia. We recommend that the material in the reading list be reviewed prior to the
Update, to get the most out of interactive teaching.
The reading list includes 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 Update and the variety of teaching
methods to be used. 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 supervision from your consultant and your local teaching programme.
Self Directed Learning
You will not pass the MRCPsych merely by attending the MRCPsych course and your local
teaching programme. The reading list indicates additional sources of information. It should be
clear from the sections of the new MRCPsych curricula, what you need to know that is not taught
in this module.
3
LIST OF TEACHERS
NA
Niraj Ahuja
Consultant Psychiatrist and Honorary Clinical Lecturer
AL
Adrian Lloyd
Consultant Psychiatrist and Honorary Senior Lecturer
4
Module Objectives
Aims




Supplement clinical experience and teaching gained in core training placements
Equip trainees with relevant resources for the new Part III MRCPsych examination
and CASC
Guidance on reading and further learning to cover aspects that are covered by the
syllabus but not formally taught in these sessions.
Increase skills, particularly in approaching MCQs and EMQs of the important recent
topics in Schizophrenia and Psychosis.
Learning Outcomes




Have gained a good understanding of the important recent topics in Schizophrenia
and Psychosis.
Be aware of the sources of evidence relevant to Schizophrenia and Psychosis.
Be clear as to the requirements of the Part III MRCPsych examination and how to
obtain the information not taught in this element.
Be clear as to what needs to be known for the exam, what will be taught in the
course and what you will need to read for yourselves.
5
Lesson Plan
Session
Subject Matter
Teaching Methods
Teacher(s)
Pre-Reading
Standard Texts
Reading List
Trainee
Introduction
Didactic
Discussion of recent important topics
Didactic with discussion
Discussion of some sub-topic-based
MCQs and EMQs
Interactive
Small group exercise
Discussion and elaboration of issues
discussed around MCQs and EMQs
Presentation and Whole
group discussion
Discussion around important resources
and reading list
Didactic with discussion
Circulation of material discussed
Post-session Handout (sent
by e-mail to all trainees who
attend the session)
NA & AL
3 hours
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Suggested Reading List
(Latest articles highlighted in Bold)
Abdelmawla N, Mitchell AJ (2006). Sudden cardiac death and antipsychotics. Part 1: Risk factors and
mechanisms; and Part 2: Monitoring and prevention. Advances in Psychiatric Treatment 12: 35-44 and;
100-109.
Al Sayegh A, Reid D (2010). Prevalence of catatonic signs in acute psychiatric patients in Scotland. The
Psychiatrist, 34, 479-484.
Atakan Z (2008) Cannabis use by people with severe mental illness – is it important? Advances in
Psychiatric Treatment 14, 423–431.
Bird V, Premkumar P, Kendall T, et al. Early intervention services, cognitive–behavioural therapy and
family intervention in early psychosis: systematic review. Br J Psychiatry, 197, 350-356.
Campion J, Checinski K, Nurse J, et al (2008) Smoking by people with mental illness and benefits of
smoke-free mental health services. Adv Psychiatr Treat, 14, 217-228.
Chaplin R, Lelliott P, Quirk A, et al (2007) Negotiating styles adopted by consultant psychiatrists when
prescribing antipsychotics. Adv Psychiatr Treat 13: 43-50.
Duggan A, Warner J, Knapp M, et al (2003) Modelling the impact of clozapine on suicide in patients with
treatment-resistant schizophrenia in the UK. Br J Psychiatry, 182, 505-508.
Fernandez-Egea E, Bernardo M, Donner T, et al (2009) Metabolic profile of antipsychotic-naive
individuals with non-affective psychosis. Br J Psychiatry, 194, 434-438
Freeman D, Garety P (2006). Helping patients with paranoid and suspicious thoughts: a cognitive–
behavioural approach. Adv Psychiatr Treat 12: 404-415.
Green B, Young R, Kavanagh D (2005). Cannabis use and misuse prevalence among people with psychosis.
Br J Psychiatry 187: 306-313
Harland R, Morgan C, Hutchinson G (2004) Phenomenology, science and the anthropology of the self: a
new model for the aetiology of psychosis. Br J Psychiatry 185, 361-362.
Haro JM, Novick D, Bertsch J, et al (2011). Cross-national clinical and functional remission rates:
Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. Br J Psychiatry 199, 194-201.
Hawton K, Sutton L, Haw C, et al (2005) Schizophrenia and suicide: systematic review of risk factors. Br J
Psychiatry 187: 9-20.
Hodgins S, Müller-Isberner R (2004). Preventing crime by people with schizophrenic disorders: the role of
psychiatric services. Br J Psychiatry 185, 245-250.
Holloway F, Aitchison K (2003). Early intervention in psychosis: from Government prescription to clinical
practice. Psychiatric Bulletin, 27, 243-244.
Jones I, Smith S. Puerperal psychosis: identifying and caring for women at risk. Adv Psychiatr Treat, 15,
411-418.
Johns LC, Cannon M, Singleton N, et al (2004) Prevalence and correlates of self-reported psychotic
symptoms in the British population. Br J Psychiatry 185, 298-305.
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Kendall T (2011). The rise and fall of the atypical antipsychotics. Br J Psychiatry 199, 266-268.
Kent A, Burns T (2005). Assertive community treatment in UK practice. Adv Psychiatr Treat 11: 388-397.
Kerwin RW, Bolonna A (2005). Management of clozapine-resistant schizophrenia. Adv Psychiatr Treat 11:
101-106
Kessing LV, Thomsen AF, Mogensen UB, et al (2010). Treatment with antipsychotics and the risk of
diabetes in clinical practice. Br J Psychiatry, 197, 266-271.
Langan J, Shajahan P (2010). Antipsychotic polypharmacy: review of mechanisms, mortality and
management. The Psychiatrist, 34, 58-62.
Larsen TK, Friis S, Haahr U, et al (2004). Premorbid adjustment in first-episode non-affective psychosis:
distinct patterns of pre-onset course. Br J Psychiatry, 185, 108-115.
Leucht S, Corves C, Arbter D, et al (2009). Second-generation versus first-generation antipsychotic drugs
for schizophrenia: a meta-analysis. Lancet, 373(9657), 31-41.
Leucht S, Komossa K, Rummel-Kluge C, et al (2009). A meta-analysis of head-to-head comparisons of
second-generation antipsychotics in the treatment of schizophrenia. Am J Psychiatry, 166, 152-163.
Leucht S, Davis JM (2011). Are all antipsychotics the same. Br J Psychiatry, 199, 269-271.
Martindale B (2007) Psychodynamic contributions to early intervention in psychosis. Adv Psychiatr
Treat, 13: 34-42.
Meltzer HY, Alphs L, Green AI, et al (2003) Clozapine treatment for suicidality in schizophrenia:
International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry, 60, 82-91.
Moncrieff J (2003) Clozapine v. conventional antipsychotic drugs for treatment-resistant schizophrenia: a
re-examination. Br J Psychiatry, 183, 161-166.
Morrison AP, French P, Walford L, et al (2004) Cognitive therapy for the prevention of psychosis in people
at ultra-high risk: Randomised controlled trial. Br J Psychiatry 185, 291-297.
Murphy BP, Brewer WJ (2011) Early intervention in psychosis: strengths and limitations of services. Adv
Psychiatr Treat, 17, 401-407.
Murphy BP, Brewer WJ (2011) Early intervention in psychosis: clinical aspects of treatment. Adv
Psychiatr Treat, 17, 408-416.
NICE. Schizophrenia: Core interventions in the treatment and management of schizophrenia in primary
and secondary care (Update) (National Clinical Practice Guideline Number 82), NICE, 2009.
www.nice.org.uk
Nilsson E, Hultman CM, Cnattingius C, et al (2008) Schizophrenia and offspring’s risk for adverse
pregnancy outcomes and infant death. Br J Psychiatry, 193, 311–315.
Nose M, Barbui C, Gray R, et al (2003) Clinical interventions for treatment non-adherence in psychosis:
meta-analysis. Br J Psychiatry, 183, 197-206.
O'Donnell C, Donohoe G, Sharkey L, et al (2003) Compliance therapy: a randomized controlled trial in
schizophrenia. BMJ, 327, 834.
Parker S, Lewis S (2006). Identification of young people at risk of psychosis. Adv Psychiatr Treat 12: 249255.
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Patel MX, David AS (2005). Why aren’t depot antipsychotics prescribed more often and what can be done
about it? Adv Psychiatr Treat, 11: 203-211
Pelosi AJ, Birchwood M (2003) Is early intervention for psychosis a waste of valuable resources? Br J
Psychiatry, 182, 196-198
Poyurovsky M (2010) Acute antipsychotic-induced akathisia revisited. Br J Psychiatry, 196, 89-91.
Rajji TK, Ismail Z, Mulsant BH (2009) Age at onset and cognition in schizophrenia: meta-analysis. Br J
Psychiatry, 195, 286-93
Ray WA, Chung CP, Murray KT, et al (2009) Atypical antipsychotic drugs and the risk of sudden cardiac
death. N Engl J Med, 360, 225-235. Erratum in: N Engl J Med 2009 Oct 29;361(18):1814.
Saarni SI, Viertio S, Perala J, et al (2010). Quality of life of people with schizophrenia, bipolar disorder
and other psychotic disorders. Br J Psychiatry, 197, 386-394.
Singh SP, Burns T, Amin S, et al (2004) Acute and transient psychotic disorders: precursors, epidemiology,
course and outcome. Br J Psychiatry 185, 452-459.
Singh SP, Singh V, Kar N, et al (2010) Efficacy of antidepressants in treating the negative symptoms of
chronic schizophrenia: meta-analysis. Br J Psychiatry, 197, 174-179.
Taylor MA, Fink M (2003) Catatonia in psychiatric classification: a home of its own. Am J Psychiatry, 160,
1233-1241.
Tiihonen J, Lönnqvist J, Wahlbeck K, et al (2009) 11-year follow-up of mortality in patients with
schizophrenia: a population-based cohort study (FIN11 study). Lancet, 374, 620-627.
Turkington D, Kingdon D, Chadwick P (2003) Cognitive-behavioural therapy for schizophrenia: filling the
therapeutic vacuum. Br J Psychiatry, 183, 98-99.
Turkington D, McKenna PJ (2003) Is cognitive-behavioural therapy a worthwhile treatment for psychosis?
Br J Psychiatry, 182, 477-479.
Upthegrove R (2009) Depression in schizophrenia and early psychosis: implications for assessment and
treatment. Adv Psychiatr Treat, 15, 372-279
Walsh E, BuchananA, Fahy T (2002) Violence and schizophrenia: examining the evidence. Br J Psychiatry,
180, 490-495.
Warner J (2004) Clinicians’ guide to evaluating diagnostic and screening tests in psychiatry. Adv Psychiatr
Treat 10, 446-454.
Wieck A, Haddad PM (2003) Antipsychotic-induced hyperprolactinaemia in women: patho-physiology,
severity and consequences: Selective literature review. Br J Psychiatry, 182, 199-204.
Yeomans D, Taylor M, Currie A, et al (2010) Resolution and remission in schizophrenia: getting well and
staying well. Adv Psychiatr Treat, 16, 86-95.
Zammit S, Thomas K, Thompson A, et al (2009) Maternal tobacco, cannabis and alcohol use during
pregnancy and risk of adolescent psychotic symptoms in offspring. Br J Psychiatry, 195, 294-300.
Zammit S, Owen MJ, Evans J, et al (2011) Cannabis, COMT and psychotic experiences. Br J Psychiatry
199, 380-385.
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