Planning for Phase III Curriculum

Identify sub-specialties (and person responsible) e.g., cardiology, pulmonary . . .

Identify the core problems for each area (there may be overlap)
e.g., hypertension, chest pain . . .

Develop a list of core clinical cases (which relate to each core problem)
   e.g., (chest pain): angina pectoris, unstable angina . . .

Set a competence level for each core clinical case
    1: Recognise based on theoretical knowledge
    2: Work with in clinical practice
    D: Independently reach to a diagnosis
    T: Independently give treatment


 

PSYCHIATRY

Sub-specialty

Person Responsible

Psychoses

Dr. M. A. Zahid

Affective disorders

Dr. Mariam Al-Awadhi

Neuroses

Dr. M. A. Zahid

Personality disorders

Dr. Khaled Al-Saleh

Stress-related disorders

Dr. Abdullah Al-Hammadi

Substance abuse

Dr. Adel Al-zayed

Organic Psychiatry

Dr. Sulaiman Al-Khadhari

Liaison Psychiatry

Dr. Adel Al-zayed

Eating disorders

Dr. M. A. Zahid

Psychosexual disorders

Dr. Khaled Al-Saleh

Forensic Psychiatry

Dr. Abdullah Al-Hammadi

Old age Psychiatry

Dr. Sulaiman Al-Khadhari

Child Psychiatry

Dr. Bib Alamiri

Learning disability

Dr. Bibi Alamiri

Psychopharmacology

Dr. Mariam Al-Awadhi

Psychotherapy

Dr. Ghenaim Al-Fayez

 

PSYCHIATRY

Overall objectives

Specific objectives

Method of delivery

 

 

 

Bed side teaching

PBL

1. PSYCHOSIS

Demonstrate proficiency in the recognition, evaluation, and management of persons with psychosis associated with schizophrenia, affective, general medical, and other psychotic disorders.

Psychosis
1. Define the term psychosis;

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2. develop a differential diagnosis for a person presenting with psychosis, including identifying historical and clinical features which assist in the differentiation of general medical substance-induced, affective, schizophrenic and other causes;

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3. state the neurobiologic, genetic, and environmental theories of etiology  and pathophysiology of schizophrenia;

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4. summarize the epidemiology, clinical features, course, and    complications of schizophrenia;

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5. summarize the treatment of schizophrenia, including both pharmacologic and psychosocial interventions; and name the clinical features of schizophrenia that are associated with good and poor outcome, and explain the significance of negative symptoms;

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6. list the features that  differentiate delusional  disorder, schizophreniform disorder, schizoaffective disorder, and brief psychotic disorder from each other and from schizophrenia.

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2. Affective disorder
Recognize, evaluate, and state the treatments for patients with mood disorders.

Affective disorder

1. discuss evidence for neurobiological, genetic, psychological, and environ­mental etiologies of mood disorders;

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2. state the epidemiologic features, prevalence rates, and lifetime risks of mood disorders in clinical and nonclinical populations; gen­eral medical/surgical illness (e.g., myocardial infarction, diabetes, CVAs, hip fractures) and the impact of depression on morbidity and mortality from their illnesses;

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3. compare and contrast the epidemiologic and clinical features of unipolar depression and bipolar disorders;

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4. State the common signs and symptoms, differential diagnosis (including general medical and substance-induced disorders), course of illness, co-morbidity, prognosis, and complications of mood disorder.

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5) contrast normal mood variations, states of demoralization, and bereave­ment with the pathological mood changes that constitute expressive illness;

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6. identify the difference in the presentation, treatment, and prognosis of major depression with and without melancholic features, psychotic features, atypical features, catatonic features, seasonal pattern and postpartum onset;

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7. compare and contrast the clinical presentations and evaluation of mood disorders in chil­dren, adults and the elderly; and in non-psy­chiatric settings

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8. discuss the identification and management of suicide risk in  general medi­cal settings

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9. outline the recommended acute and maintenance treatments for dysthymia, major depression, and bipolar disorders (manic and depressive phases)

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3. SOMATOFORM AND FACTITIOUS DISORDERS
Diagnose and discuss the principles of management of patients with somatoform disorders.

1. state the clinical characteristics of somatization disorder, conversion dis­order, pain disorder, body dysmorphic disorder, and hypochondriasis;

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2. list the psychiatric disorders that have high comorbidity with somatoform disorders;

 

 

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3. discuss the implications of the high rate of underlying general medical/ neurologic illness in patients diagnosed with pain disorder and conversion disorder;

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4.list the characteristic features of factitious disorder and malingering, and compare these with the somatoform disorders;

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5. discuss the frequency and importance of physical symptoms as manifes­tations of psychological distress;

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6. summarize the principles of management of patients with somatoform dis­orders

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4. PERSONALITY DISORDERS
Recognize maladaptive traits and interpersonal patterns that typify personality disorders, and discuss strategies for caring for patients with personality disorders.

1. Define personality traits and disorders, and iden­tify features common to all personality disorders;

 

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2. list the common personality disorders and describe the typical traits in  each personality disorder;

 

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3. summarize the neurobiological, genetic, developmental, behavioural, and so­ciological theories of the aetiology of personality disorders, including the association of childhood abuse and trauma;

 

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4. discuss the biogenetic relationships that exist between personality disorders and the development of respective psychiatric disorder

 

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5. discuss the epidemiology, differential diagnosis, course of illness, progno­sis, and comorbid psychiatric disorders in patients with personality dis­orders;

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6. list the general medical and psychiatric disorders that may present with personality changes;

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7. discuss the concepts of hierarchical levels of defence and regression under stress, and list typical defence mechanisms used in various personality disorders;

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8. Summarize principles of management of patients with personality disor­ders, both in hospital and general medical settings; including being aware of one's own response to the patient, soliciting consultations from colleagues when indicated, and using both support and no punitive limit setting.

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5. DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS
Recognize the psychiatric manifestations of brain disease of known aetiology or pathophysiology and will state the evaluation and initial management of these neuropsychiatric disorders.

1. recognize the cognitive, psychological, and behavioural manifestations of brain disease of known aetiology, anatomy, or pathophysiology;

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2. compare, contrast, and give examples of the delirium, dementia (including treatable dementia), dementia syndrome of depression (pseudodementia), cortical dementia, and subcortical dementia;

 

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3. Discuss the clinical features, differential diagnosis and evaluation of delirium including emergent conditions.

 

 

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4. State the prevalence of delirium in hospitalized elderly patients.

 

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5. Discuss the behavioural and pharmacologic treatments of delirious patients;

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6. Discuss the epidemiology, differential diagnosis, clinical features, and course of Alzheimer’s diseases, vascular dementia, substance-induced persisting dementia, Parkinson’s disease, and HIV encephalopathy

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7. Lists the treatable causes of dementia and summarize their clinical manifestations;

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8. Summarize the medical evaluation and clinical management of a patient with dementia;

 

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9. Discuss the diagnosis, differential diagnosis, and treatment of amnestic disorder due to general medical conditions e.g. head trauma) and substance-induced conditions(e.g. Korsakoff’s syndrome due to thiamine deficiency);

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10. Employ a cognitive screening evaluation to assess and follow patients with cognitive impairment, and state the limitations of these instruments;

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11. State the neuropsychiatric manifestations of HIV- related illnesses;

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12. State the neuropsychiatric manifestations of seizure disorders, strokes, and head injuries.

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6. SEXUAL DYSFUNCTIONS AND PARAPHILIAS summarize the process of evaluation and treatment of persons with sexual dysfunctions or paraphilia’s.

1. discuss the anatomy and physiology of the male and female sexual re­sponse cycles;

 

 

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2. obtain a patient's sexual history, including an assessment of risk for sex­ually transmitted diseases, especially HIV;

 

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3. state the implications of the high prevalence of sexual dysfunctions in the general population, and particularly in the medically ill;

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4. list the common causes of sexual dysfunctions, including general medical and substance-related aetiologies’;

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5. summarize the manifestations, differential diagnosis, and treatment of hy­poactive sexual desire disorder and sexual aversion disorder; male erectile disorder and female sexual arousal disorder; female and male orgasmic disorders and premature ejaculation; and dyspareunia and veganism’s;

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6. define the term paraphilia and review its management

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7. Discuss the prevalence, manifestations, diagnosis,treatment of gender identity disorder.

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7. SLEEP DISORDERS

Evaluate, and refer or treat, persons with sleep problems.

 

 

  1. Describe normal sleep physiology, including sleep architecture, throughout the life cycle;

 

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  1. Describe sleep hygiene treatment.

 

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  1. Obtain a complete sleep history;

 

 

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  1. Discuss the manifestations, differential diagnosis, evaluation , and treatment of primary sleep disorders, including dyssomnias and parasomnias;

 

 

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  1. Describe typical sleep disturbances that accompany psychiatric and substance use disorders;

 

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  1. Summarize the effect(s) of psychotropic medications on sleep;

 

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8. Substance Abuse disorders

Identify, clinically evaluate, and treat the neuropsychiatric consequences of substance abuse and dependence.

1. Obtain a thorough history of a patients’ substance use through empathic, non-judgmental, and systematic interviewing;

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2. List and compare the characteristic clinical features (including denial) of substance abuse and dependence;

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3. Discuss the epidemiology (including the effect of gender), clinical features, patterns of usage, course of illness, and treatment of substance use disorders (including anabolic steroids);

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4. Identify typical presentations of substance abuse in general medical practice;

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5. List the psychiatric disorders that share significant comorbidity with substance related disorders, and discuss some criteria for determining whether the comorbid disorder should be treated independently;

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6. Discuss the role of the family, support groups, and rehabilitation programs in the recovery of patients with substance use disorders;

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7. List the questions that comprise the CAGE questionnaire and discuss its use as a screening instrument;

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8. Discuss the genetic, neurobiological, and psychosocial explanations of the aetiology of alcoholism;

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9. List the psychiatric and psychosocial complications of alcoholism;

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10. Know the clinical features of intoxication with, and withdrawal from cocaine, amphetamines, hallucinogens, cannabis, phencyclidine, barbiturates, opiates, caffeine, nicotine, benzodiazepines, and alcohol;

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11. State the treatments of intoxication and withdrawal induced by the substance listed above;

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12. List patient characteristics associated with benzodiazepines abuse;

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13. State guidelines for prescribing benzodiazepines

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14. Discuss the difficulties experienced by health care personnel in providing empathic, non-judgmental care to substance abusers.

 

 

 

9. CHILD AND ADOLESCENT PSYCHIATRY

By the end of the clerkship, the student will summarize the unique factors essential to the evaluation of children and adolescents and will diagnose the common child psychiatric disorders.

1. Compare and contrast the process of psychiatric evaluation of children and adolescents at different developmental stages with that of adults.

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2. State the value of obtaining data from families, teachers, and other non-physicians in the evaluation and treatment of children and adolescents.

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3. State the indications for psychological assessment in children and list some of the common tests in a psychometric evaluation.

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4. List a differential diagnosis and outline the evaluation of academic performance and behavioural problems in children.

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5. Summarize the etiologic hypotheses, clinical features, epidemiology, pathophysiology, course, comorbid disorders, complications, and treatment for attention deficit hyperactivity disorder and conduct disorder.

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6. Discuss the aetiologies’, epidemiology, clinical features, and psychiatric comorbidity of mental retardation.

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7. Name the major clinical features of autism.

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8. Differentiate developmentally based anxiety (e.g. stranger, separation anxiety) from pathological anxiety disorders in childhood.

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9. Describe typical clinical features of anxiety disorders at different developmental stages.

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10. Compare and contrast the clinical features of mood disorders in children with those of adults.

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11. Discuss the epidemiology and clinical features of suicide risk in adolescents.

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12. State when and how a physician must protect the safety of child who may be the victim of physical or sexual abuse or neglect.

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13. Identify signs and symptoms of child sexual and physical abuse, and discuss its short and long-term psychiatric squeal.

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10. Psychopharmacology

Summarize the indications, basic mechanisms of action, common side effects and drug interactions of each class of psychotropic medications, and demonstrate the ability to select and use these agents to treat mental disorders.

Anxiolytics
Discuss

  1. the indications, mechanism of action, pharmacokinetics, common side ef­fects, signs of toxicity, and drug interactions of the different benzodiaze­pines and sedative-hypnotics;

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  1. the consequences of abrupt discontinuation;

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  1. patient characteristics associated with benzodiazepine abuse;

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  1. guidelines for prescribing benzodiazepines;

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  1. The differences (mechanism of action, onset of effect, and indications) be­tween buspirone and benzodiazepines.

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11.Antidepressants

Summarize

  1. the indications, mechanisms of action, pharmacokinetics, common or seri­ous side effects (including overdose potential), signs of toxicity, and drug interactions of tricyclics, SSRI’s, SNRI’s, NaSSA’s and antidepressants, monoamine oxidase inhibitors;

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  1. the effect of antidepressants on the cardiac conduction system and EKG;

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  1. dietary and pharmacologic restrictions in prescribing an MAQI;

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  1. Advantages of serotonin reuptake inhibitors.

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12. Antipsychotics

Discuss
1. the indications, mechanisms of action, pharmacokinetics, common or serious side effects, signs of toxicity, and drug interactions of antipsychotics;

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2, differences between typical and atypical antipsychotics, including the side effects common to each group;

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  1. diagnosis and management of extrapyramidal side effects including acute dystonia, parkinsonism, akathisia, tardive dyskinesia, and neuroleptic ma­lignant syndrome;

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  1. The indications and special considerations in using clozapine and risperi­done.

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13. Mood Stabilizers

Discuss

  1. the indications, mechanism of action, pharmacokinetics, side effects, signs of toxicity (neurological, gastrointestinal, renal, endocrine, cardiac), and drug interactions of lithium;

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  1. the pretreatment assessment and strategies of use of lithium, including blood level monitoring;

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  1. The indications, mechanisms of action, pharmacokinetics, common and se­rious side effects, toxicity, drug interactions, and plasma level monitoring for carbamazepine, and valproic acid.

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14.Anticholinergics

discuss

  1. the indications, mechanisms of action, pharmacokinetics, common and se­rious side effects, signs of toxicity, and drug interactions of antiparkinso­nian agents;

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  1. which antidepressants and antipsychotics have a higher incidence of anticholinergic side effects;

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  1. special considerations in prescribing these medications in the elderly

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15.Electroconvulsive therapy (ECT)

summarize

  1. indications, physiologic effects, and side effects of ECT;

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  1. clinical situations in which ECT may be the treatment of choice;

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  1. Pre-treatment assessment, including conditions requiring special precau­tions;

 

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  1. The medical care of the patient before, during, and after ECT treatment.

 

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16. Beta blockers & stimulants

Discuss

  1. the use of beta blockers in psychiatry; and
  2. The indications for and side effects of stimulants.

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17. PSYCHOTHERAPIES

Understand the principles and techniques of the psychosocial therapies sufficient to explain to a patient and make a referral when indicated.

  1. State the characteristics and techniques of, and common indications and psychodynamic contraindications for psychotherapy, psychoanalysis, sup­portive psychotherapy, cognitive and behavioral therapies, group thera­pies, couples and family therapy, and psychoeducational interventions;

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  1. Describe behavioral medicine interventions (e.g., relaxation training, asser­tiveness training, contingency management, stimulus control, relapse pre­vention, biofeedback), and know for which medical problems they are ef­fective (e.g., smoking cessation) and ineffective;

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  1. Define and begin to recognize transference, countertransference, and com­monly used defence mechanisms; discuss the concepts of hierarchical levels of defence and regression under stress; and list some typical defence mech­anisms used in various personality disorders;

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  1. State the major findings of studies of the efficacy of psychosocial interven­tions in the treatment of psychiatric and general medical disorders and in reducing health care costs

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18. COMMUNITY AND FORENSIC PSYCHIATRY

Discuss the structure of the mental health system, as well as legal issues important in the care of psychiatric pa­tients.

1. List the psychiatric services each community mental health centre must provide.

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2. Define deinstitutionalization, and discuss its effects on patients and on the community.

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3. Summarize the elements of informed consent, determination of the capacities (e.g. to consent to treatment, to mange funds), and the role of judicial or administrative orders for treatment.

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4. Define the right to treatment and right to refuse treatment.

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5. Discuss when and how a physician must protect the safety of a child or an elderly person who may be the victim of physical or sexual abuse or neglect.

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6. Discuss the economic impact of chronic mental illness on patients and their families, including the effect of discriminatory insurance coverage.

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7. Discuss the financial and psychosocial burden of chronic mental illness to family members.

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8. Discuss the concept of not-guilty plea diminished  on mental health grounds

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