Psych Med: Concept Checklist

Concepts covered across the module lectures, grouped by lecture. Tick each once you can explain it from memory.

L1 Neuropsychological development (20 Feb) L1 Psych Med Neuropsychological development

• Piaget’s four stages of cognitive development and the concept of schemas
• Erikson’s eight psychosocial stages across the lifespan
• Order and timing of brain developmental processes: neurulation to myelination; grey matter maturation through adolescence
• Critical periods in development
• Neurosequential Model of Therapeutics: brain levels mapped to child needs
• Te Whare o Oro: mātauranga Māori framework mapping the pou to brain regions, their functions, developmental goals and needs
• Normal influences on development: sex, parenting and back-and-forth responsive relationships
• Environmental, infectious, teratogenic and adverse influences on development
• Teratogenic effects of antiepileptic drugs and other teratogenic drugs
• Fetal alcohol spectrum disorder: facial features, primary and secondary disabilities
• Positive, tolerable and toxic stress responses
• Brain development as sequential, experience-dependent, relational, biologically sensitive and adaptive

L2 Child Maltreatment and Mental Disorders (20 Feb) L2 Psych Med Child Maltreatment and Mental Disorders

• Trends and relative frequency of substantiated child abuse findings in Aotearoa NZ
• Four ingredients of healthy child development
• Bronfenbrenner, Meihana and Fonofale models as contextual frameworks for development and health
• Ecological model of maltreatment: risk and protective factors at individual, family, community and societal levels
• Four types of child maltreatment
• Effects of toxic stress on brain architecture
• Toxic stress, chronic inflammation, and the dose-response link between adverse childhood experiences and adult heart disease
• Cognitive, emotional and social sequelae of maltreatment
• Developmental cascade linking the domains of sequelae
• Buffers and protective factors that reduce negative outcomes after maltreatment

L3 & 4 Psych Med Alzheimer’s disease (6 Mar) L3 & 4 Psych Med Alzheimer’s disease

• Definition of dementia and its essential element of impaired daily function
• Epidemiology and burden of dementia in New Zealand, including age-specific prevalence and Māori considerations
• Distinguish memory change in normal ageing from dementia
• Preclinical, MCI and dementia stages of the Alzheimer’s continuum
• Differential diagnosis of dementia and relative frequency of each cause
• Diagnostic criteria and clinical picture of Alzheimer’s disease
• Neuropathology: amyloid plaques and tau tangles, significance of quantity and distribution, regional involvement, atrophy on imaging
• AT(N) biomarker classification and its cross-classification with cognitive stage
• LATE: protein abnormality, clinical overlap with Alzheimer’s, prevalence over 80
• Resilience, cognitive reserve and the point of inflection
• Education as a modifier of the relationship between pathology and cognitive decline
• Life-course risk and protective factors for dementia

L5 Long term consequences of brain injury (9 Mar) L5 Psych Med Long term consequences of brain injury

• Epidemiology of TBI in New Zealand: incidence, severity distribution, mechanisms by age, under-ascertainment
• Classification of acquired brain injury: concussion, closed vs open TBI, non-traumatic
• Severity classification using loss of consciousness, GCS and post-traumatic amnesia, including very severe TBI; limitations of this system
• Coup-contrecoup injury, diffuse axonal injury and the secondary injury cascade
• Why initial severity markers predict outcome imperfectly
• Acute phase: post-traumatic amnesia, neurogenic fatigue, insight
• Short-term recovery phase and why cognitive deficits are hard to detect in hospital
• Long-term trajectory and outcomes; neuropsychological and psychological effects; psychological factors as stronger predictors of outcome
• Practical recommendations for doctors communicating with TBI patients and families
• Concussion: causes, typical recovery, symptoms and red flags for emergency referral
• ACRM diagnostic criteria for mild TBI and severity exclusions
• Neurometabolic cascade of concussion, imaging findings and emerging blood biomarkers (UCH-L1, GFAP)
• Persisting post-concussion symptoms: prevalence, risk factors and biopsychosocial formulation (predisposing, precipitating, perpetuating)
• Applying classification, phase-based management and formulation to severe TBI and persisting concussion cases

L6 Severe depression and bipolar disorder (13 Apr) L6 Psych Med Severe depression and bipolar disorder

• Historical concept of mood disorders and classification by elevation, lowering and duration axes (dysthymia, cyclothymia, BP-I, BP-II)
• Diagnostic criteria for depressive vs manic vs hypomanic episodes, including duration and functional thresholds
• Epidemiology and familial risk of bipolar disorder compared with MDD
• Recurrence pattern of bipolar disorder vs MDD, including cycle acceleration
• Pathophysiology: polygenic risk genes and white matter abnormalities
• Environmental, medical and psychological precipitants of mood episodes
• Adverse outcomes of bipolar disorder: diagnostic delay, premature death, suicide, forensic and social consequences
• Psychological and social management of bipolar disorder
• Management of acute mania: hospitalisation and mood stabiliser plus antipsychotic and/or benzodiazepine; evidence for drug choice
• Management of bipolar depression: lithium, cautious antidepressant use and risk of switching or rapid cycling, ECT, ketamine
• Maintenance therapy: indications for prophylaxis, lithium monitoring, alternatives, polarity index, BALANCE trial
• Severity spectrum of MDD, and clinical features of melancholic depression
• Features of psychotic depression: mood-congruent delusions and hallucinations, Cotard’s syndrome
• Epidemiology, biology and treatment of melancholic and psychotic depression

L7 Schizophrenia (13 Apr) L7 Psych Med Schizophrenia

• Psychosis as a syndrome, and the disorders in which it occurs
• Positive vs negative symptoms and cognitive impairment in schizophrenia
• DSM diagnostic criteria for schizophrenia, and the three-factor symptom structure with relative frequencies
• Kraepelin’s dementia praecox and manic depression distinction
• Epidemiology of schizophrenia internationally and in New Zealand, including sex and ethnic differences, age of onset and prodrome
• Risk factor model: genetic vulnerability, prenatal and later environmental factors, urbanicity, migration
• Genetic epidemiology from family, adoption and twin studies, and heritability estimate
• Genetic architecture: common SNPs, CNVs and rare mutations, and the inverse frequency-effect size relationship
• Schizophrenia as a disorder of brain network connectivity; progressive grey matter loss
• Clinical course, and predictors of good vs poor outcome
• Social and health impacts, mortality, and suicide risk factors and prevention
• Economic burden of schizophrenia
• Antipsychotic history, D2 occupancy thresholds for efficacy and side effects, duration of treatment after first episode, depot vs oral

L8 Cultural interpretations of serious mental Illness (16 Apr) L8 Psych Med Cultural interpretations of serious mental Illness

• Definition of a symptom, and its utility and limitations including cultural definition
• Definitions of hallucination and delusion
• Voice-hearing as a continuum: prevalence and features of non-clinical voice-hearing
• Phenomenological features that distinguish clinical from non-clinical voices, and those that do not
• Cross-cultural differences in the experience of voices (US, Ghana, India)
• DSM-5 culture-related diagnostic issues in schizophrenia
• Case of culturally informed assessment: atypical features, Māori concepts of mauri, tapu and mana, and comparison of Western and Te Ao Māori approaches
• Cultural syndromes, cultural idioms of distress and cultural explanations, with examples
• Clinical practice: assessing spirituality with open questions, normalising within whānau, considering multiple explanations, consulting cultural experts

L9 Suicide self-harm (17 Apr) L9 Psych Med Suicide self-harm

• Definitions of suicide, suicidal behaviour, suicidal ideation and deliberate self-harm
• Appropriate language around suicide, and why “committed” is avoided
• Māori concepts of whakamate and whakamomori, and the role of colonisation
• Ratio of attempts to deaths by age, and the C-SSRS continuum of suicidal ideation
• Common causes of suicidal feelings and motives for self-harm
• APEX approach: attitude, purpose (Sutton’s themes), emotional first aid and XYZ contract
• Psychological theories of suicide: Baumeister escape theory, Shneidman psychache, Joiner interpersonal theory, Beck hopelessness, Linehan emotion dysregulation and DBT
• Sociocultural and demographic risk factors, including colonisation, cultural identity and discrimination
• Risk formulation (Pisani): enduring vs dynamic data, risk status vs risk state, resources, foreseeable changes, planning rather than prediction
• Safety planning interventions: evidence, six components, distinction from no-suicide contracts
• Pasifika and Māori prevention frameworks and protective factors (LeVa tactics, Tihei Mauri Ora)

L10 Diabetes (6 May) L10 Psych Med Diabetes

• Epidemiology of diabetes in New Zealand, ethnic and socioeconomic inequities, and structural determinants
• Why psychological care is integral to diabetes care; the self-management burden
• Psychological challenges at each stage of the diabetes journey: diagnosis, adjustment, ongoing management, complications
• Diabetes distress: definition, distinction from depression, risk factors, consequences, PAID scale
• Health literacy and information retention, and the teach-back method
• Disordered eating in diabetes and screening with SCOFF and mSCOFF, including insulin omission
• Fear of hypoglycaemia and other diabetes-related fears
• Depression and anxiety in diabetes: prevalence, bidirectional relationship, overlap with diabetes distress, diabetes burnout
• Psychological insulin resistance: causes, assessment and consequences
• Psychological impacts of newer drugs and diabetes technology
• The 7A’s model for supporting emotional wellbeing
• Communication principles and indications for mental health referral
• Promoting self-management: key themes and practical approaches to behaviour change

L11 Obesity (11 May) L11 Psych Med Obesity

• WHO definition of obesity as chronic, complex and multifactorial; prevalence and inequities in New Zealand
• Weight stigma: definition, balanced causal framing, overt, internalised and subtle forms, implicit bias
• Sources of weight stigma, including health providers’ reluctance to raise weight
• Psychosocial consequences of obesity in childhood: bullying, teacher stereotypes, quality of life, body dissatisfaction
• Association of obesity with depression and anxiety in adults, and sex differences
• Systems view of obesity: life course and social determinants model, Fonofale and Māori frameworks
• Six categories of determinants of unhealthy weight, applied to a paediatric case
• Pathways to weight gain: dual process model and adversity route
• Bidirectional feedback loops of stigma, body dissatisfaction and weight gain
• Psychological and ethical questions raised by GLP-1 receptor agonist treatment
• Comprehensive clinical approach to obesity care
• Communication strategies for raising weight: permission, preferred terms, person-first language, reframing

L12 Intimate partner violence (15 May) L12 Psych Med Intimate partner violence

• Definition of intimate partner violence, and prevalence and sex differences from the 2019 NZ Family Violence Survey
• NZ Police statistics on family violence, including homicide and the high-risk period after separation
• Social-ecological model of IPV causation
• General and perpetrator-specific risk factors that increase likelihood or severity of IPV
• Health effects of IPV, including chronic stress and cortisol pathways, mental disorders and pregnancy complications
• Biological pathway from childhood adversity to adult health outcomes
• Perpetrator and patient behaviours in a consultation that suggest family violence
• Injury patterns suggesting family violence
• Non-fatal strangulation: signs by body region, psychological and delayed consequences, homicide risk, 2018 law change
• Where victims seek help, and the iceberg model of how family violence presents to health
• Gender considerations in IPV, including distinguishing abuse from acts of resistance
• Legal framework and justifications for information sharing
• Co-occurrence of IPV and child abuse, and child safety as paramount
• Clinician roles, the Violence Intervention Programme and the Family Violence Assessment and Intervention Guideline

L13 Grief and mourning (20 Jul) L13 Psych Med Grief and mourning

• Distinguish bereavement, grief and mourning
• Grief as a normal process rather than an illness
• Emotional, physical, cognitive, social and spiritual domains of grief
• Post-death contact experiences as part of normal grief, and their frequency
• Range and typical duration of normal grief
• Models of grief: Kübler-Ross, Sheldon, Parkes-Bowlby, dual process model, Worden’s tasks, continuing bonds, and their limitations
• Proportion of uncomplicated vs maladaptive grief
• DSM-5-TR criteria for prolonged grief disorder
• Risk factors for prolonged grief disorder
• Distinguish grief from depression
• Disorders comorbid with grief
• Principles for responding to grief, and common myths about grief

L14 Childhood abuse (22 Jul) L14 Psych Med Childhood abuse

• Reasons child abuse is under-recognised, and the clinician’s protective role
• Parental, child and social risk factors for maltreatment, and targeted prevention via IPV screening and developmental expectations
• Sentinel injuries: definition and significance
• Sentinel concerns by age/development, injury pattern and history
• Bruising: why bruises cannot be dated, TEN-4 locations, any bruising in infants under 4 months
• Duty to report suspected maltreatment, the Report of Concern process, and approaching families about a report
• Roles of paediatrics, social work and police, and preservation of forensic evidence
• Clinical protocol: history (caregivers interviewed separately, timeline, social and family history), head-to-toe examination, photo-documentation
• Investigations in suspected abuse: bloods, skeletal survey, neuroimaging, subspecialist input