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Guest eureka

essay plan pool

38 posts in this topic

Discuss the relationship between adverse childhood experience and the development of psychiatric illness in adulthood and beyond paying particular reference to personality disorders and affective disorders

shall we discuss this topic...this essay came in 2002.i just wanted to see how people would tackle an essay like this

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describing etiologies of both and then stressing on adverse childhood experience...?

talking about management and showing the imp of taking into account the psychogical impact of the adversities in treatment

do we have to give an argument in favour and against the imp of adversities in childhood.?

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Discuss the relationship between adverse childhood experience and the development of psychiatric illness in adulthood and beyond paying particular reference to personality disorders and affective disorders

understanding aetiology----------helps management.

enduring nature of personality disorder must have a longstanding threat dating back to when the formation of schemas were happening formation of maldaptive behaviour/emotions/feelings.

evidence of people with affective disorder having psyco/socio problems in childhood.

psychological domain--- aetiological weight in the development of personality/affective disorder.

psychological threats in childhood----sexual/emotional/physical/parenting/educational.

Consequent changes in schemas about self/others/world.

sexual abuse-------borderline PD(definition,psychodynamic'splitting,double personalities')

physical abuse---passive/aggresive child---soiling---ADHD-----anxiety,depression in adulthood

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Xcellent plan, Khuram, I agree.

How 'bout this title?

'Psychological treatments have little space in the learning disabled. Critically discuss this statement.'

I'll give it a go tonight and post my plan tomorrow: any more ideas welcome

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New Title:

Anti-psychotics have no role to play in the treatment of psychosis in the elderly.....

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Anti-psychotics have no role to play in the treatment of psychosis in the elderly.....

elderly:

65+

Prejudicim dated back to Freud(inflexible,not treatable but'treatability does not equate to curability!'

Vulnearability for mental problems----alcohol,social isolation,decreased social vitality/role,comorbidity(dementia,depression).

psychosis:

Def-----

types---delusions,hallucinations,passivity,affectivity.

Effects---risk to self/others,low quality of life,burden on the resources,high mortality/morbidity,effects on physical health.

antipsychotics:Def---

action---pharmacodynamics/pharmacokinetics

Types----conventional/newer

side effects.

why not to use in elderly:

low body mass index---toxicity

drug interaction with alraedy too many prescribed meds.

comorbid physical problems---cardiac etc

what are the alternatives:

role of anticonvulsants,benjos---control associated aggression

psychotherapy-----low evidence

recently forbidden atypicals---stroke

conclusion:

psychosis---should be actively treated

extra care for comorbid physical/menta/social problems

start low----go slow

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very good

my approach was along similar lines

psychosis seen in schz, dementia, delirium etc

then moving on to the dangers and over prescribing of antipsychotics

papers on hyperglycaemia and increased risk of stroke in the elderly with dementia

reasons not to use them

akathisia, acute dystonia, TD,

urinary hesitancy, constipation, blurred vision, delirium

post hypotension sedation Gastic problems etc

Duff 2004 2x increase stroke with olanzapine and risperidone in dementia

then alternative approaches. modification of the environment

cohen-mansfields approach etc

hidden cues

misinterpretations

reduce sensory deprivation

other psychosocial therapies:

CBT:

role of cholinesterase inhibitors in psychosis?

show some promise?

conclude that we should use anti-psychotics with caution in the elderly popn they have been successfully used to treat psychosis in the adult pop etc.

Other interventions to be considered/

ECT? Royal college handbook etc

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'Psychological treatments have little space in the learning disabled. Critically discuss this statement.'

Intro

LD affects 1.5 million people in the UK - Many live in poverty and are affected by emotional difficulties associated with their state.

There is a dearth of evidence that psychological Rx works in LD, however empirical reports and clinical experience in working with LD suggests that they have great value in improving pts' lives.

Body

Reasons for such a lack of evidence:

- LD is often used a exclusion criteria in studies

- Prejudice leads to thinking that LD doesn't benefit

and that low IQ = no psychological mindedness

- tendency to ascribe behavioural problems to LD rather than emotional distress that could potentially be treated

Ref. Hollins and Sinason BJP 2000

Why it could be important:

- Pt jas to face several psychological stressors:

1) dealing with the disabitly itself

2) grief/loss of the normal self that would hgave been born

3) dependency from carer

4) Fear of death/belonging to a group that society wishes to eliminate

- Response by the family is amenable to Rx

- Attachment (se Spitz studies on children in orphanotroph)

- Sexuality

Availability of therapies

- Group therapy and Family therapy of proven efficacy although by few open and non randomized studies;

- new approaches using creative therapies such as music therapy/play

- individual therapy: CBT can modify cognitions and response to them (Lindsay 1999)

Implementationn

Different approach according to

- severity of lD

- availability of servoces

- problem behaviouor (perhaps make examples)

Conclusion

There is a definite space for psych Rx in Ld and despite the difficulties in implementing it, psychiatrists should be encouraged to extend their therapeutic repertoire and to produce definable outcomes in order to increase research and evidence.

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KHURRAM

I THINK U HAVE JUST RESTRICTED your ans to antipsychotics...u need to be broad n mention psychosocail therapies , role of all modalities in psychiatry and their imp.

concluding that no treatment is complete with other components...so one has to ahve a holistic approach and not just use antipsychoitcs....

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yes describing the holistic appraoch is important.

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yes a bit of computerised cbt might help with a few candles..

and crystals.

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Dr Shamrock - your sceptcism is disappointing.  This  may reflect your own pessimistic ideas about the future.  Turn on, tune in, log on...

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Shamrock is clearly blinkered and myopic, Mr_Fries.

I'm becoming more convinced this will come up in this year's MRCPsych at some point.....for reasons I cannot easily divulge.

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now when youve all stopped discussing me ...

and when computerised cbt does turn up I'll be ready..

with the critical  reviews at the ready.. backed up with plenty of cited references..

enough about that. have to go, my computer has made me a cup of Tea

back to the task at hand

wheres a good place to get a brief summary of the EEG in illness?

ie the depressed EEG, dementia etc/.

?.

had a great thought,, will computerised CBT eventually replace the psychiatrist? isnt it the same thing?>Then we in GP land wouldnt have to wait for long for a patient to be seen it would be great, iam all for it now.

Iam going on strike, not answering anymore ISQ's  >:(

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Shamrock is clearly blinkered and myopic, Mr_Fries.

I'm becoming more convinced this will come up in this year's MRCPsych at some point.....for reasons I cannot easily divulge.

what u mean psychinsider u cant divulge???????????

spill the beans or say nothing..

youre just adding to people's anxiety here

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i agree with craftydevil, what are u on about MRCPsychinsider??

any idea how badly timed that ominous statement is.. if u dont wish to be explicit then perhaps it would be better if u dont say anything at all

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we're all chillled

ignore sensationalists.. we dont need them!

esp those with membership

in the event this dreadful computerised cbt essay should come up should we perhaps plan an essay and relieve anxiety?

habituate?>

::)

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that's is all I am saying: it doesn't take long to read one or two papers, or better still the NICE guidance (which has all the research qouted in detail), and I believe it is foolish to overlook such a major change to the stepped-care model. The topic also overlaps with politics, service provision and the nature of PCT commissioning and in doing displays bredth of reading and understanding of the bigger picture in psychiatry.

Shamrock, as for replacing psychiatrists we all know they don't do that much CBT anyway (see recent survey of scottish psychiatrists). FACT: average 18month wait for CBT. FACT: CCBT works and has very little wait.

Good luck and back to the books/pro-plus.

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mrsychinsider

i see... i think u should be a politician squirming about like that... evasively..

:-X

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Community teams , early intervention , outreach , crisis reolution may come up

Any thought about plan please

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Shamrock... maybe you could do with a course of FearFighter? I'm sure you know about it success too.

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go away Mr fries and stop harassing me .. eat your chips

ive just read a series of  reviews on the whole thing

low numbers of participants and stat significance for sure... not so sure about clinical sig however..

cant wait for the essay now./

:P

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Community teams , early intervention , outreach , crisis reolution may come up

Any thought about plan please

anything could come up..

of this lot poss early intervention..

i think the others came up b4?

i might stand corrected

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Early interventiom came up 3 years ago , I think

Crisis resloution never came up before

Outreach ? not sure

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