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      New question bank for paper B   05/11/18

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robbas

ESSAY PLAN POOLING

48 posts in this topic

Would people be up for sharing the load for writing essay plans and posting them on superego as that would help generate probably enough essay plans to cover almost all topics. I guess the disadvantage would be poeple not doing the work and still taking the liberty of using the site to nick everyone elses piece of work. I wonder if theres a way round that WEBMASTER - maybe by having like a question bank where you can only gain access if you submit a sufficient plan.

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i'd be happy to contribute.

does anyone have a list of hot topics? we could start with that.

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I guess this essay may pop up. 'Psychotherapy services in oldage'

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I did that one in Autumn 2003 - Evidence base for psychotherapy in older persons or something like that.

Che ;)

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looks like Services and Psychotherapy essays are important

I guess this essay may pop up.  'Psychotherapy services in oldage'

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                  Psychotherapy in old age

Let us do it!

As in exam. I would start with Introduction. Things which might be important in the introduction are:

-there has been alot of debate about use of psychotherapy for elderly.

-few older adult are refered for psychotherapy

- do we have to see the age as hinderness to effective psychotherapy or when we get older, we  have to deal with certain conflicts, fears, and cognitions

- currently, and in the past we realize that, there are propponents and opponents

- how should be a psychtherapy service for older adults ?

I will stop here and wait for further contribution. If it is poor introduction, please let me know!

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I would use article from APT (2004) vol 10, 371-377 as base for essay:

INTRO

- psycological prospective is a key part of the biol/psychol/social triad

-psychol tx had low priority with older people

reasons:    

- ageism

- ?treatability of older people

- not tackled like racism/sexism

- Freud cosidered people > 50 ineducable

- psychoth theory focuses on childhood and ealry aduilt development and neglects later life as a developpmental phase - apart from Erikson's work

- old age psych dominated by biol/organic model and pharmacol tx - 'brain-based' rather than 'psych-based'

although high demand on old age psych services for assement and tx of early dementia

- Murphy (2000) - 87% respondents felt services failed to deliver to older peopleleading to low referral rates (>1% ref from pts aged >75- although 9% of population)

                         - old age psych less likely to refer than gen adult!

- lack of professionals with expertise

HOWEVER is range of psychotherapies available! including:

- CBT- efficacious in dep/anx/problematic behaviours  in dementia

        - may need to adapt fro older people focusing on late events and disability and awareness of

somatisation and phys sx of organic dx

- CAT - exploring pre-exisitng trauma and low self-esteem in producion of anx/dep/self-dest behav. and link past and present

- psychodynamic tx - can deal with feelings of abondonment/narcisstic personalities etc.

                               - as effective as CBT

- IP therapy - especially for abnormal grief rxns, etc.

- Systemic FT - help in comminication and processing diag. of dementia and in unravelling reinforcing factors in dysfunct. somatising and sick-role behaviour

DEVELOPING SERVICES

- remove age barriers! therefore more accesible!

- gen adiult professionals work in tandem with old age

- psychol therapies 'network'within trust

-find out who can do what!

-have a coordinator

-make it multidisiplinary

-supervision of CPNs, SWs, OTs, inpt and day-pt staff by experieced therapists

-establish reg programme of educ, training and sharing ideas and experiences

-audit pracitce, outcomes and clients' views!

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Body:

against:

Freud considered age as 'casteration of youth'. His view has still a lot of influence.

There are also peolple who argue about how it would be possible to do talking therapy with a patient who might have lots of physical problems as a result of aging. They are particularly concerned about sensory deficits as hearing loss.

Cognitive impairment in dementia is another example of how difficult it would be to have effective psychotherapy.

For:

life has many stages and each stage has to be negotiated. Erikson's 8th stage is the last stage and older adults have to deal with dispare.

There are also other conflicts to be dealt with e.g. fear of death and how people differently view death!

In conclusion, some authors believe in timelessness of wishes, conflicts, fears,.....etc.

Talking therapy can be modified for older adults. 50 minutes psychodynamic can be modified to 20 for older adults who have physical problems.

Berievement:

do you deal with this with SSRI or Diazepam.

it has to be psychotherapy!

does any one knows about CBT evidence in Old age?

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Again from APT referenced in my last post:

'in a series of studies with older people in USA by Gallagher-Thompson and colleague, CBT shown to be highly effective with depressed pts in both hosp and comm settings as well as indiv and group formats. A more recent trial (Barrowclough et al 2001) of the effectiveness of CBT v supportive councelling on anxiety sx in older adults showed CBT to be both effective and superior to supportive councelling in terms of imporvement in anx sx and self-rating of anx and dep over a 12 month period'

Get hold of the article as it really answers the question!

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PSYCHOTHERAPY IN OLDAGE SHOULD INCLUDE PSYCHODYNAMIC THERAPY,CBT,REMINISCENCE THERAPY, VALIDARION THERAPY,GROUP THERAPY.AM I RIGHT?

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PSYCHOTHERAPY IN OLDAGE SHOULD INCLUDE PSYCHODYNAMIC THERAPY,CBT,REMINISCENCE THERAPY, VALIDARION THERAPY,GROUP THERAPY.AM I RIGHT?

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Thanks Robbas for CBT. We do good progress in our essay

Cath... for spelling correction, you can use 'Modify'.

You are certainly right about the different types of paychotherapy and this makes the essay comprehensive.

Each one of the above can be discussed. Reality orientation helps by reminding patients about facts and environment. its efficasy has been proven by RCTs.

However, it might remind them about their impairment too. Besides, it might be very frustrating for carers.

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Validation therapy:

we should know that, this is mainly used in dementia.

its creator, Naomi Feil argues, people with dementia retreat into an inner reality based on feeling rather than the intellect. They find the present reality too painful!

The therapist emphasises on the hidden feelings and hence, can communicate.

the problem with this is that, few studies had been assessing its efficasy. in addition, if the therapist focuses too much on the inner world, he/she might fail to identify simple external explanations like pain, hunger, cold, ...etc.

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'Psychotherapy services in oldage'

Introduction

Psychological therapies with older people have traditionaly held a lowly position in old age psychiatry and Psychotherapy with older people have been slow to develop.This is due to

1)ageism --------hindrance in development of psychological expertise and services.

2)predominance of models of psychological development relevant to children and younger adults.

3) dominance of the “organic” model-----biological models of illness and pharmacological treatments are dominated in the managements of dementia mainly because of the demands on old age services

4)Negative stereotypes about the treatability of older people

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Hey guys,

The plans for this topic are great but this question came up in Autumn 2003 so it's quite unlikely to come up again.

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It has been mentioned that a service provision essay is quite possible. Whats the main points therefore to include in such an essay just to give a basic essay plan.

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say for example it is LD

a)Establishing the service principles,such as equality, 'same as you' document ::)

b)Setting the boundary conditions.

c)Assessing population needs, prevalence,comorbidity..

d)Assessing current provision

e)Formulating a strategic plan for a local system of mental health services. whether specialist or generic/epilepsy/gp

f)Implementing the service components at the local level

g)Monitoring and reviewing cycle..clinical ::) governance,audit, critical incident from OTP

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RE: Service provision

Since service provision may be a part of lots of questions such as psychiatric services for prisoners, older adolescents, in early psychosis, in maternal depression, assylum seekers, minorites and so on, it is useful to have an ouline of a plan in stock.

Fistly service organisation has to be distinguished from service delivery. The former involves needs assessment, developing a strategy, resource allocation, funding and so on. It does overlap with service delivery.

The principles of service delivery are best described under certain subheadings under which you can discuss most things you know about services rather than describe each one (e.g. aidit, EBM, clinical giudelines..) separately in a incohent manner.

Every service should have the following features:

- Accessible (crisis intervention, outreach, 24h availability, location of clinics, drop inservices...)

- Comprehensive (provide most services, e.g. psychology, OT, medication, inpt services, daycare, outrech..)

- Multidisiplinary (politically correct!)

- Accountabile ( Clinical guidelines, audit, clinical governance, outcome measurement, evidence based)

- Has meaningful user involvement (again politally correct!))

- Primary,secondary and tirtiary care (called Tiers in Child psychiatry) including case identification and interventions in pr. care.; referral pathways...

You can add a few (but not too many) others.

An important aspect of the answer would be to point out the difficulties in acheiving these aims.This is the critical (as opposed to the factual) part of the answer. For example, in the case of services for prisoners mentioning the difficulties in working with two systems - health and justice - that have their own subcultures and priorities is important. The same principles apply to services for the older adolescents (child psychiatry vs, adult psychiatry) ISuch an approach inevitably raises the standard of the answer to a higher level and begets extra marks. This is what (excuse the sexist remark) sifts the men from the boys.

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for setting up a service, the following needs to be done -

1. making a business plan & appointing a temporary administrator

2. obtain epidemiological data -

local/regional

3.service povision data - available services, pattern of use.etc

4. service utilization data - partcular problems in that area - clinical contacts, events per yr

5. data on outcomes & costs to establish cost effectiveness

6. constitute a planning gr including local reps & expert advisors

7. identify referral & exit mechanisms

8. identify high priority unmet needs

9. define what the services will offer

10. determine the reqd resources & facilities

setting up a service is a likely question!! :-X

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