UNIVERSITI KUALA LUMPUR

ROYAL COLLEGE OF MEDICINE, PERAK

Psychiatric Module
Handbook

Year 3
MBBS (UniKL)
2014/2015




Coordinator
Assoc. Prof. Dr. Mohammad bin Abdul Rahman








The following are essential components of the course {i.e. the work of the class} and must be
completed in order for you to proceed to Year 4.

Attend and participate in your Clinical Attachment

Submit your Case Write-ups

Attend and participate in the Introductory, Interactive and Assessment sessions

In order to be adequately prepared for the Year 4 it is recommended that you have
participated the following:

The Introductory Syllabus

The scheduled clinics and bed side teachings

Please be sensible and use the opportunities provided for formative assessment as outlined in this
booklet. If you do not feel that you are progressing satisfactorily then ask for help.


Sections

1. The aim of this handbook

2. The objectives and outcomes of the course

3. The course syllabus

4. The introductory course

5. The interactive week

6. The final week of the attachment

7. Visits Week

8. The reading list

9. Suggestions for self-assessment and help in progressing

10. The assessment system

11. The Mentor Monitoring Activities

12. The Posting Assessment

13. The clinical attachment







Section 1: The aim of this handbook


This handbook provides direction and guidelines to both students and teachers involved in
the Undergraduate Course in Mental health. Hopefully it will help to orientate everyone for
the two weeks.

All correspondence should be addressed to:-

Ms. Nur Syafiqah Aziati Binti Md Radzi (Academic Staff)
Tel: 05 - 2432635 ext. 283
(E-mail: nursyafiqah@unikl.edu.my)

or

Associate Professor Dr. Mohammad Abdul Rahman
Tel: 05 2432635 ext. 167 (E-mail: mohammad@unikl.edu.my)


Academic Office
UniKL Royal College of Medicine Perak
No. 3, Jalan Greentown
30450 Ipoh
Perak Darul Ridzuan
Tel: 05 - 2432635 Fax: 05 - 2432636

























Section 2: The objectives and outcomes of the course


The objectives are:

1. To introduce the students with the fundamentals of Psychiatry.
2. To develop basic clinical skills (history taking and mental status examination,
3. How to approach mentally ill patients

Learning Outcomes are:

At the end of this module, the students should be able to:

1. Able to obtain a comprehensive history with physical and full mental state examination

2. Understand broader classification of Psychiatric illnesses.

3. Become familiar with common Psychiatric conditions

4. Formulate reasonable provisional and differential diagnoses for common psychiatric
conditions.

5. Formulate a rational plan of management for common psychiatric conditions.

6. Demonstrate effective communication skills.







Knowledge objectives
It includes psychiatric history, psychiatric symptomatology, and mental disorders ICD &
DSM classifications

Skills objectives
The skills range from doctor-patient relationship skill of
Active listening
Empathy
Non-judgemental attitude
Verbal and non-verbal communication skills
Opening, controlling and closing an interview









Information gathering skills
Take a history of patients complaints, reason for seeking treatment, patients
explanation of symptoms and ways in which symptom interferes with daily life.
Personal life history
Family history
Collateral information from the family and any relevant third party for his pre-
morbid personality, interpersonal relationship, functional level and patients denial
about his actions towards others.
The familys capacity to contribute to patients care

Information evaluation skills
Select the crucial pieces of salient information for formulating a diagnosis and
discussing for the differential diagnoses
Make a personality assessment
Evaluate the role of personal and social factors in the patients behaviour
Formulate a plan of management which includes also considering a referral to a
specialist or any relevant agencies

Information-giving skills
Pass information to patient and family to promote health e.g. education about
health life-style, diet and exercise.
Explain the implication of diagnosis and the nature of the illness


Reporting skills
Presentation skill verbally or in writing case report to:
Lecturers, Peers, family including relatives of patient.

Attitude objectives

The acquisition of appropriate attitude is of most importance and it would be in the
teacher mind to impart this through out his interaction with students.

Attitude concerned with medical practice in general.

Students should:
Recognize that the profession requires lifelong learning
Show capacity of critical thinking and constructive self-criticism
Be able to tolerate uncertainties and open your mind to be receptive to the views
of others
Be able to work constructively with other professionals.
Be a team player and part of the interdisciplinary team. Try to help other medical
students with their tasks.
Be self-propelled and self-motivated. Volunteer to help in a procedure or in a
difficult task or situation.
Dress in a professional manner and wear a name tab to be easily recognized and
addressed by the hospital staff and security.
Act in a pleasant manner. If there is tension because of disagreements in opinions
diffuse it out with a humour rather than intensifying in challenging a team player.


Respect the field of psychiatry and recognize it as a specialty of medical
profession.
Integrate humanistic, scientific and technological aspect of the knowledge of
psychiatry to apply in the holistic care of a socially under privileged patient.
Recognize the importance of promotion of mental health in the prevention of
psychiatric disorders and its important role in nation building.

Attitude towards patients and their families

Students should:
Respect patients and try to understand their feelings
Address patients and staff in a respectful way.
Recognize the necessity of good doctor-patient relationships
Take responsibility for your patients.
Respect patients right.
Be able to follow the developmental approach in analysing the clinical problems
along the line of stages of the life cycle to have a longitudinal perspective of the
illness
Recognize the importance of the support of the family and the environment at
large in a wider sense.

Section 3: The Course Syllabus

The course syllabus should have been covered by the end of the course

It is strongly suggested that you use this to monitor your progress.

For the purpose of the MBBS degree the following are core areas to study. These are
reflected in the summative examination and examination questions will mirror the
syllabus. Common themes to be considered are divided into the following areas:

1. Communicating with patients
2. Signs and symptoms of psychiatric illness
3. Common clinical conditions and their assessment and management

Area 1: Communicating with patients

Understanding human behavioural and their perception about their illness.
Interview skills
Dynamic aspects of doctor-patient interactions
Giving information to patients -Psychoeducation

Comment: You should by now have mastered some basic skills in communication which
are to be developed further. The aim of this area is to get you to think about where your
patients are coming from and why they may be presenting in the way that they do. By
understanding some principles of human nature you should be in a better position to be
effectively communicating with your patients. You should develop your understanding of
the needs of your patients and the way in which they may express them.



Area 2: Signs and symptoms of psychiatric illness

Recognising and eliciting psychiatric symptoms
Understanding the significance of each of the symptoms



Glossary

Affect: Observed external expression of emotion. A pattern of observable
behaviour that is the expression of a subjectively experienced feeling state.
Agitation: Excessive motor activity with a feeling of inner tension
Agoraphobia: Literally a fear of the market place. It may include a fear of
crowds, open and closed spaces and travelling by public transport.
Alexithymia: Difficulty in being aware of or describing ones emotion.
Ambivalence: The simultaneous presence of opposing impulses towards the same
thing

Amnesia: The inability to recall past experiences.
Amok: Seen in South-east Asia. There is an outburst of aggressive behaviour in
which the patient runs amoke after a depressive episode.
Anhedonia: loss of interest in, and withdrawal from, all regular and pleasurable
activities.
Apathy: Detachment or indifference and a loss of emotional tone
Attention: The ability to focus on an activity
Belle indifference: the patient shows a bland emotional indifference to one
situation; emotion associated with an event is dissociated.
Bereavement literally means the state of being deprived of someone by death; it
can also result from other losses.
Blunted affect: A reduction in emotional expression.
Capgras syndrome: A person who is familiar to the patient is believed to be
replaced by a double.
Catatonia: It literally means extreme muscular tone or rigidity; however, it
commonly describe s any excessive or decreased motor activity that is apparently
purposeless. Note that catatonic symptoms are not diagnostic of schizophrenia;
they may also be caused by brain disease, metabolic abnormalities, and
psychoactive substances and can also occur in mood disorders.
Circumstantiality: Slowed thinking incorporating unnecessary trivial details. The
goal of thought is finally, but slowly, reached.
Clang association: Speech in which words are chosen because of their sounds
rather than their meanings. It includes rhyming and punning.
Clouding of consciousness: Drowsiness and not reacting completely to stimuli
due to disturbance of attention, concentration and memory, orientation and
thinking.
Compulsions or compulsive rituals: Repetitive, stereotyped, seemingly
purposeful behavior associated with obsessional thoughts e.g. excessive repetition
of checking, counting and cleaning rituals.
Concentration: The ability to think about something carefully or for a long time:
a process in which you put a lot of attention, energy etc into a particular activity.


Concrete thinking: A lack of abstract thinking, normal in childhood, and
occurring in adults with organic brain disease or schizophrenia.
Confabulation: Gaps in memory are unconsciously filled up with false
memeories.
Cotards syndrome: A nihilistic delusional disorder in which, for example, the
patient believes their money, friends or body parts do not exist. Nihilism is
extreme. Some patients may complain that their bowels have been destroyed so
that they will never pass faces again. Still others may believe that their whole
family had ceased to exist and that they themselves are dead.
Counter transference: the therapists emotions and attitudes to the patient.
Couvade syndrome: A hysterical disorder in which a prospective Sfather
develops symptoms characteristic of pregnancy.
Couture-bound syndromes: certain pattern of unusual behavior, which may
reflect psychological mechanism of dissociation, occurring in non-western
countries.
Delirium: a global impairment in consciousness with disorientation to time and
place, which typically fluctuates. In which the patient is bewildered and restless
with associated with fear and hallucinations.
Delusion: A false and fixed personal belief firmly held out of proportion to his or
her cultural and educational background. It is unshakable or affected by rational
argument or evidence to contrary.
Delusion of doubles: The delusional belief that a person known to the patient has
been replaced by a double.
Delusion of infidelity (morbid/pathological jealousy, delusional jealousy,
Orthello syndrome): The delusional belief that one spouse or lover is being
unfaithful.
Delusion of reference: the behaviour of others, objects, and events, e.g. television
broadcasts or TV personalities, is believed to refer to oneself in particular; when
similar thoughts are held with less than delusional intensity they are ideas of
reference.
Delusional perception: A new and delusional significance is attached to a
familiar real perception without any logical reason.
Dementia: A global organic impairment of intellectual functioning without
impairment of consciousness.
Depersonalization: One feels that one altered or not real in some way; experience
of detachment from self as if looking at him or herself from a mirror.
Depersonalization and de-realization are variants of dissociation that are not
necessarily pathological.
De-realization: the term used to describe the experience when external reality or
environment seems or unreal. Depersonalization and de-realization may be caused
by psychiatric illness (e.g. depression, anxiety, schizophrenia) physical illness
(e.g. epilepsy), psychosocial stress and substance abuse.
Dissociation: The event where a disruption occurs in the usually integrated
functions of consciousness, memory, identity, perception and movement. There is
some evidence of psychological causation ( stressful events or disturbed
relationships)
Distractibility: The attention is frequently drawn to irrelevant external stimuli.
Dysphoria; An unpleasant mood.
Dysthymia: A chronic depression of mood for more than two years which does
not fulfill the criteria for recurrent depressive disorder. Most of the time the
patient feel tired and depressed.


Echolalia: The automatic imitation of anothers speech.
Echopraxia: The automatic imitation of anothers movement.
Ecstacy: A feeling of extreme happiness.
Elevated mood: A mood more cheerful than normal.
Erotomania: the delusional belief that another person is deeply in love with one.
Euphoric mood: An exaggerated feeling of wellbeing. It is pathological.
Expansive mood: Feelings are expressed without restraint.
Extracampine hallucination: The hallucination occurs outsides sensory field.
Flat affect: There is no emotional expression at all and the patient typically has an
immobile face and monotonous voice.
Flight of ideas: The speech consists of a stream of accelerated thoughts and
connected concepts, with abrupt changes from one topic to another with no central
direction. The link between concepts can be as in normal communication where
one idea follows directly on from the next; through a pun or clang association; or
through some vague idea which is not part of the original goal of speech.. as
patient becomes increasingly manic. Their associations tend to become loosen as
they find it increasingly difficult to link their thoughts. Eventually they start
approaching the incoherent thoughts of schizophrenic patient.
Formal thought disorder: see loosening of association
Formication: A somatic hallucination in which insects are felt to be crawling
under ones skin.
Fregoli syndrome: The patient believes that a familiar person, who is often
believed to be his persecutor, has take on different appearances.
Fugue: A state of wandering from usual surroundings and loss of memory.
Functional hallucination: This occurs when a normal sensory stimulus is
required to precipitate a hallucination of the same sensory modality, e.g. voices
that are only heard when the doorbell rings.
Grief: The emotional expressions that accompany bereavement.
Hallucination: A false sensory perception without real external stimuli.
Hallucinosis: Hallucinations (usually auditory) occur in clear consciousness e.g.
in alcoholism.
Hypnagogic hallucination: Pseudo-hallucination occurring in the process of
falling asleep. It occurs in normal people.
Hypnopompic hallucination: Pseudo-hallucination occurring while waking from
sleep. It occurs in normal people.
Hypochondriaisi: A preoccupation with a fear of having a serious physical
illness, not based on real organic pathology.
Ideas of reference: see delusion of reference.
Illness behavior: Actions of people who see themselves as ill, for the purpose of
defining their health status and finding a remedy.
Illusion: A misperception of a real external stimulus.
Inappropriate affect: An affect that is inappropriate to the circumstances, for
example appearing cheerful immediately following the death of a loved one.
Induced psychosis (folie a deux): folie a deux(pronounced as desk) is shared by
two people who are closely related emotionally.
Koro: Seen in south East Asia, particularly Malaysians of Chinese extraction.
Affected men have an overwhelming fear that their penis is retracting into the
abdomen and that death will then occur.
Labile affect: the affect repeatedly and rapidly shifts.
Latah: Seen in Fareast and North Africa. It is a hysterical state in which patients
exhibit echolalia, echopraxia and automatic obedience..


Made actions (made acts, made feelings, made impulses): The delusional belief
that ones free will has been removed and an external agency is controlling ones
actions, feelings and impulses.
Loosening of associations (derailment): The patients train of thought shifts
suddenly from one very loosely connected or unrelated ideas to the next. It reflects
deterioration in the capacity to think formally or logically. Commonly the
schizophrenic patient uses a private logic, with over personalised concrete
symbols. Conceptual boundaries are blurred and thinking patterns are
metaphorical and idiosyncratic. Thus, to the observer, when such thoughts are
expressed, they appear on the surface to be diffuse or bizarre. Some psychiatrists
use the term formal thought disorder synonymously.
Mannerisms: repeated involuntary movements that appear to be goal directed.
Mood: A pervasive and sustained emotion that colours the persons perception of
the world.
Mutism: total loss of speech
Negativism: A motiveless resistance to commands and attempts to be moved.
Neologism: A word newly made up, or an every day word used in a special way
or a new meaning for the patient.


Nihilistic delusion: The delusional belief that others, oneself, or the world do nor
exist or are about to cease to exist.
Obsessions: repetitive senseless intrusive and unwelcome thoughts, recognized by
the patient as his own thoughts but as irrational or ridiculous which, at least
initially are unsuccessfully resisted.
Overvalued ideas: An unreasonable and sustained intense preoccupation with
less delusional intensity.
Para-suicide (deliberate self-harm): Any act deliberately undertaken by a
patient who mimics the act of suicide, which does not results in a fatal outcome.
Passing by the point: The answers to questions, though obviously wrong, show
that the questions have been understood. It is seen in Ganser syndrome, first
describe in criminals awaiting trials.
Passivity phenomenon: the delusional belief that an external agency is
controlling aspects of the self which are normally entirely under ones own
control (e.g. alienation of thought. Made feelings. Made impulses, made actions,
somatic passivity)
Perseveration (of speech and movement): Mental operations carry on beyond
the point at which they are appropriate.
Posturing: An inappropriate or bizarre bodily posture is adopted continuously
over a long period.
Poverty of speech: Very reduce speech, sometimes with monosyllabic answers to
questions.
Pressure of speech: Increased quantity and rate of speech, which is difficult to
interrupt.
Primary delusion: A delusion arising fully formed without any discernible
connection with previous events. It may be preceded by a delusional mood in
which there is awareness of something unusual and threatening occurring.
Pseudo-dementia: Clinically similar to dementia, but has a non-organic cause
e.g. depression.


Schneiderian first-rank symptoms: In the absence of organic cerebral pathology
the presence of any of Schneiders first-rank symptoms is indicative of, though
not pathognomonic of, schizophrenia.
Selective inattention: Anxiety-provoking stimuli are blocked out.
Sick-role behaviour: Activity by individuals who consider themselves as ill for the
purpose of getting well.
Somatic passivity: the delusional belief that one is a passive recipient of bodily
sensations from an external agency.
Somnambulism: Sleep walking.
Somnolence: Abnormal drowsiness.
Stereotypy: A repeated regularly fixed pattern of movement or speech that is not
goal directed.
Stupor: A clinical presentation of akinesis (lack of voluntary movement), mutism
and extreme unresponsiveness in an otherwise alert patient staring blankly and
taking nothing in.
Systematized delusion: A group of delusions united by a single theme or a
delusion, with multiple elaborations.
Tactile hallucinations: Superficial somatic hallucinations
Talking past the point: The point of what is being said is never quite reached.


Thought alienation: It includes thought broadcasting, thought insertion and
thought withdrawal
Thought broadcasting (thought diffusion): The delusional belief that ones
thoughts are being read by others, as if they were broad cast.
Thought insertion: The delusional belief that thoughts are being put into ones
mind by an external agency.
Thought withdrawal: The delusional belief that thoughts are removed from ones
mind by an external agency.
Thought blocking: A sudden interruption in the train of thought occurs, leaving a
blank, after which what was said cannot be recalled.
Trailing phenomenon: Moving objects are seen as a series of discrete
discontinuous images. It is associated with hallucinogens.
Transference: The unconscious process in which emotions and attitudes
experienced in childhood are transferred to the therapist.
Unit of alcohol: the mass of alcohol contained in a standard measure of spirits, in
a standard glass of table wine, and in a pint of beer. It is around 8-10 g.
Visceral hallucinations: Somatic hallucinations of deep sensations.
Waxy flexibility: When the part of the body is moved it gives a feeling of plastic
resistance as if bending a soft wax rod. The bodily part remains moulded in a new
position.
Windigo: Seen in north American Indian tribes with a depressive disorder in
which patients believe they have mutated in to cannibalistic monsters.
Word salad (schizophasia or speech confusion): The speech is an incoherent
and incomprehensible mix of words and phrases.








Area 3: Common clinical conditions and their assessment and management

The ability to take a history, perform mental state examination (MSE) and physical
examination and formulate for a provisional diagnosis. Please see the appendices in the
guide for history-taking, sample questions of MSE and a flow chart for the algorithm of
the diagnosis of mental disorders.
Discussion for differential diagnoses
Relevant investigations that a house officer would call for and the interpretation of results
Social and collateral information from a third party (if applicable)
The aetiology of the mental illness
The immediate management of a patient, short term and long term therapy including
follow-ups.




General psychiatric assessment

Patient interviewing is a core skill in medicine. Despite technical advances, the bed rock of
diagnosis and treatment continues to be communication. A good interviewing is essential to
both establishing an accurate diagnosis and gaining insight into the personality and coping
style of the patient.
Effective interviewing is essential to effective treatment. The patient must communicate
personal concerns about disturbed mental functioning through language. The psychiatric
interview may require multiple evaluations over time.
The interviewer must be sensitive to the importance of empathy, respect and trust in order to
develop a good therapeutic alliance with the patient. The interviewer should assume that
seeking psychiatric help is a distressing and conflict-laden event for all patients. The
interview can be therapeutic in its own right.

Tips for interviewing techniques

1. Pay attention to patients comfort
2. Remember the basics: understanding the patient is more important than rigid
adherence to classic technique. An open-ended question is usually preferable and
should precede the focussed question. Dont ask leading questions calling for negative
answers. Avoid being judgmental. Do not impose your values upon the patient.
3. Dont be afraid to be yourself
4. Encourage the expression of feelings
5. Consider patients illness in developmental terms
6. Remember that patient is more scared than you are
7. When the interview bogs down, try repeating the patients last words
8. Go ahead and ask the unaskable especially in cases of suicidality, sexual concerns,
and drug abuse
9. Learn to be quiet: when patients come to a point in their story and are about to disclose
something uncomfortable, they will fall silent, be silent too. It may be useful to say
something neutral Yes, go on .. I am listening
10. Pay attention to body language with appropriate gestures.
11. Start broadly and then focus in

Teaching

Teaching during this 2 weeks clerkship will involve the following:

Psychiatric examination by interviewing with patient including physical examination.
Theoretical aspects of psychological medicine especially psychopathology and
symptomatology / phenomenology)

Teaching sessions will take place during small group teaching of the following:

Seminar
Case presentations among inpatients and outpatients (bed-side teaching)
Case discussion with the student on call and other members of the group.
Video recording and replaying of the students interviewing with the patient
Case reviews in wards and clinics
.

Presentation at Seminars

Two students shall normally present the topic at a seminar and the references obtained from
the lecturer at least two days before the seminar. These references shall be distributed to all
students in the group in advance as they are expected to read the text before the seminar

Case Presentations:

For case presentation, each student shall present the case with psychological problems from
ward and/or clinic
The history and mental state examination
The physical examination and investigations, and provision with provisional
diagnosis, discussion for differential diagnoses

Students will be expected to interview relatives, employers, friends or any care-giver as
required btaining information needed for the diagnosis and further management. Students can
call relatives for interviews if they do not turn up on routine visits. Please call relatives
through ward clerical or nursing staff well ahead of the case presentations, to get additional
information.

Video-taping Interview Technique Sessions

The student is expected to videotape a live interview with a selected patient on a selected
topic e.g. history of present illness.
Make sure that the informed consent is obtained from the patient and family. A service
request form needs to be filled up by the student or Puan Nora to inform earlier the camera
man from the IT Unit. To ensure the quality of the recording please arrange to bring the
patient to a Video Room or seminar room if an appropriate room is not available in the ward.

Tutorials with lecturers

A list of lecturers and students under them will be given on the first day of the posting.
Students will meet their academic mentor for tutorials at least once a week or get an
opportunity to conduct after case discussion sessions.
The lecturers are expected to use the learning management system (LMS) of the college
website for the tutorial with questions and answers related to the topics conducted by them.
The students can have access and answer the questions within limited time frame.


Case reviews
For some chronic cases with diagnostic uncertainty or changes of diagnoses at various
admissions students might be interested to make a chart review with old case notes. They can
arrange a session for discussion with their mentor lecturer assigned or the clinician in charge
of the case for academic interest.








Section 4: The Introductory Week 1

These include an introduction to psychiatry, explanation of the course, and the assessment
procedure. Each learning session is designed to build up your knowledge base and
understanding of psychiatry. The sessions are presented in a logical sequence and each
should relate to the previous sessions. It is important therefore to participate in the course
fully to get the most out of it. The timetable is given and the sessions are then outlined. By
the end of the introductory sessions, each student should be adequately prepared to begin their
clinical attachment in Year 3 and later as preparation for the Year 4.

Section 5: The Interactive Week 2

Outline of the learning sessions for the interactive week

Introductory session

The programme for the week will be outlined in the schedule.

Expectations for the week, the facilities and methods of fulfilling these will be outlined. By
the end of the session you should:-

have a clear understanding of what the objectives and outcomes of the week are
Know the practical ways in which these objectives and outcomes can be fulfilled.

The following will be initiated:-

Dynamic aspects of behaviour

The aim of this session will be to analyse the doctor/patient relationship at the unconscious
level, so as to provide students with an awareness and recognition of dynamic defences used
by both doctors and patients. The lecture on Psychological Defence Mechanism had been
delivered in Year 3 in order to enable you to apply in interviewing the patients during your
posting in other disciplines. You can learn this while you sit in at the clinic or ward rounds for
hand on experience.

Managing aggressive people during psychiatric emergencies

This session will look at behavioural, cognitive and dynamic aspects of aggression.
At the end of the session students should: -

know how to deal with aggressive people/patients in a practical manner
be able to recognise the levels of anger in people
be able to recognise situations which are becoming dangerous and to know what to do
immediately.
be able to diffuse anger in people




Interview skills and hand-on clinical experience in clinical challenges

This can be achieved during on-call duties, ward rounds and while sitting-in at the clinics to
interview the patient together with a clinician. Interviewing skills can also be learned from the
video. Students will get an insight into the following:
a clear understanding of how the interactive challenge will be run
a knowledge of the four possible scenarios; anxiety, depression with suicidal tendency,
psychosis with aggressive behaviour and manic episode, which may be tested
an idea of how they are doing at this stage with their skills
a better interviewing technique than the one when they started
some ideas on how they can improve their interviewing skills


Section 6: The Formative Assessment at the end of second week

This week will take place the formative assessment which includes:
Written exam with Modified Essay Questions MEQs/Short Answer Questions (SAQs) and
OSCE

The feedback session will allow students to give verbal feedback about the course in general
and about their clinical attachments in particular. Students will be given the opportunity to
make evaluation using written comments if they wish to do so. Students will also be given
feedback on how they have done on the course.

Section 7: Visits Week

Visits Week has been arranged together with the interactive weeks to save your time. You
have an opportunity to visit Hospital Bahagia, the biggest mental institution in Malaysia. Half
day session is allocated for better coverage of experiences in various sections. You have to
report to Dr. Hjh.Rabaiah Mohd Salleh who will do a short briefing and arrange for the
sessions in clinic setting.


















Section 8 The Reading List



The most important part of a students time in this placement is spent interviewing
patients and gaining clinical experience.
To learn factual theoretical knowledge about psychiatry the following books should prove
helpful for the under graduate level.
No one book is recommended and nor does one book contain the entire syllabus.
I t has been noted that there are one or two errors in some of the books - nothing is
perfect! The errors are not of any serious nature.


(Students are expected to buy one of these books which can
be found in the library of RCMP)

Text-books

The Oxford Textbook of Psychiatry - Gelder, Gath and Mayou, Cowen 4th Ed - Oxford
University Press, 2001

Synopsis of Psychiatry - Kaplan and Sadock, 9th Ed - William and Wilkins, 2003

Reference books

Companion to Psychiatric Studies - Johnstone, Freeman and Zealley - Churchill
Livingstone, 1993

Organic Psychiatry - Lishman ; 3nd Ed - Blackwell Science, 1998

I.C.D. 10. - World Health Organisation, 1992

Diagnostic and Statistical manual of Mental Disorders (DSM-IV) Fourth edition
American Psychiatric Association 1994

Current Diagnosis & Treatment in Psychiatry, Ebert, Loosen, Nurcombe; International
Edition 2000

Review of General Psychiatry, Goldman; fifth edition; Mcgraw-Hill 2000

Handbook of General Hospital Psychiatry, Stern, Fricchione,
Cassem,Jellinek,Rosenbaum; fifth edition; Mosby 2004

Management of Mental Disorders Volume 1 & 2; Second Edition
World Health Organization Collaborating Centre for Mental Health and Substance Abuse







Textbooks recommended by fellow students.
(It would be helpful to have regular access to one of these)

Textbook of Psychiatry - Puri, Laking and Treasaden - Churchill Livingstone, 1999

Psychiatry in medical practice - Goldberg; Benjamin and Creed, 2nd Ed
- Routledge, 1999
-
Psychiatry Sanders Pocket Essentials Puri

FIRST AID for the PSYCHIATRY Clerkship, Latha G Stead, S. Mathew Stead, Mathew
S. Kaufman

Psychiatric Secrets, Jacobson; 2
nd
edition; Hanley & Belfus, INC./Philadelphia; 2001



Section 9: Suggestions for self-assessment and help in progressing


The introductory days should start to develop your interview skills for taking a history and
performing a mental state examination. Use this to form ideas to work from.

Check the list given in the mentors section. Make sure that you are receiving the
appropriate help in all aspects of your mental health attachment.

Feedback on progress should include presenting and discussing cases with your team
psychiatrists.

The Outline Case Summaries should be discussed and wherever possible presented to your
clinical mentor.

Journal clubs and Continuing Medical Education (CME) presentations at RCMP, Hospital
Raja Permaisuri Bainun and Ward 24 are to update doctors and to present a forum for
discussion. Students will be benefitted in attending these CME sessions.

Shadow your ward doctor so that you can see their duties and practice. Particularly ask to
help with emergency admissions or new referrals from Polyclinics and General Wards.

During the final week OSCE questions, in exam form, discussion for MEQs will take
place. A 20% marks obtained will be carried over as a Continuous Assessment.

Topics do not need to be known in great detail, but safety aspects and emergency situations
are very important and should be known well.

The course syllabus is a guide to study. Students may well wish to read more widely.


If you are experiencing any difficulties during this posting, please contact Associate
Professor Dr.Esther/Associate Professor Dr.Mohammad Abdul Rahman and Dr Wan
Norhaida Bt Wan Abdullah and Ms Nur Syafiqah. Please make contact early rather
than late.


Section 10: The Assessment System

There are two aspects to assessment:-

(a) Formative assessment - this refers to forms of testing which will help you to improve
your performance and a certain percentage of marks will count towards your final assessment.

(b) Summative assessment - this refers to the end of year assessment which will decide on
whether you have reached a satisfactory standard in Year 3 in order to progress to the next
year of the course.


Assessment Methods

Modified Essay Questions (MEQs)/Short Answer Questions (SAQs)

Objective structured clinical examination (OSCE) for clinical Skills-interviewing skills-
information gathering and information giving, interpreting symptoms, and evaluating the
clinical condition. Professional manners and attitude towards the patients are also assesed.

Documents to be handed in at the end of the posting:-
* 1 Case Write-Up
* Seminar/Case Presentation Log Book
* Report of Clinical Attachment (Mental Health) J oint Assessment Book

Notes
1. Formative Assessment will be done at the end of week 2.
2. 1 case write-up will have to be handed in to the teachers on the Friday of week 2.
3. Punctuality is assessed under attitude. Absence from teaching sessions and
practical sessions without valid reasons is intolerable. We practice zero tolerance
for absenteeism.
4. 80% attendance at all sessions is a requirement under University rules for
admission to summative assessment. If agreed by the authority extra attachment to
the clinical sessions will be required to fill the gap.
5. Medical Leave must be supported by doctors certificate.










The Summative Assessment

The final assessment for record purposes will take place at the end of year. It will take the
form of an OSCE, MEQ and EMQ. The mental health input will appear based upon your
mental health attachment and will test the course syllabus as outlined in this handbook.

As part of the OSCE, there will be interactive stations and you will be tested on your ability to
conduct an interview with a person who has been trained to act the role of a patient (simulated
patient). You will be given two minutes for reading a short scenario, informing you of what is
required of you, prior to the interaction with the patient which will be allowed for six minutes.

Video-clips recording the interviewing with a patient can be used for OSCE static stations.

(Mark schemes will be made available to you in the interactive week during your interview
skills practice session).

Entry to the End of Year 3 Examination

This will be dependent upon satisfactory attendance and completion of the work of the class.
The work of the class is that students should have completed the formative assessment aspects
of the course which include: -

Attendance and participation on their clinical
1 Case Write-Up
Completion of the Seminar/Case Presentation Log Book
Report of Clinical Attachment (Mental Health) Joint Assessment Book
Attendance and participation in the Introductory, Interactive, Visits and Assessment Weeks

Section 11: Clinical Tutors' Meetings

Venue: Faculty of Medicine
Day and Time: Friday, 3pm
Duration: 2 hours
Participants: Lecturer with representative of Medical Students

NB: This meeting can be arranged between the Lecturer/Representative with the
Medical Students if you are facing any difficulties during the posting. Kindly consult
with Ms. Nora if you wish to discuss regarding this matter.

Section 12: The Mentor Monitoring Activities
Mentors should check the logbook and discuss with their students before they leave
the clinical posting.

Any problems with student attendance or participation should be reported as early as
possible so that it can be addressed.


At the end of the posting, students should also submit Seminar/Case Presentation
Logbook and 1 Case Write-Up.


Section 13: Clinical Attachment

During this time, students should gain experience of:-

Clinical clerkship in wards, including all aspects of patient management.

Assessing and managing Out-patients

Presenting cases with summary, formulating for diagnosis and differential diagnoses
followed by discussion of management plan. A variety of cases with different diagnoses
should be seen as many as possible. The students are encouraged to take initiatives in
clerking interesting cases at the Hospital Bahagia and discussed with the lecturers
concerned.

A weekly Tutorial where students can discuss specific aspects of cases seen and also
discuss points of interest rose from their own reading.

Contact No.

No. Lecturer

Hosp./ Department Contact No.
1. Associate Professor Dr Mohammad
Abdul Rahman
UniKL RCMP 05-2432635 ext: 278
H/P: 017-6338359
2. Associate Professor Dr Esther
Gunaselli
UniKL RCMP 05-2432635 ext: 276
H/P: 013-5201220
3. Dr Wan Norhaida bt Wan Abdullah UniKL RCMP 05-2432635 ext: 164
H/P: 012-9582665
4. Dr Tan Chea Loon UniKL RCMP 05-2432635
H/P: 017-5352048
5. Dr Rajinder Singh Psychiatry Clinic
Hospital Ipoh
05-5222394
H/P: 013-5300002
6. Dato Dr N. Raman Psychiatry Clinic
Hospital Ipoh
05-5222394 /
H/P: 012-5696041
7. Dr Rabaiah Salleh Hospital Bahagia
Ulu Kinta
05-5332333 /
H/P: 012-5696041
8. Dato Dr.Suarn Singh Director, Hospital
Bahagia
05-5332333
9. Dr Cheah Yee Chuang Hospital Bahagia
Ulu Kinta
05-5332333

10. Dr Satnam Kaur Hospital Bahagia
Ulu Kinta
05-5332333
11. Dr Ong Lieh Yam Hospital Bahagia
Ulu Kinta
05-5332333