Competencies for all psychiatrists

As specified for all doctors, plus the following.

• Full biopsychosocial assessment of patients, across the age range, with physical health problems, physical symptoms and mental health symptoms or psychological distress, including:

1. • somatisation/medically unexplained symptoms

2. • adjustment disorder

3. • the interrelationship of depression and anxiety on chronic medical conditions, for example diabetes, asthma, chronic obstructive pulmonary disease.

• Mental state examination in difficult circumstances:

1. • intensive care units

2. • breaking bad news

3. • variable conscious level

4. • lack of privacy.

• Assessment of self-harm across the age range, including children

• To advise competently on the treatment of patients with chronic mental health problems while in the general hospital

• Knowledge of medical and surgical treatments and conditions that have an impact on mental state

• Anxiety, depression and psychotic states in in-patients in medical and surgical settings

• Assessment of general medical and surgical admissions

• Demonstrate knowledge of management of alcohol and substance misuse problems in medical and surgical settings

• Diagnose psychiatric symptoms in the presence of confounding severe physical illness and biological symptoms (e.g. cancer, renal disease, severe trauma)

• Implementation of appropriate management plans, including the use of basic psychological, social and environmental interventions as well as psychotropic use from the British National Formulary

• Use risk assessment to advise management plan

• Review notes and drug cards, including investigations and results

• Awareness of medical, surgical and nursing assessment and management plan in the general hospital and its interaction with mental state

• Assessment of patient in A&E

• Identification of medically unexplained symptoms

• Identification, investigation and advice on the immediate management of delirium

• Basic management of patients with eating disorders in medical and surgical settings

• Criteria for referral and signposting to other mental health services including liaison

• Management of behavioural disturbance in medical and surgical settings including:

1. • assessment

2. • environmental measures

3. • use of appropriate drug treatments

4. • management of delirium tremens

5. • management of other drug withdrawal states.

Biopsychosocial assessment of patients

Carry out a full biopsychosocial assessment of patients, in medical and surgical settings, with physical health problems, physical symptoms and mental health symptoms, impaired mental well-being or psychological distress, including:

1. • systematic documentation of the chronology of the patient's medical history, including use of timelines

2. • working with other clinical members of the liaison team

3. • know the epidemiology and common presentations of psychological problems in medical and surgical settings

4. • use of appropriate questionnaires in medical & surgical settings and recognise their limitations.

Guidance

The trainee should be observed interviewing a patient who is not previously known to them. This competency will usually be assessed using an Assessed Clinical Encounter (ACE); however, subcomponents may be assessed using a mini-ACE (e.g. in the context of a patient review).

Construct

The trainee should be able to take a history in a physically ill patient or in a patient with medically unexplained symptoms, exploring aspects such as previous medical problems, family illness and associated life events or ongoing stressors. Trainees should focus on the importance of timelines and illness chronology, as well as exploring the patient's understanding of their illness. Trainees should utilise the full range of available information, such as patient notes, informants, carers and staff on the ward. They should also be able to suggest, initiate and interpret appropriate investigations, including physical investigations and collecting corroborative information.

Mental state examination

Carry out a basic mental state examination identifying specifically:

• mood

• psychosis

• delirium

• insight

• understanding.

Guidance

This could be done with a new patient or during a ward review, most commonly using a mini-ACE. Several workplace-based assessments will be required to cover the range and depth of psychopathology.

Construct

The trainee should be able fully to differentiate between overvalued ideas, delusions, illusions and hallucinations, and explore the patient's health beliefs, expectations and understanding. The trainee should be able to diagnose delirium (acute confusional state), using appropriate history-taking and examination, including cognitive testing. Trainees should explore all perceptual areas and use appropriate questions in order to determine mood disturbance in physically ill patients.

Capacity

Be able to determine capacity, based on an understanding of the concepts.

INTRODUCTION

Past works on the nature and content of state-building in medieval South India have focused largely on the inscriptional corpus, and a limited set of narrative accounts, in order to support classic formulations of such ideas as the ‘segmentary state’ and ‘ritual kingship’. In this essay, we return to some of the questions raised by our colleagues and predecessors in the field, but with a view to looking at ideological and ideational issues far more than concrete institutional arrangements. We should note at the outset that the specter of a perpetually receding horizon of universal concepts—those that can be used with equal confidence, say, for the analysis of pre-1800 societies in Europe, Asia and Africa—has taken something of a toll in recent decades. Is it at all legitimate to assume that ‘money’ existed in all or even most of these continents? What of the ‘economy’ itself, or even ‘society’?

Biopsychosocial assessment of patients

Carry out a full biopsychosocial assessment of patients, in medical and surgical settings, with physical health problems, physical symptoms and mental health symptoms, impaired mental well-being or psychological distress, including:

Guidance

The trainee should be observed interviewing a patient who is not previously known to them. This competency will usually be assessed using an Assessed Clinical Encounter (ACE); however, subcomponents may be assessed using a mini-ACE (e.g. in the context of a patient review).

Construct

The trainee should be able to take a history in a physically ill patient or in a patient with medically unexplained symptoms, exploring aspects such as previous medical problems, family illness and associated life events or ongoing stressors. Trainees should focus on the importance of timelines and illness chronology, as well as exploring the patient's understanding of their illness. Trainees should utilise the full range of available information, such as patient notes, informants, carers and staff on the ward. They should also be able to suggest, initiate and interpret appropriate investigations, including physical investigations and collecting corroborative information.

Mental state examination

Carry out a basic mental state examination identifying specifically:

Guidance

This could be done with a new patient or during a ward review, most commonly using a mini-ACE. Several workplace-based assessments will be required to cover the range and depth of psychopathology.

Construct

The trainee should be able fully to differentiate between overvalued ideas, delusions, illusions and hallucinations, and explore the patient's health beliefs, expectations and understanding. The trainee should be able to diagnose delirium (acute confusional state), using appropriate historytaking and examination, including cognitive testing. Trainees should explore all perceptual areas and use appropriate questions in order to determine mood disturbance in physically ill patients.

Competencies for all psychiatrists

As specified for all doctors, plus the following.

• Full biopsychosocial assessment of patients, across the age range, with physical health problems, physical symptoms and mental health symptoms or psychological distress, including:

• Mental state examination in difficult circumstances:

• Assessment of self-harm across the age range, including children

• To advise competently on the treatment of patients with chronic mental health problems while in the general hospital

• Knowledge of medical and surgical treatments and conditions that have an impact on mental state

• Anxiety, depression and psychotic states in in-patients in medical and surgical settings

• Assessment of general medical and surgical admissions

• Demonstrate knowledge of management of alcohol and substance misuse problems in medical and surgical settings

• Diagnose psychiatric symptoms in the presence of confounding severe physical illness and biological symptoms (e.g. cancer, renal disease, severe trauma)

• Implementation of appropriate management plans, including the use of basic psychological, social and environmental interventions as well as psychotropic use from the British National Formulary

• Use risk assessment to advise management plan

• Review notes and drug cards, including investigations and results

• Awareness of medical, surgical and nursing assessment and management plan in the general hospital and its interaction with mental state

• Assessment of patient in A'E

• Identification of medically unexplained symptoms

• Identification, investigation and advice on the immediate management of delirium

• Basic management of patients with eating disorders in medical and surgical settings

• Criteria for referral and signposting to other mental health services including liaison

• Management of behavioural disturbance in medical and surgical settings including: