Psych formu transcript — SMP305 lecture transcript

yeah for Let's talk about that. Are. it just being. Something. Yeah, it's like, but it must be. Oh yeah, I would see that it must be wrong. Well, I guess it could be. It. Very much. At least 3. That's all I I like. I Is so. So. Although. Good. Yes, but I. It. Yeah I it's gonna have to be. I like when it's something or like. Just keep in mind Let's. Oh straight. So. Which one's. But Yeah, it's a little better. I don't really the 65 outside. which. Oh. It. Yeah. I do not want to be a specialist. in I don't know if that exists. Yeah I That was not. questions. Yeah, let's see. Yeah. Oh Uh, uh. Just Total disaster. But I just so. I was with my best. I was I was. I it's someone else Like. I I think I need to. Yeah. It. Good because it's quite. I. Yeah. I feel like. Oh. And we talk about. And I'll Right. I need my I I know I know. I like that. I know. You say your. I I. OK. I think. I. you. I think. Yeah.

Right guys, we'll crack on. We've got, we'll just do the bingo and then we've got formulation to plough through and then you can have a long lunch before you've got your coms skills later. So you should all have a little bingo card in front of you. I. Hope everyone has everyone played bingo before? Yeah, so I'll read out, so I'm gonna read out the descriptions of what um the phrase will mean. Have you, is if everyone's, if anyone's not got one, let me know. Um, but I'll read out a description and you've got to cross out what I am describing, OK? And We're just gonna play for a full house, so that means you have to tick all of them off on your thing, OK? And you can win. I have some. This is the only thing I had some salted caramel lintt balls. OK. There is a chance that um 2 people could win because I think there's like it only allowed me to do 33, so um a few people have got the same card but ah well, hey.

Right, so. What shall we start with? Repeated intrusive, distressing thoughts or images. Um, A sensory experience in the absence of an external stimulus. So in the absence of an external stimulus. A repetition of a particular response. A delusion of being dead or decaying. Believing that the world around you is not real. Yes. Mm. The immediate and observable expression of emotion. A misinterpretation of an external stimulus. So when there is a stimulus there. A sudden interruption of a person's train of thought. Including excess and detailed information, but eventually returning to the point. Believing that others can know your thoughts without you voicing them. An action that is done to reduce anxiety from obsessions. False beliefs of an inflated sense of self-worth, power, knowledge or identity. Delusional beliefs of unfaithfulness in a relationship. The state of mind or feeling over a period of time. A believing er a belief of yourself not being, not feeling real. Or feeling different, feeling strange? Delusion that a spouse or a family member has been replaced by an imposter. Someone must be closed now, we've got like.

Have you got a few left. Um, so someone's a bit more difficult, but so believing a person is in love with them, so a delusional belief that someone else is in love with them, usually it's a stranger or a celebrity, someone that's got a higher power than them. A condition where two people hold the same delusion. OK. Anybody yet? Yeah, bingo, well done. You win some salted caramel. I'm not gonna check it. Actually. C. I Can you tell us which one is best? Yeah, not in the right order, not in the right order, no, um, so. We had done so derealization, which was believing that the world was not real, grandiose delusion, so the false belief and inflated sense of self, uh, self-worth power knowledge erotomania. So that is the, uh, delusional belief that someone else is with you. So, um, Othello syndrome is the delusional belief of faithfulness, um, Cabrass. Is um the delusional belief that a family member or spouse has been replaced by an impostor, um, Cotards is the delusional belief of being dead or that part of you is rotting following a de is when two people hold the same delusion assets, so the immediate and observable expression of emotion, the mood.

The state of mind or feeling over time circumstantiality, so excess or detailed information, but getting back to the point thought blocking so sudden sudden interruption of a person's train of thought, severation, so the repetition of a response compulsion actually to reduce anxiety from session. Obsession is the repeated intrusive, distressing thoughts or images. Thought broadcasts at least when you others can know your thoughts without saying them. Hallucinations are the sensory experiences the absence of an external stimulus. Illusion, the misinterpretation of an external stimulus, and then depersonalization, so believing it yourself is not real for you. Right, it's good, so. Hopefully that's just a bit more of a way of getting it into your mind. Or going over it in a. Different manner, so the last thing we've got to do before you can leave for a while is just run through formulation. So formulation is a method that we use so we don't always jump into diagnosing someone with a specific disorder um and if we do we know that not everybody's problems are always related to that disorder. We like to think of things a bit more holistically, look at what has led to this situation and what might be playing into it and um. What, think about the ways that we can help it, prevent it from happening again um or. Yeah, help the situation. So a formulation is just the way we look at it from different aspects. Um, yeah, so summary of the origins and nature of the problem, um, and what steps should be done to improve the nature. So there are lots of different methods of formulation, but the one that's commonly used is the five P's. So looking at kind of the presenting problem, predisposing factors, precipitating factors, perpetuating factors and protective factors. So lots of big words but we'll go through them. So I don't know why there's a picture of Joey on here, but Pranav obviously was watching Friends at the time. So presenting complaint, that's what we get from our history, we've already done that, so that's the first P, what is going on right now. Second P is predisposing factors. So what led up or what has um. What has happened in the past that has led or gone into this happening, so thinking about drugs and alcohol, all things that make you more vulnerable to getting a mental health disorder. So drugs and alcohol we know predispose you to getting lots of mental health conditions. Genetic vulnerabilities obviously as with all most conditions there are genetic um parts. We don't fully understand the genetics of all mental health disorders, but there's lots of evidence to suggest um things like schizophrenia, bipolar, and in some cases like depression as well, um, and addictions are very genetically linked. Um, so physical health problems as well, um, trauma, especially lots of childhood trauma, um, that affects your attachment and the way that you view and respond to the world and social isolation. So these are things that are predisposing that person to become mentally unwell. Precipitating factors are things that happened. Maybe just before someone became unwell so again not sure why Joey isn't involved in all these slides, these are Pranav slides um. So we've got the predisposing things that someone might have but also might never become mentally unwell, so lots of us might have predisposing factors for lots of illnesses but we might never get them. Often we think of it as a two hip hypothesis, so you have to have the predisposing things and then you have to have another trigger or a precipitating factor to become unwell. So what sort of things then could be precipitating factors? So things like a major life. Event so a relationship breakdown, a bereavement, losing your job, um, problems with housing, a trauma of any sort that might be um a change in your physical health, in your functioning, in your identity. Um, which could be a loss of any kind of role, um, we see that a bit similar to a bereavement really. Um, and again drugs and alcohol, so drugs and alcohol are basically apart from protective factors are fit in most of these peas because they can predispose you. They can be a precipitating factor if you have say had a sudden increase in the amount of alcohol or drugs that you are using. And they can also be a perpetuating factor as well, so we've got predisposing, so what makes you more likely to become unwell in the future, precipitating what has happened kind of directly before, what's been the trigger for you becoming unwell this time, Perpetuating, so what is keeping you unwell, so what is continuing this cycle? Um, and this is thinking about kind of. What that person's life look like looks like right now, so what what is their lifestyle? Is that conducive to getting them mentally well or is it continuing in that cycle of maybe depression, um. Low motivation, stuff like that, isolation, financial difficulties, poor coping strategies, um, so not having healthy ways of dealing with emotions, again drugs and alcohol, um having a chaotic lifestyle um and not engaging with the support or medication from er teams. So these are things that are going to continue the illness. Then protective factors are things that help to get you better. So having good social support and having stability, whether that be financially, housing, in a job, um having good coping mechanisms and that is something that we do a lot of work with people in the community mental health team about is um developing healthy coping mechanisms, having a out outlet, so having a hobby, having something that keeps you er mentally well. Um, and engaging with the team, engaging with treatment as well. So what we can then tend to do is we can use another model of formulation which you'll have used all the time throughout your medical school career so far, the biopsychosocial model of formulation. Um, so we can split that up into those categories as well, so the biological factors like your genetics, your physical health conditions, um, psychological factors, what's happened with your mental health in the past, um, what are your current symptoms, what are your beliefs around being, um, unwell, what are your coping mechanisms, things like that, and then social factors, your support, your housing, your finances, um. And all of those things. And then we can split it into both. So Not, yeah, I'm not entirely sure what is. But if we think what can fall into both, so predisposing factors for biological, um we've obviously got genetics as well, but alcohol, poor diet, so this is for. Freddie Flintoff, this is a um for his bulimia, so psychological predisposing with stress and pressure. And social kind of the lifestyle that he led that put him at risk. Precipitating factors, so obviously a change in his body, in his image, which affected his self-worth and his self-image. And socially that's important because he was in the public eye. What continued this problem, so what perpetuated it, carried it on was alcohol and poor diet, the stigma and shame of having an eating disorder and kind of coming out with that. And isolation And then protective factors, so going forward now, so abstinence from alcohol. Becoming more psychologically minded, so engaging in therapy, completing therapy and having family support, so this is the way that we would break it down and often in community teams there's big long meetings about kind of doing a formulation for somebody, breaking it down into those five P's, um, and just seeing kind of what is it that that means this. Person is at risk of becoming unwell. What are their triggers, so what are their precipitating factors? When they are unwell, what keeps them unwell? What cycles do they get in, what negative things keep them unwell? And when they are well, what keeps them well? So what are their protective factors? So they're the things that we break it down into and then you can split them into the biological, psychological and social. But they're the main formulation methods we use, um. Yeah. Any questions on that? No, whistle stop tour of formulation, it's something you'll hear used a lot. You don't need to be um. Like great at it initially, you'll get the hang of it over time, it's just learning to kind of think about, yeah, think about all those factors that play into someone becoming unwell, it's not just kind of one thing, usually, and all of them things then mean that we can, Assist in all of those areas, um, so if it's alcohol that is a precipitating factor or a perpetuating factor, getting the drug and alcohol team involved to help abstinence, to give someone support, if it's housing, looking at housing support to get someone in a different accommodation, sorting out someone's finances. Um, getting people involved with the right physical health teams if they're in chronic pain. So using formulation can be good to look at all the ways that we can help someone's mental health that isn't just med our medication because there's plenty of things that we can be doing and it helps you think a bit more holistically when you go through it in that manner. Fab. Right, any other, any questions? No, otherwise you are free to, free to go. I'll hang around for a few minutes if you do have anything that you.

What to ask. OK Hi, um, are the slides gonna go out because I couldn't, I couldn't find them on Minerva, um, but they were really useful, so. OK, thanks very much. I think that's 3 different. OK. Come on. yeah. Yeah, I. I would take, yeah, they take you and then yeah. Sorry, I was just wondering if you know what time our communication skills starts this afternoon. 1:30. It's 1:30 I think our timetable says something different. What it's just 1 o'clock on one thing, 1:30 on the other. I think it's 1:30 because basically you're supposed to have the formulation bit afterwards and I said just put it in the morning. So there's no formulation thing this afternoon. No, it's just let me find. Yeah. I OK, cool, perfect. Yeah, so in I guess head to one of them seminar rooms they'll split you up for like the communication skills so you're not all in one room chatting at the same time, but yeah, 1:30 to 3:30. I think I'm just wondering. I know they've been so late yeah yep.

Yeah it's very slow And also you got a list of ones that you were up to. Um, I mean, feel free to take a picture of these. I just kind of scribbled it. I was so close. I was like going away. Yeah, me too. It's so frustrating, isn't it? Yeah, yeah, yeah, yeah, yeah, yeah, yeah, write it down, yeah. Yeah, I'll send them through. It's just because I know you'll have other slides on there, but I prefer reading off like my slide from history and MSC because then I actually know what's written. Yeah, yeah. get the formulation slides but everything else is, is there. I don't know. Uh, it's not, they normally attach it to the timetable. It's in the block in the lectures. So there's just like 15 lectures. I'll send it over, yeah. Your one was better than the one they uploaded. Lovely. Hi sorry, I was asking, I was wondering what's the name of the person you said would be good to do research in because I think I've looked at the old lecture slides as well, and they just didn't have the email for it. So, so there is Scott Vic. Let me find you what his is. So Scott.

Dot W E I C H at Sheffield Partnership dot NHS.uk. She walked Yeah, so that's him. So he's a professor. He's involved in, he doesn't do much clinical work now. He's involved in a lot of research. So he is very used to students being in touch and doing stuff. And Will Gan is the other one. So it's just William. Gan. Is that just G A N G A N N. No, so G A N N. Oh, OK, yeah. Yeah, and then at the same thing. Yeah. So they're the two people. So Scott's very, very used to people emailing and will, he's the phase 3 lead. So we'll be very happy for you to email him. He might have less. Stuff going. He's really into psychedelics research and stuff like that. So that's what Will is big into. Yeah, but reach out to both of them and see what's available. Right. Thank you. I wanted to put he was so he was so passionate about like hang up, which I thought was like really refreshing. I cool right now, yeah. It looks like it hit 2 because first she went. But it turns on the light in surgery. I turned on the lamp frame and he went. I. something like that and she goes, oh my. I'm like. I was like, hi Alex, uh, this is my colleague. He's a premier doctor. I was like, no, no, no, was always on. He set up. I just go through the front door. through this side of the room or through the front door. Oh my God, that is. No, the nurse will be behind him like. I went and did it they'd be like he'd be like, you heard me, I have people calling sexual sunroof, yeah, I've had. It's a bit Yeah, I had Yeah, I was like oh yeah yeah yeah I was just I think I think a bit more. And then I'm gonna go at the time. But Yeah, I think they were How are you I have no idea. Thank you so much. I think we can find. Yeah, I, I have the latest number. Dr. but