Table Of ContentPractical Psychiatry for
Students and Trainees
This is a welcome addition to the literature
for medical students, newly qualified doctors,
and very early career psychiatrists. As well as
covering basic key clinical skills and information
in an accessible way it provides extremely
useful material on professionalism and self- care.
This will be invaluable to all doctors starting out
and beginning to discover the complexity and
rewarding field of psychiatry.
— Kate Lovett, Immediate Past Dean,
Royal College of Psychiatrists, UK
This is an excellent, highly practical book for
both medical students and for doctors at the
early stages of their postgraduate training
in psychiatry. It provides a highly readable
overview of the key clinical areas, with use of
mnemonics and valuable practical tips such
as how to set up the clinical interview and
sample phrasing of difficult- to- ask questions.
This is combined with relevant reference
to the underlying phenomenology and the
evidence base.
— Anne Doherty, Consultant Liaison Psychiatrist,
Editor in Chief, Books Programme,
Royal College of Psychiatrists, UK
Practical Psychiatry
for Students and
Trainees
Anne-Marie O'Dwyer, M.D., M. Ed.,
F.R.C.P.I., M.R.C.Psych.
Clinical Professor
Department of Psychiatry
Trinity College Dublin & Consultant Psychiatrist
Psychological Medicine Service
St James’s Hospital
Republic of Ireland
Mariel Campion, MB, MScLHPE,
MRCPsych,
Senior Registrar in Liaison Psychiatry
St James’s Hospital and Clinical Lecturer in Psychiatry
Trinity College
Republic of Ireland
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This handbook is dedicated to our patients, from whom we
learn our clinical skills. Their forbearance and kindness in
allowing us to learn from them, often as they face extreme
hardship in the context of illness, are simultaneously both
humbling and heartening.
Our clinical skills are first laid down as students, often the
most formative clinical learning experiences we have. The
habits we learn then can persist for a lifetime. We owe it to
our patients to start well.
Contents
Letter to the reader ix
Acknowledgements xi
Abbreviations xiii
1 The clinical interview— setting the scene
2 The psychiatric history— what to ask 3
3 Mental state examination 25
4 Proposing a diagnosis: classifications, formulation, and investigations 3
5 Personality disorders 43
6 Mood disorders 53
7 Psychotic disorders 7
8 Anxiety and obsessional disorders 87
9 Eating disorders 05
10 Psycho- active substance use 5
11 Psychiatry of later life 3
12 Child, adolescent, and perinatal psychiatry 47
13 Psychiatry of intellectual disability (ID) 67
14 Psychological medicine (hospital psychiatry) 77
15 Forensic perspectives in general psychiatry 9
16 Psychological treatments 20
17 Physical treatments 23
18 Emergencies: urgent, serious, and high-risk scenarios in psychiatry 233
19 Professionalism, boundaries, and well- being 247
Glossary 259
Index 265
Letter to the reader
Dear Reader,
Most students (especially medical students!) skip introductions. We hope that by
speaking to you directly, we will stop your hand in mid- flight as it moves to ‘skip’
the introduction. While we initially wrote this handbook for medical students in
psychiatry, it is for any of you unfamiliar with clinical interviewing. It provides stu-
dents, and trainees, with core knowledge and the skills needed to deliver essential
clinical care to patients with mental health needs.
The book places clinical interviewing skills—w hat to ask and how to ask it— and
mental health in the context of medical (including Emergency Department and
GP placements) as well as psychiatry settings. It considers the person within a
global mental and physical framework. This reflects the authors’ work as psychi-
atrists embedded in a general hospital, as well as clinical experience in medicine
prior to psychiatry. Subsequent training with exceptional clinicians and teachers at
the Maudsley and Institute of Psychiatry (London) and Addenbrooke’s Hospital
(Cambridge) for one of the authors (AMOD) provided formative clinical experi-
ences in a true ‘apprenticeship’ style. The hope is to distil some of their clin-
ical expertise and knowledge for future generations of students. This experience
is combined with the practical approach and perspective of a psychiatrist ap-
proaching the end of comprehensive training as a junior hospital doctor (MC).
The handbook is an introduction to practical clinical issues. Each chapter out-
lines key learning points, practical clinical tips, and is illustrated with clinical cases.
It provides specific guidance to enable clinicians to conduct a clinical interview
with patients presenting with mental health needs. It also introduces core con-
cepts of professionalism, burnout, and self- care, vital not only for the student
clinician, but also for the patients whom they treat.
This is not a definitive textbook, nor is it a reference guide to research in
psychiatry. It deliberately does not provide lists of references at the end of each
chapter. It has not sought to include all areas. Instead, the text focuses on the
more common issues that need to be grasped by the novice and, particularly,
by students/ graduates who may never again study psychiatry but will encounter
mental health issues in all aspects of medical and surgical care. Good clinical inter-
view skills are essential for all clinicians whatever their ultimate area of practice.
We assume no prior knowledge of psychiatry. The aim of the text is to be
both clear and simple. The area of psychological ill- health and mental illness is,
of course, neither clear nor simple. However, given that we remain almost ex-
clusively reliant on our clinical skills and judgment, students should begin with a
clear ‘black- and- white’ starting- point, from where they will then head into the
multi- coloured reality of psychological disorders.
In writing any book in the modern age, one recognizes that rapidly advan-
cing fields of technology render almost any textbook outdated on the date it is
