TrOn mapping

2.1 Basic frameworks for conceptualising development: nature and nurture, stage theories, maturational tasks. Possible definitions of maturity. Examination of gene-environment interactions with specific reference to intelligence. Relative influence of early versus later adversities. The relevance of developmental framework for understanding the impact of specific adversities such as trauma. Historical models and theories: Freud and general psychoanalytic; social-learning, Piaget.

2.2 Methodology for studying development: cross sectional, cohort and individual studies. Identification and evaluation of influences.

2.3 Bowlby attachment theory and its relevance to emotional development, affect regulation and human relationships in childhood and later on. Conditions for secure attachment. Types and clinical relevance of insecure and disorganised attachment. Early separation and its consequences. Consequences of failure to develop selective attachments. Brief consideration of attachment, maternal ‘bonding’ parental sensitivity.

2.4 Other aspects of family relationships and parenting practices. The influence of parental attitudes compared with parenting practices. Systemic theory including supportive systems in development, and aspects of distorted family function: e.g. discord, overprotection, rejection, and enmeshment. The impact of bereavement, parental divorce and intra-familial abuse on subsequent development and mental health of the child. The relevance or otherwise of different family structures including cultural influences on family and stages of family.

2.5 Individual temperamental differences and their impact on parent-child relationships. Origins, typologies and stability of temperament and the evolution of character and personality. Childhood vulnerability and resilience with respect to mental health.

2.6 Cognitive development with critical reference to key models such as the bio-psychosocial model and Piaget’s model. The impact of attributions and beliefs, and cultural, genetic and other influences. The relevance of preoperational and formal operational thought to communication with children and adults.

2.8 Development of social competence and relationships with peers:

acceptance, group formation, co-operation, friendships, isolation and rejection. The components of popularity.

2.9 Moral development with critical reference to Kohlberg’s stage theory. Relationship to development of social perspective taking.

2.11 Sexual development including the development of sexual identity and preferences.

2.12 Adolescence as a developmental phase with special reference to pubertal changes, task mastery, conflict with parents and authority, affective stability and ‘turmoil’. Normal and abnormal adolescent development.

2.13 Adaptations in adult life, such as pairing, parenting, illness, bereavement and loss.

2.14 Pregnancy and childbirth and their stresses both physiological and psychological.

2.15 The development of personal (ego-) identity in adolescence and adult life. Work, ethnic, gender and other identities. Mid-life ‘crises’.

2.16 Normal ageing and its impact on physical, social, cognitive and emotional aspects of individual functioning. Social changes accompanying old age, importance of loss, personality changes with ageing. Social and economic factors in old age; attitude, status of the elderly, retirement, income, accommodation, socio-cultural differences.

2.17 Genetic influences on development including gene environment interactions.

2.18 Neuroimaging and its role in understanding development. Up to date findings in this field.

3.1 Basic Techniques in neuroscience:

3.1.1 Recording from the brain:

3.1.1.1 Single unit recordings

3.1.1.3 Neuroimaging and its role in understanding brain function (including structural MRI, DTI, fMRI, PET, MR spectroscopy)

3.1.1.4 Microdialysis.

3.1.2 Perturbing brain function (including lesion studies, electrical stimulation, optogenetics, TMS, tDCS, deep brain stimulation, vagus nerve stimulation).

3.1.3 Animal models of psychiatric disease.

3.1.4 Computational modelling and models, and data-analytic descriptions.

The physiology of neurons

Currently no corresponding content on: G-protein coupled receptors, allosteric modulation of receptors, synaptic plasticity and pruning.

3.5.1 The neural circuits involved in the following, and how these functions are disturbed in psychiatric disorders:

3.5.1.1 Appetite, hunger and thirst, including disturbance in eating disorders and mood disorders, medication side-effects.

Currently no corresponding content for: disturbances in eating disorders and mood disorders

The physiology of arousal and sleep.

Currently no corresponding content on: effects of sleep deprivation, primary sleep disorders, role of sleep in other psychiatric disorders.

3.5.1.3 Sex, including effects of hormonal treatments, gender identity, disturbances related to psychiatric disorder, and psychotropic-induced disturbance.

3.5.1.4 Aggression.

3.5.1.5 Pain and chronic pain.

3.5.1.6 Motor control, including neurobiology of extra-pyramidal side-effects.

The neural and endocrine systems.

Currently no corresponding content on: chronic pain

The neural and endocrine systems

3.5.1.15 Empathy, theory of mind, including in autism and dissocial behaviour

3.5.2 Default mode and salience networks.

3.8.1 The development and localisation of cerebral functions throughout the lifespan from the foetal stages onwards.

3.8.2 Neurodevelopmental models of psychiatric disorders.

3.8.3 Neurobiology of attachment

3.8.4 Neuroplasticity including:

3.8.4.1 Neurobiological effects of stress: pre-, peri- and post-natally, developmentally and in adults.

3.8.4.2 Neurobiological effects of learning and psychological therapies.

3.8.5 Intelligence and learning disability.

3.9.1 Autism

3.9.2 ADHD

3.9.3 Drug use, addiction, tolerance, withdrawal, relapse

3.9.4 Anxiety Disorders

3.9.5 Post-Traumatic Stress Disorders

3.9.6 Obsessive Compulsive and related Disorders

3.9.7 Major Depressive Disorders

3.9.8 Bipolar Affective Disorders

3.9.9 Psychosis

3.9.10 Neurocognitive deficits in psychotic disorders

3.9.11 Self-harm and suicidality

3.9.12 Medically unexplained symptoms

3.9.13 Delirium.

3.10.2 Alzheimer’s Disease.

3.10.3 Vascular dementia.

3.10.4 Pick’s Disease and Fronto-temporal Dementias.

3.10.5 Lewy Body diseases including Parkinson’s Disease.

3.10.6 Prion Diseases.

3.10.7 HIV brain disease.

4.1.1 Outline knowledge of the history/evolution of psychotropic compounds.

4.1.2 Classification of major classes and intra-class groups.

4.1.3 The placebo effect.

4.1.4 Compliance/adherence: relevance and methods of maximisation.

4.1.5 Assessment methods and monitoring: efficacy and tolerability.

4.1.6 Basic principles of drug development and evaluation:

4.1.6.1 Phases I – II

4.1.6.2 Phase III – the RCT in psychiatry: randomisation/endpoints (primary/secondary)/superiority vs non-inferiority/accounting for missing data.

4.1.7 Drug regulation: the purposes and processes of licensing, ‘approved’ versus ‘off-label’ use, branded versus generic drugs.

4.2.1.1 General principles of: absorption/distribution/metabolism/elimination.

4.2.1.2 effect of mode of administration on kinetics.

4.2.1.3 protein binding – consequences in health and disease.

4.2.1.4 half-life (t½)/Tmax/Cmax)/volume of distribution (Vd)/area under the curve (AUC) – relevance to prescribing.

4.2.1.5 Principle of kinetic modelling – linear versus zero-order kinetics: practical implications.

4.2.2 Kinetic changes in health (e.g. pregnancy) and disease and across the life span.

4.2.3 Psychotropics:

4.2.3.1 lipophilicity versus hydrophilicity

4.2.3.2 the blood-brain barrier – structure and function especially in relation to psychopharmacology.

4.2.4 Principles of pharmacogenomics and pharmacogenetics.

4.3.1.1 Main receptor subtypes in relation to psychotropic drug actions.

4.3.1.2 Outline knowledge of receptor structure/function. ‘Superfamilies’:

4.3.1.2.1 metabotropic (with emphasis on G protein-coupled receptors)

4.3.1.2.2 ionotropic.

4.3.1.3 Receptor binding mechanisms – concept of affinity and basic assessment methods.

4.3.1.4 receptor binding profiles of commonly utilised agents.

4.3.1.5 Major pharmacological actions at receptor sites:

4.3.1.5.1 concept of intrinsic activity

4.3.1.5.2 agonism/antagonism/partial agonism/inverse agonism.

4.3.1.6 Intracellular effects of receptor activation signalling cascades/second messengers/gene networks.

Currently no corresponding content for 4.3.1.1 and 4.3.1.4

4.3.2 Putative mechanisms of action of major psychotropic/psychoactive classes (‘target’ actions) at molecular and systems levels:

4.3.2.1 Antipsychotics

4.3.2.2 Antidepressants

4.3.2.3 Mood stabilisers

4.3.2.4 Sedative hypnotics

4.3.2.5 Cognitive enhancers

4.3.2.6 Opioids

4.3.2.7 Psychostimulants

4.3.2.8 Cannabinoids

4.3.2.9 Hallucinogenics

4.3.2.10 Novel (new) psychoactive substances.

4.3.3 Major aetiological theories underpinned by pharmacological mechanisms:

4.3.3.1 the Dopamine Hypothesis

4.3.3.2 the Biogenic Amine Hypothesis

4.3.3.3 the Cholinergic Hypothesis (cognition)

4.3.3.4 the Cholinergic-Adrenergic (balance) Hypothesis (mood)

4.3.3.5 the Glutamatergic Hypothesis

4.3.3.6 the Amyloid Cascade Hypothesis.

4.3.4 ‘Non-target’ (off-target/adverse) actions of major psychotropic/psychoactive classes and their management.

4.3.4.1 from general pharmacology: for example: postural hypotension/sedation/sexual dysfunction etc.; weight gain and metabolic dysfunction; QTc prolongation.

4.3.4.2 from specific pharmacology: for example extrapyramidal symptomatology/NMS; serotonin syndrome.

4.3.4.3 idiosyncratic – toxic/allergic reactions: for example: blood dyscrasias; hepatotoxicity/allergic hepatitis; skin reactions – including outline knowledge of Stevens-Johnson syndrome/toxic epidermal necrolysis; myocarditis/cardiomyopathy.

4.3.5 Teratogencity and developmental abnormalities associated with psychotropic drug use in pregnancy.

4.3.6 Non-psychotropic medications in psychiatric practice and their use: for example:

4.3.6.1 antimuscarinics

4.3.6.2 antiepileptics (non-mood stabilising)

4.3.6.3 analgesics: opioid/non-opioid

4.3.6.4 beta-blockers

4.3.6.5 dopamine agonists

4.3.6.6 adrenergic agonists.

4.4.1.1 Establishing goals of treatment.

4.4.1.2 Rational prescribing in the context of:

4.4.1.2.1 specific psychiatric diagnoses (disorders and severities of disorder)

4.4.1.2.2 phases of illness (acute/subacute/maintenance)

4.4.1.2.3 physical health status/co-prescribed medications

4.4.1.2.4 age.

4.4.1.3 Tailored prescribing and the individual risk-benefit appraisal.

4.4.2.1 Knowledge of dose ranges, minimum effective doses, time scales for evaluating efficacy

4.4.2.2 strategies for managing non-/poor-response: standardised definitions of ‘treatment resistance’ (schizophrenia/major depression) and systematic strategies for management of ‘treatment resistance’.

4.4.2.3 Recommendations for switching within major classes and across compounds.

4.4.3 Monitoring – efficacy and tolerability, including knowledge of commonly utilised standardised schedules.

4.4.4 Dependency and withdrawal – including management:

4.4.4.1 with substances of abuse

4.4.4.2 with prescribed psychotropics.

4.4.5 Prescribing in special circumstances:

4.4.5.1 children and adolescents

4.4.5.2 the elderly

4.4.5.3 eating disorders

4.4.5.4 physical co-morbidities: hepatic failure/renal failure/cardiovascular disease

4.4.5.5 pregnancy.

4.4.9 Advice on driving and other complex behaviours.

4.4.10 Drug-drug interactions:

4.4.10.1 Pharmacokinetically mediated

4.4.10.2 Pharmacodynamically mediated.

5.1 Classification systems:

5.1.1 a working knowledge of ICD and DSM classification and diagnostic systems

5.1.2 WHO classification of impairments, disabilities, and handicaps. A working knowledge of “statementing” for special needs education.

Currently no corresponding content

5.2.1 history taking and examination of the mental state.

5.2.2 Descriptive Psychopathology:

5.2.2.1 Disorders of self

5.2.2.2 Disorders of emotion

5.2.2.3 Disorders of speech and thought

5.2.2.4 Disorders of perception.