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S16

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S14–S17

Symposia – Services users and carers are experts

in mental health

EECP 06

Involving people with intellectual

disabilities in the formal assessment

of psychiatrists’ skills

S. Soni

1 ,

, I. Hall

2

, P. Doulton (Director)

3

,

P. Bowie (Chief Examiner)

4

1

Camden and Islington NHS Foundation Trust, Learning Disability

Psychiatry, London, United Kingdom

2

East London NHS Foundation Trust, Learning Disability Psychiatry,

London, United Kingdom

3

Professional Role Players Ltd, London, United Kingdom

4

Royal College of Psychiatrists, London, United Kingdom

Corresponding author.

Purpose

It is widely recognised that people with intellectual

disabilities receive a poorer quality of healthcare than their non-

disabled counterparts. Training for healthcare professionals in

intellectual disability is often scant or non-existent. The purpose

of this work is to explore the usefulness of employing actors with

intellectual disabilities as simulated patients in the assessment of

trainee psychiatrists.

Design/methodology/approach

The development of a structured

clinical exam “station” designed to assess the ability of trainee psy-

chiatrists to communicate with a simulated patient played by an

actor with an intellectual disability is described. The paper also

assesses the potential benefits of this kind of assessment and the

experience of actors and examiners taking part in this process.

Findings

The station was found to performwell in discriminating

between candidates of various abilities and was well received by

actors, examiners and observers. The station is now routinely used

in the formal assessment of trainee psychiatrists in the UK.

Practical implications

The use of people with intellectual disabili-

ties in training and assessment appears to be advantageous in terms

of improving knowledge, attitudes and skills amongst healthcare

professionals and gives increased opportunities for people with

intellectual disabilities to undertake valued social roles.

Originality/value

Few institutions currently employ actors with

intellectual disabilities as simulated patients as part of their train-

ing programmes and as a result there is little in theway of literature

on this subject. This paper describes an alternative approach to

teaching and assessment which falls in line with recommendations

from the UK Department of Health to involve service users in the

training of healthcare professionals.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.812

Training workshop – Dissociative symptoms, how

to recognise and treat them

EECP 07

Discussion

G. Stanghellini

“G. d’Annunzio” University, Department of Psychological –

Humanistic and Territorial Sciences, Chieti, Italy

The concept of “dissociation” covers a rather wide array of

psychopathological conditions, ranging from dissociation of con-

sciousness (e.g., post-traumatic conditions), to dissociation of

personality, (i.e., multiple personality disorder) and dissociation of

the basic structures of the pre-reflexive self (as it is the case with

schizophrenic abnormal experiences). I will focus on this last issue

and describe the dissociation of time experiences in people with

schizophrenia as a characterizing feature of this condition.

Schizophrenic persons often describe their sense of temporal real-

ity as: “things to a standstill”, “immobility, but not calm”, “time

going back to same moment over and over”, “people like statues”,

“frozen moment”, “out of time”, “marmoreal”, “unreal stillness”.

Time is fragmented, there is a breakdown in time Gestalt, and an

itemization of now-moments. The mere succession of conscious

moments as such cannot establish the experience of continuity.

Another typical phenomenon is that a revelation is on the verge to

happen, the world is on the verge of ending, a new world is com-

ing, one’s own life is on the point of undergoing a radical change.

The schizophrenic mood can be characterized as the dawn of a

new reality, an eternally pregnant now in which what is most

important is not present, what is really relevant is not already

there, but is forever about to happen. Time in the schizophrenic

mood is “a state of suspense”, “pregnant now”, “being is hang-

ing”, “something imminent”, “something

. . .

I didn’t know what

. . .

was going to happen

. . .

between inspiration and expiration”. The

main feature of abnormal time experience in schizophrenia is dis-

articulation – a breakdown of the synthesis of past, present and

future. This includes four subcategories: disruption of time flow-

ing, “déjà vu/vécu”, premonitions about oneself and the external

world. The integrity of time consciousness is the condition of pos-

sibility of the identity through time of an object of perception as

well as of the person who perceives it. Abnormal time experience

may be related to the manifold of other schizophrenic subjective

abnormal experiences and symptoms, including anomalies of phe-

nomenal consciousness (e.g., disintegration of the appearance of

external objects and itemization of external world experience),

selfhood (e.g., disruption of the implicit sense of being a unified,

bounded and incarnated entity), and sociality (e.g., breakdown of

one’s sense of being naturally immersed in a meaningful flow of

social interactions with others).

Disarticulation of time experience includes four subcategories.

Disruption of time flowing: Patients live time as fragmented.

Past, present and future are experienced as disarticulated. The

intentional unification of consciousness is disrupted. The present

moment has no reference to either past or future. The external

world appears as a series of snapshots. Déjà vu/vécu: Patients expe-

rience places, people and situations as already seen and the news as

already heard. This abnormal time experience entails a disarticula-

tion of time structure as the past is no more distinguishable from

the present moment. The already-happened prevails. Premonitions

about oneself: patients feel that something is going to happen to

them or that they are going to do something. This abnormal time

experience entails a disarticulation of time structure as the immedi-

ate future intrudes into the present moment. The about-to-happen

prevails. Premonitions about the external world: patients feel that

something is going to happen in the external world. As the previ-

ous one, this abnormal time experience entails a disarticulation of

time structure as the immediate future intrudes into the present

moment. The about-to-happen prevails.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.813