European Psychiatry - Volume 33 - March 2016

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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 ∗, I. Hall , P. Doulton (Director) ,
P. Bowie (Chief Examiner)
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.
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.