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The Central Nervous System and Mental Health

  • Module code: PY5030
  • Year: 2018/9
  • Level: 5
  • Credits: 30
  • Pre-requisites: None
  • Co-requisites: None

Summary

The module gives an overview of the structure and function of the CNS. These lectures, tutorials and practicals will set the scene for the teaching of neurological and mental health dysfunction including depression, anxiety, schizophrenia, drug abuse and addiction, Parkinson's disease, Alzheimer's disease, epilepsy and pain. The focus will be on the more common psychiatric and neurological disorders, which future pharmacists will need to treat and will cover pathology, diagnosis, treatment and treatment side-effects. There will also be discussion of treatments with respect to drug development and individual variations to treatment. The development of specialist formulations used in the management of these conditions, such as IV infusions, depot injections and patches will also be covered.

Aims

  • To introduce the student to the structure function and dysfunction of the brain and CNS, and the effect of these on physical and mental health and wellbeing
  • To describe the main psychiatric and neurological disorders and their treatments
  • To introduce and develop students' knowledge on how pharmacists contribute to the care of people with neurological and mental health conditions
  • To develop the knowledge of formulations used in the management of pain, neurological and mental health conditions

Learning outcomes

On successful completion of the module, students will be able to:

  • Know and understand the structure and function of the CNS and how it influences illness and health
  • Understand the physical and chemical properties of drugs used in the treatment of psychiatric and neurological conditions
  • Know and understand the management of common neurological and psychiatric conditions such as epilepsy, Parkinson's disease and depression, including the ability to compare data from the Cochrane database and NICE guidelines.
  • Explain the options available to manage pain, the drugs used, the formulation of those drugs and be able to select the most appropriate treatment option
  • Explain the mechanisms of addiction, know the role of the pharmacist in substance abuse and describe how substance misuse services are provided.

Curriculum content

  • Structure of the brain eg. white and grey matter, meninges, ventricles and cerebrovasculature. Also the main nuclei and systems
  • Structure of neurons, glia, astrocytes and the cerebrovasculature.
  • Main transmitters (eg. dopamine, 5-HT, noradrenaline, glutamate, GABA, acetylcholine, neurokinin, adenosine) and hormones (eg. cortisol, estradiol, pregnanalol, testosterone).
  • The main targets of treatments in the brain: receptors (GPCR), ion channels (Ligand gated, voltage gated), transporters (dopamine, 5-HT and noradrenaline transporters), enzymes (e.g. MAO, synthesis and metabolism of main transmitters) and pre-cursors (eg. L-Dopa, tyrosine, tryptophan, glutamine etc.).
  • The pathology and symptoms of depression, anxiety, Parkinson's disease, Alzheimer's disease, stroke and epilepsy
  • Treatments for common psychiatric and neurological illnesses and their side-effects eg. SSRIs, TCA, MAOI for depression and anxiety; antipsychotics for schizophrenia, blood thinners and clot busters for stroke, dopamine agents for Parkinson's disease, cognitive enhancers for Alzheimer's disease and anticonvulsants for epilepsy.
  • The evidence base for the management of neurological and mental health conditions
  • Guidelines, eg. NICE, for the management of neurological and mental health conditions
  • Pain management
  • Therapeutic drug monitoring of phenytoin and lithium.
  • Substance abuse and addiction
  • Drug delivery systems for the management of pain, substance misuse and psychiatric conditions.
  • The role of the pharmacist in substance abuse
  • Introduction to the parenteral route and alternative dosage forms such as patches
  • Nicotine and fentanyl patches
  • Use of the parenteral route in the management of pain, epilepsy and schizophrenia
  • Depot injections

Teaching and learning strategy

Wherever possible the strategy is one of learning by doing in practicals that engage students, or in small teaching sessions that allow direct contact between students and tutors. It is hoped that there can be some common labs and tutorials with medical and biomedical science students to allow some inter-professional development. After each block of related lectures, students are encouraged to try formative tests available on Canvas (KU) and/or Moodle (SGUL) that allow them to self-direct their learning. The tests are reviewed in small group teaching sessions where tutors give feedback and provide guidance that feed-forwards and allows students to best prepare for the examination.  Small group teaching sessions also allow certain key employability skills to be developed (eg. interpersonal skills, oral communication). Other employability skills are inherently tested and developed in practicals (eg. numeracy, written communication, teamwork). Throughout the module we will integrate basic and clinical sciences with basic scientists, pharmacists and clinicians working together to deliver the module.

Breakdown of Teaching and Learning Hours

Definitive UNISTATS Category Indicative Description Hours
Scheduled learning and teaching Lectures 48 hours Practicals 10 hours Workshops 16 hours Tutorials 9 hours 83
Guided independent study Directed and student self-directed study 217
Total (number of credits x 10) 300

Assessment strategy

The module will use a combination of an end of year written exam in combination with practical assessments and mini quizzes. The mini quizzes will be in the form of revision MCQs will be used in small group teaching sessions, some of these quizzes will be formative and a number summative. In addition to promoting engagement in the tutorial sessions the mini quizzes will enable students to track their progress and performance and where necessary carry out further revision or seek further support. The mini-quizzes are as follows:

Tutorial mini-quiz portfolio (10%)

Neurotransmitters quiz (2%)

Stroke quiz (2%)

Substance abuse quiz (2%)

Alzheimer's Disease quiz (2%)

Schizophrenia quiz (2%)

Feedback will be given during and after practical sessions and three practical sessions will make up a portfolio of summative practical assessments. Important skills and competences as well as knowledge and understanding are developed in the practical series, so it is important that students engage with the series as well as have an ongoing measure of their performance and progress. The summative practical assessments can be summarised as follows:

Practical assessment portfolio (30%)

Neuroanatomy practical assessment (10%)

MAOI practical assessment (10%)

Sterile dosing practical assessment (10%)

Level 5 MPharm students are required to pass a synoptic OSCE style assessment and a synoptic calculations test before they can progress to Level 6. These are to assure that even at this Level the student is demonstrating the appropriate skills, knowledge, understanding and attributes to become a future pharmacist. Learning in this module feeds forward into these synoptic assessments. In particular the scientific and clinical background to patient management will be developed in practicals and tutorials where they will be formatively and summatively assessed, along with questions in the mini-quizzes, feeding forward into the synoptic OSCE assessment.

Mapping of Learning Outcomes to Assessment Strategy (Indicative)

Learning Outcome Assessment Strategy
1) Know and understand the structure and function of the CNS and how it influences illness and health Practical exam Tutorial mini-quizzes End of module exam
2) Understand the physical and chemical properties of drugs used in the treatment of psychiatric and neurological conditions Practical exam End of module exam
3) Know and understand the management of common neurological and psychiatric conditions such as epilepsy, Parkinson's Disease and depression, including the ability to compare data from the Cochrane database and NICE guidelines. End of module exam Tutorial mini-quizzes
4) Explain the options available to manage pain, the drugs used, the formulation of those drugs and be able to select the most appropriate treatment option End of module exam Tutorial mini-quizzes
5) Explain the mechanisms of addiction, know the role of the pharmacist in substance abuse and describe how substance misuse services are provided End of module exam Tutorial mini-quizzes

Elements of Assessment

Description of Assessment Definitive UNISTATS Categories Percentage
Written exam Written exam 60%
Written exam Portfolio of tutorial mini-quizzes 10%
Practical exam Portfolio of practical assessments 30%
Total (to equal 100%) 100%

Achieving a pass

It is a requirement that the major elements of assessment are passed separately in order to achieve an overall pass for the module.

Bibliography core texts

JR Cooper, FE Bloom & RH Roth, The Biochemical Basis of Neuropharmacology, 8th Edition.

NR Carlson, Physiology of Behaviour, 7th Edition.

NICE guidance 

British National Formulary (latest edition) Pharmaceutical Press, London. Also available on the BNF website.

Bibliography recommended reading

ER Kandel, JH Schwartz & TM Jessell, Principles of Neural Science, 5th Edition.

BE Leonard, Fundamentals of Psychopharmacology, 3rd Edition.

MJ Neal, Medical Pharmacology at a Glance, 6th Edition.

RA Barker & S Barasi, Neuroscience at a Glance, 3rd Edition.

C Katona, C Cooper & M Robertson, Psychiatry at a Glance, 4th Edition.

Wills S. Drugs of Abuse, 2nd Edition, Pharmaceutical Press, 2005. ISBN 979 0 85369 582 0

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