Year 4 Psychiatry — Junior Clerkship

Name: Year 4 Psychiatry — Junior Clerkship
Author: Abongo Davis

Mount Kenya University, Department of Psychiatry & Mental Health. Three semesters of weekly lectures with a clinical rotation each week.

Semester 1 — Foundations of Assessment & Major Disorders

Dr. Kendi: history taking, psychopathology, psychotic / neurodevelopmental / neurodegenerative disorders, emergencies. Dr. Neema: classification, MSE, mood / anxiety / somatic disorders, suicide, substance use. Ends with a written CAT + OSCE (history-taking & MSE).

Week 1 Adult psychiatric history taking — Structured adult history: presenting complaint, HPC, past psychiatric/medical, family and social history; building rapport.
Week 1 Classification of mental disorders (DSM-5-TR & ICD-11) — Structure and purpose of DSM-5-TR and ICD-11; the major diagnostic categories.
Week 2 Child & adolescent history taking — Developmental history, parental/collateral reports, age-appropriate rapport.
Week 2 Mental State Examination (MSE) — Appearance, behaviour, speech, mood/affect, thought, perception, cognition, insight — and documenting them.
Week 3 Introduction to psychopathology I — thought & perception — Thought disorder; hallucinations, illusions, delusions.
Week 3 Introduction to psychopathology II & biopsychosocial formulation — Constructing a basic biopsychosocial formulation.
Week 4 Psychotic disorders I — schizophrenia spectrum — Phenomenology and diagnosis.
Week 4 Mood disorders I — depressive disorders — DSM-5-TR/ICD-11 criteria; Kenyan cultural (somatic) presentations.
Week 5 Psychotic disorders II — management & antipsychotics overview — First-line management principles and basic monitoring.
Week 5 Mood disorders II — bipolar I & II — Bipolar I vs II; hypomania, mania, cyclothymia.
Week 6 Neurodevelopmental disorders I — autism spectrum & intellectual disability — Core features and basic assessment approach.
Week 6 Anxiety disorders — GAD, panic, social anxiety, phobias — Diagnosis using standard criteria.
Week 7 Neurodevelopmental disorders II — ADHD & disruptive behaviour — Presentations in children and basic management options.
Week 7 OCD & related disorders — Phenomenology; CBT/ERP principles at overview level.
Week 8 Neurocognitive disorders I — delirium vs dementia — Clinical and cognitive-testing features that separate them.
Week 8 Trauma & stressor-related disorders (PTSD, ASD, adjustment) — Core diagnostic features.
Week 9 Neurodegenerative disorders II — dementia subtypes — Alzheimer's, vascular, HIV-associated neurocognitive disorder.
Week 9 Somatic symptom & related disorders — Somatic symptom disorder, illness anxiety, consultation-liaison psychiatry.
Week 10 Psychiatric emergencies I — acute psychosis, agitation, violence risk — Immediate de-escalation and safety steps.
Week 10 Suicide risk assessment & management — Structured risk assessment and a basic safety plan.
Week 11 Psychiatric emergencies II — rapid tranquillisation & Mental Health Act (Kenya) — Rapid tranquillisation protocol; Kenya Mental Health Act 2021.
Week 11 Substance use & addictive disorders (Kenya burden, NACADA data) — Screening with AUDIT/DAST; burden of alcohol, cannabis, opioids.
Week 12 Integration & revision — Kendi thread — Consolidate psychotic, neurodevelopmental and neurodegenerative content.
Week 12 Integration & revision — Neema thread — Consolidate mood, anxiety, somatic, suicide and substance-use content before the CAT.
CAT Semester 1 written CAT + OSCE — History-taking & MSE.

Semester 1 — Clinical rotation focus

Week 1 Orientation; observed adult history taking
Week 2 Supervised MSE practice
Week 3 Case formulation exercise
Week 4 Case presentation: psychosis / mood
Week 5 Supervised MSE on assigned patient
Week 6 Developmental / anxiety screening practice
Week 7 Case presentation (student pair)
Week 8 Ward round participation
Week 9 Cognitive testing clinic (MMSE / MoCA)
Week 10 Suicide risk OSCE practice
Week 11 Emergency simulation; addiction screening tools
Week 12 Full OSCE practice: history, MSE, formulation

Semester 2 — Psychopharmacology & Applied Treatment

Dr. Kendi: antipsychotics, anxiolytics, stimulants, special populations, ARV interactions, motivational interviewing. Dr. Neema: antidepressants, mood stabilisers, protocols, investigations, CBT/IPT. Ends with a written CAT + OSCE (prescription writing & case management).

Week 1 Introduction to psychopharmacology — PK/PD, receptors, neurotransmitters — Basic PK/PD and the major neurotransmitter pathways.
Week 1 Antidepressants I — SSRIs & SNRIs — Indications, starting doses and common side effects.
Week 2 Antipsychotics I — FGAs (mechanism, EPS, depot) — FGA mechanism, EPS profile, depot options.
Week 2 Antidepressants II — atypicals, switching & discontinuation — Mirtazapine, bupropion, trazodone.
Week 3 Antipsychotics II — SGAs & clozapine protocol — Metabolic side effects and monitoring.
Week 3 Mood stabilisers I — lithium — Mechanism, monitoring, toxicity.
Week 4 Anxiolytics & hypnotics — benzodiazepines, dependence, tapering — Mechanism, dependence risk, tapering principles.
Week 4 Mood stabilisers II — valproate, carbamazepine, lamotrigine — Mechanisms and key interactions (women of reproductive age).
Week 5 Stimulants & ADHD medications — Mechanism and Kenyan availability.
Week 5 Antidepressants in comorbidity (HIV, epilepsy, cardiovascular disease) — Prescribing in medically comorbid patients.
Week 6 Special populations I — pregnancy & lactation prescribing — Risk categories and safest-agent principles.
Week 6 National & international treatment protocols — Kenya Guidelines 2025 & WHO mhGAP — Structure of the guidelines.
Week 7 Special populations II — paediatric & geriatric prescribing (Beers criteria) — Cautions in children and older adults.
Week 7 Psychopharmacology in HIV/AIDS — ARV interactions — ARV–antidepressant / mood-stabiliser interaction categories.
Week 8 ARV–psychotropic interactions — CYP450, efavirenz / ritonavir — Major interaction categories in Kenyan ART.
Week 8 Investigations in psychiatry — bloods, TFT/LFT/RFT, ECG, imaging — Indications and how to order them.
Week 9 Long-acting injectables — depot antipsychotics — Available depots and patient-selection criteria.
Week 9 CBT principles & applied psychoeducation — The CBT model, cognitive distortions, behavioural activation.
Week 10 Motivational interviewing & brief interventions (FRAMES, OARS) — Brief-intervention frameworks.
Week 10 IPT principles (Kenyan adaptation) — Interpersonal inventory; grief, role transition, disputes.
Week 11 Prescribing audit & real case application — Spotting common prescribing errors.
Week 11 Real case application — pharmacology + psychotherapy integration — Linking diagnosis to a basic pharmacological plan.
Week 12 Clinical reasoning integration & OSCE preparation — Kendi thread — Antipsychotic, anxiolytic and special-population prescribing.
Week 12 Clinical reasoning integration & OSCE preparation — Neema thread — Antidepressant, mood-stabiliser and protocol knowledge.
CAT Semester 2 written CAT + OSCE — Prescription writing & case management.

Semester 2 — Clinical rotation focus

Week 1 Prescription writing practice
Week 2 Titration case exercise
Week 3 Clozapine / lithium monitoring clinic
Week 4 Case: bipolar patient — review bloods, adjust plan
Week 5 ADHD case formulation
Week 6 Shared decision-making simulation
Week 7 HIV-positive patient case
Week 8 Investigation ordering exercise
Week 9 Role-play: CBT thought challenging
Week 10 MI / IPT role-play, supervisor-rated
Week 11 Observed prescribing; supervisor sign-off
Week 12 Full OSCE practice: history, diagnosis, prescription

Semester 3 — Mental Health Correlates, Social Psychiatry & Leadership

Dr. Kendi: ACEs, developmental theories, personality disorders, eating/sleep/sexual disorders, forensic psychiatry, ethics. Dr. Neema: community mental health, social determinants, gender, IPV, global mental health, policy, QI. Ends with the written end-of-clerkship exam + logbook + OSCE.

Week 1 Adverse childhood experiences (ACEs) — ACE types and the dose-response link with adult health.
Week 1 Community & public mental health in Kenya — Community mental health landscape; Mathari; decentralisation.
Week 2 Developmental theories — Erikson, Piaget, Bowlby.
Week 2 Social determinants of mental health I — poverty, housing, unemployment
Week 3 Personality disorders I — Cluster A — Paranoid, schizoid, schizotypal.
Week 3 Social determinants of mental health II — alcohol outlet density, structural violence
Week 4 Personality disorders II — Cluster B — Antisocial, borderline, narcissistic, histrionic.
Week 4 Gender & mental health — Prevalence differences by gender; DSM critique.
Week 5 Personality disorders III — Cluster C & general management — Avoidant, dependent, OCPD.
Week 5 Intimate partner violence — Screening, documentation, safety planning.
Week 6 Feeding & eating disorders — Anorexia, bulimia, binge eating and complications.
Week 6 Peripartum mental health & grief / loss — Postpartum depression, peripartum psychosis, baby blues.
Week 7 Sleep-wake disorders — Insomnia, hypersomnia, parasomnias.
Week 7 Global mental health & humanitarian settings — Global burden; refugee mental health in Kenya.
Week 8 Sexual dysfunctions & gender dysphoria — Culturally safe sexual history-taking.
Week 8 Mental health policy landscape — Mental health component of Kenya's BPHS.
Week 9 Paraphilic disorders — Classification and mandatory reporting.
Week 9 Quality improvement in psychiatry — Audit-cycle concepts and mhGAP indicators.
Week 10 Forensic psychiatry & Kenya Mental Health Act 2021 — Fitness to stand trial; MHA 2021 provisions.
Week 10 Research literacy — Reading a psychiatric research abstract critically.
Week 11 Ethics in psychiatry — Autonomy, confidentiality, involuntary admission.
Week 11 Prevention & promotion — Anti-stigma; school and workplace mental health promotion.
Week 12 Integration, reflection & assignment presentations — Kendi thread — ACEs, personality disorders or developmental theories.
Week 12 Integration & assignment presentations — Neema thread — Gender & DSM critique or community mental health.
CAT End-of-clerkship examination + logbook + OSCE

Semester 3 — Clinical rotation focus

Week 1 ACE screening / community mapping exercise
Week 2 Reflective case discussion
Week 3 Case formulation: personality features
Week 4 Therapeutic alliance-building exercise
Week 5 IPV simulation
Week 6 Case: postpartum mood symptoms
Week 7 Case: comorbid sleep / somatic presentation
Week 8 Reflective seminar on personal bias
Week 9 QI project scoping exercise
Week 10 Mock court report / journal club
Week 11 Ethics case discussion
Week 12 Final OSCE preparation: complex case with social formulation

Compiled by Abongo Davis · Ompath Study · shared for MBChB students at Mount Kenya University and other universities.