MRCPsych on the Go: Revision Essentials

What if you slept twenty hours a day for weeks at a time, then woke up with barely any memory of it?

In this episode, we explore Kleine-Levin syndrome, the rare recurrent hypersomnia nicknamed Sleeping Beauty syndrome, affecting roughly one to five people per million. We cover what an active episode looks like, and the classic three Hs of hypersomnia, hyperphagia and hypersexuality. We look at what brain imaging reveals about the circuits involved, with reduced blood flow in the thalamus and hypothalamus, the brain regions that regulate sleep, appetite and behaviour. We also cover the genetic and immune clues to its cause, the differential diagnosis, why lithium is used despite limited evidence, the good long-term outlook, and where patients and families can find support.

Ideal for MRCPsych Part A revision, psychiatry trainees, medical students and anyone who enjoys a strange corner of clinical medicine. 

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, section 3.5.1.2 on neural circuits, and the ICD-11 classification of sleep-wake disorders. 

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What happens in the brain when a burst of laughter makes your knees give way, while you stay completely awake?

In this episode, we explore narcolepsy through the lens of the brain's sleep-wake circuitry. We cover the classic tetrad of excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations, and the difference between narcolepsy type 1 and type 2. We tell the story of Emmanuel Mignot's decade-long hunt through a colony of narcoleptic dogs, and how it led to the discovery of orexin, also called hypocretin. 

We then explore how losing orexin neurons in the lateral hypothalamus destabilises the switch between sleep and wakefulness. We also cover diagnosis with polysomnography and NICE-guided treatment, from modafinil and stimulants to sodium oxybate and solriamfetol.

Ideal for MRCPsych Part A revision, psychiatry trainees, medical students and anyone curious about the science of sleep. 

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, section 3.5.1.2 on neural circuits, and the ICD-11 classification of sleep-wake disorders.

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If you were told, right now, that you could lie down and fall asleep within five minutes, would your body actually believe you? For most people with insomnia, the honest answer is no, and that gap sits at the centre of the entire disorder.

In this episode, we open a five part series on sleep disorders, classified according to ICD-11. We cover how insomnia disorder is actually defined and diagnosed, the two-process model of normal sleep, the hyperarousal model and Spielman's 3P model of how insomnia develops and persists, what investigations are genuinely useful, and current NICE-guided management, from sleep hygiene and CBT-I through to the Z-drugs, melatonin, and the newest licensed option, daridorexant.

Ideal for MRCPsych Part A revision, psychiatry trainees, medical students and anyone who has ever lain awake exhausted but unable to switch off. 

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 1.1.10, and the ICD-11 classification of sleep-wake disorders.

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In 1780s Paris, patients sat around a wooden tub filled with iron filings and bottles of "magnetised" water, gripping rods that protruded from it, waiting to convulse.

The man who invented this spectacle believed he'd discovered a new force of nature. He hadn't, but he'd stumbled onto something real anyway.

In this episode, we close our series on states and levels of awareness with two ways of deliberately altering consciousness: hypnosis and meditation. We trace hypnosis from Mesmer's showmanship through Charcot's clinic to the modern scientific debate over what it actually is, then turn to meditation's measurable effects on the brain and its established clinical uses.

Ideal for MRCPsych Part A revision and anyone curious about how much of the mind can be deliberately, rather than accidentally, altered.

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 1.1.10.

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When a mother kills her own child while acutely mentally ill, is that murder, or is it an illness? The mistrial in the Lindsay Clancy case has put that exact question back in the headlines.

Part 2 of 2. In our last episode, we covered the clinical picture of postpartum psychosis itself. In this episode, we follow up with the legal side: the Lindsay Clancy case in Massachusetts, the insanity defence and the M'Naghten rules, England and Wales's Infanticide Act 1938 and Scotland's different approach, a landmark UK case that shows how this plays out closer to home, and a proper look at automatism, the defence we teased last time.

This episode is written for absolutely anyone, and it's especially relevant for psychiatry trainees covering forensic psychiatry and the perinatal curriculum. 

If you haven't heard episode 40 on what postpartum psychosis actually is, we'd recommend starting there first.

 Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 12.1. 

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What if the same hormones that helped grow and deliver a healthy baby could, in a small number of women, also trigger a complete break from reality within days of giving birth?

Part 1 of 2; Postpartum psychosis has been all over the headlines because of the Lindsay Clancy case in Massachusetts, so in this episode, we step outside our usual syllabus order to explain the illness itself properly. 

We cover what postpartum psychosis actually is, how it differs from the much more common baby blues and postnatal depression, what causes it, and what NICE guidance says about recognising and treating it, including the evidence behind lithium. 

In part 2, our very next episode, we follow up with the legal side of the Clancy case itself.

 This episode is written for absolutely anyone, new parents, family members, healthcare professionals, psychiatry trainees, or simply anyone who's been following the news. 

It's aligned with NICE guideline on antenatal and postnatal mental health, and it's relevant to the MRCPsych perinatal psychiatry curriculum too.

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Every night, your brain spends part of its time paralysed and hallucinating, in a state that looks almost exactly like being awake. That's REM sleep, and it happens to all of us. 

In this episode, we cover the structure of a normal night's sleep and the major theories of why we dream, the parasomnias that can intrude on sleep, and the biorhythms that govern when we sleep at all, along with what happens when we don't get enough of it.

Ideal for MRCPsych Part A revision and anyone who has ever wondered what their brain is actually doing while they're unconscious.

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 1.1.10.

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Why can a radar operator miss an obvious blip after two hours on shift, but catch it easily in the first ten minutes? The problem isn't their eyesight, it's how alertness itself behaves over time.

We look at how the brain regulates arousal through the reticular activating system, why sustained attention reliably decays over time, the vigilance decrement, and how the same arousal circuits link to ADHD and to disturbed attention and awareness in delirium.

A note before we start: the syllabus pairs attention with arousal here, but we already covered the main attention models, Broadbent, Treisman and the cocktail party effect, back in episode 9. This episode covers what's new. Arousal itself, and how attention holds up over time. If you haven't heard episode 9, it's worth going back to.

Ideal for MRCPsych Part A revision and psychology students who want the arousal and vigilance side of this topic without repeating what's already been covered.

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 1.1.10.

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What if your mind wasn't one thing, but three, constantly negotiating with each other? One wants, one restrains, and one judges. That's Freud's structural model of the mind: the id, ego and superego.

In this episode, we go beyond Freud's topographical model from episode 35, into his structural model of the mind, the ego's defence mechanisms, and his theory of psychosexual development, including the Oedipus and Electra complex. 

We also look honestly at where this theory has held up, and where it hasn't, including Karl Popper's famous unfalsifiability critique.

Ideal for MRCPsych Part A revision, psychology students and anyone who wants to understand the foundations, and the limits, of psychoanalytic theory.

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 9.1.1.

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What do you call someone who forgets you entirely, then confidently tells you something that never happened? That's a patient with Korsakoff's syndrome. They can hold a normal conversation with you, then forget you were ever there the moment you leave. Ask them to explain the gap, and they won't lie. They'll fill it with something that feels completely true.

In this episode, we explore Korsakoff's syndrome, picking up from the patient we met in episode 35. 

We cover how thiamine deficiency damages the brain's memory circuitry, why confabulation happens, and how ICD-11 classifies the condition differently from older systems. We also look at its relationship to Wernicke's encephalopathy, and the narrow treatment window that separates recovery from permanent amnesia.

Topics include the Wernicke-Korsakoff spectrum, the pathophysiology of thiamine deficiency and the brain's memory circuit, the clinical picture of anterograde amnesia and confabulation, ICD-11's classification of amnestic disorders, and emergency and long-term management.

Ideal for MRCPsych Part A revision, psychiatry trainees and anyone who wants to understand one of psychiatry's most striking examples of memory failure.

Aligned with the Royal College of Psychiatrists MRCPsych Part A syllabus, paragraph 1.1.10, and the ICD-11 classification of amnestic disorders.

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