ROTATION #10 - PSYCHIATRY

I was placed on the adult psychiatry service that deals with consults on the hospital wards. Here is what my day would look like.

 

8:30am – Team meeting - Discuss any consults pending and determine any follow up required on patients previously consulted 

9:00am – 2:30pm This time can include teaching and grand rounds if scheduled. Otherwise this time is dedicated for follow ups on patients and any consults that need to be done for the day

2:30pm - 5:30 pm – Psych rounds - The team rounds on the new consults that have been first seen by the student/resident with the attending that is on for the service. Together you watch the attending lead the patient interview and deterimine the final assessment and plan. Here I learned what you look for in different psychiatric presentations. 

In psych you don't need a stethoscope and you also don’t need to touch your patient: P. As the weeks went by I started to style my hair down (don't need to tie it up for OR or procedures) and wear “nicer clothes”:)

In psychiatry your words are your tools and the patient interview is important.  At first I thought I was being judgmental but in psychiatry you need to describe how the patient looks, how they speak, smell and how they think. Psych is the art of observing, describing behavior/mood and determining how you can help. 

CONSULTS - what is included 

ID 

Reason for consult 
HPI - Depending on the consult it is important to add collateral history from the patients family and friends. Asking them if there are any changes in the patients behavior or their thoughts on how the patient is managing. For example if they believe that the patient is able to make financial or medical decisions. 
ROS – I ask if they have any auditory or visual hallucinations, suicide ideation and questions that suggest mania or depression depending on the consult. 
Past Psych History – any past psych admissions and history 
Meds/Allergies 
Social history - important as most presentations are environmentally influenced ex. drugs, alcohol, abuse, family
MSE (mental status exam) – appearance, behavior, speech, mood, affect, thought process, insight and judgement, cognition (MOCA or MMSE scoring system) 

PSYCH ON CALL (weekdays till 11pm weekends 8am-11pm)

We also had call for psychiatry which was psych consults from either adult or pediatric emerge. On call you work with a resident and assist with patient interviews /consults. Most emerge consults were unfortunately suicide attempts and ideation on both the adult and pediatric sides. 

WHAT I SAW

Psychosis

Schizophrenia

Hypomania

Opioid/benzo withdrawal

Anxiety

Capacity / Competency consults

Suicide attempt – hanging, stabbing, drug overdose ex. tylenol

Suicide ideation

Borderline personality disorder - cutters

Depression (know your acronym SIGECAPS)

Anorexia nervosa

Psychotic porphyria

Post-partum psychosis 

RECOMMENDED BOOKS

1. Interview Guide for Evaluating DSM-IV Psychiatric Disorders and Mental Status Examination by Mark Zimmerman MD

 

    2. The Mental Status Exam – Explained by David J. Robinson MD

  Overall I enjoyed psychiatry. It was a change of pace from internal medicine and it was a different perspective of health. In psychiatry you analyze the patient’s mental health and how it influences the patient’s life. You spend more time with your patient discussing how they feel and together determine the best treatment options.   From this rotation I learned how much your mind impacts your rehabilitation and course in hospital as well as how common mental illnesses are.