Rotation Summary

The past few weeks I rotated at CPEP in QHC, the emergency psych department.  Previously, I had not had a lot of experience with patients who were psychiatrically unstable so I was happy to find that I really enjoyed the field. What I found most interesting about psychiatry is how important it is to be patient when obtaining patient information and conducting an interview.  It took me some time to get used to asking patient personal questions about their mental health but as it came more naturally, I felt I was able to be reassuring and comforting when having hard conversations.  I learned a lot from the PAs and physicians on how to speak to a patient and bring up sensitive topics.  In addition, I learned a lot from talking to family members of the patients in order to collect collateral.  Often these people are seeing their love ones going through a scary time in their lives; it felt both challenging but rewarding being the person on the other end of the call to reassure them.

One thing I think I will continue to work on over the course of rotations is asserting myself and throwing myself into situations I can learn from.  It is beginning to become more natural to me to ask a physician or PA if I can see a patient alone or remind a nurse to go over a procedure with me.

Here is a log of the patients I saw over this rotation Case Logs2

Site Evaluation

Reflection

At my first site evaluation, I presented a case about 27 y/o female with a psychiatric history of schizoaffective disorder who was a few days post-partum and having another psychotic episode.  She was extremely paranoid and did not want to trust anyone with her new born baby, her mother informed me that she was talking to herself.  I learned that the patient was switched from lithium and Abilify to Haldol after finding out she was pregnant and her psychotic symptoms were not well controlled on this regiment.  I really enjoyed discussing this case with Dr. Saint Martin, as he encouraged me to see this patient with fresh eyes even though she was well known in the unit, allowing me to think critically about her diagnosis.  In addition, we discussed what would be best in terms of child care for the newborn, and with the right assistance, this patient could be fit to parent.

The case I presented on my final evaluation was a 52 y/o female with no psychiatric history and a medical history of HIV who presented to CPEP with pressured speech, hyperverbal and with delusions of grandiosity.  Again, I appreciated that Dr. Saint Martin questioned my decisions regarding the plan for this patient and allowed me to see the case from a different perspective.

Overall, my evaluations were a great learning experience and a really great way to reflect on how I’ve seen patients being managed and what other considerations could have been at play.

Here is a history and physical I presented at one of my evaluations.

HP Rotation 2

Journal Article

At my final site evaluation I presented an article that explored the treatment of schizophrenia with Lorasidone.

Summary

Lurasidone for the treatment of depressive symptoms in schizophrenia: analysis of 4 pooled, 6-week, placebo-controlled studies

This study pooled 4 similarly designed, double-blind, placebo-controlled, 6-week registration studies of lurasidone in adult patients with acute exacerbations of schizophrenia.  The changes in depressive symptoms were measured by the Montgomery-Asberg Depression Rating Scale. The MADRS scores were availile for 1330 patients.  Patients taking lurasidone experienced significantly greater decreases in MADRS score compared with patients receiving placebo.  Patients with a baseline score of greater than or equal to 12, depression remission was attained in 45% in lurasidone-treated patients and 36.3% of patients receiving the placebo.  The study concluded that lurasidone significantly improved depressive symptoms in patients with schizophrenia.

Attached is the article Lurasidone