The Psychiatry Stuff That I Was Too Lazy To Post the Other Day

Now that I'm on my last week of my rotation, I guess I should talk about it a little bit. Sorry I've been so scarce - I've been moving (more on that later) and just busy and tired.

Anyway, I'm in psychiatry for 8 weeks - and our schedules are split into "primary" and "secondary" assignments. The primary assignment is the one that we do in the mornings, and it changes every 2 weeks. The secondary one is our afternoon stuff, and it stays basically the same throughout the 8 weeks. So for the first two weeks, I was at the "main hospital" (the one that is closely associated with the medical school) in the mornings, and we did/observed outpatient therapy and med checks for both adults and children, and covered psych consults for the hospital (along with the attending and/or the resident, of course.) The outpatient stuff work was slow, because most of the doctors and therapists were on vacation, and patients also tend to cancel appointments. But the consults were interesting - I saw a case of delirium (which I think was brought on by both a head injury and withdrawal from a bunch of substances) in a guy who had been in an ATV accident (without a helmet, of course.) I think it would help the whole "Don't be an idiot, wear a helmet when you're on an ATV" campaign if they just showed a clip of this poor guy thrashing around in his bed. He was so sad. And we saw a couple of cases of delirium, and that was about it for my consult experience so far. (I should mention that they keep our rotations "standardized" by giving us a list of procedures we're supposed to either observe or do, and patient encounters that we're supposed to have, and we have to have a certain percentage of them signed off before we can pass the rotation. So patient encounters for psychiatry are things like, ADHD-adult; ADHD-child; Anxiety Disorder; Bipolar Disorder; Conduct Disorder; Delirium, Dementia, Domestic Violence; Eating Disorder; Major Depressive Disorder; Mental Retardation/Developmental Delay - adult; Mental Retardation/Developmental Delay - child; Obsessive Compulsive Disorder; Oppositional Defiant Disorder; Panic Disorder; Personality Disorder(s); Schizophrenia; Substance Abuse/Dependence; Tourette's, etc. And for procedures, we have to do some Mental Status Exams, Substance Abuse Assessment, attend an Alcoholics Anonymous meeting, Psychological Testing, Electroconvulsive Therapy, etc.) For the rest of those mornings for the first two weeks, I observed some child therapy, some play therapy, adult med checks, and watched some DVDs of those patient encounters (like The Teachings of Jon for MR/DD Adult, or Thin for Eating Disorders, or The Basketball Diaries for Substance Abuse/Dependence.) In the afternoons, I have lectures on Monday and Friday, see my Hospice patient on Wednesday, see patients in Student Clinic on Thursday, and Tuesday afternoon I have off.

For the second two weeks, I went to a private inpatient hospital for my morning assignment. That's where things started to get interesting, because that's where I started to see schizophrenic patients, patients with psychosis, that sort of thing. We (Todd and I) would get to the hospital around 9 (okay, he would get there at 9, I'd get there circa 9:15), see a couple of patients and write SOAP notes/progress notes, and when our attending got there at 9:30 or 10, we'd see some patients with him or get a mini-lecture from him on, say, Borderline Personality Disorder, if we'd seen a patient with it that morning. This was where I started having my "I can't believe they're letting me do this!" moments - when I was grabbing charts and writing notes (in BLACK INK, for the love of all that's good and pure - I wrote in blue ink exactly once, and it was such a BAD THING that I might as well have pricked the patient's finger and written with their blood) and also talking to patients and asking them personal questions, and they'd actually TELL ME. Signing my progress notes with my name followed by "MS-III" IS fun, I have to admit. I'll bet MS-IV will feel even better, if I make it to that point. I had two really interesting patients at that hospital - one was bipolar and had been really manic for about 5 days, not sleeping at all during that time. At the end of this lack of sleep, he got one of those Nigerian scam emails, and had a little bit of a psychotic break, and believed it. He became delusional about having millions of dollars in various international banks, and insisted that he was a descendent of the ruler of a country in Africa. I got to follow him almost the entire time he was a patient there, and it was great to get to see him get better with the mood stabilizer meds. He also had an episode of acute dystonia after they started him on Zyprexa (which is muscle spasm in the neck and shoulders) - and I learned that you treat that with Benadryl, of all things. It's the anticholinergic properties of Benadryl that fix it. And then there was another patient with schizophrenia who believed that people could hear him think. He said that he was "allergic to photos" - that if he looked at a picture for too long, he would "fill it up" and that the people who could hear him think would die. I looked forward to seeing how he was doing every morning.

And then for the next two weeks, I was at a different inpatient hospital, with some very, very sick folks. At the end of my two weeks there, even these patients - who were terribly delusional and psychotic at admission or committment - are showing some improvement. That's really rewarding, even though I had nothing to do with it. :-) For the last two weeks, I'm back at the first hospital - the outpatient stuff and the consults. Yesterday I had my oral exam (on an adolescent patient in a 30-day inpatient program at one of the hospitals - on which I got a 97, woo! Thank the Lord.) Friday I have my miniboard exam, and that will be all for psychiatry.

If I think of anything else interesting from the past eight weeks that I left out (and I'm sure I will, because something interesting happens every day) I'll post about it ... well, sometime.