Handbook Of Medicine In Psychiatry

[Doménica Spielmann]

Editor-in-chief Dr. Demosthenes Lorandos has brought together a world-class team of more than 40 experts and litigators to help judges, lawyers, and experts deal with expert evidence in forensic medicine, psychiatry, and psychology. The handbook provides attorneys and experts with the tools necessary to handle scientific evidence in the courts, with step-by-step guidance on how to use and challenge experts and ensure favorable rulings under Daubert, Kumho Tire, Frye, and other legal standards on expert testimony.

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Thank you for your interest in the Wright State University Residency Training Program in Psychiatry. We are excited to teach and to train at Wright State, and hope your online tour of our program will convey our enthusiasm.

Choosing psychiatry as a career puts you in place to make the kind of human contact that has become rare in other specialties. It is a practical choice, too: Our senior residents find themselves deluged with desirable job offers both because the field is under supplied and because the quality of our graduates is nationally known.

Psychiatry is at a dynamic point in its history. Our knowledge of neuroscience is synthesizing with our understanding of human psychology. We are coming to identify the connections between history and chemistry, emotion and anatomy, brain and mind. Our faculty is rich with clinician scientists who will guide you in your training to see how the biopsychosocial network functions.

Wright State University faculty and residents regard learning as a shared opportunity. We are all partners in the task of increasing psychiatric knowledge. For over 30 years, our program is fully integrated with our education partner, United States Air Force. Each civilian class is joined by up to 5 military residents.

Psychiatry is an exciting, multidimensional specialty, growing and thriving in an era of expanding scientific knowledge. Since 1977, the Wright State University Integrated Psychiatry Residency Training Program has been dedicated to preparing the practitioners of psychiatric medicine to deal comfortably and effectively with emotional and behavioral issues through personal intervention.

The program is eclectic in philosophy, regarding expertise in biological, behavioral, social and psychodynamic perspectives as necessary capacities for the practice of contemporary psychiatry. Training equips the resident with the ability to treat patients of different ages, cultures, and gender with a broad range of modalities.

The program maintains a consistent focus on the role of the psychiatrist in the community. Consultation and liaison skills, and the ability to interact with other health professionals, are necessary elements of this focus. The roles of the psychiatrist in the medical profession and in society are always emphasized.

The integrated nature of our training program affords an unusual opportunity to meet these goals. Operating at a number of clinical sites involving public and private sectors, the program truly functions in partnership with the community. The educational experience we provide is effective preparation for the challenges the graduate will face in becoming a productive psychiatrist in the modern world.

Psychiatrists are physicians who focus on understanding and treating mental health disorders and psychological distress, primarily through the use of talk therapy and medication. The psychiatry clerkship gives medical students the chance to gain first-hand experience with this complex and continuously evolving specialty.

This guide will cover the psychiatry clerkship, including when to place this rotation, how to make the most of your rotation, psychiatry clerkship resources, the shelf exam, and the pros and cons of pursuing this specialty.

Clinical clerkships (also known as rotations) allow medical students to practice medicine while being supervised by an established physician. Clerkships provide students with direct, first-hand knowledge of what the many different medical specialties are actually like, enabling students to better determine the field of medicine they are most passionate about and want to practice when they eventually become a physician themselves.

While it can sometimes be easy to confuse psychiatrists and psychologists, psychiatrists are medical doctors, which means they have an MD or DO. This means psychiatrists have been through four years of medical school, a residency, and perhaps even a fellowship.

It should also be noted that psychiatry is about a lot more than simply memorizing DSM criteria and assigning each patient a diagnosis. The DSM is more of a guide. Psychiatrists formulate a more holistic view of their patients by considering the psychological, socioeconomic, and physiological causes of their symptoms, not only the symptoms themselves.

Unlike other rotations, psych is often considered standalone, placed ad hoc with additional priority given to the big rotations, such as Internal Medicine. It stands in stark contrast to the placement strategy of OB/GYN and surgery, where positioning one before the other provides a huge advantage in terms of OR preparation and exposure to surgical culture for the latter rotation.

While psychiatry is unique, it can also be seen as a soft entry into medicine/neurology, especially in the outpatient setting. The psych clerkship allows you to get used to the pace of outpatient clinics and exposes you to writing long notes, which will help with medicine, so you may want to prioritize it early on.

For example, you may be able to opt for 2 weeks in an unlocked inpatient psychiatry wing followed by 2 weeks in the adjacent locked unit, or you may select or be placed in a 4-week rotation at a community mental health center that provides low-cost outpatient psychiatry services.

Finally, you may have the opportunity to benefit from a built-in elective component, such as 2 weeks at a child/adolescent program or addiction medicine clinic. Much like neurology, OB/GYN, and surgery, you will find yourself in a variety of settings, each with its own unique patient population.

Unsurprisingly, your daily schedule will vary according to what service you are on. Regarding the inpatient side, rejoice in a more reasonable wake up schedule. You will likely not find yourself waking up at 4 AM to pre-round ahead of the first OR case of the day, nor will you feel like you are on a marathon-long episode of House.

As you would expect, the acuity of patients differs greatly between the inpatient and outpatient settings. Furthermore, there is a huge difference between the unlocked and locked units. The type and intensity of psychiatric conditions will vary accordingly, as will the amount of time spent with each patient.

Your patient list may include people with schizophrenia who are actively psychotic, those with bipolar I disorder who are currently manic, and suicidal major depressive patients. If someone is recovering well, you may speak with them for less than 15 minutes. On the other hand, you may devote multiple hours a day to a patient who is trending toward an extension of their psychiatric hold.

If you are part of the locked unit team, do not expect to do too much pre-rounding or visits on your own, as safety and continuity of care take priority. You may also find yourself on a team who takes ED consults, which often results in voluntary or involuntary admissions for acute bouts of psychosis, major depression, or substance abuse.

Finally, given the low priority of mental health in the United States, many of your patients will be unable to afford outpatient services, so expect regular social work and occupational therapy consults to serve as stopgap measures. Less commonly, you will lead consult requests to other medical specialty teams, such as cardiology (usually for psychiatric medication side effects) or addiction medicine.

Unlike the inpatient side, you may not find yourself with as much responsibility or autonomy in outpatient psychiatry, especially if it is a packed schedule and the attending wants to get home on time. On the other hand, if you are placed in a community health setting, you may have more autonomy than even your inpatient weeks could provide.

If your outpatient weeks follow your inpatient ones, expect the same spectrum of conditions, but less emergent presentations of such. For example, you may see a follow-up for major depression in which the patient is well-controlled on their current medication regimen and no major changes are made to the therapeutic regimen followed by a young adult who was referred for workup of generalized anxiety disorder.

While psychiatry is full of surprises, you can still prepare for your rotation appropriately and effectively. To help you with that, we have expanded upon the most common conditions you will run into during your psychiatry rotation as well as what skills you should expect to acquire and practice.

To that end, we recommend you view your psychiatry rotation as the self-encapsulated discipline that it is, knowing that while the inpatient and outpatient tasks are, on the whole, similar to other medical specialties, you must become familiar with (quite literally) a different book of knowledge.

If you thought neurology was a cerebral specialty, just wait until your first rounds with the psychiatry team. Although the DSM-5 makes everything seem cut and dry, real-life patients are anything but that.

As such, it is imperative to take a thorough standardized history, incorporating the unique elements of psychiatry. For those hoping to brush up on their suturing skills, look elsewhere. Psychiatry is one of the least hands-on specialties. Nonetheless, your enhanced history-taking skills will be an invaluable addition to your tool set for every other rotation.

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