First week in Psychiatry

1/31/2004 2:38 pm

I finished my Internal Medicine on a Friday and began my psych rotation on Monday, Jan 26, 2004. The first day, I was asked to report to my preceptor, Dr. C at 8:00 am in the morning. This itself was a big difference from IM where we used to report at 6:30 am. Dr. C is the head of a department of Behavioral Medicine. The first day was kind of unstructured. He took me around to the Children's Inpatient unit, the Adolescent Inpatient unit and the Adult Inpatient units. We also got a glance at a special unit for mentally retarded children. I basically got to spend the day in the lounge outside his office. He could not let me in while he interviewed some patients as my presence would affect the dynamics of the interview.

The Department of Behavioral Medicine has several programs/units:
Child Psychiatry
Adolescent Psychiatry
Adult Inpatient Units
A special unit for children and adolescents with mild to severe mental retardation
A Chemical Dependancy Unit and
An outpatient facility that runs intensive throughout-the-day psychotherapy, psych-education programs.

In the afternoon I got to sit in on the outpatient day therapy sessions. They were in groups and the topic being discussed was dealing with grief.

During the rest of the week, I spent a couple of days at the Chemical Dependancy program attending the day sessions -- almost all of the therapy is done in groups in this unit, and studying the drug protocols in the charts. For alcohol dependency/abuse, the detox protocols consisted mainly of Librium and Clonidine. I was surprised to learn that Clonidine is used. I was told by a psychiatrist in that unit that alcoholics will often exhibit sympathetic respnses during their detox -- higher blood pressures, perspiration, tremors, and that Clonidine helps with this.

Since my days were so slow and I was not spent yet, I volunteered to join the staff that man the ER in the 3:00 pm to 11:00 pm shift. Apparently, that is when they get most of their admissions to the psych unit. I was amazed and appalled at how many people come in with suicidal ideation and even a plan. Amazingly, almost all of the people I saw in the first week there were females in the ages ranging from 13 to 25. One evening, after 4 such "I want to kill myself" cases in a row, I was somewhat encouraged when the fifth person I interviewed, a 31 year old Caucasian male said "I hear voices". I asked "What are the voices saying to you?" The answer: "The voices are telling me to kill myself. Here we go again...

I like working the ER because I am getting to see some florid pathology and I get to practise my ability to do the mental status exam and come up with the appropriate DSM-IV diagnosis.