Welcome to the Primary Care Psychiatry Elective

Description

The Primary Care Psychiatry Elective provides residents the opportunity to grow in their skills in psychiatry through multiple experiences based upon the needs and desire of the resident. Three months prior to the elective, the resident is to meet with faculty to develop goals for the elective and begin developing a plan to tailor the experience to the goals. Possible opportunities include: consult liaison service at UH, working directly with Dr. Ruegg or Dr. Wulsin at McMicken, experiencing collaborative care at UCMC or even being part of implementing collaborative care at the FMC. This rotation works best as an intensive deep-dive during a 2-week block. However, depending on the resident’s goals, in rare instances may be adapted into a longitudinal experience (residents must get permission from faculty for this).

If interested, please submit a request form and reach out to Dr. Pulliam to begin planning for the experience. 

FM Faculty Lead

Schedule

Elective Duration: 2 weeks

Resources

Mental Health Page on Website

Bipolar Review Article

Capacity Evaluation

MOCA

MoCa Instructions

Sample Potential Goals and Objectives:

Goals:

Following this rotation, the resident will be able to:

1. Triage and begin initial management of urgent and emergent patient conditions

2. Refer patients to a variety of mental health specialists using elements of effective referrals

-substance abuse evaluation and management

-Community mental health resources

Objectives

Patient Care

1. Triage patients presenting with suicide ideation, depression, mania, acute psychosis, intoxication, or nonspecific altered mental status, identifying those patients who require psychiatric admission, acute emergent treatment, medical transfer, or who could be managed as an outpatient.

2. Perform a complete psychiatric evaluation of patients presenting with psychiatric complaints.

3. Order cost effective laboratory and imaging studies for patients presenting with psychiatric complaints.

4. Perform a capacity evaluation on patients in the inpatient and outpatient setting.

5. Evaluate patients with acute delirium, performing a focused history, exam, and ordering diagnostic studies based on the differential for acute delirium.

6. Initiate treatment, including non-pharmacologic management, of patients with acute delirium in the inpatient setting.

7. Evaluate patients with ongoing and/or acute substance abuse issues, performing a focused history, exam, and ordering diagnostic studies as needed

8. Initiate treatment, both pharmacologic and non-pharmacologic, for substance abuse issues as well as learn to navigate the outpatient referral options for these patients.

Medical Knowledge

1. List the differential for patients presenting with acute delirium.

2. List the risk factors for acute delirium.

3. Describe the methods for reducing delirium that have been proven to be effective in the literature.

4. Compare and contrast the following psychiatric presentations:

   1. Major Depressive Disorder

   2. Bipolar Affective Disorder (Types I, II, and NOS)

   3. Schizophrenia

   4. Borderline Personality Disorder

   5. Suicide ideation with and without intent

   6. Psychosis

   7. Post-Traumatic Stress Disorder

   8. Substance-Induced Mood disorder and/or abuse, intoxication, dependence

   9. Explain the capacity evaluation for patients.

   10. Describe the approach of a patient with suicidal ideation, identifying risk-factors, comprehensive assessment and determination of need for or against hospitalization.

   11. Compare and contrast the following drug classes as it pertains to mechanism of action, indications, contraindications, and side effects:

       1. Anti-depressants

          1. SSRIs

          2. Bupropion

          3. Mirtazapine

          4. SNRIs

          5. TCAs

          6. Trazodone

          7. Typical and atypical antipsychotics

             1. Haldoperidol

             2. Risperidone

             3. Olanzapine

             4. Quetiapine

             5. Ziprasidone

             6. Aripiprazole

             7. Mood stabilizers

                1. Lithium

                2. Valproic acid

                3. Lamotrigine

                4. Carbamazepine

                5. Benzodiazipines

                   1. Diazepam

                   2. Lorazepam

                   3. Clonazepam

                   4. Antihistamines

                      1. hydroxyzine

                      2. diphenhydramine

                      3. Sedative/Hypnotics

                         1. Zolpidem

                         2. Zaleplon

                         3. Eszopiclone

                         4. Chloral Hydrate

                         5. List the elements of an effective referral.

                         6. List community resources available to patients for substance abuse and mental health disorders.

Interpersonal and Communication Skills

1. Communicate effectively to patients and family members their psychiatric diagnosis, treatment plan, and prognosis.

2. Communicate in succinctly to psychiatric consultants and support staff concerning patients with psychiatric complaints providing the key elements to a psychiatric evaluation.

3. Document H&Ps, consultations, and daily notes which are detailed, concise, and timely.

4. Explain discharge medications, follow-up, and other relevant information to patients and families.

Professionalism

1. Refer patients to speciality services (psychiatry, counseling, drug and alcohol) when the patient’s needs exceed the limits of care available in the family medicine setting.

2. Interact with patients, staff, and colleagues in a professional and courteous manner.

Practice Learning and Improvement

1. Critically analyze the medical literature using the principles of evidence-based medicine to apply the best medical evidence to the care of the patient.

2. Exhibits an investigatory approach to knowledge deficits: Generates questions and utilizes available resources to answer the questions.

3. Responds to feedback provided by faculty and senior residents.

System Based Practice

1. Participate in the team based approach to patient care, playing an active role in the team.

2. Actively involve a multidisciplinary approach to patient care utilizing case management, and social work services.