Mar 02, 2024
ELECT EOPYA - Psychiatry Crisis Unit Elective
Director Fourth Year Department Courses: Juliana Fort, MD
Director(s): James Patterson, MD
Administrative Contact: Christy Hay
Duration: 4 weeks
Location: Ochsner/LSU Health - Shreveport, Psychiatry Crisis Unit, 3rd Flr above ER
Elective Offered During Blocks: All
Course Code: EOPYA
NOTE: Content/Activities: Medical students will spend 5 days per week for 4 weeks in the Psychiatry Crisis Unit
Specific Objectives, - By the end of this rotation, students will:
• Perform a thorough (but focused) psychiatric interview appropriate to the ER setting
• Gather data from appropriate sources, including the patient’s medical record, hospital staff, family, law enforcement, outpatient care team members, and other relevant individuals.
• Identify early signs of escalation and agitation and recommend appropriate interventions (non-pharmacological and pharmacological) to effectively manage.
• Identify opportunities for treatment initiation in the ED setting.
• Develop initial comfort level with crisis-based psychotherapeutic interventions.
• Liaise with ED Nursing and Social Work staff to provide holistic patient care.
• Learn to distinguish primary psychiatric presentations from psychiatric symptoms associated with medical conditions via thorough history collection and examination, as well as via appropriate laboratory and imaging studies.
• Discuss options for treating undifferentiated acute agitation.
• Be exposed to the indications, risk, and benefits of seclusion and restraint.
• Discuss safe and appropriate dispositions according to the patient’s clinical presentation and a thorough risk assessment.
• Discuss the importance of context of the patient’s symptoms and that they may differ in a medical ED setting.
• Consider the implications in the evaluation of and treatment recommendations for special populations of psychiatric patients, including pregnancy/postpartum, geriatric, and developmentally delayed adult patients.
• Begin to learn to build rapport with patients in a fast-paced, medically and psychiatrically acute setting.
• Understand and practice the principles of effective teamwork in an emergency setting.
• Understand the importance of Psychiatry in cost containment efforts (e.g., in an Emergency setting, the impact of preventable admissions, appropriate dispositions, and prevention of readmissions via provision of treatment and solid follow-up care planning).
• Develop comfort with the variety of legal implications/issues in Emergency Psychiatry, including decisional capacity, guardianship, and criteria for involuntary commitment.
• Demonstration of the ability to locate, critically review, and apply evidence-based literature when applicable to the practice of emergency psychiatry.
While rotating in this acute setting, medical students will conduct psychiatric assessments under the direct supervision of the attending ED Psychiatrist. In this medically acute setting, senior students will hone their skills in evaluating and managing acute psychopathology, differentiating primary psychiatric concerns from medical conditions with psychiatric symptoms, and employing best systems-based practice principles in recommending appropriate, clinically indicated studies for this patient population
Resources for Learning:
The student will be assigned to an attending. The senior student will supervise junior medical students on the rotation. The attending will meet with the student on a weekly basis for individual supervision. Faculty will also observe interview skills while on the rotation.
Texts: 1. Synopsis of Psychiatry, 12th Edition, Kaplan and Sadock.
2. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)
Clinical performance and interview observation