Psych Evaluation Reflection:
For my Psychiatry Rotation evaluation, I presented a 39-year-old male patient who presented to CPEP on his own for visual hallucinations and insomnia for four days. I enjoyed presenting this patient as he was a very good historian and familiar with his diagnosis of schizophrenia. The patient spent a good amount of time speaking with me about his history of schizophrenia and his distress over his sub-therapeutic Lithium levels in his system. The patient was also very concerned about making sure he has stabilized appropriately so that he would be safe at home with his mother. The patient was admitted to CPEP in order to discover why his lithium levels were sub-therapeutic, as well as to observe his compliance with his medication regimen. He was very cooperative, but did display some magical thinking as well as visual hallucinations that he described as “moving dots”. Also, the patient had begun smoking tobacco again after having ceased for the last few months. He was very distressed about his tobacco relapse and was hoping to also receive counseling and treatment for his nicotine addiction. Overall, I felt his presentation was very important to discuss as he was a fairly normal presenting patient who lives a good quality of life. His knowledge of his mental illness and well as his medications were thorough and attest to his goal of living a happy, healthy, and normal life, even with schizophrenia. I included a very thorough examination of the patient’s mental status to convey this patient’s overall normal behavior and his above-average insight into his mental illness.
Psych Article Summary: I chose this article because it is a systematic review consisting of 11 total articles for review that included randomized RCTs, a total patient number of 889 participants, discussing the efficacy of pindolol in use with SSRIs. The cohort group was of the largest size within a fairly recent time frame. Also, I appreciated that this meta-analysis specifically discussed how treatment with pindolol dwindled after week 4, this could be efficacious as a consideration for stopping therapy with pindolol and SSRI combination as the effects wear off quickly. Also, the discussion of the refractory depressive syndrome is discussed as part of this review, saying that for patients who did not initially respond to SSRI treatment in the first place, would not respond to the addition of pindolol to their depression medication regimen. Also, while this systematic review is on the older side, it was the largest cohort available and I felt it lent the highest level of evidence in this particular PICO instance. Ultimately this systematic review did point out that the transient benefit of pindolol in accelerating the patient’s response to antidepressants may not be a strong enough benefit when weighing against possible beta-adrenoreceptor blockade adverse effects. While pindolol may not be efficacious long-term, it at least can help the patient to possibly feel less depressive symptoms at the beginning of their new SSRI treatment, where sometimes that may take more than 3 weeks to set in depending, of course, upon the patient themselves.
Psych Self Reflection:
For this rotation in Psychiatry, I was in an atmosphere that I had never been in before. Having had several years of experience in other branches of medicine, I was completely out of my element in psychiatry. There was a bit of a learning curve for me to become comfortable with such a subjective specialty. I very much enjoyed following each provider and getting to really know the patients I followed with them. Many of the patients in CPEP were just trying to do their best to live happy and normal lives with family and friends. Many also were trying to handle careers as well as other societal obligations. I found it fascinating how completely subjective psychiatry is. No two patients presented with the same symptomology even for the same ailment or chief complaint. I also was able to work on my empathy in this rotation. So many patients were just looking for support in their journey to be healthy, functioning adults. I learned to perform a very thorough mental status exam as well as a thorough psychiatric evaluation. One of the biggest changes for me was the way a psychiatric HPI is written. I enjoyed writing the HPI for the patients I saw so that I could receive criticism and better hone my skills in reporting my patients. Overall this was a very interesting and invaluable experience on my PA journey.
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