Psychiatry Final Reflection

The psychiatric rotation at CPEP (Comprehensive Psychiatric Emergency Program) was more challenging than I could’ve ever predicted, but it also provided very valuable insight into the nature of severely debilitating mental illnesses. My stay at CPEP began with a vicious attack by someone that tested positive for cocaine, cannabis, and likely the synthetic cannabinoid K2. It definitely reinforced my ability to maintain situational awareness at all times and to always keep myself and the people around me out of danger. The psych ER is populated by many patients that, due to the nature of their afflictions, can be very impulsive and violent. It’s not uncommon that these patients need to be restrained and sedated with antipsychotics like Haldol and benzodiazepines like Ativan. This is something that I didn’t realize would happen at the frequency that it did, but I understand that it’s necessary in order to protect the staff and other patients. Ultimately, a patient may need to be admitted to inpatient care and have their rights taken away from them against their will, but this is ultimately for the benefit of the patient in order to make sure that they remain safe.

            Initially, I had some difficulty in adjusting to the differences between psych and general care. The psych note is written with an emphasis on their history of mental disorders and their other past medical history, like diabetes or liver dysfunction, is not usually taken into account unless it can interfere with certain psychiatric medications. This is different from other settings where the long term treatment of their various physical ailments is the usual the goal. It took some time to figure out a good formula for fitting the patient’s demographics and history of mental illness into the first couple of lines, along with the behavior that they were exhibiting that brought them to the ER. I also learned the absolute importance of obtaining collateral information from the patient’s family or primary psychiatrist to gain deeper insight into their condition. This is important especially for presenting the patient to the doctors, because they need to understand if a patient is psychotic or experiencing suicidal or homicidal ideations right away. I also learned how to assess a mini mental state exam for dementia, which is something that I can bring with me to my future rotations. The focus of treatment is to have the patient stabilized enough to return to society without being a danger to themselves or other people, and from there they can follow up with outpatient services. It’s important to always have empathy for the patient, and it can be difficult to understand that they may not be compliant with their medications or require more advanced care that we can provide at the ER. I would want my preceptor or other colleagues to see that I’ve gained a good understanding of the medications most commonly used in the psych ER, as well as a good ability to accurately describe the patient in a mental status exam. I plan to improve by getting better at eliciting information from patients and assessing their current psychiatric needs, even if they are unable to verbalize them clearly.