(Dr. Pessar)

Inpatient Psychiatry

The psychiatry clerkship is not complete without a taste of Inpatient Psychiatry. This is where the acute patients from CPEP or other emergency rooms are brought voluntarily or involuntarily if they are a threat to themselves or others. Here you will see the successful, or unsuccessful, treatment of patients; the disappearance or new onset of voices and visions; and the reality testing of delusions. You get to experience police codes for out of control patients and medical codes for stuporous or intoxicated ones. Most of all, you will get a taste of what full blown psychosis, delusions, and mood disorders really are, and also get to see how much a person changes when the medications kick in, or don't. The best way to survive this part of your clerkship is to find out what your attendings expect from you and how to ask your residents for help. The residents are key, and they are your best source of information. Do not forgot to create a differential before presenting to your attendings, for what may seem to be an obvious diagnosis will almost always need exclusion of all other diagnoses. Never forget AXIS II !!! Also remember that some patients really feel Psychiatry is very taboo, so don't get offended if you patients will not speak with you because you are not a "medical doctor." If you have the opportunity, I highly suggest working at the VA hospital. The cases are different than that you will see at ECMC, but just as interesting. Dr. Xu is the senior attending, and she will make sure you know your stuff by the time you are through with her afternoon lectures. However, expect to work full days while you are there, all the way until 4pm.


CPEP is a wonderful environment to see acute psychiatric issues and emergency care. It is the place medical students dream of for viewing psychosis, mood disorders, and personalities galore. One cannot describe the amazing satisfaction of witnessing a first psychotic break; just wait until you get to CPEP. With all this said, the difficulty in adjusting to an emergency room setting is quickly obvious to the medical student. Clearly medical students are the lowest part of the CPEP ladder, and we are constantly skirting nursing staff, residents, and attendings, just to get a quick peek at the patient clipboard to see if there are any "first lined" patients awaiting a student to "second line" them. When not busy checking the clipboard, consulting medical staff for patient issues, or scribbling quick SOAP notes in the far corners of the "CPEP fishbowl," students are sequestered away in the conference room. Essentially a closet of retreat where students can read psychiatry material, discuss patient cases amongst themselves, or again write patient progress notes.

Attendings come and go like whirlwinds and it really feels this way in CPEP to the medical student. The confusing part is that every attending expects write-ups/presentations/follow-ups in a different manner, but there is rarely a good time to divulge attending expectations to the scattered medical students. In other psychiatry units the residents will often direct the students for a more streamlined team effort, but CPEP only has one resident for 4-5 students, and the resident is often swept up with patients as the attending is. Nursing staff, in turn, may feel obligated to take a part in shuttling students around, pointedly reminding students to remain in the conference room when not presenting patients or making collateral phone calls.

To succeed in CPEP, make sure you know what the day attending expects of your student team (ie. Dr. Improta likes you to chase him down and hound him to present your patient while Dr. Millward will come seek you out when he is free and prefers that you wait in the conference room.) Beware the nurses that prefer you stay out of their way, and befriend those you can turn to with questions. Learn all of their names and expect good returns. Also, since Emergency Room care is shift-duty, you must stay your full 8:30-4:30 shift and wait past 4:30pm if necessary should the evening attending arrive late. You will be expected to present your patient(s) to her/him before leaving for home.

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