Early Impressions of the Top Floor

Posted by Eric Zhao at Sunday, October 09, 2011

I'm on the top floor of UMHS where you need a keycard to access to the unit. Two weeks into my psychiatry rotation, I feel safe in saying that I doubt I will ever experience a patient population more interesting or empathy-inducing.

A Day in the Life
7:45 am: Patient workup prior to team meeting

8:30 am: Team meeting with attending physician, medical residents/students, nurse practitioners, physician assistants, and social workers. During this meeting, we talk about the patients, their progress overnight, and our therapeutic plan. If you see any pharmacy interventions, speak up here.

10:00 am: Rounding with the medical team. Now's the time to see the patients and view how they're doing. Pharmacists make sure that the medications are working as intended while minimizing any side effects. For example, in an obese patient or an athlete, recommend an antipsychotic that minimizes weight gain and other metabolic complications; aripiprazole and ziprasidone are good choices, while clozapine and olanzapine are not. As always, consider the patient profile as a whole, but you knew that.

12:00 pm: Patients are usually at lunch or group therapy, so we spend time chatting with our preceptor about our patients, giving journal clubs, and attending grand rounds.

1:00-4:00pm: Follow-up with patients and ask any questions. This is a good time to write up pharmacy notes, visit patients again with the team, and provide therapy recommendations.

Variety is the Spice of Life
As you can guess, no two days are the same. Diagnoses may be similar, but no two hallucinations, delusions, or psychotic episodes are alike. Also, there are few things more inspiring than seeing a patient's mood improve as their medications take effect. One of the strategies used to manage severe, drug-resistent forms of acute metal illness is called electroconvulsive therapy (ECT). Tune in next time as we explore the clinical dimensions of ECT.

-Eric Zhao

Committed to Mental Health

Posted by Jim Stevenson at Sunday, November 07, 2010

My current rotation is at Pine Rest Christian Mental Health Services in Grand Rapids, MI. It's a psychiatric inpatient unit, meaning the patients are a potential danger to themselves or others. Needless to say, the interesting patients are one of the best parts of the rotation.

I've seen most of the major psychiatric conditions, and many times patients have more than one diagnosis. I've seen patients hospitalized for major depression, bipolar disorder, schizophrenia, mood disorders, substance abuse, eating disorders, and post-traumatic stress disorder. Some of patients with psychoses are very insistent that what they perceive is real, while others have very good insight that what they are experiencing is a symptom of their disease.

Aside from the interesting patients, there are some other perks to the rotation. There is only one clinical pharmacist for the entire facility, so I get to participate on all pharmacy consults. That also means that he is the lone pharmacotherapy expert on the team and his opinion is well-valued.

In terms of pharmacotherapy, I am learning a lot. Because of the long-term nature of these conditions, stopping therapy is not an option (and is often not legal due to court orders). As a result, psychiatry is one area where we do try to treat side effects with additional medications. It's also an area where different drug forms are of high value. For example, decanoate injectable forms of drugs are useful because they allow us to achieve therapeutic levels with monthly or every two week injections as opposed to daily oral therapy. In a patient that has compliance issues, this is a great option. We also turn to liquid or orally-disintegrating tablets in certain patients that have been known to hide a tablet under their tongue to spit it out later. This is sometimes an issue in paranoid or manic patients.

So far, I've really enjoyed my rotation at Pine Rest. The patients are interesting. The medication therapy is interesting. I also feel that the facility is run in a very safe and humane way. If you're interested in psychiatry and have a place to stay in Grand Rapids, I can certainly give this rotation my recommendation.