For Regular Clerkship Students

 

Readings for CL Psychiatry Course   (Tues 9:00 AM -9:50 AM in Dr. Leigh's Office)

    (The chapters are from  the 2nd Edition of Handbook of Consultation-Liaison Psychiatry by Hoyle Leigh and Jon Streltzer, published by Springer, 2015.  The links below lead to the chapters.

The book is available in the CL Office as well as on-line here.)

Session 1.

    Chapter 4.  Common Reasons for Consultation and their Management   

    Chapter 14.  Anxiety and Anxiety Disorders       

    Chapter 16. Trauma and Stressor-Related Disorders 1: Acute Stress Disorder, Posttraumatic Stress Disorder

    Chapter 17. Adjustment Disorders                  

          Food for Thought and Brainteaser Questions for this session:             

                 Consultation Psychiatry

                1. Develop an algorithm for dealing with a patient with agitation and visual hallucinations presenting to an Emergency Room.

                      2. Develop an algorithm for dealing with a patient who is referred to you for saying “I’d rather be dead”

 

                Anxiety/Stress

                1. Why is anxiety? Is it good or bad?

                2. What is Klϋver-Bucy syndrome?

                3. What is the usefulness of meditation, yoga, exercise, and dance in treating anxiety?  Why?

                      4. Please develop a method of making one of your colleagues into a bibliophobe, and then cure him/her

                      5. Why is PTSD the "SLE" of Psychiatry?

 

                

     Session 2.

     Chapter 7.    Basic Foundations of Diagnosis, Psychiatric Diagnosis, and Final Common  Pathway Syndromes            

    Chapter 15.  Affect, Mood, Emotions: Depressive Disorders and Bipolar and Related Disorders

        Food for Thought and Brainteaser Questions for this session:       

                Psychiatric Diagnoses, Final Common Pathway

                1. Please discuss gene x meme x environment interaction and the biopsychosocial model.

                2. What is a final common pathway syndrome?

                3. What is the role of differential diagnosis in a final common pathway syndrome? 

                4. What are the similarities and differences between neuroleptic malignant syndrome (NMS) and serotonin             syndrome?      

            

               Depression

                1. Why is depression?  Is there evolutionary reason for depression?

                2. Suppose we eradicate sadness entirely.  Consequences?

                3. What are effective antidepressants?  Why?

                4. What do SSRI’s, antipsychotics, Lithium, and ECT have in common?

                      5. What is the role of placebo in treating depression?  How effective is placebo?
                     

                                                                                                            
Pearls about Differential Diagnosis

 

                                                                                    A. Secondary Contributing Factors

                                                                                                   a. Substances – good and bad

                                                                                                   b. Medical Diseases

                                                                                    B. Primary Psychiatric Syndromes

                                                                                                    a. Mood Syndromes

                                                                                                    b. Psychoses

                                                                                                    c. PTSD (SLE of psychiatry)

                                                                                           If indicated:

                                                                                        d. Anxiety Syndromes (e.g. GAD, Panic, OCD)

                                                                                                    e. Somatic Symptom Disorders                 

   

     Session 3.

 

    Chapter 19.   Psychosis (Schizophrenia Spectrum and Other Psychotic Disorders)           

 

    Chapter 25.   Patient’s Personality, Personality Types and Traits, and Disorders  in the CL Setting

 

           Food for Thought and Brainteaser Questions for this session:

                    Psychosis

                    1. Why is psychosis?

                    2. When is psychosis “normal”?

                    3. What is the difference between psychosis and schizophrenia?

                    4. Is schizophrenia genetic?

                    5. What are the challenges in using antipsychotic drugs?

                    6. A schizophrenic patient, who has been stable on olanzapine 20 mg per day for more than 5 years, wants to get off olanzapine because  he heard that it causes diabetes.

                        His current weight is 8 lbs heavier than he was before starting olanzapine, and his fasting glucose level  is 100-110 mg.  As his psychiatrist, what would you do?

 

                   Personality

                    1. What is personality, and why is a patient’s personality relevant in medical practice?

                    2. What is the best way to deal with an orderly, exacting, obsessive-compulsive patient in an acute medical setting?

                    3. How could one deal with a long-suffering, whining patient who seems to get worse with every intervention?

 

 

 3. Optional Background Reading Material

     Readings on Epigenesis

    The Patient: Biological, Psychological, and Social Dimensions of Medical Practice by Leigh & Reiser, 3rd Edition (1994)

     Charles Brenner: An Elementary Textbook of Psychoanalysis 

               Chapter 1        Chapter 2        Chapter 3      Chapter 4     Chapter 5

               Chapter 6        Chapter 7        Chapter 8