For my mid-rotation evaluation I presented a patient who presented to CPEP claiming that the surgeons implanted a chip into his head when they surgically removed his kidney stones one year prior. This patient had a history a multi-substance abuse and in preparation for the presentation I reviewed how different illicit substances may induce psychosis, and the adverse effects of all illicit substance intoxications and withdrawals in general. This was very useful for the EORE. Additionally, during the evaluation I mentioned that the pt’s mother chose to send him to CPEP because the pt has been declining in function and out patient psychiatrists only had appointments available in a very long time. On my plan for the patient, I had for him to follow up with out patient psychiatry upon discharge. Dr. Saint Martin asked me how the patient would be able to get an out patient psychiatry appointment upon discharge, if he has been having difficulty getting an appointment until now. This made me think about healthcare as a whole as opposed to just the medicine and treatment plan.

For my second site evaluation I wrote two H&Ps. I chose to present the 34 year old male patient going through a major depressive episode, which was exacerbated by finding out that his wife of 14 years had cheated on him. I was asked to distinguish why I chose the diagnosis of major depressive disorder as opposed to an adjustment disorder. What I explained was that the patient was experiencing anhedonia and other depressive symptoms prior to finding out that his wife was cheating on him. However, when he found out about it, the symptoms intensified and included suicidal ideations. I also learned, and discussed, that personality disorders can be present in patients on top of their other mental health diagnoses. During this evaluation I also presented my journal article on how the efficacy of treatment for major depressive disorder is affected by a concurrent personality disorder diagnosis.

Both site evaluations were held over zoom with the 4 other students who were also doing their psychiatry rotation present. I felt that having them was beneficial as I got to hear about their patients and learn about the diagnoses on their list of differentials. The questions that Dr. Saint Martin asked were relevant to understanding the illnesses and how treating the patient works as an overall approach. It was very enlightening and overall an experience that taught me a lot.