MENTAL HEALTH FOR INTERNISTS

 

GOAL: To increase the general internist's ability to provide care to patients with common mental health problems.

CORE COMPETENCIES:

A. KNOWLEDGE:

1. To demonstrate knowledge necessary to appropriately evaluate and begin management for patients with the following problems:

a. Mood disorder

1. Major depressive disorder

2. Dysthymic disorder

3. Bipolar disorder

b. Anxiety

1. Panic attack

2. Generalized anxiety disorder

c. Substance abuse

d. Obsessive-Compulsive disorder

e. Eating disorders

f. Somatization

g. Personality disorder

1. Odd/Eccentric (paranoid, schizoid, schizotypal)

2. Dramatic/Emotional (antisocial, borderline, histrionic, narcissistic)

3. Anxious/Fearful (avoidant, dependent, passive-aggressive)

h. Grief and Adjustment disorder

i. Insomnia

2. To be able to diagnose and manage patients with different dementing syndromes:

a. Potentially Reversible

1. Medication

2. Depression

3. Normal pressure hydrocephalus

4. Endocrine/metabolic

5. Malnutrition

6. CNS Infection/tumor

7. Trauma

b. Irreversible

1. Alzheimer disease

2. Multi-infarct dementia

3. Binswanger's disease

4. Chronic ETOH abuse

3. To be able to distinguish delirium from dementia

4. To demonstrate knowledge regarding the clinical features, diagnosis, etiology, and treatments for delirium:

a. Intoxications

b. Withdrawal

c. Metabolic/endocrine

d. Infection/tumor

e. Post-operative/ICU

B. PRACTICE SKILLS AND PROCEDURES:

1. To improve diagnostic skill in interviewing patients, families, and care-givers and in ordering and interpreting neuropsychological/personality testing.

2. To be able to take a mental health history with particular attention to the following:

a. Symptoms of depression

1. Lack of energy

2. Insomnia/Early morning awakening

3. Guilt

4. Loss of appetite/ weight loss

5. Withdrawal

6. Anhedonia

7. Suicidal ideation

b. Symptoms of Anxiety

1. Fear, panic, impending doom, impulse to flee

2. Life stressors

3. Avoidant behaviors

c. Past medical history

d. Past psychiatric history

e. Family history/dynamics

f. Impulse control

g. Substance abuse/ CAGE questions

3. To be able to select and managing the following therapeutics with regard to pharmacology, drug interactions, side effects, cost, follow-up and dose adjustment schedules, with special attention to the elderly patient:

a. Senatonin re-uptake Inhibitors

b. Heterocyclic antidepressants

c. MAOI=s

d. Anxiolytics

e. Antipsychotics

f. Mood Stabilizers

C. ATTITUDES / LEARNING HABITS:

1. Gain insight into the resources available for families managing a dementia patient at home.

2. To become familiar with the groups available to help substance abusers and their families.

3. To understand the large impact of mental health problems in the elderly population ( eg, depression, delirium, dementia, substance abuse) and their presentations to the general internist.

4. To know when to refer a patient to a psychiatrist for further assistance and management:

a. Insight-oriented therapy when there is emotional upheaval or disabling symptoms.

b. Substance abuse

c. Prominent phobic behavior

d. Suicidal ideation

e. PTSD/OCD and other uncommon mental health diseases

f. Patients not responding well to initial pharmacologic therapy.

g. Choice of psychotropic medication in patients with multiple medical problems and possible drug interactions.

h. Psychosis

i. Treatment resistant depression

j. Substance abuse

k. Treatment resistant anxiety/panic attacks

l. Significant suicidal ideation

m. Prolonged grief reaction

n. Polypharmacy

5. Know when not to refer a patient to psychiatry (social work/chaplain issues)

 

OPTIONS

 

Monday Tuesday Wednesday Thursday Friday

Inpatient Rounds

(Geriatric Affective)

 

Psychopharmacology Clinic (8-12)

 

 Inpatient Rounds Inpatient Rounds Inpatient Rounds Inpatient Rounds
 

 

 

 

  

 

  

 

  

 

  

 

Psychiatry

Grand Rounds

(11-12:15)

 

 

 
 

 

 

 

  

 

Memory Disorder

(1-5 pm)

 

 

 

Substance Abuse

Medicine Rotation (Hoots) (1-5pm)

  

 

Neuro Behavioral Clinic (1-5pm)

  

 

Substance Abuse Medicine Rotation (Hoots) (1-5pm)

  

 
 

 

Consult Rounds

(3-5pm)

 

 

 

 

 

  

 

Consult Rounds

(3-5pm)

  

 

Consult Rounds

(3-5pm)

  

 

Consult Rounds

(3-5pm)

  

 

Consult Rounds

(3-5pm)

 

Additional Day Long Options:

1. Community Mental Health Center rotation with Psychiatry resident.