Psychiatrist As Sherlock Holmes
It’s not unusual that patients we interview minimize or deny information that is unpleasant for them to share. Also, it is not unusual that they try to distract you or move you away from pursuing this sensitive information. Let me give you a recent example and explanation.
Developmentally Delayed Individuals on the Boards
When assessing a patient on the psychiatry oral board exam – and this holds true for the adult and the child adolescent exam – who appears to have mental retardation or developmental delay, you must expect to be asked questions relevent to this topic. And yet, in my experience, many candidates are not prepared to do so. In fact, this topic makes them uncomfortable to the point that they lose their emotional equilibrium and start performing more poorly on the rest of their exam. Here are some simple tips to help you handle these cases better.
Psychiatric Treatment Plan – Laser Clarity
As you know, I observe and assess several hundred psychiatric treatment plans each year as I am mock-examining psychiatrists preparing for their Psychiatry and their Child Adolescent Psychiatry oral boards. There is a small, simple concept to keep in mind during your presentation of the treatment plan that can help you avoid this common shortcoming.
Treatment Plan – Wrong Way & Right Way
Let’s start with the wrong way. The following is an efficient way of making your treatment plan weak, generic, and not optimized to help the patient. Drum roll, please ….
The Doughnut Interview
One type of interview error I run across among both adult and child adolescent psychiatrists preparing for their oral boards is what I call the ‘doughnut interview.”
Increased Suicide Risk from Antiepileptic Drugs
Beginning in 2008, the FDA began notifying clinicians of the potential of antiepileptic drugs to increase suicide risk and earlier in 2009 issued a public health advisory notifying the public of this increased risk. Also, the FDA is mandating that manufacturers of antiepileptic drugs change the labeling of their meds, adding this risk to the Warnings section of the drug insert.
The Underutilized Anti-Depressant “Wonder Drug”
Today’s post is about an antidepressant augmenter that can lead to incredibly powerful responses and yet, that is NEVER used by a majority of psychiatrists. What drug am I referring to? It is T3 or triiodothyronine.
Patient On Methadone Using Lorazepam
Today’s post is my response to a brief case vignette of a psychiatry oral board exam patient. Today I address the drug abuse issues. I will leave the issue related to when and how to give an Axis II diagnosis for the follow up post. Let’s start.
Suicide Assessment: Fantasies That Increase Risk
Today is the second in a series on the suicide assessment. A factor that really increases a patient’s risk of suicide that is often not even on our radar is the nature of the patient’s fantasies regarding their suicide. Read more on this fascinating topic.
Suicide Assessment: Beliefs That Can Increase Or Decrease Risk
Suicide assessments, to provide us any direction, need to be in-depth. Why? Because the suicide risk factors we’ve all learned about (e.g., living alone, abusing alcohol, even having suicidal thoughts) are poor predictive factors. So even after assessing a patient for suicide, we end up not knowing if and when that person will actually engage in a suicide attempt.
This state of affairs leads one to ask, “So what’s the point in conducting a suicide assessment at all?” The answer is that if we learn to conduct in-depth assessments, we can identify the factors that increase level of risk. We then can intervene to lower those risks, whether or not they would have led to suicide. In other words, even if we can’t predict future action, we can use the assessment to guide us to lower the risk. Today I start a series on different aspects of the suicide assessment. Today’s topic is on suicidal beliefs. The next topic is on suicidal fantasies.