Tips for a Psychiatry Rotation
Written by Rand Hashim
Your psychiatry rotation will be a unique experience compared to other clinical rotations. Although there are certainly medical diagnoses for each patient, the main focus will be your patient’s psychiatric diagnoses.
One major difference in clinical experience is the mental status exam. The mental status exam includes an objective evaluation of the following:
Appearance: are they well kept? What is their body language like? Are they cooperative?
Behavior: What type of gestures are they using? Do they follow commands? How is their eye contact?
Speech: What is the volume, tone, latency, and amount (increased/decreased/normal) of their speech?
Thought process: Are they logical/organized or tangential and disorganized?
Flight of ideas: when their thoughts quickly jump from one to another
Thought blocking: when their thoughts are interrupted and incomplete
Thought content: What is the content of their thoughts? Are they hallucinating or obsessing?
Mood: Are they sad/happy/content? Add this part of the mental status exam in quotes “***” based upon what the patient states.
Affect: What is the emotional state of the patient? Are they flat/sad?
Can be congruent or incongruent with their mood
Cognition: Are they alert and oriented to person, place, and time?
A good rapport is important in all your clinical rotations but can be especially important in psychiatry as your patients will be sharing very private information about themselves. Building a good relationship with your patients can help them feel more comfortable with you. Some key aspects of the history include hallucinations (“are you hearing/seeing things that other people don’t hear/see?”) and whether they are suicidal/homicidal (“do you have any thoughts about hurting/killing yourself or others?”). The best approach is one that is clear and direct.
It’s also important to remember the diagnostic criteria and timeline for each psychiatric diagnosis. The mild differences can help you distinguish one from another and help you understand the various treatment options.
Some helpful mnemonics to remember:
Major Depression= 2+ weeks of 5+ depressive symptoms: SIG E CAPS
Sleep disturbance
Interest in activities (loss of interest)
Guilt
Energy (decreased)
Concentration (decreased)
Appetite changes
Psychomotor slowing
Suicidal ideation
Mania= 1+ week of 3+ manic symptoms: DIG FAST
Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Activity/agitation (increase)
Sleep (decreased)
Talkativeness
Lastly, the psychiatric medications are highly tested on your rotation and the shelf exams. Be sure to know all the different drugs in each class and their side effects. Sketchy Pharm and Anki is great to learn medications.
Shelf exam resources:
First Aid for the Psych Clerkship: short & condensed chapters
OnlineMedEd
AnKING for Step 2
UWorld/Comquest/Amboss
Sketchy Pharm
Divine Intervention Podcasts/Emma Holliday
Some general advice is that this can be an emotionally taxing experience so make sure you check in with yourself. Ensure you are physically safe and set boundaries with your patients. Try not to play into the delusions that your patients may have but be respectful that these are things they genuinely believe. Always stay calm and in control. Be present in all different experiences (therapy, patient discussions, group meetings, etc) and you will learn a lot. You may see things you never will see again! Good luck!
