Match week
Congratulations to everyone who found out they matched yesterday! To anyone who didn't, I wish you best of luck in SOAP this week.
The pressure isn't exactly the same from the advising side but I still let out a big sigh of relief when I heard all our students were matched this year! (Source: Student Doctor Network)
Source: Student Doctor Network - March 12, 2024 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Ketamine
I have an medically complex patient with severe pain and severe MDD. They were admitted to the medical hospital and in conjunction with the pain service we initiated PO ketamine. Frankly, I was blown away by the response. Rapid, immediate improvement in both pain and depression which has also allowed them to progress medically. I truly think the ketamine is having a direct effect on this patients depression and the mental status improvement isn't just mediated through reduction in pain.
The...
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Source: Student Doctor Network - February 29, 2024 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Good rate for PHP evals?
I am in discussions with a PHP to do their psychiatric intakes as a secondary gig. 1099, 1-4 evals per week, flexible schedule. 60 min appts. They have NPs to handle follow ups while the pts are in the PHP (I need to clarify this, but fairly certain no obligations vis a vi being the NPs official collaborating physician. For the purposes of my question here can assume they would not be working under my license). The patient population is complex but one I enjoy working with.
What's a good...
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Source: Student Doctor Network - February 11, 2024 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Belsomra
I do mostly inpatient consults but have a small subspecialialzed outpatient practice as part of my faculty position. Prescribed Belsomra (suvorexant) this week for the first time and discovered it's a controlled substance. Why?? Is there actually any abuse potential? (Source: Student Doctor Network)
Source: Student Doctor Network - January 27, 2024 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Heat
It is unseasonably warm.
Our hospital building is old. I don't know what witchery controls the HVAC system, but it does not switch gears easily.... And so for the last two days large parts of the hospital, including many patient units, have been sweltering.
It has felt like the hospital is literally and metaphorically boiling over. Patients acting up. Staff with short tempers. To the point it feels like a genuine safety issue.
I'm not looking forward to this becoming a repeated pattern... (Source: Student Doctor Network)
Source: Student Doctor Network - December 29, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Antipsychotics & hypothermia
What are your experiences with patients having HYPOthermia (not hyperthermia/NMS) as a side effect of antipsychotic therapy? I encountered my first case where this seems to be happening and am not sure what to make of it. From what little literature we could find it seems very rare and to be most common in the time periods after initiation or dose change, neither of which apply to my patient. They also have it as a documented reaction to multiple prior antipsychotics which are quite...
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Source: Student Doctor Network - December 4, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Wernicke's
So, I had my first case of 100%, undoubtedly wernicke's encephalopathy this week. Damndest thing. Don't want to be too detailed and identifying but the pt had risk factors and was on PO thiamine. But they were also had been altered for more than a week. It was clearly a medical delirium, not a psychiatric illness. Didn't resemble the textbook for wernicke's encephalopathy much other than being altered. Prominent visual hallucinations. Various medical things going on, but nothing that could...
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Source: Student Doctor Network - November 20, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
The system is broken, example #4728262
Part of my academic gig involves an embedded clinic with a medical subspecialist. I love this work--by working side by side with my medical colleague (often seeing the patients together) I can address issues that are very hard to get to in separate clinics.
But here's one real annoying thing. Epic won't let us schedule the same patient on both of our scheudles at the same time.
You know what IS possible? Double or even triple booking patients on an individual schedule.
So the physically...
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Source: Student Doctor Network - October 20, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
It's not GAD
Seems like every patient I see has generalized anxiety disorder listed in their chart.
Maybe 1/10 or less actually has it. If you actually bother to draw the meaningful distinctions within everything described as "anxiety", turns out most of these people have one or more of PTSD, OCD, social anxiety disorder, Mdd w/anxious distress, bipolar disorder, hell even legit adhd, sometimes acute appropriate situational anxiety (ie...while waiting for a biopsy result...) literally anything else but...
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Source: Student Doctor Network - September 25, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Some days
I think of myself as pretty well-jaded at this point but some days the sheer volume of horrific things that have happened to my patients still overwhelms for a bit. On the inpatient consult side there isn't usually an indication to go deep into trauma histories, but in my outpatient gig a fuller understanding of the history is often required. Yesterday was one of those days where every patient had been through things that no human being should be subjected to.
I love my work. I say a...
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Source: Student Doctor Network - September 9, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
I love my job
Started as an attending at the beginning of the month. There were any number of admin cluster****s that made the week harder than it should have been, but everything clinical went great. I feel like I am really able to help patients and my colleagues (I am CL after all, and a happy primary team who listened to my recs makes me as happy as an improved patient) and I'm so so glad I chose psychiatry.
Online forums by their nature skew negative sometimes and just wanted to throw this out there...
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Source: Student Doctor Network - August 17, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Vacation coverage in private practice
What do y'all do in terms of vacation coverage if you are in solo private practice? I'm starting a small private practice in addition to my main academic gig. I have no current plans to go on a long vacation where I would want to be completely disconnected but I'm sure that will come up eventually in the future. (Source: Student Doctor Network)
Source: Student Doctor Network - July 15, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Psychiatry Pharmacology Resources
Hello everyone,
I am an incoming PGY-1 psych resident and I wanted to learn about some of the best sources for psychiatry pharmacology. I have the Stahl's prescriber's guide but while it is certainly comprehensive, I feel that I would like a condensed version as well. For example, it would be helpful to learn about the highlights of certain drugs such as "Celexa is one of the SNRIs that prolong the QT the most" or "Haldol and Geodon can prolong the QT the most out of antipsychotics. Is...
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Source: Student Doctor Network - July 5, 2023 Category: Universities & Medical Training Authors: hopefulscribe2 Tags: Psychiatry Source Type: forums
Medication high scores
Let's have some fun. What are the highest prescribed doses of medication you've ever seen, both indicated and not indicated? Let's keep to outpatient and also things you know a pharmacy actually filled. I've had catatonic and manic inpatients on elephant doses of benzos but that's different.
Here are some of mine:
Risperidone 8mg bid. An antipsychotic was indicated, but... Not that much.
Adderall IR 30mg qid. Suspect pt was diverting, shocked someone was filling it.
Xanax 2mg qid. Pt...
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Source: Student Doctor Network - June 28, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
Glp-1 agonists
Articles about using ozempic etc for weight loss have been all over the popular press. Has anyone had a patient using a glp-1 agonist inappropriately as part of eating disordered behaviors? I figure it's only a matter of time but I haven't come accross it yet. (Source: Student Doctor Network)
Source: Student Doctor Network - June 1, 2023 Category: Universities & Medical Training Authors: Celexa Tags: Psychiatry Source Type: forums
