MDE 8842: Emergency Psychiatry LVHN 15-16

Prior approval from Drs. Cavorsi and Norris required at least three months prior to the start of the elective.

This elective gives the student the unique opportunity to participate in the evaluation, diagnosis, and the short-term treatment planning for patients in the JAHVA Emergency Room. Under close supervision by the faculty and staff of this service, the student gains experience in interviewing, diagnosing, and managing the acute psychiatric patient. The student sees a very wide range of pathology from adjustment disorders to frank psychoses to complex multisystem illnesses. Students work with the attending psychiatrists as well as the Director of the Service, Dr. Barbara Lubrano. Students will participate in the decision making process performing a risk assessment to determine if the patient requires inpatient admission or create a plan for outpatient care. Directed readings will be provided.

Objectives

1. Obtain a history and perform relevant physical exam for urgent psychiatric complaints.
2. Conduct a thorough mental status assessment inclusive of: 
   1. A comprehensive assessment for dangerousness inclusive of suicide and violence risk 
   2. Use of the MoCA to screen for cognitive deficits. 
3. Differentiate functional from organic disorders, define and identify common psychotic, affective and characterological disorders.
4. Recognize interaction of substance abuse with other syndromes. 
5. Differentiate problems which require further inpatient assessment and treatment versus outpatient care.
6. Appropriately utilize medications and recognize major side effects. 
7. Demonstrate appropriate use of brief interventions inclusive of crisis intervention, chemical and physical restraint, etc. 
8. Know and be able to list the elements required for confidentiality, involuntary hospitalization and surrogate decision making under the Florida statutes and Mental Health Code. 
9. Identify appropriate sources of collateral information to inform the psychiatric evaluation (i.e. family, pharmacy, ALF, narcotic verification registry etc.). 
10. Demonstrate the ability to document a psychiatric history, mental status exam and medical decision making for an urgent psychiatric assessment. 

Evaluation

• Direct observation by supervising faculty of interviewing and PE skills (at least weekly).
• Review of medical documentation by faculty supervising the rotation (daily).
• 10 minute oral presentation on a topic of interest

The grade will be compromised of 75% clinical evaluation and 25% oral presentation on a topic.