Monday PM contemporary psychiatry in US OCT 2015 CTUMP version

Contemporary Psychiatry in US
1

Richard C. Veith, MD
Ashley Bouzis, MD
Psychiatry & Behavioral Sciences
University of Washington, Seattle, Washington, USA


Summary of Psychiatry Training in US
2

•

In the US, medical school requires 4 years of training after having usually completed 4 years of general
university education

•

Medical students are required to pass national competency (USMLE) exams after year 2 and year 4 for
graduation

•

Psychiatric specialty training (residency) requires 4 years of training following graduation from
medical school

•

Post-residency added-qualification, subspecialty fellowships are available in: child psychiatry (2 yrs),
geriatric psychiatry (1 yr), addiction psychiatry (1 yr), psychosomatics (consultation-liaison psychiatry)

(1 yr), forensic psychiatry (1yr). All have certification exams.


MS Year 2 Brain & Behavior Course
3
 

 

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

4 Hours

4 Hours

3 Hours

3 Hours

4 Hours

Quiz

Quiz

Quiz

Quiz

Quiz Cumulative

 

Week 1

Mood Disorders

Psychotic Disorders

Anxiety Disorders

Personality Disorders

Suicide

18 hrs

Antidepres-

Antipsychotics

Management

Somatization

Psychotherapy

 

sants

Movie Clips

Lithium

 

DAY 6

DAY 7

DAY 8

 

4 hours

2 Hours

2 hours

 

Quiz

Quiz

Week 2

Child Psychopath I and II

Delirium

Differential Diagnosis

8 hrs

Stimulants

Dementia

Final exam

 
 


Medical Student Psychiatry Clinical Clerkship
Goals and Objectives
4



All 3

rd

year medical students take a required 6-week psychiatry clinical clerkship consisting of 4 weeks

of inpatient psychiatry and 2 weeks of hospital-based consultation-liaison psychiatry



The overall goal of the clerkship is to provide a thorough introduction to Psychiatry through supervised
patient encounters, clinical teaching and a weekly structured didactic program.


UW Psychiatry Residency
4-year Specialty Training after Medical School
5

 10 months inpatient
 4 months hospital consultation services
 4 months primary care (Medicine/Pediatrics)
 2 months neurology
 1 month emergency psych
 12 months outpatient plus 3 years longitudinal clinic
 2 months child psychiatry
 1 month addictions
 1 month geriatrics
 "exposure" to community psych, forensics

Contemporary Psychiatry Practices in US
6



Inpatient treatment of seriously ill, suicidal, psychotic patients



Outpatient community mental health center care with socialization, case management,
medications, vocational support for those with chronic serious mental illness



Private practice or health care system outpatient care for less seriously ill individuals who can afford
it



Recent introduction of “collaborative care” or “integrated care”models to bring behavioral health
care into the general medical, primary care setting


Psychiatry in US – Pharmacotherapy
7



Much of the focus of care in inpatient services is on arriving at the correct diagnosis, keeping patients

safe from suicidal impulses or disturbed thinking in those who are psychotic



Most patients who are voluntarily hospitalized are depressed or experiencing a manic or psychotic
episode



There is much reliance (depend) on antipsychotic, antidepressant, and mood stabilizing medications,
such as lithium



Seriously depressed patients might require electroconvulsive therapy (ECT)



A typical length of hospital stay for inpatient units with voluntary patients is ~ 7 days.


Psychiatry in US – Cognitive Behavioral Therapy (CBT)
8



Theoretical model assumes that changing maladaptive thinking leads to change in affect and behavior



CBT techniques challenge thinking patterns and beliefs to replace "errors in thinking such as
overgeneralizing, magnifying negatives, minimizing positives and “catastrophizing”(dự báo tai ươn)
with more realistic and effective thoughts, thus decreasing emotional distress and self-defeating
behavior



These errors in thinking are known as cognitive distortions



CBT techniques help individuals take a more open, mindful, and aware posture toward them so as to
diminish their impact


Psychiatry in US – Dialectical Behavior Therapy (DBT)
9



Biện chứng


Medical Students at CTUMP
10

Open Discussion:



How was your experience in psychiatry coursework and clinical rotations?



What reasons might a CTUMP student have for going into psychiatry or not going into
psychiatry as a career choice?



What would help you get a better understanding of the challenges and opportunities in
psychiatry?



What might make it more attractive for a student to consider psychiatry as a career choice?


Thank You

11

James D. Ralston