PS CONSULTATION/LIAISON AND HIV PSYCHIATRY

Transcription

1 PS CONSULTATION/LIAISON AND HIV PSYCHIATRY Location: HARBOR COURSE CHAIR: Julia Chung, M.D. (310) David Stone, M.D., Donna Mendelson, MD Pat Venaglia (310) REPORT TO: Harbor-UCLA M.C., Bldg. 1 South, Room 19 at 8:30 a.m. 1. Biopsychosocial approach to the medically ill. 2. Improved psychiatry evaluation in the medically ill. 3. Diagnosis of complex psychiatric disorders. 4. Knowledge of DSM-IV. 5. Knowledge of psychotropic medication in the medically ill. 6. Psychiatric syndromes/toxicities related to medications. 7. Multidisciplinary approach to the medically and psychiatrically ill. 8. Improved doctor-patient relationship. 9. Oral presentations. 10. Medical record keeping. 11. Knowledge of psychometric testing. COLLEGE AFFILIATION: Academic Medicine STUDENTS / PERIOD: max 1 min 1 ROTATIONS BEGIN WEEKS: By Arrangement DESCRIPTION: The HIV Psychiatry Service at Harbor-UCLA Medical Center is an outpatient consultative service which evaluates adults in all stages of HIV infection. A variety of psychiatry disorders are seen. Emphasis is placed on evaluating biological, psychological, and social factors manifesting in psychiatric disorders. The Psychiatric Consultation/Liaison Service is an inpatient service that evaluates patients hospitalized for medical/surgical treatment. Emphasis is placed on understanding the influence of chronic psychiatric conditions on medical care, the psychiatric conditions that may be associated with medical conditions, and the use of psychotropics in the medically ill. 1. Depression/Mood Disorders 2. Dementia 3. Delirium 4. Substance Abuse 5. Psychotic Disorders 6. Adjustment Disorders 7. Competency and Consent Issues 8. Medication Reactions/Toxicities INTERNS OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: C/L: 10 12; HIV: 8 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 60 9:00 11:00 Resident Rounds 11:00 12:00 9:00 11:00 Resident Rounds 11:00 12:00 9:00 11:00 Resident Rounds 11:00 12:00 9:00 11:00 Resident Rounds 11:00 12:00 9:00 11:00 Resident Rounds 11:00 12:00 1:00 4:00 3:00 4:30 Grand Rounds 1:00 4:00 1:00 4:00 1:30 2:30 C/L Lecture Series 2:30 4:00 ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: The student will spend two afternoons half-days in the HIV Psychiatry Clinic under the direct supervision of the attending psychiatrist, plus 1 1/2 hours /week of individual supervision. The remainder of the time will primarily be spent on the inpatient C/L Service, under the supervision of the attending and third-year psychiatry residents. The student will also attend two seminars each week with the psychiatry residents, and the Grand Rounds for the Department of Psychiatry. 209

2 PS CHILD PSYCHIATRY Location: UCLA COURSE CHAIR: Bhavik Shah, M.D. (310) Jennifer Levitt, M.D. (310) James McCracken, M.D. Carla Vera (310) REPORT TO: Semel Institute, ABC Program (7 West) at Westwood Plaza, L.A., CA COLLEGE AFFILIATION: Academic Medicine STUDENTS / PERIOD: max 1 min 1 cvera@mednet.ucla.edu ROTATIONS BEGIN WEEKS: 1. Knowledge of the common Psychiatric Disorders of Childhood Phenomenology Etiology Natural history Treatment approaches 2. Improved Assessment Skills Interviewing parents Interviewing children Use and interpretation of Psychological testing Use and interpretation of Educational testing Evaluation of Autism 3. Improved knowledge of therapeutic modalities in Child Psychiatry Individual therapy Group therapy Family therapy Psychopharmacology Behavioral modification Educational therapy 4. Improved oral presentation of cases. DESCRIPTION: Any student wishing experience in child psychiatry may set up an individualized schedule working with children or adolescents in an outpatient partial hospital setting with access to all resident and fellow teaching seminars, conferences and participation with supervision in family therapy, cognitive behavioral therapy, and social skills training. Students applying from outside or within UCLA are welcome. A three week rotation offered continuously throughout the year. 1. Attention Deficit Disorders 2. Conduct disorders 3. Learning disorders 4. Affective disorders 5. Autism 6. Childhood psychoses 7. Mental retardation 8. Anxiety disorders 9. Fetal Alcohol Syndrome CLINICAL FACULTY INTERNS X OTHER: Staff, Social workers, Nurses, Occupational and Recreational Therapists. APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 2-3 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 10 ABC Program ABC Program 8 am to 4 pm 11 am Rounds 1-3 pm Case Conference 2-6 pm Anxiety Disorders Clinic 300 Medical Plaza Room 1208 ABC Program ABC Program 1-3 pm Rounds ABC Program Fellow Teaching Seminar 10am-1pm Developmental Disability Evaluation Outpatient Clinic (optional) 300 Med Plaza, 1st floor 1-2 pm Clinical Supervision with Fellows and Attendings ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: Early childhood partial hospital interventions with Autistic children. 210

3 PS CONSULTATION LIAISON PSYCHIATRY Location: UCLA COURSE CHAIR: John Luo, M.D. (310) Drs. Laurie Casaus, Aaron Kaufman, John Brooks, Erick Chenng, Katrina DeBonis, and Barry Guze Carla Vera (310) REPORT TO: Semel Institute, Room B8-241 at 9:00 a.m. and ask for Jillian Major COLLEGE AFFILIATION: Urban Underserved STUDENTS / PERIOD: max 2 min 0 cvera@mednet.ucla.edu ROTATIONS BEGIN WEEKS: 1. To acquaint students with interview approaches to medically ill patients in a variety of settings using the biopsychosocial model. 2. To engage in effective interactions with a variety of consulting services by learning to define the consultation question and to accurately report findings and recommendations. 3. Learn effective documentation skills for a psychiatric consultation note. 4. Learn a variety of therapeutic interventions used to evaluate and treat mentally ill patients including pharmacotherapy, behavioral psychotherapy, and psychoeducation. 5. Appreciate the psychological components of medical illness. 6. Gain experience in performing specialized psychiatric assessments for specific populations including solid organ transplant candidates, chronic and acute pain patients, behaviorally disturbed patients, cross-cultural patients, somatoform patients and victims of trauma. 7. Gain experience in performing psychiatric consultations to a general Emergency Medical Center. 8. To increase student s knowledge about psychometric testing. DESCRIPTION: The UCLA Consultation & Liaison Service is an inpatient consultation psychiatry service that provides psychiatric evaluations to the Ronald Reagan UCLA Medical Center. The service provides focused consultations to medical and surgical services for urgent and routine matters. The service consists of 3 4 resident physicians, a psychologist, a psychiatric social worker and multiple faculty members with expertise in various aspects of Consultation/Liaison Psychiatry. The service also provides consultations to the Emergency Medical Center that is a major trauma center for large urban hospital. The scope services includes capacity to consent to or refuse medical treatment, pain management, presurgical evaluation for solid organ transplant candidates, post-operative follow-ups for acute behavioral disturbances, mood and anxiety disorders in a teaching hospital Depression 4 2. Delirium/dementia 3. Management problems Substance Abuse 5. Psychiatric Disorder OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 8-12 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 100 Ward Rounds Ward Rounds Ward Rounds Ward Rounds Ward Rounds Consults in UCLA and EMC Psychiatry Department Grand Rounds Teaching Case Conference Consults in UCLA and EMC Consults in UCLA and EMC Consults in UCLA and EMC Attend Resident Didactics Consults in UCLA and EMC Consults in UCLA and EMC Consults in UCLA and EMC ON-CALL SCHEDULE & WEEKEND ACTIVITIES: NONE (1) Wadsworth VA Consultation-Liaison Grand Rounds (2) Sepulveda VA Behavioral Medicine Clinic and Grand Rounds ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: 211

4 PS ADVANCED CLINICAL PSYCHIATRY Location: CS COURSE CHAIR: Waguih William IsHak, M.D. (310) Selected Staff Anita Parsons (310) REPORT TO: Dr. IsHak, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians W-157, Los Angeles, CA COLLEGE AFFILIATION: Academic Medicine 1. Knowledge and understanding on the biopsychosocial model of disease. 2. Knowledge of specific disease processes and coping techniques demonstrated by patients. 3. Basic science program designed to provide a comprehensive understanding of clinical psychopharmacology. 4. The learning of detailed history taking and psychiatric evaluation of patients with organic disorders. 5. Knowledge of correct and appropriate consultation techniques. 6. Knowledge of effective liaison relationship with the medical health care team. 7. Knowledge of the doctor/patient relationship. 8. Knowledge of the theoretical aspects of psychosomatic disorders. 9. Participate in research activities including data interpretation, manuscript drafting and co-authorship. AVAILABLE FOR EXTERNS: No STUDENTS / PERIOD: max 2 min 1 ROTATIONS BEGIN WEEKS: By Arrangement DESCRIPTION: This elective will provide medical students with a rich experience in the interface between medicine and psychiatry at Cedars-Sinai Medical Center. Identification and treatment of psychiatric disorders due to general medical conditions, substance/ medication induced psychiatric disorders. This elective is more suitable for medical students who are interested in strengthening their medico-psychiatric skills in a large general hospital setting. Medical students will be expected to review consultation liaison articles for discussion. Students interested in research will have the opportunity to contribute to publications as a co-author. 1. Medical Problems 2. Psychiatric Care of Cancer 3. Psychiatric Care of Transplantation 4. Psychiatric Care of Cardiac Patients 5. Delirium/Dementia 6. Impact of Medical Illness 7. Psychiatric Care at End of Life 8. Psychiatric Care of Serious Medical Illness RESIDENTS INTERNS OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 9-10 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 60 Psychiatric Diagnosis Research Activities Research Activities ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: Participation in research and scholarship is available. Please Dr. IsHak with any questions or additional interests to be accommodated. 212

5 PS OUTPATIENT (PACE) CONSULTATION/LIAISON PSYCHIATRY Location: SFVMP COURSE CHAIR: Javier Quintana, M.D., Ph.D. (818) , ext Jeannie Weber REPORT TO: Javier Quintana, M.D., Ph.D., Bldg. #200, Green Team, Room 2362 COLLEGE AFFILIATION: Academic Medicine STUDENTS / PERIOD: max 2 min 1 ROTATIONS BEGIN WEEKS: (818) x jeannie.weber@med.va.gov 1. Signs and symptoms, differential diagnosis, psychodynamics, psychophysiology, epidemiology, and psychiatric behavioral conditions most commonly encountered in medical settings. 2. Indications, contraindications, dosage, and side effects of psychotropic medications for conditions described above. 3. Describe indications and contraindications for nonpharmacological treatment of conditions described above, including: (a) Individual, long-term psychotherapy; (b) Family Therapy; (c) Crisis Intervention; (d) Intervention by non-psychiatric medical personnel; (e) Behavior therapy; (f) Cognitive Therapy, (g) Relaxation Training; (h) Interpersonal and insightoriented therapy. 4. Demonstrate ability to collect information from the patient, from the medical chart, from the referring physician, and from relevant other sources. Developing psychiatric interviewing skills specific to the medical ambulatory consultation setting. 5. Describe influence of psychological and social variables on the predisposition, onset, course, and outcome of somatic illness. 6. Describe common patterns of psychological and social adaptation to illness. DESCRIPTION: This advanced level elective offers an introduction to the rapid assessment and effective management of psychiatric and behavioral problems experienced by patients with significant medical or surgical illness in the medical ambulatory clinic. Students are integral members of the C/L team, and learn to apply a Bio-psychosocial approach to evaluation of psychiatry problems in that setting (including mood, psychosis, anxiety, cognition, substance abuse, and personality disorders). Management of these problems includes both pharmacological and nonpharmacological approaches (supportive therapy, crisis intervention, cognitive-behavioral and insight -oriented psychotherapy.) A three- to sixweek elective, Sepulveda V.A. Medical Center. Prerequisites: Clerkships in Psychiatry and medicine. 1. Depression 2. Agitation Insomnia 3. Dementia 4. Psychotic Disorders 5. Dual Diagnosis 6. Anxiety Disorders 7. Organic Brain Syndromes 8. Habits, Drugs/Substance Abuse 9. Somatoform Disorders CLINICAL FACULTY INTERNS OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 10 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 40 Includes Resident Presentations OP Consults w/ Residents & Attendings OP Consults w/ Residents & Attendings OP Consults w/ Residents &Attendings OP Consults w/ Residents & Attendings w/ Residents OP Consults w/ Residents & Attendings OP Consults w/ Residents & Attendings OP Consults w/ Residents & Attendings Case Evaluation OP Consults w/ Residents & Attending Case Evaluation w/ Residents ON-CALL SCHEDULE & WEEKEND ACTIVITIES: Once per week. Optional. ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: 213

6 PS PSYCHOSOMATIC MEDICINE / C&L PSYCHIATRY Location: OVH COURSE CHAIR: Saba Syed, M.D. (818) sasyed@dhs.lacounty.gov Robert Dasher, M.D. Deenen Ray (818) REPORT TO: Dr. Syed at 9:00am in room 6D 120 COLLEGE AFFILIATION: Primary Care STUDENTS / PERIOD: max 1 min 1 DURATION: 3 weeks dray@dhs.lacounty.gov ROTATIONS BEGIN WEEKS: 1. Expose students to a wide range of neuropsychiatric presentations in medical surgical patients 2. Teach concise interviewing skills and differential diagnostic formulation. 3. Examine the impact of illness, hospitalization and medical care on the psychological functioning of patients 4. Educate students about the role of psychiatric, psychological, and behavioral factors in the pathogenesis of medical disorders 5. Promote liaison relations with medical and surgical services, and increase awareness of mental disorders in medical patients. 6. Demonstrate appropriate approaches to the execution of a psychiatry consultation, with emphasis on assessment techniques unique to the consultation setting, the nature of communication with the consulting team and the responsibilities and limitations of the consultant. 7. Demonstrate a variety of interventions and therapies relevant to medically ill patients, including time-effective psychotherapy, behavioral techniques, and multidisciplinary team approaches. 8. Learn capacity assessment for medical decision-making. Develop understanding of concepts of substituted judgment and power 3200 for court appointed surrogate decision maker. 9. Gain experience in diagnosis of Dementia and assessment for Probate Conservatorship 10.Understand the concepts of law and medical ethics as it applies to C&L Psychiatry. DESCRIPTION: The Psychosomatic Medicine / C&L service at Olive View-UCLA Medical Center provides inpatient psychiatric evaluations to Medical, Surgical, Pediatrics and Ob/Gyn departments. The scope of services include psychiatric diagnostic evaluations using biopsychosocial approach; management of agitation and behavioral problems; treatment of anxiety, mood disorders and psychosis; capacity evaluations, and provide assistance to primary medical teams to apply for power 3200 and probate conservatorship. HIV Psychiatry Clinic provides biopsychosocial evaluations and treatment to patients with HIV/AIDS and co-morbid psychiatric disorders. Also assess suicide risk in newly diagnosed HIV patients and provide pscho education and supportive therapy to patients. 1. Delirium/Management of Agitation 2. Dementia 3. Depression/Affective disorders 4. Anxiety disorders 5. Psychotic disorders 6. Somatoform disorders 7. Substance disorders 8. Capacity evaluations CLINICAL FACULTY FELLOWS INTERNS OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 10 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 45 9:00 11:00 Consults 11:00 12:00 Team Rounds 9:00 11:00 Consults 11:00 12:00 Team Rounds 9:00 11:00 Consults 11:00 12:00 Team Rounds 9:00 12:00 HIV Psychiatry Clinic 9:00 11:00 Consults 11:00 12:00 Team Rounds 1:00 2:00 Consults 3:00 4:00 Team Rounds 1:00 2:00 C&L Lecture 2;00 3:00 Consults 3:00 4:00 Team Rounds 1:00 4:00 Consults Independent Study 1:00 4:00 HIV Psychiatry Clinic 1:00 2:00 Consults 3:00 4:00 Team Rounds ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: The service consists of 2 residents and a board certified faculty. Psychiatry social worker and psychology participation is available on as needed basis. 214

7 PS ADULT OUTPATIENT PSYCHIATRY Location: BVA Revised 12/10/12 COURSE CHAIR: Jacob Moussai, MD (310) x Yong Song, MD; Benjamin Shapiro, MD; Paul Sinuk, MD Jacob Moussai, MD (310) x REPORT TO: West LA VA - Building Room B105 at 8:30 am to Jasmine Sampson 1. Improve ability to take a psychiatric history, perform a mental status exam, and generate a DSM-IV differential diagnosis. 2. Improve knowledge of typical psychiatric outpatient problems. 3. Expand knowledge of PTSD and Traumatic Brain Injury in young adult veteran population. 4. Improve knowledge of psychopharmacology. 5. Skill in working on a multidisciplinary outpatient health care team. Including primary care, social workers and psychologists. 6. Know ledge and ability to apply some psychosocial treatment principles to dual diagnostic patients. 7. Demonstrate skill in psychiatric interviewing techniques. COLLEGE AFFILIATION: Primary Care College STUDENTS / PERIOD: max min 2 1 DURATION: 3 weeks ROTATIONS BEGIN WEEKS: DESCRIPTION: The Post Deployment Clinic located at West LA VA provides a comprehensive, integrative, multi-disciplinary approach to treatment of returning combat veterans. Clinical interventions include psychopharmacology, group therapy, individual therapy including evidence-based therapies for PTSD. In addition, there will be an emphasis in enhancing interviewing skills, expanding knowledge about psychiatric illnesses presenting in early adulthood and integration of psychiatric needs with psychosocial stressors. The clinic will also provide an opportunity to expand knowledge of commonly used substances amongst young adults and their psychiatric consequences. 1. PTSD 2. Substance abuse 3. Depression 4. Anxiety spectrum disorders 5. Bipolar illness 6. ADHD 7. Post concussive syndrome 8. Psychotic disorders FULL-TIME FACULTY FELLOWS INTERNS X OTHER: Social workers APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 7 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 60 Didactics Case Conference Didactics Grand Rounds Didactics ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: Students will have the opportunity to work one-on-one with faculty from psychiatry, psychology, social work, mental health nursing, and internal medicine.

8 PS ADULT INPATIENT PSYCHIATRY Location: UCLA COURSE CHAIR: Barry H. Guze, M.D. (310) Laurie Casaus, M.D. and Aaron Kaufman, M.D. Carla Vera (310) REPORT TO: Dr. Barry Guze, Resnick Neuropsychiatric Hospital, 150 Med Plaza, Room #4122 at 8:30 COLLEGE AFFILIATION: Academic Medicine 1. Acquisition of knowledge of the psychopathology and phenomenology of serious psychiatric disorders in adults. 2. Development of skills and knowledge in the evaluation, diagnosis, treatment, and disposition of hospitalized psychiatric patients. 3. Acquisition of advanced knowledge of therapeutic modalities, such as pharmacotherapy and ECT. 4. Refining of basic interviewing and management skills. 5. Participation in the interdisciplinary team approach of modern hospital psychiatry. 6. Development of clinical skills and decision-making in the assessment and management of psychiatric emergencies. 7. Enhancement of skills in efficient communication of findings and formulations through verbal presentations and chart progress notes. 8. Progress in medical record-keeping abilities including comprehensive history, examinations, plans, progress notes, discharge summary, and multi-axial diagnostic formulation STUDENTS / PERIOD: max 1 min 1 ROTATIONS BEGIN WEEKS: DESCRIPTION: The student functions as a sub-intern on a general adult psychiatric service, is assigned to a resident, who serves as a preceptor and primary clinical instructor, and admits and treats patients under supervision. 1. Major depressive disorder 2. Bipolar disorder 3. Schizophrenic disorders 4. Neurotic disorders 5. Organic mental disorders 6. Adjustment disorders 7. Personality disorders 8. Anxiety disorders X OTHER: Chief resident, nursing, social service APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 5 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 40 Unit Rounds Rounds Colloquium Rounds Rounds Rounds Patient Workups and Care Patient Workups and Care Case Conference Clerkship Seminar Patient Workups and Care Patient Workups and Care ON-CALL SCHEDULE & WEEKEND ACTIVITIES: Student may elect to take call when resident-preceptor is on duty. ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: The student is responsible for all aspects of medical care, including those of a non-psychiatric nature. The student's schedule will approximate that of the resident-preceptor. Supervised participation in various other aspects of departmental activities may also be provided by individual arrangement. 216

9 PS DUAL DIAGNOSIS TREATMENT PROGR Location: HARBOR COURSE CHAIR: John Tsuang, M.D. (310) Faculty in Psychology & Social Works, and Psychiatry departments Pat Venaglia (310) REPORT TO: Harbor/UCLA D2, 9:00 am, Dr. John Tsuang 1. Know about psychopharmacological options in the treatment of dual diagnosis patients. 2. Learn about acute treatment of intoxicated patients in Psychiatric Emergency Room. 3. Understand diagnostic strategy for dual diagnosis patients. 4. Demonstrate ability to assess a dual diagnosis patients. 5. Learn about treatment strategy for dual diagnosis patients 6. Know and able to apply some psychosocial treatment principles. 7. Know about overall drug and mental health treatment strategy and aftercare progress for them. COLLEGE AFFILIATION: Urban Underserved STUDENTS / PERIOD: max 1 min 1 DURATION: 3 weeks ROTATIONS BEGIN WEEKS: By Arrangement DESCRIPTION: This program is purposely flexible to meet the needs of individual students. The rotation is based out of the outpatient treatment program at Harbor/UCLA. There are core group, individuals, and med clinics that students need to attend. There are some assigned readings. 1. Mental Illness, Axis I disorders 2. Substance abuse 3. Detoxification/Stabilization 4. Understand interaction of drugs and psych conditions 5. Personality disorders 6. Medical conditions secondary to chronic drug use CLINICAL FACULTY FELLOWS X OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 5 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 10 9:00-12:00 Team meeting and groups 9:00-12:00 Team meeting and groups 9:00-12:00 Team meeting Facilitate a medical consequences group Medication clinic 9:00-12:00 Team meeting and groups 9:00-12:00 ER Medication clinic Teaching round 1:00 5:00 Harbor/UCLA Psychiatric Emergency Room consultation 1:00 5:00 Harbor/UCLA Psychiatric Emergency Room consultation 1:00 5:00 Harbor/UCLA Psychiatric Emergency Room consultation 1:00 5:00 Harbor/UCLA Psychiatric Emergency Room consultation 1:00 5:00 Harbor/UCLA Psychiatric Emergency Room consultation ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: 217

10 PS EMERGENCY PSYCHIATRY Subinternship Location: HARBOR COURSE CHAIR: David Rad, M.D. (310) Drs. A. Djenderedjian, D. Rad, K. Burgoyne, D. Stone, W. Procci, and J. Tsuang, C. Grob, B. Chung, N. Del Pan, M. Makhinson Pat Venaglia (310) COLLEGE AFFILIATION: Acute Care REPORT TO: Psychiatric Emergency Room, Harbor-UCLA Medical Center at 8:00 a.m. 1. Gain proficiency in formulating different psychiatry diagnoses and management in an emergency setting, i.e., schizophrenia, bipolar disorder, major depression, drug psychosis, etc. 2. Acquire familiarity with emergency psychopharmacologic intervention through the use of various psychotropic medications. 3. Develop skills in psychiatric interviewing technique, performing mental status examination, and gathering information for a complete psychiatric history. 4. Learn to make accurate assessments of suicidal and/or dangerous patients and develop plans for proper management. 5. Learn crisis intervention strategies to intervene with nonpsychotic patients. 6. Learn to assess and treat patients with different dual diagnoses, i.e., medically and psychiatrically ill patients and also those with coexisting substance problems. STUDENTS / PERIOD: max 4 min 1 ROTATIONS BEGIN WEEKS: DESCRIPTION: The Psychiatric Emergency Service of Harbor-UCLA Medical Center provides evaluation and treatment to approximately 9000 patients a year. Its catchment area includes over 1% of the population of the USA. Direct clinical experience is provided to medical students with an emphasis on bedside teaching. 1. Schizophrenia 2. Drug psychosis and substance abuse 3. Bipolar disorder 4. Major depression 5. Personality disorder 6. Panic and anxiety disorder 7. Obsessive compulsive disorder 8. Adjustment disorder X OTHER: Nurses APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 30 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 750 8:00 9:00 Morning Rounds 9:00 9:30 Case Assignment 8:00 9:00 Morning Rounds 9:00 9:30 Case Assignment 8:00 9:00 Morning Rounds 9:00 9:30 Case Assignment 8:00 9:00 Morning Rounds 9:00 9:30 Case Assignment 8:00 9:00 Morning Rounds 9:00 9:30 Case Assignment 4:30 Check out Rounds 3:00 4:30 Psychiatry Grand Rounds 4:30 4:40 Check-out Rounds 4:30 4:40 Check-out Rounds 4:30 4:40 Check-out Rounds 4:30 4:40 Check-out Rounds ON-CALL SCHEDULE & WEEKEND ACTIVITIES: Optional, per request by students. ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: A four week experience is also available on request. 218

11 PS PSYCHIATRIC CRISIS MANAGEMENT Location: HARBOR COURSE CHAIR: Samuel Sessions, MD (310) Ben Furst, MD, Michael Makhinson, MD Pat Venaglia (310) REPORT TO: Harbor-UCLA, South, Room 1, 8:30 a.m. COLLEGE AFFILIATION: Acute Care College STUDENTS / PERIOD: max 3 min 1 DURATION: 3 weeks pvenaglia@dmh.lacounty.gov ROTATIONS BEGIN WEEKS: 1. To gain experience with the formulation of differential diagnoses and treatment plans for acutely ill psychiatric inpatients. The most common disorders seen in this setting are schizophrenia, bipolar disorder, major depressive disorder, and substance-induced psychiatric disorders. 2. To gain experience and familiarity with evidence-based psychopharmacology in treating psychiatric disorders and evaluating for treatment-emergent side effects. 3. To gain experience and competence in psychiatric interviewing, mental status examinations, and techniques to enhance doctor-patient rapport. 4. To gain experience and familiarity with California's mental health legal system and to witness and understand legal hearings for probable cause, Riese, and writ of habeas corpus. To understand what an LPS Conservatorship is and when it is used. 5. To learn the basics of inpatient psychiatric care, including collaboration with a multi-disciplinary team, suicide and violence assessment, documentation, and medico-legal issues. 6. To have a good time in an environment that promotes learning and providing care in the best interest of the patient. DESCRIPTION: This is an excellent opportunity to experience a multidisciplinary, integrated approach to the care of psychiatric patients. Non- UCLA externs may elect to participate for periods greater than three weeks as conforms with your institution s schedule. The South Unit is a 14 -bed unit with length of stay approximately 7-10 days. There is also a 24-bed unit on 8 West with the same 7-10 days length of stay. Students electing this advanced clerkship will be assigned to a specific team, and will have an opportunity to work independently with patients suffering from a wide variety of psychiatric disorders under direct supervision of the attending. (Please see additional comments below.) 1. Schizophrenia 2. Manic depressive illness 3. Major depression 4. Suicidality 5. Personality disorders 6. Marital and family problems 7. Adjustment disorders 8. Organic disorders FELLOWS X OTHER: Psychologists and Psychiatric Social Workers APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 15 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 120 8:45 9:30 Rounds 9:30 12:00 8:30 11:00 Inpatient Lecture 11:00 12:00 8:45 9:30 Child Psychiatry 10:30 11:00 8:45 9:30 Rounds 9:30 12:00 8:45 9:30 Rounds 9:30 12:00 1:00 4:30 1:00 3:00 3:00 4:30 Dept. Conf. Parlow Auditorium 1:00 4:30 1:00 4:30 1:00 4:30 ON-CALL SCHEDULE & WEEKEND ACTIVITIES: One evening per week in the Psych. ER ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: Additional opportunities include participation in group and family therapy sessions as well as chances to attend mental health court to observe court testimony and forensic psychiatric evaluations. There is a focus upon diagnostic workups and biological interventions within a psychosocial and sociocultural framework. The psychiatry modules are richly staffed inpatient units with a multidisciplinary team, including attending psychiatrist, two psychiatric residents, and a full complement of nursing, psychology, social work and occupational therapy staff. 219

12 PS ADULT PSYCHIATRY Subinternship Location: UCLA COURSE CHAIR: Barry H. Guze, M.D (310) Laurie Casaus, M.D. and Aaron Kaufman, M.D. Carla Vera (310) REPORT TO: Barry Guze, M.D., Resnick Neuropsychiatric Hospital, 150 Med Plaza, Room #4122 at 8:30 COLLEGE AFFILIATION: Urban Underserved 1. Student will workup at least three new patients per week and per rotation. 2. Student will actively participate in the on-going care of the patient. 3. Student will learn how to treat significantly ill/complex patient cases in diverse patient populations. 4. Student will have substantial or primary patient care responsibility. 5. Acquisition of knowledge of the psychopathology and phenomenology of serious psychiatric disorders in adults. 6. Development of skills and knowledge in the evaluation, diagnosis, treatment, and disposition of hospitalized psychiatric patients. 7. Progress in medical record-keeping abilities including comprehensive history, examinations, plans, progress notes, discharge summary, and multi-axial diagnostic formulation. 8. Acquisition of advanced knowledge of therapeutic modalities, such as pharmacotherapy and ECT. STUDENTS / PERIOD: max 1 min 1 ROTATIONS BEGIN WEEKS: DESCRIPTION: In this advanced clinical clerkship the student will function as a sub-intern under faculty and chief resident supervision. Clinical activities will occur on the Adult Psychiatry Inpatient wards and the Adult Partial Hospital Program. Sub-intern will be responsible for all aspects of patient care, from admission to discharge. All clinical activity will be supervised via individual meetings and daily rounds with faculty and chief residents. 1. Unipolar depression 2. Bipolar disorder 3. Schizophrenia 4. Organic mental disorders 5. Anxiety disorders 6. Adjustment disorders 7. Personality disorders X OTHER: Chief resident, nursing, social service, rehabilitation therapy. APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 4-8 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 80 Rounds Rounds Rounds Rounds Rounds Case Conference Seminar ON-CALL SCHEDULE & WEEKEND ACTIVITIES: Optional ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: Student will actively participate in the ongoing care of the patient. 220

13 PS Subinternship SCHIZOPHRENIA TREATMENT UNIT Location: BVA COURSE CHAIR: Joe Pierre, M.D x C. Scott Saunders, M.D., Angel Cienfuegos, M.D. Joe Pierre, M.D x Develop an understanding of and familiarity with individuals with psychotic disorders and other severe mental illness 2. Develop a working knowledge of evidence based therapies for severe mental illness including both pharmacotherapies and psychotherapies. 3. Demonstrate skill in psychiatric interviewing techniques 4. Demonstrate skill in psychiatry differential diagnosis 5. Gain experience working with a multidisciplinary inpatient team REPORT TO:. Dr. Pierre, West LA VA, Bldg 500, Ward 9:00 am COLLEGE AFFILIATION: Primary Care STUDENTS / PERIOD: max 2 min 1 DURATION: 3 weeks ROTATIONS BEGIN WEEKS: DESCRIPTION: The clinical focus of the Schizophrenia Treatment Unit is on the management of inpatient veterans with psychotic disorders, typically refractory schizophrenia. Clinical interventions including psychopharmacology, group therapy, and supportive individual therapy. We also treat a variety of major mental illnesses including bipolar disorder, major depression, PTSD, and substance abuse. Sub-interns will be assigned a caseload of patients and assume primary responsibility of their clinical management. Opportunities will also be available for involvement in clinical research and exposure to outpatient treatment. 1. Schizophrenia 2. Bipolar disorder 3. Major depression 4. Substance dependence 5. PTSD 6. Dementia 7. Malingering 10 optional CLINICAL FACULTY FELLOWS INTERNS OTHER: APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 50 Treatment Rounds NPI Grand Rounds NPI Lecture Treatment Rounds VA Lecture Research Seminar VA Grand Rounds Treatment Rounds Clinical Care Group Therapy Clinical Care Outpatient Clinic (optional) Clinical Care Outpatient Clinic (optional) Clinical Care Clinical Care ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: 221

14 PS Subinternship INPATIENT GERIATRIC PSYCHIATRY Location: UCLA COURSE CHAIR: Randall Espinoza, M.D., M.P.H. (310) Drs. Helen Lavretsky, James Spar, David Merrill, Aaron Kaufman and Stephen Chen Carla Vera (310) REPORT TO: Ward 4 North, R-NPH, Chief Resident, at 9:00 a.m. Nurse s Station: (310) , 150 Medical Plaza, 4th Floor. COLLEGE AFFILIATION: Primary Care STUDENTS / PERIOD: max 2 min 1 ROTATIONS BEGIN WEEKS: 1. Acquisition of knowledge of the psychopathology and phenomenology of serious psychiatric disorders in adults with special emphasis on problems of aging and the interface of psychiatry, medicine and neurology. 2. Development of skills and knowledge in the evaluation, diagnosis, treatment and disposition of hospitalized psychiatric patients. 3. Acquisition of advanced knowledge of therapeutic modalities such as pharmacotherapy and ECT. 4. Refining of basic interviewing and management skills. 5. Participation in the interdisciplinary team approach of modern hospital psychiatry. 6. Development of clinical skills and decision-making in the assessment and management of psychiatric emergencies. 7. Enhancement of skills in efficient communication of findings and formulations through verbal presentations and chart progress notes. 8. Progress in medical record-keeping abilities including comprehensive history, examinations, plans, progress notes, discharge summary and multi-axial diagnostic formulation. DESCRIPTION: The student functions as a sub-intern on an inpatient unit which specializes in the evaluation and treatment of patients with psychiatric problems associated with aging. The student is assigned to a resident who serves as preceptor and primary clinical instructor. 1. Major depressive disorder 2. Alzheimer dementia 3. Multi-infarct dementia 4. Delirium 5. Cardiovascular disorders 6. Other medical illnesses associated with aging 7. Adjustment disorders 8. Personality disorders X OTHER: Chief Resident, Nursing, Social Service, Rehabilitation Therapy APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 15 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 20 Attending Rounds Grand Rounds Attending Rounds Didactic Lecture Community Meeting Interviewing Seminar Attending Rounds Case Conferences Work Rounds Case Conferences Attending Rounds Clerkship Seminar Work Rounds ON-CALL SCHEDULE & WEEKEND ACTIVITIES: While night work is not required, the student may elect to take call when the residentpreceptor is on duty. ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: Student responsible for all aspects of medical care, including those of a non-psychiatric nature. The schedule will approximate that of the resident-preceptor. Supervised participation in various other aspects of departmental activities may also be provided by individual arrangement. Student gains in-depth experiences in geriatric psychiatry and neuropsychiatry with supervised responsibility for patient care. 222

15 PS ADDICTION PSYCHIATRY Subinternship Location: UCLA COURSE CHAIR: Timothy Fong, M.D. (310) Larissa Mooney, M.D., Laurie Casaus, M.D., and Karen Miotto, M.D., John Tsuang, M.D. Carla Vera (310) Acquire knowledge about the etiology, diagnosis and management of addictive disorders. 2. Develop skills in inpatient detoxification of drugs of abuse. 3. Learn interviewing techniques such as motivational interviewing specific to substance abuse. 4. Become familiar with local, state and national treatment resources for patients with substance use disorders. 5. Learn the medical and psychiatry consequences of drugs of abuse. REPORT TO: Substance Abuse Rounding Room #4103 on the 4th floor of the RRUMC/Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, LA, CA, at 8:30 COLLEGE AFFILIATION: Urban Underserved STUDENTS / PERIOD: max 1 min 1 ROTATIONS BEGIN WEEKS: DESCRIPTION: This elective provides an overview of how to identify and manage patients with substance use disorders. Student will function as a sub-intern on the inpatient substance abuse service. Duties will include care of patients admitted for detoxification, management of co-occurring psychiatric disorders and assisting in developing an aftercare program. Student will also participate in the outpatient, Addiction Medicine Clinic to learn techniques of psychopharmacological management of addictive disorders. Finally, students will visit residential treatment facilities, sober living homes and drug courts to gain a full appreciation of the clinical management of patients with substance use disorders. 1. Alcohol dependence 2. Stimulant dependence 3. Prescription drug abuse 4. Opiate dependence 5. Pathological gambling 6. Marijuana dependence 7. Nicotine dependence 25% 75% 2 8 X OTHER: Social Workers, academic addiction researchers, & nurses APPROXIMATE # OF PATIENTS EVALUATED EACH WEEK BY STUDENT: 20 TOTAL # OF PATIENTS EVALUATED EACH WEEK BY ENTIRE SERVICE: 4 8:00 12:00 Unit Rounds R-NPH 8:00 12:00 Unit Rounds R-NPH 8:00 12:00 Unit Rounds R-NPH 8:00 9:00 Addiction Seminar 9:00-12:00 Addictive Medicine Clinic 8:00 12:00 Unit Rounds R-NPH Ward and Field Work (Variable) Ward and Field Work (Variable) Ward and Field Work (Variable) Ward and Field Work (Variable) Ward and Field Work (Variable) ADDITIONAL COMMENTS AND OTHER SPECIAL REQUIREMENTS: 223