History and physicals:
Typhon Report:
Site Visit Summary:
Site visits were engaging and led to thorough conversations on differentials, treatment, and stabilizing the patient. These site visits were a learning experience that allowed me to expand my knowledge of psychiatry via discussions with other students in my cohort. My understanding of psychiatric conditions and management grew with the use of these site visits. For example, in psychiatry, the patient’s mood, affect, whether they were having hallucinations or good sleep and appetite were essential in the patient’s management. I also learned from my classmates about different diagnoses, drugs, and special cases they participated in. The site evaluator also challenged and strengthened my knowledge of procedures, differentials, and treatment plans.
Case and Journal Summary:
Case: Mr. SG is a 50 y/o Hispanic M, domiciled with family (lives on separate floors), single, unemployed on SSI, pphx of schizophrenia with multiple inpatient psychiatric hospitalizations and visits to CPEP (12/2/23 discharge), transported by brother to the ED for auditory hallucinations telling him to assault his brother in law. The patient states that he is compliant to his medications but still experiences auditory hallucinations.
Journal Article: Mellin, J. M., Alagapan, S., Lustenberger, C., Lugo, C. E., Alexander, M. L., Gilmore, J. H., Jarskog, L. F., & Fröhlich, F. (2018). Randomized trial of transcranial alternating current stimulation for treatment of auditory hallucinations in schizophrenia. European psychiatry : the journal of the Association of European Psychiatrists, 51, 25–33. https://doi.org/10.1016/j.eurpsy.2018.01.004
Summary:
Randomized trial of transcranial alternating current stimulation (tACS) for the treatment of auditory hallucinations in schizophrenia is a randomized controlled trial (RCT) published in the 2019 Journal of the Association of European Psychiatrists. Mellin et al. performed an RCT with participants placed into three cohorts to compare the effectiveness of transcranial alternating current stimulation (tACS) in schizophrenic patients with auditory hallucinations that are refractory to treatment. The cohorts received 20-minute sham sessions, 10 Hz 2 mA peak-to-peak tACS, or two mA tDCS (fronto-temporal transcranial direct current stimulation) over five consecutive days. Symptom improvement was assessed using the Auditory Hallucination Rating Scale (AHRS), the Positive and Negative Syndrome Scale (PANSS), and the Brief Assessment of Cognition in Schizophrenia (BACS). They predicted that tACS would improve auditory hallucinations more than sham and tDCS treatments by enhancing the synchronization between the frontal and temporoparietal areas of the left hemisphere. The researchers studied a total of 22 participants over five consecutive days.
Mellin et al found there is no significant difference between the three cohorts. However, they stated that based on the AHRS, tACS had the greatest effects for the week of stimulation. All in all, the benefits of tACS on refractory auditory hallucinations in schizophrenia patients remain elusive. As the topic of using tACS is under-analyzed, further research with larger cohorts for longer lengths of time is needed.
Rotation Reflection:
My last clinical rotation was at Queens Hospital Center (QHC) psychiatric department. Queens Hospital Center (QHC) serves a diverse community of African Americans, Caribbeans, Asians, and Hispanics. My ninth rotation had a selective array of patients and diagnoses. My ninth rotation challenged my ability to properly diagnose and treat patients through my history taking and physical exam. I had the privilege of rotating through the QHC psychiatric floors, the psychiatric Emergency Department (CPEP), and consults from the hospital.
I grew a new understanding of the presentation of psychiatric illnesses and how to diagnose them through History-taking during my time at CPEP. I was able to see and experience how proper history-taking can improve a patient’s quality of life and ensure that they receive treatment promptly. During my didactic year, I had trouble grasping the differences and understanding different psychiatric conditions to make a diagnosis and create a management plan. My time at CPEP and on the psychiatric floors has sharpened this skill and many others through discussions held with my preceptors and being able to see patients in front of me. I honed my clinical skills by performing mental status and neurological exams. The clinicians were focused on teaching students and taught me valuable skills that I will continue to use in my career. The clinicians and nurses were kind and interested in teaching me techniques and strengthening my knowledge base.
During my rotation, I learned that CPEP is a unique place where patients can receive acute treatment. I discovered the importance of receiving collateral information and effective communication. Patience is necessary for clinicians because it strengthens the connection with patients and leads to medical adherence. Effective communication is essential as CPEP is a busy place with mainly acutely psychotic patients. During my time at CPEP, I learned how detrimental medication non-compliance was to the patient and their community’s lifestyle. Collateral information is essential in understanding the patient’s mental status and providing effective treatment. Explaining the patient’s diagnosis and treatment plan to themselves and their collateral also requires effective communication; the clinicians at QHC taught me how much of an acquired skill it is. QHC was a great way to end my clinical rotation experience. I enjoyed my time at QHC and I am excited for what comes next: Graduation!
