Reddit mentions of First Aid for the Psychiatry Clerkship, Third Edition (First Aid Series)

First Aid for the Mental Health Clerkship is a really good primer if you haven't done your psych rotation yet.

Have you done your psych rotation yet?

Because (as quoted from an earlier response of mine to a similar question): "unless you've actively been involved in trying to treat someone as they devolve into catatonia or disorganization ... seen the aftermath, observed just how limited the tools we have to combat mental illness are. Watched that struggle first hand, seen failure and recurrence after failure and recurrence ... you have no idea what you're getting yourself into."

I haven't worked in psych, I only had a 6-week rotation, though when I was an EMT I saw plenty of psych too. I rotated through a county facility, where we had inpatient, and emergency.

In psych emergency, we'd have patients primarily brought in on 5150s (72 Hour Eval / Involuntary Hold). But there wasn't the resources to actually sit down with these people regularly, explore their home resources, get them the sort of time-intensive therapy that a lot of them needed. You just had to figure out if they were going to hurt somebody RIGHT AWAY, or not. And if not, they went back out onto the street, or home.

So you'd get in and do hand-off: Who's in for what, what'd they do, who'd been evaluated, who hadn't, and the all important warnings of who was about to snap.

Then you'd just go and talk to them. What happened to bring them here? Any thoughts of hurting themselves? Others? People were pretty forthright. You might be the only person who actually cared to listen to them in a month, so they'd talk. Then it was either "Yeah, he/she needs to be admitted because they might hurt themselves or others still" or "Discharge" or "I need to talk to them more later." Maybe you'd call around to whatever facility they came from, or their family, and get their history and all that.

We didn't have the resources for things like Cog B therapy, etc. We'd just shuttle them into categories based on the DSM "Bipolar, Type I, Manic Phase," start them on a drug, and refer them.

If somebody needed rehab or something, we'd try to get them placed, but there probably wasn't a bed available. If they seemed like they actually were going to try, like getting clean mattered, we'd try to get them a bed at a good one, the others instead might go to one of the ones that were clearly trying to get the biggest profit margin they could muster. But even that was unlikely.

The inpatient care portion of the facility had the more severe patients. Your schizophrenics and anybody who continued to say they really wanted to kill themselves or somebody else, and anybody who still refused to talk. The nurses would corral each one in turn so they'd be ready, they'd sit down, we'd talk to them, find out if they were taking their meds, and either keep them or discharge them. Sometimes the psychiatrist would only ask one question. "Why aren't you taking your meds?" or "Do you want to talk today?" and they'd say nothing and glare, and then it was back onto the floor for them, and maybe we'd see them tomorrow. Then we'd head out to the floor for the more unruly ones, and talk to them if they'd let us, and if not, we'd keep them for longer.

You'll note that everything seems to center around discharge or not in a public facility. There just wasn't the resources for anything more. But even if we had access to more, I don't know how far we'd get them.

Because in psych, there is no cure. And the treatments are sometimes as disabling as the disease. We don't know enough about the brain yet, how it works, to really fix anything. In the best cases, we help people enough that they can manage in the world, and hold down a job and keep their family together. You do that once, it made your week. But there were so very, very few of those.

And the others, they would stick in your head. The 12 year old exhibiting early signs of schizophrenia. How you had to tell the parents what to expect, the road they were headed down. How the parents argued and yelled and blamed each other despite your best attempts to explain that it was neither of their fault. How you'd already seen where it ends up in your other patients. "What's going to happen to me?" "Well, we're going to try to start you on some medications, and then mommy and daddy are going to take you home." "I'm scared. Will I be okay?" "We're going to do our best." But you were sitting in a room full of people who didn't end up okay. The woman mumbling to herself in the corner? Same diagnosis. The guy screaming non-sensical biblical verses at every passerby? Same diagnosis. I'm not going to tell you, but I'm scared for you too, kid. I'm scared for you too.

And the housewife, back from rehab for just two days and relapsed, because before she'd left for rehab, in a drunken flurry had hid little bottles of alcohol all over the house for herself to find when sober. How she cried when she talked about her two little girls, and how they thought daddy was mean for taking mommy away. And talking things through, and and crying with her and feeling like you'd made a difference, had a catharsis. And then seeing her back two days later. Because when she tried to find and throw away the hidden bottles, she'd thought "Well, what a waste, I'll just have a bit and throw the rest away."

There were those who would scream and shout obscenities until they lost all meaning.

But the scary ones were the ones who smiled at you, who weren't outwardly angry, or sad, who patiently and happily sat, waiting to be evaluated. Because you had no idea what was going on beneath the surface.

You wanted to know the joys and difficulties of psychiatry. I once asked an attending how he coped with all that he sees on a daily basis. And he said as soon as he closes a chart, he forgets it. All of it. Everything had to stay in the chart. He said in the beginning he would have to remind himself not to think about a patient outside of work. After awhile, it was habit.

I don't know if everybody's like that, but you might not get too many responses if most people are.

Because otherwise, psych eats at you. At least, it does for me. You have to sympathize, but not empathize. Even now, when I see a psych patient, I'm drained afterwards.

You asked about the joys and difficulties.

It was only a 6 week rotation, but I don't know if I remember any joy.

http://www.amazon.com/First-Aid-Psychiatry-Clerkship-Third/dp/0071739238

I agree, this book is great for the psych shelf :)