I enjoyed my Psychiatry rotation at QHC CPEP much more than I expected to. At many other rotations I split my time between multiple units, during this rotation I spent the entirety of the rotation in CPEP. I did not have a lot of psychiatric experience beyond what I saw during my ED rotation so I was unsure what to expect in terms of common presentations. There was a variety of different diagnoses and psychoses that were seen in patients ranging from teenagers to those in their 80s. I was able to work with a team including physicians, PAs, nurses, social workers.

The first week was interesting, there were so many patients that were being loud and aggressive. It took a few shifts to get used to that being the norm. I had to be more aware of my surroundings during this rotation compared to any other due to the aggressiveness of some patients. Over the course of the rotation I saw many patients with various psychiatric disorders. Some were acutely psychotic and aggressive, others were more calm. There was never a dull moment in CPEP. I was able to learn from the providers how to evaluate patients even when they were being aggressive or psychotic. It was also harder to get a complete history from many patients due to their psychiatric state. This made the need for collateral information from family members more important.

While there was not as much physical skills to practice and work on, I did work on mental status exam and mini-mental exams. Mental status exam was something that would be done for every patient beginning when they entered the unit based on their appearance and demeanor, before we even began the interview. The patients would be evaluated upon entry into CPEP and re-evaluated each day to trend how their therapy and medication were working.

Many cases were emotionally difficult, there was 1 patient that stands out who was acutely psychotic since the loss of their child. The patient was constantly crying and going on about how everyone and everything they saw was their child or reminded them of their child. Things as simple as a provider wearing a black shirt set the patient off because their child owned a black shirt. It took a lot of time to redirect the patient and try and help them calm down. After 2 days the patient needed to be admitted for further assessment and treatment. Other patients that fell into a similar category for me were suicidal patients. There were a lot of patients that came in with suicidal thoughts or plans, and a few that even made attempts. It took some time before I felt comfortable asking about the more specific details of their depression and suicidal thoughts. 

Overall I really enjoyed my time in CPEP even though I do not envision myself working in this environment upon graduating. I hope the providers that I worked with could see the effort I was putting in to improve my knowledge with every shift.  My next rotation is family medicine at CitiMed JFK. This is my last rotation and I am looking forward to getting back to working on my physical skills.

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