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BASIC PSYCHIATRY – Spring Syllabus (Weissberg 2/10)
This basic psychiatry sequence will introduce you to common psychiatric problems, how to screen for them and initiate treatment once they
are diagnosed. Psychiatric illnesses are brain diseases, which impact how we feel, think, behave, and are caused by a combination of
genetic vulnerability and life experience. No matter the specialty, most physicians will practice psychiatry since much of medicine involves
treating people with emotional issues and psychiatric disease. Depression, anxiety, substance use disorders, sleep difficulties are among the
most common complaints in all of medicine.
Psychiatric diseases are some of the most responsive diseases in medicine to treatment. In the past 30 years, psychiatric research has
made major strides in the precise diagnosis and successful treatment of these illnesses. Once mentally ill people were warehoused in public
institutions; today most people who suffer from a mental illness--including those that can be extremely debilitating, such as schizophrenia -can be treated effectively and can lead full lives.
The term "mental illness" is misleading because it implies a distinction between "mental" and "physical" disorders which does not exist
since the mind does not exist apart from the brain. And, the brain influences - and is influenced by - experience. Eric Kandel, psychiatrist,
neuroscientist, and Nobel Laureate, outlined five principles for a framework for psychiatry and the neural sciences:
1.
All mental processes…derive from operations of the brain.
2.
…genes and specifically combinations of genes…exert significant control over behavior… (Therefore) one component contributing to the
development of major mental illness is genetic.
3.
Altered genes do not…explain all of the variance of a given major mental illness. Social or developmental factors also contribute very
importantly…Behavior and social factors exert actions on the brain (and) … learning produces alterations in gene expression…
4.
Alterations in gene expression induced by learning give rise to changes in patterns of neural connections…
5.
Insofar as psychotherapy or counseling is effective and produces long-term changes in behavior, it presumably does so through
learning, by producing changes in gene expression…
(Eric Kandel, Am J Psychiatry 155:4, April 1998)
BASIC PSYCHIATRY - YEARS ONE AND TWO
We have built your psychiatry curriculum - prior to your clinical rotations - around 14 small group patient interviews, and “mini” & regular
lectures during three blocks, CVPR, Neuroscience, and Metabolism. You will utilize the CU MEDICAL STUDENT ASSESSMENT OF
COMMON PSYCHIATRIC PROBLEMS booklet, which includes THE 30-MINUTE INTERVIEW plus the PSYCHIATRIC SCREENS, throughout
your psychiatry curriculum including during your 3rd-year psychiatry clerkship. Keys to successful groups:

A commitment to express your ideas in collegial ways. An effective group depends on your participation so speak up.

A commitment to independent learning as demonstrated in your interview reviews

And support of your colleagues in their work and patient interviews.
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GROUP MEETINGS on selected Wednesdays 10:30-11:50 (8-9 students/2 psychiatry faculty)
During CVPR block
1.
In your first group, outline group expectations and 30-minute interview format.
2.
Second group, interview patient with depression, screen for depression. Begin to utilize the 30-minute interview
3.
Third group, interview patient with anxiety & evaluate for symptoms of depression & anxiety, specifically panic.
4.
Fourth group, interview patient with cardiovascular, pulmonary or renal disease – evaluate for depression, anxiety, suicide.
At the end of these four groups, you will get written formative feedback about your group work. This feedback will not be part of your
final grade. Only your evaluation at the end of the sequence in year two
will be factored into your final grade.
Neuroscience Fall, year II
5.
Interview patient with PTSD.
6.
Interview patient and family with autism.
7.
Interview patient with dementia and/or their family.
8.
Interview patient with chronic pain.
9.
Interview patient with Parkinson's disease.
10. Interview patient with schizophrenia or bipolar illness.
11. Interview patient with schizophrenia or bipolar illness.
12. Interview patient with substance use disorder.
Metabolism Fall, year II
13. Interview physician who has psychiatric or physical disease.
14. Interview patient with an eating disorder.
GRADES

You will get a final grade at the end of the sequence in year two with written formative feedback at the end of year one.

Psychiatry exam questions will be part of your regular block examinations. In year one, most of the questions will come from the
“pearls and pitfalls” sections of your handouts.

In addition, you will take a NBME behavioral science “shelf” exam at the end of the entire sequence. Your scores on the
psychiatry block questions and shelf will make up your cognitive grade for the sequence.

Your final group grade will be based on three things: your group participation, patient interviews and your interview reviews,
which you will complete after each patient interview.

See “grading” sheet attached
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
Your final overall grade will be based on a combination of your group and cognitive grades.
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CVPR BLOCK: Depression, Anxiety, Grief, and Suicide
Depression, suicide, anxiety and grief are clinically connected, often etiologically related, and interact bi-directionally with cardiac,
pulmonary and renal disease. For instance, the burden of chronic physical illness is an important risk factor for depression and suicide.
The risk of suicide in people with chronic renal disease is similar in magnitude to suicide risk with other chronic illnesses, such as
chronic pulmonary disease and stroke. Depression and anxiety adversely impact morbidity and mortality associated with cardiac, renal
and pulmonary disease. [We will cover schizophrenia later, but patients with schizophrenia also have an increased risk of dying from
heart disease and suicide when compared with the general population].
Unfortunately, anxiety, depression and suicide are often overlooked and under-treated in all medical settings. While 80% of patients
with depression can be effectively treated, less than 50% get the help that they need. (Depression and Heart Disease, NIMH
Depression Publications No. 02-5004, May 2002). Depression affects 6% of men and 18% of women at any one time. Lifetime risk is
20-25% for women and 7-12% for men. Unipolar depression is the 4th leading cause of early death and disability worldwide. More than
half of patients who kill themselves see their doctor in the month before they do it. Panic attacks are often misinterpreted as heart
attacks. And, anxiety disorders are the most common psychiatric diseases in the general population.
In depression, the HPA axis is hyperactive with increased corticotrophin-releasing hormone, reduced function of glucocorticoid
receptors and higher cortisol levels following the dexamethasone suppression test. Corticosteroids mobilize FFA causing endothelial
inflammation and excessive clotting and are associated with HTN, high cholesterol and glucose dysregulation. Endothelial shearing
stress can lead to vascular damage and plaque formation. In addition, depressed patients may have excess norepinephrine which can
stimulate platelet activity, also contributing to clotting. There is altered autonomic function in depressed patients and decreased heartrate variability is associated with increased risk of ventricular arrhythmias and sudden death. Decreased heart-rate variability has been
observed in people with panic disorder, depression and schizophrenia. Variability is decreased when sympathetic activity overrides
parasympathetic influences via the vagus nerve. Depressed patients also have greater BP variation, which is also a predictor of cardiac
events. (Kemp DE et al Heart Disease and Depression. Cleveland Clinic Journal of Medicine. Vol 70:9 pp 745-761 Sep 2003)
BASIC PSYCHIATRY IN CVPR BLOCK: GOALS
1.
To practice and begin to master THE 30-MINUTE INTERVIEW with patients with anxiety, depression and with a history of
cardiovascular, renal, or pulmonary disease.
2.
And utilize appropriate screens for depression, anxiety and suicide found in the CU MEDICAL STUDENT ASSESSMENT OF
COMMON PSYCHIATRIC PROBLEMS.
3.
With particular attention paid to:
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the eight domains of the psychiatric evaluation
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4.
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the use of summarizing during interviews
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identifying why the patient volunteered to be interviewed (the “why now” domain) and the patient’s current biggest worry.
And, to be able to describe the presentations, etiologies, treatments AND relationship to cardiovascular, pulmonary and renal disease of
depression, anxiety disorders, and suicide in medical practice.
ORGANIZATION and READING
1.
25-minute talks, 10:00-10:25 am, on April 7, 14, 28 and May 12, followed by
2.
Clinical Patient Groups, 10:35-11:50 am.
3.
Reading assignments for each date are below. Handouts are required reading. Blueprints-Psychiatry, 5th Edition, Murphy, et al,
is the textbook and will be utilized for background information only during the CVPR Block. It will be the textbook used for the
psychiatric portion of the Neuroscience and Metabolism Blocks (Fall 2010). There are a few copies in the library for checkout.
SCHEDULE Mini lectures 10:00-10:25:
4/7 Introduction and overview (read handouts: sequence organization, introduction to psychiatry & the psychiatric evaluation)
A.
Sequence organization and expectations including the Interview Reviews.
B.
How is psychiatric illness identified and assessed?
C. THE 30-MINUTE INTERVIEW: Engage, Assess, Focus
4/14 Depression & Grief: (read handouts: Depression, Grief; for background, Blueprints (5th edition), Chapter 2)
Students will be able to demonstrate knowledge of:
A.
Symptoms/presentation of depression and grief, particularly in medical settings, and be able to differentiate depression from
normal grief
B.
Bi-directional relationship of depression & grief with medical illness: cardiac, pulmonary, renal disease, including increased
mortality in survivors
C. Basic etiologies of depression: risk factors, genetics, life experiences, basic neurobiology
D. Very basic psychotherapeutic and pharmacologic treatments of depression & grief
4/28 Anxiety (panic disorder): (read handout: Anxiety; for background, Blueprints (5th edition), Chapter 3)
Students will be able to demonstrate knowledge of:
A.
Symptoms/presentation of anxiety, primarily panic disorder, particularly in medical settings
B.
The relationship of anxiety with depression and impact on pulmonary disease
C. Basic etiologies of panic disorder: risk factors and patient vulnerabilities, genetics, life experiences, stress and basic neurobiology
D. Very basic psychotherapeutic and pharmacologic treatments of panic disorder
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5/12 Suicide: (read handout: Suicide for background, Blueprints (5th edition), pp 70-71)
Students will be able to demonstrate knowledge of:
A.
Symptoms/presentation of suicide, particularly in medical settings
B.
The association of suicide with medical illness: cardiac, pulmonary, renal disease
C. Basic etiologies of suicide: risk factors and patient vulnerabilities, genetics, life experiences, stress and basic neurobiology
D. Very basic treatments of suicide
SCHEDULE Patient Groups 10:35-11:50 (see schedule in syllabus for groups, group leaders and room numbers)
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10:35-10:50 discuss Interview Reviews
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10:55-11:40 new patient interview
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11:40-11:50 group wrap-up
In Patient Groups, students practice THE 30-MINUTE INTERVIEW and screens from the CU ASSESSMENT OF COMMON PSYCHIATRIC
PROBLEMS. Particular attention should be paid to the eight domains of the psychiatric evaluation, the use of summarizing during the interview
and to sorting out why the patient volunteered to be interviewed (the “why now”) and attempting to identify the patient’s current biggest worry.
Following patient interviews, each student completes an Interview Review for discussion the following week. Groups (8-9 students, 2 faculty)
will meet FOUR times during this block. The focus of the last THREE clinical groups will be on patients’ stories of their illnesses and the
role that grief, depression, anxiety or suicide, if any, played in their experiences.
Each student completes a BRIEF PATIENT INTERVIEW REVIEW (copy of forms in back of syllabus), which will be submitted electronically
each week. Instructions on accessing the electronic form will be on Blackboard with the forms. Group leaders will give you the deadline for
submission each interview day. Please be ready to discuss the interview, BRIEFLY, the following week before the next patient interview.
Interview reviews will be critiqued and returned.
4/7 Session 1: Outline Clinical Patient Group goals and the evaluation of psychiatric illness. Groups might also discuss issues of patient
confidentiality and group ground rules, e.g. groups are not “therapy” groups. Discuss & practice how patient information will be collected
using the 30-MINUTE INTERVIEW
4/14 Session 2: Interview patient with depression. Students will practice THE 30-MINUTE INTERVIEW and appropriate screens. Evaluate
for depression. Discuss findings and issues. During the week, complete Interview Reviews.
4/28 Session 3: Discuss Interview Reviews. Interview patient with anxiety. Practice 30-Minute Interview and appropriate screens.
Evaluate for depression and anxiety. Discuss findings and issues. During the week, complete Interview Reviews.
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5/12 Session 4: Discuss Interview Reviews. Interview patient who has renal disease. Practice the 30-Minute Interview and appropriate
screens. Evaluate for depression, anxiety, and suicide. Discuss findings and issues. Complete Interview Reviews and turn in to your
group leaders (by whatever means you and your group leaders decide, as this will be your last session).
If there is not a way for you to directly give them to your group leader(s), you may send them to Sharon Campbell via campus mail at
F546, email them (sharon.campbell@ucdenver.edu), fax them to 303-724-1399 or deliver them to her office in Building 500, Room
E2332 (2nd floor).
2/17/2016