Psychiatry Rotation
PHILADELPHIA VA MEDICAL CENTER
Preceptor:
Karimah Lynum, Pharm.D.
PHONE NUMBERS
Phone: 4038, 2598; (outside hospital: 215-823-4038); 6363 (Research)
Pager: 215-894-1276
Pharmacy Administration Office: 5844 (outside hospital: 215-823-5844)
Outpatient Pharmacy: 3534, 4408 (outside hospital: 215-823-6361)
Inpatient, Mental Health: 6600 (7 West); 4107 (7 East)
INSTITUTION
Philadelphia VA Medical Center (PVAMC) provides health care for some 433,000 veterans living in America's
fifth largest metropolitan area and surrounding seven counties. The PVAMC, the second largest VA medical
center in Pennsylvania, is a VA acute referral center for the tri-state area and offers a wide range of advanced
high tech treatments for the special needs of veterans. The facility is staffed by more than 1,500 employees and
supports more than 150 acute beds and a 240-bed Nursing Home Care Unit.1
DESCRIPTION OF RESIDENCY ROTATION (ELECTIVE)
The psychiatry rotation is designed to provide both an introduction and beginning level of concentration into the
area of psychiatry. The resident will have the opportunity to provide pharmaceutical care in both the outpatient
and inpatient setting for the mental health and behavioral health primary care services at PVAMC. The resident
will participate in clinic services offered by the preceptor through the outpatient clinic, in addition to evaluating
and observing patients with various mental disease states through clinical assessment and daily monitoring in
the inpatient setting. The resident will interact daily with the preceptor and other healthcare practitioners in the
outpatient/inpatient setting.
KEY ROTATIONAL OBJECTIVES
Upon completion of this rotation, the student will demonstrate the ability to:
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Monitor pharmacotherapy regimens for appropriate dosing adjustments, therapeutic duplications,
drug-drug interactions, adverse events, polypharmacy, medications without indication etc.
Independently gather patient data (medication history, physical findings, laboratory values, etc.) and
assess therapy.
Effectively communicate drug information requests with patients and healthcare providers
Discuss the basic pathophysiology and pharmacotherapy of the following disease states/conditions
discussed during the rotation, which include:
 Schizophrenia/Psychosis
 Depressive Disorders
 Bipolar Disorder
 Anxiety Disorders
 Sleep Disorders
 Substance Abuse Disorder
 Alzheimer's Disease and Dementia
ORIENTATION
The resident's orientation will include review of syllabus, including: rotation goals, objectives, evaluation
process, assignments and responsibilities; introduction to the medical team and team members; orientation to
the outpatient and inpatient clinic; introduction to key personnel (technicians, nurses, social workers,
psychiatrists, psychologists, primary care team); and review of pertinent hospital and pharmacy policies and
procedures. The preceptor will ensure the completion of CPRS Training prior to beginning rotational activities.
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EDUCATIONAL OBJECTIVES and COMPETENCIES
R1.5
Provide concise, applicable, comprehensive, and timely responses to requests for drug information from
patients and health care providers.
R2.1
As appropriate, establish collaborative professional relationships with members of the health care team
R2.2
Place practice priority on the delivery of patient-center care to patients.
R2.3
As appropriate, establish collaborative professional pharmacist-patient relationships.
R2.4
Collect and analyze patient information.
R2.5
When necessary, make and follow up on patient referrals
R2.6
Design evidence-based therapeutic regimens
R2.7
Design evidence-based monitoring plans.
R2.8
Recommend or communicate regimens and monitoring plans.
R2.9
Implement regimens and monitoring plans.
R2.10 Evaluate patients' progress and redesign regimens and monitoring plans.
R2.12 Document direct patient care activities appropriately.
R5.1
Provide effective medication and practice-related education, training, or counseling
R6.1
Use information technology to make decisions and reduce error.
E7.2
Communicate effectively
E7.4
Manage time effectively to fulfill practice responsibilities.
PRE-REQUISTE LEARNING
The resident should obtain access to at least 3 different sources listed in the Available References section of
syllabus. The resident should be familiar with basic patient interview techniques as well as basic
pathophysiology and drug therapy of the above listed disease/disorder states. The resident should be familiar
with normal laboratory values, especially those associated with metabolic syndrome, the "SOAP" format, and
creatinine clearance determinations.
CLERKSHIP ACTIVITIES AND ASSIGNMENTS
OUTPATIENT ACTIVITIES:
 MHC PHARMACY MEDICATION MONITORING CLINIC
o Interview patient referred by mental health for metabolic syndrome monitoring
o Evaluate current stages of patient and necessity for monitoring
o Develop plan/monitoring parameters, etc.
o Document via CPRS progress note
 CLOZARIL® CLINIC (Weekly)
 MOOD DISORDER CLINIC (Consult Service)
 MHC PHARMACY-WALKIN (Daily)
 SPECIAL PROJECTS
INPATIENT ACTIVITIES:
 Participate in interdisciplinary team meetings, Tuesday, Wednesday, and Thursday mornings.
 Participate in daily monitoring and clinical assessment of patients within the designated patient case
load (3) with the following required activities:
o Review medications and pertinent laboratory data
o Address appropriate interventions with preceptor
o Leave intervention notes for physicians with clinical recommendations that are co-signed by the
preceptor
o Follow-up on previous days' interventions
o Reconcile Medication Administration Record upon admission, during stay, and at time of
discharge.
o Participate in discharge medication counseling and order processing.
o Note Patient Case Load Requirements:
 Designate at least 4 initial patient cases to follow by the 2nd day of the rotation start on
inpatient.
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The resident and preceptor will discuss the cases to ensure a variety and multiple
educational opportunities are present, as determined by the preceptor and resident.
The resident is to maintain at least 3 patient cases at any one time.
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GENERAL ACTIVITIES:
 Attend and participate in Outpatient and Clinical Staff Pharmacy Meetings
 Present announcements/topics to Mental Health Clinic during staff meetings
 Provide drug information to Mental Health Clinic/Behavioral Health Primary Care Team
 Respond to Drug Information requests within 3 days
 Meet with preceptor for topic discussions/journal reviews
 Attend staff meetings for MHICM team
GENERAL ASSIGNMENTS:
 Prepare for topic discussions assigned by preceptor by reviewing current literature
 Evaluate current medical literature and present one journal club per month to pharmacy department
staff and students
 Present one patient case presentation per week to preceptor
 Present pharmacy in-service to nursing staff and/or pharmacy staff
 Drug Class Reviews
REQUIRED READINGS:
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STAR*D trial
CATIE antipsychotic trial
Ciranni MA, Kearney TE, Olson KR. Comparing Acute Toxicity of First- and SecondGeneration Antipsychotic Drugs: A 10-Year, Retrospective Cohort Study. J Clin Psychiatry
70:1, January 2009
Boyer EW and Shannon M. The Serotonin Syndrome. New Engl J Med 2005;352:1112-20
Blanchet PJ. Antipsychotic Drug-Induced Movement Disorders. Can J Neurol Sci 2003; 30:
suppl 1:S101-7.
Cutler, AJ, Kalali AH, Weiden PJ, et al. Four-Week, Double-Blind, Placebo- and ZiprasidoneControlled Trial of Iloperidone in Patients With Acute Exacerbations of Schizophrenia. Journal
of Clinical Psychopharmacology; Volume 28:2, Supplement 1, April 2008
Dipiro Pharmacotherapy and Mental Health chapters
“Drug Therapy: Alzheimer’s Disease” N England J Med Vol 351(1), July 2004. Pages 56-67.
Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, et al. Effectiveness of Antipsychotic Drugs
in Patients with Chronic Schizophrenia. N Engl J Med 353;12, September 22, 2005
AVAILABLE REFERENCES:
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Clinical Psychopharmacology made Ridiculously Simple, 4th Ed. J. Preston and J. Johnson
DSM-IV TR
Essential Psychopharmacology, 2nd Ed. Stephen Stahl
Child and Adolescent Clinical Psychopharmacology Made Simple, J. Preston, J O’Neal, and
M. Talaga
ASHP Therapeutic Position Statement of the Use of Second-Generation
Antipsychotic Medications in the Treatment of Adults with Psychotic Disorders. August 4,
2004.
Diverse Roles of Anticonvulsants in Bipolar Disorders. Annals of Clin Psyc Vol 15(2) June
2003, pp95-108.
Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes
(2004).
Thase ME, Howland RH, Friedman ES. Treating Antidepressant Nonresponders With
Augmentation Strategies: An Overview. J Clin Psychiatry 1998;59[suppl 5]: 5-12.
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Inouye SK. Delirium in Older Persons. N Engl J Med 2006;354:1157-65.
Fick DM, et al. Updating the Beers Criteria for Potentially Inappropriate Medication Use in
Older Adults. Arch Inter Med 2003;163:2716-2724.
ASHP Therapeutic Position Statement on the Use of Second-Generation
Antipsychotic Medications in the Treatment of Adults with Psychotic Disorders (Jason Noel2007).
EVALUATION
Based upon the following:
 Attendance, attitude, and professionalism
 Motivation to achieve independent competence
 Demonstration of disease state knowledge and application to clinical practice
 Participation in topic discussions
 Nursing/Pharmacy In-service
 Final Examination (At the discretion of the preceptor)
 Formal Journal Club
 Case Presentation (4)
 Drug Review (4)
A midpoint evaluation will assess progress and provide suggestions for improvement.
TARDIES AND ABSENCES
ALL tardies or absences MUST be called in directly to the preceptor.
Tardies and absences will be handled accordingly:
 For each tardy resident will be required to makeup the time
 For each unexcused absence, the resident will be required to makeup the time with an additional project at
the discretion of the preceptor.
JOURNAL CLUB GUIDELINES
Article selection
 The topic should be psychiatry related
 The topic should be one that the resident has not discussed previously
 Selection of article must be from a peer-reviewed medical journal
 Article should have been published within the past 6 months
 Article and handout will be provided to the preceptor 2 days prior to presentation
Format
 Presentation should be 20 minutes long and 2-3 minutes for questions/discussion
 Introduction
 Title, authors, journal and date
 A brief introduction to subject
 Review of article
 Methods should include study design; inclusion/exclusion criteria
 Results
 Author’s conclusion
 Your conclusions
 Discuss strengths and weaknesses of the study
 Discuss application to clinical practice
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CASE PRESENTATION GUIDELINES
CASE SELECTION
 The topic should be one that the resident has not discussed previously.
 Presentation should be no longer 15-20 minutes including time for questions
FORMAT
 Introduction
 Vital statistics on admission
 Chief complaint, history of present illness
 Past Medical History, allergies
 Medications prior to admission
 Social/family history
 Pertinent physical exam, vitals, labs
 Problem list
 Abbreviated summary of hospital course (labs, tests and drug changes)
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Review of topic
 Background
 Focus mainly on drug therapy
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Conclusions
 Please relate topic to patient at the end
 Be prepared to comment on any discrepancies with the care of the patient
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Handout
 Maximum of 4 pages
 Provide a list of references (at least 2 have to be primary literature)
 Presentation should be an outline, not a transcript
 Refer to medications by generic names only
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