I did my Psych rotation at Queens Hospital Center with 2 of my fellow classmates and had a great experience! I went into this rotation with no intention of enjoying psychiatry or even ever wanting to do it in the future, but I was pleasantly surprised. I found that this field has a lot more to offer then I gave it credit for, and doing the rotation at the QHC Psychiatric emergency department was a great way to get an overall look at the emergent psych condition and how we can treat them. In CPEP we were only able to hold patients involuntarily for up to 72 hours, then had to make a disposition about if they were safe to discharge or had to be admitted. For this reason, we only saw the patients transiently, but were unable to follow them and their treatment long-term.  

In the Psych CPEP we got exposure to a plethora of cases that we learned about in didactic. We got to see all the diseases that we read about in real time. We saw numerous cases of psychosis secondary to diseases such as schizophrenia, schizophreniform, substance use, and schizoaffective. We also had many patients with depression and suicidal ideations, as well as those with homicidal ideations. Majority of the patients that we saw admitted to either auditory or visual hallucinations. And most of the patients that we saw are “usuals” meaning they come in every few weeks/days and have an extensive history of past psychiatric disorders who are on medications. A lot of the patients that we saw at QHC were either homeless or from a shelter, as they did not have insurance and QHC is a public hospital.  

I will discuss some examples of the more memorable cases we saw of psychosis, depression, and agitation. One of the psychosis patient’s we saw was expressing a lot of grandiose delusions and was convinced that he is a messenger of God, he was very agitated in CPEP and had to be sedated. Another patient had extreme auditory hallucinations telling her to hurt herself and others, and she admitted herself seeking help. We also had an example of cannabis induced psychosis, as the patient starting using marijuana every day and had started having auditory hallucinations of her boyfriend, whom she talked to throughout her stay in CPEP. Our most recent psychosis patient was one who stripped himself of his clothes, started screaming, urinating and defecating on the floor, and began eating his feces. Patients who came in with depression ranged from some sad and tearful demeanor to those who actively came in after attempting suicide. We had one patient who was overwhelmed with the stress of the pandemic and wanted to end her life. We also had one patient who came in after trying to stab herself in the neck, and the expressing aspects of conversion disorder. Our patients who came in for agitation often came in accompanied by NYPD, after having an altercation at home with family or acting bizarre and agitated towards bystanders and strangers in public areas. Finally another interesting case that we saw was a patient who suddenly became catatonic in CPEP, and after given a Ativan shot, she suddenly snapped out of it and became very aggressive to the other patients and staff.  

In the CPEP the main procedure of assisting the patient was with proper interviewing skills and a lot of patience. A lot of the patients are agitated and not in the right state of mind to be good historians, but we learned after following the PAs and Doctor’s the certain questions and wording one can do to extract proper information from the patient. We did mental status exams with the patients, and gauged whether their delusional demeanor was secondary to a underlying psychiatric disorder or due to early onset dementia. We also were able to monitor the patient’s mood, affect, and behavioral changes such as tics or tremors, and discuss what underlying diseases or medications they can be associated with. We also would observe which patients would receive 5mg haldol and 2mg ativan, to stabilize and control the patients. The Doctors would also take us to the Medical ER to do consults for patients who needed a psych eval, and assess whether or not they belong in the psychiatric floor. All the Doctors and PAs were wonderful teachers and wanted to make sure we learned something from each case. After seeing each patient, we would get in a huddle and discuss the case and possible differentials, and rule out why certain things would be not applicable to our patient. We wold also dicuss the proper medications and treatment method. Because of this, we learned a great deal from all the Providers we had the opportunity to work with.  

Overall this rotation came with its set of challenges and rewards. It is not a question, that aside from infants, psychiatric patients are one of the most difficult populations to interview and interact with, as a lot of them are uncooperative and not of sound mind. A lot of patients would also fluctuate in mood and go from very cooperative to very agitated and frightening. For this rotation, due to the safety of the students, we were all able to go interview patients in groups with a provider, and were never forced to go by ourselves for our safety. We learned how to redirect a patient, especially those who were tangential and had loose association of words. For those who were quite we learned to give them space and come back to reassess. One thing I have to learn to work on is being confident when talking to a patient, especially one that is not cooperative. It is important for them to realize that at the end of the day we are on their side and want to see them get better. It was very rewarding to see those who were suicidal and depressed feel more safe and secure prior to leaving. It is of course a very uncertaina nd difficult field since there is no ultimate cure to mental illness, and no magic pill. There is still a lot of doubt when discharging patients if they will get better or not, but as a practioner, one can only do the best they can. Here I learned the importance of caring for those who cannot care for themselves, those who are not aware of their illness, and those whose lives are controlled by their negative mental illness.