psych inpatient clinical things

-when taking an interview in the ER, for the HPI try to find out why now? why here? what happened this time that brought patient to ER

-unless absolutely necessary never use family member as interpreter, especially children

-patient on edge? glance over the EMS report before doing the interview to get a better sense of whats up

remember you need patient consent to give the family details about the patient, but you don't need consent to get details from the family

while getting a parallel history, if the family etc start to inquire about patient, just reply, "there in a safe place"

tremor and tongue fasciculations? could be EtOH withdrawal

mental health therapy aides, "nurses aides", have been around the longest and have the best subjective sense about patients

stress comes from emotionally draining patients.

whats a delusion? fixed, false belief not culturally shared.

an arkow pearl: limit setting with a borderline patient is imperative, "i don't care if you have the chainsaw gassed up and ready to kill yourself if you have to leave, than we can just go the state hospital and you can figure it out over the next few months"

the pronouns are screwed up with borderline patients, you should be I, (patient)- I have the problem, I have issue, its my fault

clozapine is different - it never crosses the threshold for extrapyramidal symptoms, good for negative symptoms

axis I diagnosis will trump adjustment disorder

fluoxetine takes ~5 weeks to washout, paroxetine has the most DDI

when diagnosing depression, don't say "major depressive episode, or major depression", instead say you have "a depression", educate about symptoms

SSRI side effects

1. anorgasmia

2. tend to be activating

3. loose bowel movements/GI symptomes

4. black box for under 25yo

end point with SSRI's is "six months of feeling good"

stay away from benadryl and anti-cholinergic

help projecting complainer i.e. - gimme help please, no thanks don't need it.

when choosing residency don't go to a place where you have to drive far to work

check and see if the residency is unionized

risperdal consta can lead to retrograde ejaculation in young men

-regarding psychopathology - "if its not affecting you, its affecting someone else..."

-arkow pearl: "we once had a patient who was a fireman try to crawl through the ceiling tile trying to escape out of here"

-is there a giant fight going on over a patient in the nurses station? look for the patient quietly reading a magazine nearby, that's who there fighting over