PhPr 810I - Psychopharmacy/Neurology Rotation
(Also refer to the general goals and objectives for PhPr 810)
Goal
The goal for training in neuropsychiatry is to give the student an understanding and appreciation of the practitioner's role in recognizing and treating neuropsychiatric disorders and monitoring the safe and effective use of psychotropic medications.
Objectives
At the completion of this rotation, the student shall be able to:
- Conduct a patient interview (which may include a mental status exam, chief complaint, history of present illness, past psychiatric history, alcohol and drug history, family history, medication history, and medical history).
- Conduct a mental status examination to assess:
- General description (appearance, motor behavior, speech, attitudes)
- Emotions (mood, affective expression, appropriateness)
- Perceptual disturbances (hallucination and illusions, depersonalization and derealization)
- Thought process (stream of thought, thought content [delusions, obsessions, compulsions, preoccupations, phobias], abstract thinking, education and intelligence, concentration)
- Orientation
- Memory (remote, recent past, recent)
- Impulse control
- Judgment
- Insight
- Reliability
- Assess neuropsychiatric patients (by interview, physical exam and/or laboratory work-up) for the presence of substance abuse, addiction, noncompliance, and/or drug misuse.
- Discuss the clinical use, pharmacokinetics, adverse effects, toxicity, and drug interactions of the following classes of medications:
- Antianxiety (benzodiazepines, buspirone)
- Sedative-hypnotics (benzodiazepines, non-benzodiazepines)
- Antidepressants (all types)
- Antipsychotics (all types)
- Mood stabilizers (lithium, valproate, carbamazepine, gabapentin, lamotrigine, topiramate)
- CNS stimulants (all types)
- Antiparkinson agents (all types) - for neurology rotation
- Antimigraine agents (all types) - for neurology rotation
- Analgesics and opioids (all types ) - for pain rotation
- Anticonvulsants (all types) - for epilepsy rotation
- Recommend or initiate the collection of laboratory data relevant to developing a pharmacotherapeutic plan.
- Identify possible drug-induced abnormalities and develop a differential diagnosis and plan to support or rule out a drug-induced etiology for psychiatric, neurologic or medical illness.
- Recognize potential drug-drug interactions with medications and recommend monitoring parameters, changes in pharmacotherapy, and alternative therapies to minimize adverse effects.
- Identify the symptoms and diagnostic criteria for the most common psychiatric disorders as described in the Diagnostic and Statistical Manual of Mental Disorders, IV-TM - revised (2000).
- Initiate, recommend and/or monitor the pharmacotherapy for the major psychiatric and/or neurologic disorders and recommend modifications in drug therapy based upon the patient's presentation, target symptoms, progress, and adverse effects.
- Discuss the pathophysiology, clinical diagnosis, and pharmacotherapy of the following psychiatric and neurologic disorders:
- Mood disorders (major depressive disorder, bipolar disorders)
- Anxiety disorders (agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, social phobia, specific phobia)
- Sleep disorders (insomnia, sleep apnea, narcolepsy)
- Psychotic disorders (schizophrenia, schizoaffective disorder)
- Parkinsonism (for neurology rotation)
- Migraine headache (for neurology rotation)
- Acute and chronic pain (for pain rotation)
- Seizure disorders (for epilepsy rotation)
- Review and evaluate the psychiatric, neurologic, medical, and/or pharmaceutical literature as it applies to the neuropsychiatric patient.
- Provide medication education and counseling regarding drug therapy to psychiatric or neurological patients and families.
- Serve as an educational resource regarding drug therapy for staff and trainees working in the psychiatry and/or neurology setting.
- When possible, conduct research and scholarly activities applicable to the care of psychiatric and/or neurologic patients and the development of psychopharmacy practice.
- Serve on a health care team and provide pharmaceutical care services to selected patients under the supervision of a physician.