Contemporary Psychiatry in US Richard C Veith, MD Ashley Bouzis, MD Psychiatry & Behavioral Sciences University of Washington, Seattle, Washington, USA Summary of Psychiatry Training in US • In the US, medical school requires years of training after having usually completed years of general university education • Medical students are required to pass national competency (USMLE) exams after year and year for graduation • Psychiatric specialty training (residency) requires years of training following graduation from medical school • Post-residency added-qualification, subspecialty fellowships are available in: child psychiatry (2 yrs), geriatric psychiatry (1 yr), addiction psychiatry (1 yr), psychosomatics (consultation-liaison psychiatry) (1 yr), forensic psychiatry (1yr) All have certification exams MS Year Brain & Behavior Course     DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 Hours Hours Hours Hours Hours Quiz Quiz Quiz Quiz Quiz Cumulative   Week 1 Mood Disorders Psychotic Disorders Anxiety Disorders Personality Disorders Suicide 18 hrs Antidepres- Antipsychotics Management Somatization Psychotherapy   sants Movie Clips Lithium   DAY DAY DAY   hours Hours hours   Quiz Quiz Week 2 Child Psychopath I and II Delirium Differential Diagnosis 8 hrs Stimulants Dementia Final exam     Medical Student Psychiatry Clinical Clerkship Goals and Objectives  All rd year medical students take a required 6-week psychiatry clinical clerkship consisting of weeks of inpatient psychiatry and weeks of hospital-based consultation-liaison psychiatry  The overall goal of the clerkship is to provide a thorough introduction to Psychiatry through supervised patient encounters, clinical teaching and a weekly structured didactic program UW Psychiatry Residency 4-year Specialty Training after Medical School  10 months inpatient  months hospital consultation services  months primary care (Medicine/Pediatrics)  months neurology  month emergency psych  12 months outpatient plus years longitudinal clinic  months child psychiatry  month addictions  month geriatrics  "exposure" to community psych, forensics Contemporary Psychiatry Practices in US  Inpatient treatment of seriously ill, suicidal, psychotic patients  Outpatient community mental health center care with socialization, case management, medications, vocational support for those with chronic serious mental illness  Private practice or health care system outpatient care for less seriously ill individuals who can afford it  Recent introduction of “collaborative care” or “integrated care”models to bring behavioral health care into the general medical, primary care setting Psychiatry in US – Pharmacotherapy  Much of the focus of care in inpatient services is on arriving at the correct diagnosis, keeping patients safe from suicidal impulses or disturbed thinking in those who are psychotic  Most patients who are voluntarily hospitalized are depressed or experiencing a manic or psychotic episode  There is much reliance (depend) on antipsychotic, antidepressant, and mood stabilizing medications, such as lithium  Seriously depressed patients might require electroconvulsive therapy (ECT)  A typical length of hospital stay for inpatient units with voluntary patients is ~ days Psychiatry in US – Cognitive Behavioral Therapy (CBT)  Theoretical model assumes that changing maladaptive thinking leads to change in affect and behavior  CBT techniques challenge thinking patterns and beliefs to replace "errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and “catastrophizing”(dự báo tai ươn) with more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior  These errors in thinking are known as cognitive distortions  CBT techniques help individuals take a more open, mindful, and aware posture toward them so as to diminish their impact Psychiatry in US – Dialectical Behavior Therapy (DBT)  Biện chứng Medical Students at CTUMP 10 Open Discussion:  How was your experience in psychiatry coursework and clinical rotations?  What reasons might a CTUMP student have for going into psychiatry or not going into psychiatry as a career choice?  What would help you get a better understanding of the challenges and opportunities in psychiatry?  What might make it more attractive for a student to consider psychiatry as a career choice? Thank You 11 James D Ralston