During my site evaluations for this rotation, I presented two cases that I found to be interesting and very relevant to my psychiatry rotation. For my first H&P, I discussed a 20 year old female with a medical history of muscular dystrophy and reported history of depressive and anxiety disorder due to medical condition brought in by EMS secondary to passive suicidal ideation. She reported recent worsening anxiety, restlessness, and depressed mood. She also endorsed difficulty with sleep and poor appetite due to anxiety. On evaluation, patient appeared with a depressed mood and blunted affect. She spoke softly and quietly. In CPEP, we started her on Zoloft 25 mg and mirtazapine 7.5 mg at bed time. After reevaluation, patient appeared better with no more suicidal ideations and with intent to attend therapy and outpatient psychiatry. I chose this case because it demonstrated the significant impact that chronic medical illnesses can have on a patient’s mental health. It reinforced the importance of viewing psychiatric symptoms within the context of the patient’s overall medical condition rather than treating them as isolated diagnoses. This case taught me the importance of performing a thorough suicide risk assessment, addressing stressors, and developing a treatment plan to address the patient’s current symptoms and long term management. 

For my final site evaluation, I discussed a 36 year old male with psychiatric history of depression on Zoloft 50 mg from PCP, and substance use disorder of cannabis who presented to CPEP brought in by EMS activated by wife for suicidal ideations. Wife reported that patient has been sending texts and messages over the past few days expressing thoughts of suicidal ideations. Patient reported having ongoing depression and expressed inability to function. At this time, he endorsed suicidal ideation but with no plan or intent. Patient’s history is significant for a prior manic episode following a prolonged depressive period. He described a period of impulsive spending, elevated mood, and poor judgement resulting in significant financial losses and disruption of family functioning. On evaluation, patient appeared cooperative, but with a mood described as “ashamed” and labile affect. He had good eye contact, with pressured speech, and impaired judgement and insight. Patient was started on Wellbutrin 150, Depakote 250 mg, and Zyprexa 5 mg at bedtime. After reevaluation, patient was feeling better, with motivation to quit cannabis use, remain adhering to medications, and follow up with outpatient psychiatry and therapy. This case taught me the importance of obtaining a detailed psychiatric history rather than solely focusing on the patient’s current depressive symptoms. Learning about his previous manic episodes highlighted the distinction between major depressive disorder and bipolar disorder as his ultimate diagnosis. 

Overall, I received valuable feedback on my case presentations throughout the rotation. These experiences reinforced the importance of performing comprehensive psychiatric evaluations, developing appropriate differential diagnoses, and creating individualized treatment plans.