The Psychiatry Teaching awards are presented annually during
Psychiatry Grand Rounds. Their purpose is to honor excellence in
teaching, supervision, mentoring or related instructional activities in a
number of categories. Nominees for each award are selected for their
ingenuity, clinical skill, innovation, availability, supportiveness,
dedication, humanism, respect for diversity, improvement in the teaching
process, and introduction of new important subjects.
Outstanding Medical Student Teaching
Eligible candidates are full-time faculty in the department who
lecture, supervise or tutor in any of the courses for first or second
year medical students or in any of the psychiatry clerkship or medical
student electives (include those offered at our V.A. or affiliated
medical programs). Benjamin Woo, M.D.
Dr. Benjamin Woo is the site director for the third year Psychiatry
clerkship at the Olive View Medical Center and works with the medical
students that rotate through the inpatient psychiatry unit. One student
that had begun their rotation with no particular interest in the field
acknowledged that he had an epiphany about psychiatry while under the
guidance of Dr. Woo, stating “I suppose that is what the truly great
teachers do. They take something that may initially seem so foreign and
unattractive and change it into the most interesting and fascinating
thing in the world. This is indeed what Dr. Woo did for me in
psychiatry. He undoubtedly planted an infectious desire to learn more
about psychiatry and a new found drive to be instrumental in the
treatment of the mentally ill. Subsequently, I have now decided to
pursue a career in psychiatry.” A former student believes that the
traits that Dr. Woo modeled early on have been indispensable in their
development as a clinician and educator, adding that “Dr. Woo has been
an invaluable part of my career, and I look forward to him inspiring
future generations to come”. For his dedication to teaching students,
Dr. Benjamin Woo is truly deserving of the 2012 Outstanding Medical
Student Teaching Award.
CDT is a simple method to detect whether you may be suffering from memory loss. Ask your loved one to draw a clock, point the hands to "10 after 11," and voila -- you are done! It is one of the ways to screen for dementia. Even if you have depression on top dementia, this simple test can still be useful (http://www.ncbi.nlm.nih.gov/pubmed/15533989)
a. Olive View—UCLA Medical Center, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, USA
While patient entry into a psychiatric emergency service (PES) can be an important first step toward improved mental health, PESs have become increasingly more complex. Over the years, on top of providing triage and disposition, PES has become the place where psychiatric treatment may be rendered for patient safety. In times of economic recession, however, PESs may also have become de facto psychiatric wards [1].
Allen and Currier [2] have surveyed 51 psychiatric emergency services to assess the type and scope of services delivered. They found that psychiatrists initiating treatment with medications have become the norm, not the exception, in the PES. In comparison to the consultation model (in which psychiatrists are consultants to the emergency department), the PES model is found to be more timely, effective and safe [3]. As PES may act as a barometer of the overall mental health system, Boudreaux et al. [4] have developed and applied ten quality indicators to eight PESs across the nation. The study reinforced that even in the busy psychiatric emergency settings, benchmarking can ultimately improve quality of care.
Two years ago, in this Journal, an editorial [5] highlighted the importance of providing quality care in the PES. Optimal and appropriate care may be achieved only when safety, effectiveness, efficiency, timeliness, equity and patient-centeredness are actively promoted. The editorial explicitly called for future research to examine the relationship between quality of care and racial disparity. In this issue, Unick and colleagues [6] provide a timely report on whether ethnicity plays a role in clinical, demographic and service system characteristics in the PES and subsequent inpatient admission.
The authors reported on patients admitted to the only 24-h PES operating in San Francisco County in a 3-month period in 2005. Inpatient admissions from the PES were associated with delusions and deteriorated psychosocial functioning. Multiple previous PES visits in the past 2 years, as well as being admitted to PES on a Sunday, were associated with lower probability of inpatient admissions. These associations highlighted that despite inpatient admission should be strictly based on clinical necessity, other factors contribute to the algorithm of evaluation and disposition in the PES. Further studies should investigate the impact of clinical, demographic and service system characteristics on PESs nationwide.
Unick et al [6] noted that, in San Francisco County, African Americans were over-utilizing and Asians were under-utilizing the PES than adults in the population at large. The authors found that both Asians and blacks had higher levels of functional impairment on PES admission in comparison to other ethnicity groups. Not only that, Asian patients also had a higher probability of being admitted to the inpatient unit when compared to White patients. Clearly, ethnicity plays a role in PES utilization and inpatient admission.
What are the clinical implications of the growing emphasis on cultural emergency psychiatry? Asian Americans are one of the fastest growing groups in the US, particularly in the Los Angeles, New York, and San Francisco areas. Despite being labeled as a group of “model minorities,” multiple studies [7], [8] and [9] have shown that Asian Americans suffer from equal or higher rates of depression and suicides, but underutilize any type of mental health services, in comparison to the mainstream population. In the current study [6], the data confirm that few Asian Americans seek psychiatric emergency treatments. Not only that, many of them were sicker than others on PES admissions. Future studies should investigate whether limited access to care and cultural barriers contribute to the under-utilization of PES among different ethnicity groups.
While heterogeneity in mental health risk factors exist among different Asian subgroups, i.e., Chinese, Filipino, Korean, Vietnamese, etc., they are often aggregated in mental health services data collection. There are indeed numerous differences among different Asian ethnic sub-groups. For example, Southeast Asians are more likely to be refugees and immigrants from the Vietnam War. Thus, they may be under higher risk of loss, depression and post-traumatic stress disorders. Despite that PESs are exceedingly busy, clinicians should strike for providing culturally appropriate emergency psychiatric care. Furthermore, equity can only be achieved when cultural barriers are removed. Future studies should examine mental health disparities by ethnic subgroups among Asian Americans in the PES.
This study had a number of limitations. The main limitation of this study was its retrospective nature and the fact that it included only patients from a single PES. Second, the findings may not be applicable to other settings. However, this study represents a commendable effort to capture how clinical, demographic and service system characteristics are influencing decision making in the PES. This study also fills an important gap by providing a current snapshot of how cultural barriers may interfere with quality PES care.
The current health care costs have become increasingly unsustainable. Acute psychiatric hospitalization is the most expensive and restrictive level of care available in the mental health system. On top of providing culturally sensitive services, PES should strike for equity, efficiency and quality by removing cultural barriers and improving access to care. Providing cost-effective, timely, patient-centered health care in the PES would be a vital first step to ensure appropriate use of our scarce healthcare resources. To thrive in an era of healthcare reform, we must take up the unparalleled opportunities for system reform in all levels of psychiatric service to provide quality of care.
References [1] T.T. Lo and B.K. Woo, The impact of unemployment on utilization of psychiatric emergency services. Gen Hosp Psychiatry, 33 3 (2011), pp. e7–e8. [2] M.H. Allen and G.W. Currier, Use of restraints and pharmacotherapy in academic psychiatric emergency services. Gen Hosp Psychiatry, 26 1 (2004), pp. 42–49. [3] B.K. Woo, V.T. Chan and N. Ghobrial, et al. Comparison of two models for delivery of services in psychiatric emergencies. Gen Hosp Psychiatry, 29 6 (2007), pp. 489–491. [4] E.D. Boudreaux, M.H. Allen and C. Claassen, et al. The Psychiatric Emergency Research Collaboration-01: methods and results. Gen Hosp Psychiatry, 31 6 (2009), pp. 515–522. [5] B.K. Woo and D.L. Sultzer, A key step for quality care in psychiatric emergency settings. Gen Hosp Psychiatry, 31 6 (2009), pp. 503–504. [6] G.J. Unick, E. Kessell, E.K. Woodard, M. Leary, J.W. Dilley and M. Shumway, Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service. Gen Hosp Psychiatry, 33 (2011), pp. 618–625. [7] S. Sue and J.Y. Chu, The mental health of ethnic minority groups: challenges posed by the supplement to the surgeon general's report on mental health. Cult Med Psychiatry, 27 4 (2003), pp. 447–465. [8] B.K. Woo and T.T. Lo, How often do Chinese Americans stay on treatment after transitioning from outpatient mental health to primary care setting?. Gen Hosp Psychiatry, 33 1 (2011), pp. e5–e6. [9] D.T. Takeuchi, R.C. Chung and K.M. Lin, et al. Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. Am J Psychiatry, 155 10 (1998), pp. 1407–1414.
除了癲癇，創傷性腦損傷(Traumatic Brain Injury)、失智症(Dementia)、腦腫瘤(Brain Tumor)、肝功能衰竭(Liver Failure)、性病(Venereal Disease，particularly HIV or Neurosyphilis)、細菌或病毒感染(Bacterial or Viral Infection)等等，也能導致思覺失調。許多藥物，如類固醇(Steroid)，也列出思覺失調或情緒變化為他們的副作用。所以正確的診斷，有助於病人可以藥到病除，節省數月的無效治療。
醫生須要提供思覺失調病患有關的知識，幫助親人增加對病發的警覺性及症狀處理，以及學習壓力及危機處理。家人最苦惱的，往往是如何照顧和關懷患者。通過早期參與輔導，家庭成員能減少負擔及倦怠(Burnout)。家庭為本治療還包括降低憤怒情緒表達(Decrease High Expressed Emotion)，辨認早期復發跡象(Identifying Early Warning Signs)，和學習如何預防復發(Relapse Prevention Planning)。家人的鼓勵及協助是最為重要的！
