A Novel Refractory Mood Disorders and Electroconvulsive Therapy Elective for Medical Students: Fighting Stigma through Experience.

Treatment resistant mood disorders (TRMD) have a significant impact on patients and society. Electroconvulsive therapy (ECT) has been shown to be effective for treatment resistant depression (TRD). Despite the effectiveness and safety of ECT, there remains significant stigma surrounding its use. Studies worldwide have shown that many medical students receive their knowledge from the media, which often portrays ECT in a negative light, and very few have exposure to ECT prior to their psychiatric clinical rotations. In this article we highlight the importance of medical education and introduce a novel approach in helping to fight the stigma of ECT through educational intervention for medical trainees that combines active, longitudinal and theoretical learning. By ensuring that trainees have a robust education in this arena, we can help them educate patients about treatment options, improve confidence in prescribing and administering these therapies, and ultimately improve patient and societal outcomes.

Cannabis use: A co-existing condition in first-episode bipolar mania patients.

BACKGROUND: An association between first-episode presentation of bipolar mania and concurrent cannabis use disorder has been well established in the current literature (Bally et al., 2014, Baethge et al., 2008). Previous studies have shown that 30-70% of patients admitted for a first manic episode had concurrent cannabis use (Bally et al., 2014). The exact mechanism of this association has yet to be confirmed. AIMS: We aim to evaluate the prevalence of cannabis use in patients with bipolar disorder (BD) admitted to UTHealth Harris County Psychiatric Center (HCPC) for a first manic episode. METHODS: In this retrospective cohort study, 15,969 inpatient records of patients admitted to HCPC between 2012-2013 were examined to identify patients admitted with a first manic episode according to ICD-9 criteria (single episode mania). The prevalence of multiple sociodemographic and clinical variables including cannabis positivity in urine drug screening (UDS) were examined. RESULTS: Twenty patients were admitted for a first manic episode. Half of the patients were females; mean age was 28.65 ± 10.56 years and mean length of stay (LOS) was 7.15 ± 3.72 days. Fifteen patients received a UDS. Of these fifteen, seven were positive for cannabinoids (47%). One patient was positive for phencyclidine (in addition to cannabis) and one patient was positive for amphetamine (but not cannabis). CONCLUSIONS: The prevalence of cannabis use was higher in first-episode mania patients compared to the general population. The influence of cannabis on the first episode of mania requires additional study.

A Difficult Patient Encounter: Using a Standardized Patient Scenario to Teach Medical Students to Treat Medication-Seeking Patients.

INTRODUCTION: Substance dependence and the misuse of prescription narcotic medications have recently been a topic of increased national attention. Since this is both a difficult and increasingly important area for medical student training, we created an addition to our psychiatry clerkship curriculum to address this need using a standardized patient scenario. METHODS: Standardized patient scenarios are a useful instructional and assessment tool for providing medical students with exposure to specific clinical scenarios that could not be consistently and reliably encountered in clinical rotations. We present a standardized patient scenario designed to challenge psychiatry clerkship students with recognizing and managing substance use disorders in patients with a difficult interaction style and medication-seeking behavior. Our scenario is unique in its expectations of students to appropriately manage a difficult clinical interaction in which collaborative treatment planning and advanced communication skills are critical to treatment success. RESULTS: In a narrative analysis of student postencounter reflections on this experience, most students who provided feedback indicated that the encounter was valuable to their psychiatry clerkship education. DISCUSSION: The inclusion of this learning opportunity in our clerkship has added value by assessing students' interpersonal communication skills and clinical ability to evaluate and manage substance use disorders, as well as by instructing students to manage a common and difficult clinical scenario regardless of their future specialty choice.