Dr. Paul Garfinkel is a Canadian physician, who currently is a professor in the Department of Psychiatry at the University of Toronto, as well as a staff psychiatrist at the Centre of Addiction and Mental Health in Toronto, where he also held the title of president and CEO for 12 years. During his 40 year career in the field of medicine, and more specifically, psychiatry, Dr. Garfinkel has accrued a wealth of experiences, and become exceptionally skilled and knowledgeable when it comes to psychiatric patients. However, through his many years in psychiatry he has also become intimately familiar with the stigma and systems issues in mental health care, in addition to handling countless highly emotional and controversial cases, and experiencing numerous challenges both professional and personal, all of which are common to a life and a career in the field. In his book A Life In Psychiatry: Looking Out, Looking In, Dr. Garfinkel takes readers with him on a look back at his journey from medical school to the present, giving us a inside look at what it's like being a psychiatrist. From discussing topics like finding a balance between therapy and pharmacology, to handling the pain and anguish associated with losing a patient to suicide, Dr. Garfinkel touches on it all, providing guidance to future psychiatrists, in addition to emphasizing lessons many of us can learn from. You can read excerpts from his book here: "A Patient's Suicide, A Doctor's Devastation" and "When a Psychiatrist Crosses The Sexual Line". "I think psychiatrists have a harder time dealing with the death of a patient than other specialists, like cardiologists or oncologists, when the death is by suicide. Skilled therapists tend to develop intense, close relationships with their patients. They care deeply about their progress and survival. A therapist may take it upon himself or herself to act as the saviour of a particular patient. This can set the therapist up for a devastating personal loss should the patient choose death over life." Recommended For: Anyone with a budding interest in the field of psychiatry, or who is curious to know more about the ins and outs of life in the specialty
Put your knowledge and skills to the test with the case of a 61 year old male who presents to hospital with a 30+ year history of bipolar 1 disorder and increasing depressive symptoms over the last 2 months. The patient is currently treated with risperidone and divalproex, and reports numerous stressors including divorce, financial issues, and homelessness. Though the patient attributes his low mood to the psychosocial stressors listed above and has been hospitalized numerous times previously for mental health reasons, he also presented to hospital with anemia, thrombocytopenia, and a rash. He has been having trouble sleeping, feels fatigued, and feels cold and shivers at times. His medical history is positive for hypothyroidism and a splenectomy in childhood. Can you make the diagnosis or come up with a treatment plan? "A curious case of depression" by Pavle Joksovic, Pieter Joost van Wattum, and Catherine Chiles (Current Psychiatry) Put your knowledge and skills to the test with the case of a 20 year old female, who has had depression for a number of years, and now presents with worsening depressive symptoms, as well as anxiety and suicidal ideation and plans. The patient also describes a new onset of #manic symptoms that last for 3-5 days, and as such she's given a new diagnosis of bipolar I disorder with rapid cycling, most recent episode mixed. It is also important to note that this young patient also has a diagnosis of osteogenesis imperfecta, which has caused brittle and fragile bones and has led to 62 fractures and 16 surgeries. How would you treat her mental health condition, while still protecting her bones? "Depressed, Suicidal, and Brittle In Her Bones" by Tahir Rahman, Emily F. Cole, & Deepika D. Parmar (Current Psychiatry) For a brief synopsis of schizophrenia, including what it is, the basic facts about the disorder including onset, prevalence, and risk factors, as well as the common therapies utilized to aid in recovery and the key side effects to be aware of, check out the great infographic below from Global Medical Education (www.gmeded.com)!
Put your knowledge and skills to the test with the case of a 48 year old female, who was previously hospitalized for persistent auditory hallucinations, and who for the last 20 months has been sending a psychiatric resident letters and postcards that total over 3000 pages. Though the resident has never treated or even interacted with the patient, the patient believes he was her physician and prescribed her medications. In her letters the patient expresses romantic feelings for the resident and "describes the resident's refusal to continue treating her as 'abandonment' and states she is contemplating self-harm because of his rejection." She goes on to threaten to strangle the resident, and threatens the resident's female acquaintances and former romantic partners which she has garnered information about from the internet. Though the resident sends her multiple requests to cease contact, they are not acknowledged, and the patient goes on to call the resident's home over 100 times for another 2 months. Can you think of how the resident can handle this situation safely and ethically? "Stalked by a 'patient'" by Jacob Appel & Stuart Kleinman (Current Psychiatry) Tuesdays will now be our day to learn and reflect on personality disorders. The Canadian Mental Health Association BC division has a great page (see link below) if you are looking to become more familiar with these disorders, their causes and treatments. Stigma surrounding these disorders suggests that they are difficult to treat or even untreatable, but recent research indicates that there is reason to be optimistic. In the following weeks, we will try to focus on the experiences of individuals who deal with personality disorders in their every day lives. http://www.cmha.bc.ca/get-informed/mental-health-information/personality-disorders#personality |
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Supporting and enhancing students' and health professionals' knowledge and understanding of mental health and psychiatry
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