CPCP: Corticosteroid Induced Psychosis by Medical Student Hope Steinke

Hope Steinke M3Here’s another great Clinical Problems in Consultation Psychiatry (CPCP) presentation, this one by 3rd year medical student Hope Steinke, who is interested in pursuing a career in Family Medicine.

As you can see the prevalence of steroid-induced mental disorders is quite high. Something else I noticed that is different from the previous reviews I’ve seen: authors now say that pre-existing psychiatric illness may be a risk factor (see Judd et al):

Risk for depression, mania, panic disorder, or suicide attempt during glucocorticoid treatment increased for patients with past histories of these conditions, contrary to findings from some earlier studies.

The earlier study in recent memory was the one by Warrington TP, Bostwick JM: Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 2006; 81:1361–1367.

Dr. William R. YatesAnd my former mentor, Bill Yates, MD, the originator of the CPCP series is very pleased to “see the CPCP conference is alive and well!”  He just informed me that I ought to consider writing a follow-up paper on the CPCP that he and a former Chief Resident (Dr. Terri Gerdes, MD) published in General Hospital Psychiatry:

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.
Problem-based learning (PBL) is a method of instruction gaining increased attention and implementation in medical education. In PBL there is increased emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education. A weekly PBL conference was started by a university consultation psychiatry team. One active consultation service problem was identified each week for study. Multiple computerized and library resources provided access to additional information for problem solving. After 1 year of the PBL conference, an evaluation was performed to determine the effectiveness of this approach. We reviewed the content of problems identified, and conducted a survey of conference participants. The most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%). Computerized literature searches provided significant assistance for some problems and less for other problems. The PBL conference was ranked the highest of all the psychiatry resident educational formats. PBL appears to be a successful method for assisting in patient management and in resident and medical student psychiatry education.

I just might look into that. Bill said he’d be glad to pitch in and that it might be a good project for a resident. Hmmmm….  Note that the title is “Problem-based learning in consultation psychiatry,” which is reminiscent of what we now call one of the core competencies, Practice-based learning. As you can see, residents gave it high ratings. It’s a lot better than the Maintenance of Certification (MOC) modules. You knew that was coming.

An update would be quite something, especially since the Drs. Yates and Gerdes mention in the discussion, “Despite increased computer access availability, many residents/medical students are not familiar with computer literature searches.” Nearly two decades later they know a ton more than their geezer teacher does.

Hope is a great teacher…has a nice ring to it.

Hope made some excellent slides to get the point across. In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.

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