CPCP: Catatonia by Medical Student Ashwin Subramani

Dr. Bill Yates

The Clinical Problems in Consultation Psychiatry (CPCP) is an excellent educational exercise developed for the psychiatry consultation psychiatry service over 20 years ago by one of my former teachers, Dr. William R. Yates, MD. He and Dr. Terri Gerdes published a paper about it, the abstract for which is below:

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.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.

There are many examples of it on this blog, and the one for today is an outstanding CPCP presentation by a 2nd year medical student, Ashwin Subramani, who is interested in pursuing residency in Neurology. Ashwin is also a scholar. He was the recipient of a Medical Student Research Award in 2016, The Hansjoerg E. Kolder Award for Ophthalmology Research. I asked him to dig into the literature about catatonia and see if we could clarify for ourselves what the latest research is about the pathophysiologic mechanism underlying catatonia. It’s a complex, neuropsychiatric syndrome which consultation psychiatrists see occasionally in the general hospital. It can be caused by both medical and psychiatric disorders. It’s a reminder to health care professionals to maintain a “both/and” rather than an “either/or” approach to medical and psychiatric problems.

The CPCP has been a staple of continuing clinical education on the psychiatry consultation service during my entire career at Iowa. It’s the kind of on-the-run learning that fits the model of the smokejumper model of psychiatric consultation in the general hospital–which I’m hoping will evolve into something more effective, collaborative, and innovative as I head into phased retirement starting next month.

Naturally, the topic of catatonia is a great segue into the topic of neuropsychiatry, examples of which Ashwin and other trainees encounter commonly on the consult service and on the medical-psychiatry inpatient unit at Iowa. Every few years, the idea that neurology and psychiatry should merge arises. Dr. Ron Pies, MD, another psychiatrist I admire and respect, had this to say about that:

Still, we have other reasons to believe that the discourse of psychiatry differs fundamentally from that of neurology, notwithstanding the common substrate of these two disciplines (i.e., the human brain). The discourse of psychiatry, notwithstanding its burgeoning interest in neuroscience, remains grounded in human subjectivity and existential concerns. This applies not only to psychotherapy but to psychiatry as a whole. Psychiatry has always been, and essentially remains, a discourse of interlacing and multilayered meanings. Neurology is fundamentally a discourse of neuroanatomical and neurophysiological relationships. Pies, R. (2005). “Why psychiatry and neurology cannot simply merge.” J Neuropsychiatry Clin Neurosci 17(3): 304-309.Pies, R. (2005). “Why psychiatry and neurology cannot simply merge.” J Neuropsychiatry Clin Neurosci 17(3): 304-309. 

And a major exponent of the move to combine them, Dr. Barbara Schildkrout, MD, makes this counterpoint:

Psychiatry has traditionally concerned itself with what is individual and personal—namely, life experiences and the construction of meaning. Brain function is also an important aspect of individuality. In this era of rapidly advancing scientific information about the brain, it is now possible for psychiatrists to integrate knowledge of neuroscience into their understanding of the whole person by asking, What person has this brain? How does this brain make this person unique? How does this brain make this disorder unique? What treatment will help this disorder in this person with this brain? (Schildkrout, B., et al. (2016). “Integrating Neuroscience Knowledge and Neuropsychiatric Skills Into Psychiatry: The Way Forward.” Acad Med 91(5): 650-656.).

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One thought on “CPCP: Catatonia by Medical Student Ashwin Subramani

  1. I just thought of something. You’ve seen those stick men cartoons supposedly representing the “I got your back” concept?

    Of course that’s not the idea at all. When you say “I got your back” it means you support someone else, not that you’ve stolen his spine. What if neurologists and psychiatrists could work together like that? Could politicians do it? How about us in general?


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