IntroductionSubstance 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.MethodsStandardized 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.ResultsIn 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.DiscussionThe 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.
Studies have demonstrated that estrogen plays an important role in psychotic and mood disorders in women. Estrogens have a protective effect against the development of these disorders, while hypoestrogenic states may be a risk factor for the development or exacerbation of mental illness. Additionally, women with menstrual cycle abnormalities such as those with a history of anovulation may be more susceptible to monthly estrogen level fluctuation-related mood and psychotic symptoms. We present the case of a young woman with polycystic ovarian syndrome, who experienced three episodes of premenstrual mixed mood and psychotic symptoms.
The estrogen hypothesis of psychosis states that estrogens contribute a protective effect against the development of psychotic disorders. Conversely, hypoestrogenic states have been shown to be associated with the occurrence of psychotic disorders in women. We present the case of a 24-year-old transgendered female who experienced a first-onset psychosis and subsequent relapses associated with discontinuation of non-prescription estrogen replacement therapy.
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