Orientation to Psych
Topics include emergency psychiatry, DSM-5, MSE (mental status examination), and ethics. [8 hours]
This course is comprised of four sessions, totaling 8 hours. Interns have an opportunity to discuss the issues related to dealing with emergency situations in psychiatry, and discuss the psychiatrist’s role in working with the patient and the patient’s family and friends who may be part of the contact. Assessing risk and dangerousness, determining the need for psychiatric hospitalization, and learning to intervene in potentially volatile circumstances are addressed in this session.
In a subsequent session, familiarization with psycho-diagnosis, using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5) will focus on the most current diagnostic concepts and conventions used in diagnosing mental disorders. Another session will address the elements of a complete, and formal mental status examination, which will be an essential element of the resident’s contacts with patients from the start of their training.
The final session will address specific concerns relating to ethical issues that face psychiatrists in the performance of their professional duties. These issues will be addressed by looking at the special, annotated ethical guidelines published for psychiatrists. There will also be special attention given to the application of these guidelines in clinical practice and research. A case-based approach will allow for discussion and consideration of challenging situations that will be encountered in the practice of psychiatry.
Introduction to DSM-5
These seminars introduce the importance of developing a differential diagnosis based on the DSM-5 diagnostic categories. Select adult and child disorders are discussed to illustrate the proper use of the DSM system and to learn criterion-based diagnosing.
Substance-Related and Addictive Disorders
These seminars comprehensively review the diagnosis and management of substance use disorder. Topics include neurobiology and neurochemistry, the disease model, intoxication and withdrawal and a discussion of various substances such as alcohol, sedatives, stimulants, opioids, cannabinoids, dissociatives and hallucinogens. Lectures are delivered by the medical director and physicians who staff the Illinois Institute for Addiction Recovery.
Introduction to Psychopharmacology
The pharmacology of all classes of psychotropic medications is presented. Although practical clinical use is emphasized, synaptic physiology, drug interactions, pharmacokinetics, and therapeutic drug monitoring is also introduced. Residents learn about informed consent, compliance, and the right to refuse medications. Current research is discussed. The primary text is Stahl’s Essential Psychopharmacology. Advanced Psychopharmacology is taught in the PGY-2 year.
Schizophrenia Spectrum and Other Psychotic Disorders
These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of psychotic disorders including schizophrenia, schizoaffective, and psychotic disorders due to medical conditions. The etiology of psychosis is reviewed as are the terms and phrases associated with psychotic disorders. The importance of using the biopsychosocial model is emphasized. Medications, including typical and atypical antipsychotic agents, are discussed with regard to dose, adverse effects, monitoring and expected outcomes. Augmentation strategies are reviewed.
Bipolar and Depressive Disorders
These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of mood disorders including depression, bipolar disorder, dysthymia, and cyclothymia. Residents learn methods to accurately diagnose and to apply a biopsychosocial model to treatment. Medications in several classes are discussed with regard to dose, adverse effects, appropriate labs to follow, and expected outcomes. Augmentation strategies are reviewed. Recent research is covered. This didactic offers a complete understanding of electroconvulsive therapy, including history, theory, technique, and patient management. Other somatic treatments such as light therapy are also covered.
rTMS, VNS, ECT
These lectures review the proposed mechanism of action and delivery of FDA approved somatic therapies for major depressive disorders. The resident will be exposed to concepts having to do with theory, indications, implementation and delivery of such therapies. The lecture augments the PGY-1 clinical electroconvulsive therapy experience and presages the PGY-4 elective in rapid transcranial magnetic stimulation that is available to resident physicians in the program.
Anxiety, OCD, and Trauma-Related Disorders
These seminars provide an in-depth study of the etiology, clinical presentations, diagnostic processes, and management of anxiety disorders, OCD, and PTSD/ASD. Residents learn assessment, differential diagnosis, treatment options and selection considerations. Differences between adult and childhood manifestations of anxiety disorders are reviewed. Recent research is discussed.
These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of personality disorders from clusters A, B, and C, for example, schizoid, borderline, and avoidant. Residents learn methods to accurately diagnose and to apply a biopsychosocial model to treatment. The appropriate psychotherapeutic means to manage these disorders is emphasized (including issues of transference and countertransference) while evidence-based support for medications in several classes are also discussed. Recent research is covered.
Special Topics in Psychiatry
These conferences allow for the discussion of unique topics in mental health. Residents may suggest topics of interest. The informal setting affords residents an opportunity to share intriguing cases derived from inpatient and outpatient experiences, ideas, or research interests. Guest speakers may be invited to discuss an important issue related to the practice of psychiatry.
These conferences allow residents to engage in discourse about the state of the residency, general concerns, responsibilities, social networking, career advancement, and contemporary psychiatric topics. The chief resident will learn administrative skills as they lead the group discussion. The meetings provide a forum for meeting process improvement objectives.
Psychiatry Journal Review
These monthly conferences teach residents to present and critically analyze psychiatric research, including its application to the residents’ clinical practices and/or to their own research. The critical analytic skills developed during this course are intended for use as a life-long learning skill set for judging the relevance of new research to one’s clinical practice and/or research efforts.
Clinical Case Conference
These interactive conferences provide residents with practical exposure to the assessment and management of adult, child, consultation, and psychotherapy problems. Residents present a case and pose pertinent clinical questions. Faculty moderate a dialogue, interview, or demonstrate methods of interviewing a patient or family followed by a resident-guided discussion among peers and faculty to address the queries originally posed. This conference augments information provided in the associated Diagnosis and Management seminar series.
Psychiatry Grand Rounds
These monthly conferences provide residents a forum to learn about contemporary issues in psychiatry. The presentations are expected to include nationally recognized leaders in mental health. Residents present twice during the training program, allowing for experience in educating others and to improve interpersonal communication and practice-based learning skills. Peer review will be an important component of feedback.
Board Review and Clinical Skills Assessment
This conference series prepares residents to pass national standardized examinations via a comprehensive review of psychiatry. A growing question database will be used to allow residents to hone test-taking skills, assess medical knowledge, and reduce anxiety for national exams. The peer-group forum offers an opportunity for teaching experience and learning how to provide constructive feedback. The American Psychiatric Association’s Practice Guidelines are an important resource in the conferences. The series will also help meet ABPN requirements for successful completion of three clinical skills evaluations. All residents in all years have the opportunity to interview a live patient before a Board Certified faculty member and benefit from the feedback provided by the faculty and residents. The three components measured are: physician-patient relationship (rapport development, appropriate responses to the patient, ability to follow cues presented by the patient), the conduct of the psychiatric interview (ability to obtain sufficient data to formulate differential diagnosis, ability to obtain psychiatric, medical, family, and social histories, screen for suicidal and homicidal ideas, use of open and close-ended questions, performance of mental status examination), and case presentation (presentation of organized and accurate history and mental status findings). The opportunity to observe and practice structured interviews and formulate presentations is expected to be well received by residents.
Scholarship and Research Retreat
This annual retreat, a requirement of the Scholarship Program, exposes residents to knowledge and skills involved in producing scholarly contributions to the field as well as stimulating ideas for required scholarly products and scholarly productivity generally within the department. Residents will hear from invited external and internal speakers about scholarly topics involved in the production and dissemination of scholarship and are invited to discuss research ideas with faculty and guest speakers. The interactive retreat is expected to generate enthusiasm and promote new research ideas among attendees.
These seminars provide residents a forum for group-based learning in the integration of conceptual materials derived from the core Diagnosis and Management and Introduction to Psychopharmacology seminars. Investigational research, advanced neurochemistry, adherence to treatment, the role of the Federal Drug Administration, the use of medication algorithms, the role of evidence-based literature, the impact of the pharmaceutical industry, the cost of medicine, and the role of clinicians as educators in society are covered.
Statistics and Research Principles
These seminars provide an overview of research methodologies including the development of hypotheses, study design, institutional review board approval, literature review, statistical analysis, and result interpretation. Residents learn to critically appraise the quality and value of scientific literature.
Feeding and Eating Disorders
These seminars provide an in-depth study of the DSM-5 diagnostic symptoms and management of anorexia nervosa, bulimia nervosa, and other eating disorders. Case examples illustrate the clinical presentation of these disorders. Particular emphasis is placed on the assessment and management of physical complications associated with eating disorders especially anorexia nervosa. Cognitive behavioral management of these disorders will be reviewed. The course covers a mental health perspective of obesity, including how services with other providers may be integrated for best outcomes. Attention is provided to the pre-surgical evaluation of candidates for bariatric surgery.
Child and Adolescent Development and Psychopathology
This is the first of a two part seminar series that introduces residents to human development and focuses on childhood and adolescence; the second part, Adult Development, focuses on early adulthood through the end of life. The series provides a comprehensive understanding of the multiple facets of typical and atypical development. Multiple theories, including those of Piaget, Freud, Erickson, and others are discussed. Epidemiology, assessment, diagnosis, and treatment of disorders presenting in childhood and adolescents are covered. Residents are also taught principles of pharmacology and specific therapies for children, including recent FDA guidelines, treatment algorithms, and the unique challenges in treating an increasingly independent patient. Finally, residents apply their knowledge to a real case, necessitating formulating a case, developing a working diagnosis, and initiating a treatment plan based on evidence-based principles. Residents learn to place pediatric psychopathology in a framework that asks, “Where did typical development go awry?” and “How does treatment return development to a more typical trajectory?”
Neuropsychological and Psychological Testing
These seminars review the use of common objective and subjective psychological and neuropsychological testing instruments such as the MMPI-2 and Wechsler scales. Psychological assessment, psychometric methodology, and research issues are discussed. Residents learn to administer and appropriately interpret commonly used, standardized tests through demonstration and practice. Residents discover how and when to refer patients for testing and integrate the reported results into clinical care.
Principles of Psychotherapy I
These seminars introduce residents to the fundamentals that lay the foundation of the major schools of psychotherapy including psychoanalytic/psychodynamic, cognitive-behavioral, interpersonal, humanistic, brief, supportive, dialectical, and others. The series is taught through consecutive modules that include interviewing skills, verbal response modes, working alliance, indexing patterns, change, resistance, transference, and countertransference. Residents are introduced to the psychotherapeutic process, content, and case formulation skills that will be developed through the sequenced psychotherapy clinical curriculum. Evidence-based practice as well as ethical and cultural considerations are highlighted. Residents build knowledge and skills through lecture, interactive methods, and work assignments while beginning to understand self-assessment and personal attitudes that effect patient care.
Sexual Dysfunction, Paraphilia and Gender Dysphoria
These seminars provide an overview of the DSM-5 criteria for sexual and gender identify disorders, including sexual dysfunction and paraphilia. Residents learn to develop a differential diagnosis and to discern one diagnosis from another. Empirically supported treatments will be discussed. The changing historical, social, and cultural concepts of normal and abnormal human sexual behavior and attitudes are also included.
Dissociative, Impulse Control and Adjustment Disorders
These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of three distinct disorder categories: dissociative, impulse control, and adjustment disorders. Residents learn methods to accurately diagnose and treat these disorders from a biopsychosocial model including the role of medication and psychosocial interventions. Recent research is covered.
These PGY-2 lectures cover basic DSM 5 sleep disorder concepts that may not be covered during the PGY-1 rotation in neurology. The classification encompasses 10 disorders or disorder groups: insomnia disorder, hypersomnolence disorder, narcolepsy, breathing-related sleep disorders, circadian rhythm sleep disorders, non-REM (NREM) sleep arousal disorders, nightmare disorder, REM sleep behavior disorder, restless legs syndrome, and substance- or medication-induced sleep disorder. The core features of each disorder and how they relate to the patient’s dissatisfaction regarding the quality, timing, and amount of sleep with resulting daytime distress and impairment will be reviewed.
Somatic Symptom and Related Disorders
These seminars provide residents an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of somatic symptom, illness anxiety, conversion and factitious disorders. Residents learn methods to accurately diagnose and distinguish between these disorders.The significance of a biopsychosocial approach is emphasized as a model of treatment. Psychotherapeutic modalities and medications are discussed.
Legal Psychiatry (and Malingering)
These seminars discuss the fundamental areas of forensic psychiatry. Topics include competency to stand trial, criminal responsibility, sex offenders, malingering, involuntary hospitalization, professional misconduct, disability, confidentiality, informed consent, right to treatment, right to refuse treatment, and others. The psychosocial and legal implications of malingering will be discussed.
Geropsychiatry and Bereavement
These seminars offer a review of the important medical and social aspects of managing older patients. The role of families and other caregivers within complex social systems that include residential and nursing home facilities and in-home services are discussed. Topics include common psychiatric and comorbid illnesses, abuse and neglect of adults, and dignity and end-of-life concerns. Issues of bereavement and the classic stages of grief are also covered.
These seminars provide residents an overview of the major cultural aspects of psychiatric care and the role of mental health in society. The traditions and meanings of religious, national, language, gender, sex, and minority cultures are reviewed. Emphasis is placed on the regional rural Midwestern subculture that residents may encounter in clinical care. Residents learn to take a cultural, sexual and spiritual history.
History of Psychiatry
Residents receive an overview of the rich history and tradition of the field of psychiatry. The seminar includes a survey of psychotherapeutic theories and their founders including Freud, Sullivan, and Klein, among others. The chronological progression of the field of medicine and society is presented so residents may appreciate past struggles and accomplishments and be prepared to lead the discipline into the future. A recently DVD video (2009), The History of American Psychiatry, produced by the program director as Chair of a Group for the Advancement of Psychiatry subcommittee may be used, in part, to augment this course.
These seminars begin with a review of brain anatomy, brain biology and the inter-relationship between brain chemistry (neurotransmitters, receptors, modulators) and pathology. Pharmacotherapy at the chemical level will be highlighted. Following the review, the series provides an in-depth study of the epidemiology, assessment, diagnosis, and acute and chronic management of psychiatric manifestations of neurological conditions. Topics include encephalopathies, dementias, epilepsy, headaches, cerebrovascular events, and movement disorders. Also covered are the cognitive disorders, delirium, amnestic, and sleep disorders such as sleep apnea and the parasomnias. Residents learn methods to accurately diagnose and apply a biopsychosocial model to treatment. Medications in several classes, including anticholinesterase inhibitors, are reviewed with regard to dose, adverse effects, and expected outcomes. Augmentation strategies and social implications are reviewed. An overview of the physical basis, indication and evaluation of neuroimaging including CT, MRI, SPECT and PET are introduced. Residents learn about the scientific basis and clinical application of evolving treatment modalities such as deep brain stimulation, transcranial magnetic stimulation, and vagal nerve stimulation.
This course meets four times per year to provide a forum for discussion of scholarly preparation and activity. The sessions support resident research and dovetail with the Department’s Scholarship Program. Residents learn to appreciate the benefits of scholarly inquiry, planning, investigation, presentations styles, academic writing, grant work, and dissemination of data.
Cognitive and Behavior Therapy
These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in cognitive and behavioral therapies. Residents are introduced to learning theory, information processing theory, behavioral therapy and cognitive therapy practices and principles. Case formulation and treatment planning knowledge and skills are emphasized. Specific treatment interventions consistent with this model of therapy are taught. Course content is integrated into residents’ current clinical practice through interactive discussion.
Child and Adolescent Psychotherapy
This is a required 2-session course focused on techniques used in child and adolescent psychotherapy. Residents are taught techniques such as parent training, play therapy, and CBT for children and adolescents through the use of videos, case examples, and handouts. Discussion is focused on tailoring commonly used adult interventions to child and adolescent populations.
This is the second of a two part seminar series that introduces residents to human development along the life-continuum. Typical developmental tasks of adulthood are addressed through the stages discussed by Erikson, and residents learn to place psychopathology in a framework that asks, “Which developmental tasks were interrupted?” and learn to assess how the presence of certain disorders could interrupt progression along the typical developmental continuum. The unique responsibilities of adulthood, changes in relationships, childcare, career development, coping with stress and loss, are all educational components of this series.
These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in supportive, crisis-oriented, and brief therapies. Residents learn how to identify patient strengths and weaknesses, to assist in the safe confrontation of social and interpersonal problems, and to buttress a patient’s psychosocial network of support. There is a focus on the conceptual material and skill development necessary to achieve competency in non-expressive therapies. Residents learn about eliciting patient requests, negotiating goals, and setting time-sensitive objectives. Specific issues such as bereavement, loss, acculturation problems, compliance, and risk assessment are addressed.
Couples, Family and Group
These advanced seminars, a broad collection of didactics, focus on the conceptual material and skill development necessary to achieve competency in a variety of therapies that include: couples, family, and group therapies. The course will look at an overview of systems theories that have application to the treatment of families, couples, and other types of groups, such as work groups. In addition, approaches to group therapies will explore a variety of types of groups that have a range of theoretical foundations, and a range of circumstances in which they are appropriately employed.
These advanced seminars focus on the conceptual material and skill development necessary to achieve competency in therapeutic relationships and dynamic psychotherapies. Residents learn to identify appropriate candidates for success. Topics of discussion include defense mechanisms, transference, countertransference, resistance, and interpretation. Readings include integration of theory, neurosciences, development, and pathology. Experiential assignments foster explicit and implicit learning.
Psychiatric Interview and Psychological Testing
This course provides an overview of psychometrics, test development, and commonly used psychological and neuropsychological assessments (e.g., Wechsler intelligence and memory tests, MMPI-2, MCMI-2, academic achievement tests, and structured clinical interviews). Residents also learn when and how to make appropriate referrals for testing and how to decipher assessment reports.
In these seminars residents learn the fundamentals of career development in various practice formats such as private practice and academics. Financial issues, malpractice, time-management, utilization review, quality assurance, professionalism, practice-based learning requirements (for example CME and state licensure), and performance improvement are among the topics discussed.
Principles of Psychotherapy II
A continuation of Principles of Psychotherapy I, these seminars teach residents the fundamentals that lay the foundation of the major schools of psychotherapy including psychoanalytic/psychodynamic, cognitive-behavioral, interpersonal, humanistic, brief, supportive, dialectical, and others. The series is taught through consecutive modules that include interviewing skills, verbal response modes, working alliance, indexing patterns, change, resistance, transference, and countertransference. Residents are introduced to the psychotherapeutic process, content, and case formulation skills that will be developed through the sequenced psychotherapy clinical curriculum. Evidence-based practice as well as ethical and cultural considerations are highlighted. Residents build knowledge and skills through lecture, interactive methods, and work assignments while beginning to understand self-assessment and personal attitudes that effect patient care.
The course in interpersonal therapy will focus on the basic tenets of this approach, including the history of its development in research, and its subsequent use as an evidence-based psychotherapy. The overview of the theoretical elements of IPT, rooted in attachment theory, will be complemented by focusing on skills that are employed in the performance of IPT, such as obtaining an interpersonal inventory, and making an interpersonal formulation. The structure and dosing of IPT will also be covered, with an emphasis on assessing and treating grief and loss, role transitions, and role disputes. An emphasis on maintenance IPT will also be included.
DBT and other “Third Wave” Behavioral Therapies
This lecture series introduces residents to “third wave” behavioral therapies including dialectical behavior therapy, mindfulness-based cognitive therapy, and acceptance and commitment therapy. The history and evolution from first to second to third waves of therapy is reviewed. Concepts and techniques presented include: acceptance, mindfulness, cognitive distancing and diffusion, and behavioral activation. Traditional cognitive behavioral conceptualizations and third wave conceptualizations are compared and contrasted.
This course is elective in the PGY3 year. Residents attend a day designated by the Illinois Psychiatric Society to meet with state government legislators and leaders. Residents attend an orientation segment to learn about psychiatric administration, governmental policy-making, and advocacy for mental health. Residents are not required to advocate for a political stance, but will learn about and understand the issues of general concern to the field of psychiatry. After Advocacy Day, residents share the experience at a Business Meeting and highlight active mental health issues before the legislature.
Resident Case Conceptualization Presentations
PGY3 residents write a case conceptualization of one of their psychotherapy patients from one of the primary theoretical models covered in the PGY3 psychotherapy clinics (psychodynamic, DBT, DBT, or IPT), and how viewing the case from the other models would influence treatment. Conceptualizations are presented to the department.
This didactic series addresses a wide-variety of important current issues in psychiatry including resident wellness and burnout, coping with patient suicide, cultural diversity, case-based ethics, professionalism, etc. The specific lecture topics change annually and are attended by both residents and faculty.