PGY1

PGY1 Seminars

Seminars in the PGY1 year provide a broad, practical overview of the major elements of psychiatric practice to provide residents a working knowledge of key skills they require in encounters with patients. All require compulsory attendance.

Orientation to Psychiatry – Joseph Vlaskovits MD, Leslie Horton MD, Robert Rubin MD, PhD

This seminar provides an overview of the psychiatrist’s identity as a practitioner of holistic, psychological medicine. Topics include holistic concepts of human functioning (e.g., bio-psycho-social-spiritual model), required balance of learned professional skills, the patient-physician relationship, history taking, family and other contacts, psychiatric diagnostics, bio-psycho-social treatment formulation, therapeutic practice (including all relevant modalities), and the psychiatrist as a multidisciplinary mental-health team leader. Physician-psychiatrist wellness and growth will be emphasized as trainees encounter the complexity and intensity of severe and persistent mental illness in the acute hospital setting. Ethics and professionalism in psychiatric practice will also be stressed, which includes thorough documentation of patient encounters and review of American Medical Association and American Psychiatric Association Codes of Medical Ethics, clinician/patient boundary violations, confidentiality and HIPAA compliance, relationships with commercial enterprises (e.g., Pharma), and academic/research ethics. This seminar will prepare residents for the Professional Development / Transition to Practice seminars. 20 hours (5 sessions).

Emergency Psychiatry – Jason Cooper MD, Joseph Vlaskovits MD

The purpose of this seminar is to quickly orient new residents to the Ventura County Medical Center (VCMC) Crisis Stabilization Unit (CSU), a central location for the evaluation of emergency psychiatric patients from all areas of Ventura County. Residents will evaluate a broad spectrum of patients, providing direct clinical experience in parallel with first-year didactics including evaluation, diagnosis, and treatment. Didactic topics include rapid resolution of crises(e.g. aggression, delirium) through interpersonal contact and medication management, the phases of crisis resolution and appropriately adjusting the mix of therapeutic modalities, re-evaluation of the stable patient, gleaning family and other collateral information, post-CSU planning and disposition, and legal aspects of involuntary holds/commitments. 16 hours (4 sessions).

Psychopathology and Psychiatric Diagnosis – Joseph Vlaskovits MD, Leslie Horton MD, PhD, Robert Rubin MD, PhD

How to take a psychiatric history, including when to listen, when to speak, and how to ask questions of the patient, is the first topic in this series. The Mental Status Examination, the central component of the psychiatric diagnostic evaluation, is presented in detail. The American Psychiatric Association Diagnostic and Statistical Manual (DSM), Fifth Edition, isused as the structure for consideration of the three major categories of psychopathology (disorders of thinking, feeling, and behaving). A brief history of the DSMs is given to highlight the transition between descriptive (DSMs I and II) and criterion-based (DSMs III, IV, and 5) diagnoses. DSM-5 as a guide to diagnosis and treatment, rather than as dogma, is discussed, along with the perspective of the medical humanities in understanding historical and cultural factors shaping diagnostic systems. Additional uses of DSM-5 for statistical aggregation of diagnoses (e.g., in epidemiological studies), insurance payments, etc., are discussed. The ~20 diagnostic categories given in DSM-5 (neurodevelopmental disorders, schizophrenia spectrum and other psychotic disorders, etc.) are presented individually in overview to provide a beginning orientation to these categories. Each category is introduced by discussion of relevant aspects of normal psychological development. Cultural concepts of distress relevant to each category are emphasized, along withspecial considerations in each category; e.g., suicide as a potential outcome of affective (and sometimes psychotic). Residents gain considerably more experience with DSM-5 throughout all their residency rotations and activities. 40 hours (10 sessions).

Psychological Testing – Psychology faculty and outside experts as needed In this seminar, the use of psychological assessment as an empirically validated method to assess personality traits, psychopathological symptoms and syndromes, and neuropsychological (cognitive) function are discussed. Major categories of standardized psychological testing for adults will include personality/psychopathology tests such as the Minnesota Multiphasic Personality Inventory-2, Millon Clinical Multiaxial Inventory, and Personality Assessment Inventory; and neuropsychological tests for assessing several domains of cognitive function, such as the Wechsler Adult Intelligence Scale, the Mini-Mental State Examination, and the Montreal Cognitive Assessment. Alignment of psychological test results with DSM-5 diagnoses are emphasized. 8 hours (2 sessions).

Introduction to Psychopharmacology – Joseph Vlaskovits MD, Jason Cooper MD, Robert Rubin MD, PhD

The purpose of this seminar is to provide an overview of the major classes of psychopharmaceutical agents currently in use. These include antipsychotics, antidepressants, antianxiety agents, mood stabilizers (lithium and anti-epileptic agents), hypnotics, stimulants, and cognitive enhancers. The concept of broad use of different classes of drugs for multiple diagnoses is emphasized (e.g., use of antidepressants to treat anxiety, use of antipsychotics as adjuncts to treat mood disorders, use of sedating antidepressants as hypnotics, etc.). Drug-drug interactions, both among psychopharmacologic agents and between these agents and other classes of drugs, and major adverse events (e.g., neuroleptic malignant syndrome), are emphasized. The genetic underpinnings of drug metabolism and interactions and their effects on therapeutic response are considered. So-called neutriceuticals (e.g., St John’s Wort), especially their limited efficacies, are discussed in the context of complementary medicine. Of importance, the concepts of evidence-based medicine are considered with each class of medications discussed (e.g. the strength of therapeutic effect versus placebo and comparison drugs and the strength of drug-drug interactions as established in the medical literature). 40 hours (10 sessions).

Introduction to Somatic Therapies – Joseph Vlaskovits MD, and outside experts as needed

The purpose of this seminar is to provide an overview of the spectrum of somatic therapies now being used in psychiatry, including electroconvulsive therapy (ECT), transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation. Indications for these treatments ( e.g. for severe and intractable depression and catatonia), are emphasized. 8 hours (2 sessions).

Introduction to Psychotherapies – Leslie Horton MD, PhD, Daniel Powell MA, LMFT

This seminar provides an overview of the spectrum of psychotherapies now being used in psychiatry to aid residents in developing therapeutic skills in psychotherapy. The unique role of psychotherapy in the practice of psychological medicine is emphasized, including understanding key elements of ego defense mechanisms and transference and countertransference. PGY1 residents learn to formulate a psychological assessment of patients adapted for the inpatient setting, using elements of ego psychology, object relations theory, and self-psychology, and they develop psychotherapeutic skills based on solution-focused and supportive psychotherapy, techniques appropriate for inpatients. Fundamental topics include the following: what is psychotherapy, basic psychodynamic theory, ego psychology/defense mechanisms, transference and countertransference, learning/behavioral therapies, supportive therapy, and psychosocial rehabilitation. Couples, family, and group therapies are presented. Of importance, concepts of evidence-based medicine are considered with each class of therapy discussed(e.g., the consistency of therapeutic effect versus no treatment or “treatment as usual”) as established in the medical literature. Psychotherapeutic techniques relevant to outpatients in various settings are taught in later years. 40 hours (10 sessions).

Professional Development / Transition to Practice – All faculty

The emphasis of this residency program is on training psychiatrists to meet the needs of Ventura County mental health programs. As such, the role of the psychiatrist in these programs is considered from the standpoint of both practicing clinician and administrator/team leader. This seminar series is carried through all four postgraduate years, with greater frequency in PGY4. In later years, post-residency opportunities in public institutions and clinics are discussed in detail, including both clinical and administrative positions. Opportunities and challenges in private practice, academic and educational settings, and careers in basic and clinical research are considered. 8 hours (2 sessions).

PRITE Review Course – All faculty
12 hours (3 sessions).