Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old man is evaluated for a 3-month history of depressed mood, poor concentration, decreased energy, increased sleep, and weight gain. He reports missing many days at work and that his work performance has lagged. He has no suicidal ideation. He states that his current symptoms differ markedly from his usual state ...

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Chapter 1: Physiology “I am a brain, Watson. The rest of me is a mere appendix.” - Sir Arthur Conan Doyle Bound by flesh and bone, therein lies a mystery of undefined potential which the cosmos cannot even parallel in mystery and in complexity beautiful and terrifying. It is that which allows movement to leave the study hall beneath the starry sky, professors to lull us to sonorous sweet slumber, to remember minute ...

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I was incredibly nervous going into my first day in the inpatient child/adolescent psychiatry unit. “Was this where the truly psychotic kids are? Am I going to be safe here?” I wondered as I casually introduced myself to the staff on the floor. After a morning of sitting in on group therapy led by psychologists and occupational therapists, I calmed down. Against the backdrop of the soothing soft pastel colors, ...

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In January, the National Academy of Medicine is launching a new committee to address the high rates of depression and suicide among physicians and other health care workers in the United States.  They plan to bring together medical professionals, educators and hospital administrators, and I hope they will also bring to the table professionals who have experienced burnout, and who may have attempted suicide due to burnout.  I say this ...

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I listened to a Planet Money podcast recently titled, Burnout.  It dealt with the origin and characteristics of burnout, and I would highly recommend it. You’ve all heard the term and have a vague knowledge of what burnout is, I’m sure. You may have experienced it yourself. It affects call center employees (as in the podcast), all sorts of service workers, doctors and other health care providers and countless others. Looking back ...

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Someone presented me with the opportunity to write a section on psychiatry for medical students. This is wonderful (an opportunity to influence future physicians!) and terrible (GAAAAH there’s so much in psychiatry!). Between thinking about psychiatry at multiple levels at work and thinking about the foundations of psychiatry while writing the section, I’ve felt cognitively impaired when thinking about what I should write here. But the thinking never stops … and ...

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I will not argue that drugs are “bad” and holistic care is “good.” I have seen the way medications can transform a person’s life for the better, and I could never invalidate the experience of someone living with mental illness. But I will argue vehemently that holistic, preventive, and integrative health measures should come first, and medication should be used as a secondary option. The current structure of psychiatry -- ...

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I’m just coming out of two years of sleep deprivation. Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was up every three hours at night for the last two years. This has given me more experience in living with sleep deprivation than I ever wanted and plenty of time to think ...

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seanpetrosuicide-900x600 Cheryl lost her son Sean to suicide in medical school. Just a few months ago. Her only child. Cheryl didn’t know that medical students were at high risk of suicide -- until her son was dead. Nobody warned her. Rhonda lost her daughter Kaitlyn to suicide in medical school. Unable to recuperate from the pain of her daughter’s suicide, Rhonda died by suicide ...

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Psychosomatic. I learned not to use that word forty years ago, after I'd told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!” Well, maybe I should've been more circumspect. I hadn't realized until then that people can understand “psychosomatic” in a different way than I do. I'd meant what ...

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