Psychiatry rotation was very different from the other rotations: there are no diagnostic labs to assess the different psychiatric pathologies. All the diagnosis are done with history, which is why learning to ask the right questions, understand how they are answered, and observe the patient’s attitude and body language are essential for this rotation. Everyday I was gaining more confidence with assessing the patient and was able to present it to the doctor. Writing the comprehensive history and physical for psychiatric patients are very different from the standard H&P. I learned their writing format and analyzed the most important information that revealed the patient’s current state of mind.

One perspective that changed as a result of psych rotation was the seriousness of patients suffering from substance abuse withdrawal; it could be from alcohol withdrawal, opioid, benzodiazepines, etc. The physiological symptoms of acute substance withdrawals are often dangerous if they are not treated in the hospital. I used to disregard the severity of withdrawal symptoms but after witnessing patients suffering from acute alcohol, opioids, and benzos withdrawal, I was able to see first hand how bad their symptoms actually were.

The most memorable experience was encountering patients who seemed “normal,” with unremarkable mental status, just a few months or weeks ago but were now in CPEP with psychosis, bizarre behaviors, and aggression. Some of these patients were the textbook presentation of schizophrenia (or a brief psychotic disorder for symptoms of less than 1 month) with the risk factors and family history, others did not have a simple diagnosis but they were leading towards schizophrenia. These patients became memorable not only because they helped me understand their illness but because of the empathy and sorrow I felt for the patients and their loved ones. As part of my history taking, I had to call people who know the patient. Most of them were family members or friends, and sometimes they would cry from their disbelief that their loved ones were not themselves anymore.

I believe the psychiatric rotation will help me a great deal in my future rotations and PA career. The art of history taking was the most important element in this rotation. This valuable tool will assist me on reducing my nervousness when speaking to patients or presenting cases to my superiors. Another strategy that worked for me when planning on studying psychiatry was to start with the easiest topics first and the harder ones that needed more attention and time toward the last weeks of the rotation. This helped me greatly as I was able to finish quicker and have more time to review the important topics.

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