Article summary:

I chose this article as it was a systematic review published within 5 years that’s discusses late-onset psychosis and very-late-onset-schizophrenia-like-psychosis which is what my patient in H&P #3 had. Psychotic disorders are known to peak during adolescence and early adulthood; however, a considerable number of patients have their first onset at or after the age 40. This article reviews psychotic disorder that have their first onset after the age 40, which is considered late onset.
This review included twenty-seven studies with participants who met the diagnostic criteria for schizophrenia or other psychotic disorders of the DSM. Late-onset of psychotic disorder (LOP) is defined as between 40 to 60. Very late onset of schizophrenia like psychosis (VLOSP) is defined as 60 and older. Some clinical differences researchers have found in the clinical presentation of early-onset type versus late onset is late -onset psychotic disorder is found more common in females, lower genetic risk (reflected by a lower incidence of family history of psychosis), and higher rates and more severe paranoid symptoms and persecutory delusions. What constitutes the two late-onset conditions remain inconclusive. More studies are needed to be done to better define what late onset and very late onset is defined as and more characteristics and best evidenced based treatments.

Site Visit Summary:

I enjoyed my site visits with Dr. St. Martin due to the higher level of expectations he had of us. He asked many questions, hard questions and would create hypothetical changes to our patient scenario and test our ability to adapt a treatment and plan on the spot. I appreciate this kind of real-life adaption and testing. I learned a lot about pharmacology, duration of antidepressant and duration of therapy during our two visits.

Reflection on the Rotation:

This was a very interesting rotation and unlike any of the others. I was able to practice compassionate interviewing and how to deal with difficult patients which is two techniques that was always good to practice. I would say that there were times I was aware of what “could” happen and that could scare me, but I was cognizant enough to make sure there were always behavioral staff nearby if I felt uncomfortable. I would say I could see this job being very intimidating if it were ever busy and if I had to go alone as a physician assistant staffed. However, the staff at Queens Hospital Center and our preceptor made sure as students we were aware of surroundings and practiced safety protocols. I liked interviewing patients and coming up with differential diagnoses and seeing how some symptoms can lead to various differential diagnoses. I do wish I could have seen the inpatient side of psychiatry and the definitive diagnosis for some, and the medication management chosen. However, as someone interested in emergency medicine this was a good experience for me to see when to consult psychiatry. Overall it was a very enjoyable rotation with many patients stories I will never forget.