Improving medical students

Archive for the ‘Psychiatry’ Category

Diagnosing ADHD with EEG

Posted by medliorator on December 5, 2008

he use of QEEG [Quantitative EEG] is based on findings that individuals with ADHD have a distinctive pattern of brain electrical activity that is often referred to as “cortical slowing”; this is characterized by an elevation of low frequency theta waves and a reduction of higher frequency beta waves in the prefrontal cortex. Theta wave activity is associated with an unfocused and inattentive state while beta activity is associated with more focused attention. Thus, an elevated theta/beta ratio reflects a less alert and more unfocused state.

In past studies, roughly 90% of individuals diagnosed with ADHD based on a comprehensive evaluation tested positive for this EEG marker. In contrast, about 95% of normal controls tested negative. Thus, while not a perfectly reliable indicator, the sensitivity and specificity of QEEG in identifying ADHD was extremely strong.

Neurofeedback/ Quantitative EEG for ADHD diagnosis [SharpBrains]

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Empathy’s Strengths & Weaknesses in Medical Education

Posted by medliorator on November 4, 2008

In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.

“What do they really need to know before graduating from medical school, and how could they most efficiently learn?” Dr. Drybye asked, reflecting on one of the central challenges of medical education. “All the information we want to share with them is not necessarily what they really need to learn.”

Medical Student Burnout and the Challenge to Patient Care [NYT]

Objective – To determine whether lower levels of empathy among a sample of medical students in the United States are associated with personal and professional distress and to explore whether a high degree of personal well-being is associated with higher levels of empathy.

Results – Medical student empathy scores were higher than normative samples of similarly aged individuals and were similar to other medical student samples. Domains of burnout inversely correlated with empathy (depersonalization with empathy independent of gender, all P < .02, and emotional exhaustion with emotive empathy for men, P = .009). Symptoms of depression inversely correlated with empathy for women (all P ≤ .01). In contrast, students’ sense of personal accomplishment demonstrated a positive correlation with empathy independent of gender (all P < .001). Similarly, achieving a high quality of life in specific domains correlated with higher empathy scores (P < .05). On multivariate analysis evaluating measures of distress and well-being simultaneously, both burnout (negative correlation) and well-being (positive correlation) independently correlated with student empathy scores.

How Do Distress and Well-being Relate to Medical Student Empathy? A Multicenter Study [J Gen Intern Med]

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Comfort Crying Patients like a Pro

Posted by medliorator on October 30, 2008

Crying can be a completely natural and expected response to information… You also don’t know what else is going on in the patient’s life; sometimes your news is actually the single straw—as unremarkable as it may be—that, according to the proverb, breaks the camel’s back.

You don’t have to do anything if your patient is crying. Sometimes, the best course of action is to just be with the patient. The gives the message that (1) it’s okay to cry, (2) I’m not going to freak out just because you’re crying, and (3) maybe the best response to the situation is to cry.

  1. Acknowledge the situation in a calm manner – Try: “This is understandably upsetting. I’m afraid that I cannot spend the time with you that I’d like to due to the clinic schedule.” Your overt recognition of the situation acknowledges the patient’s experience. Sometimes, that in itself can be healing.
  2. Communicate that you are concerned about the patient and, though there may be nothing you can do to “fix” the situation, you would like to offer what you can – you can offer to visit the patient again later on in the day… you can offer to call the patient in a day or two to check in
  3. Ask the patient what would be most helpful in that moment – This inquiry communicates that you respect the patient’s opinion, that this is a collaborative effort, and that you want to help.

What to Do When a Patient is Crying [intueri]

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Medical Students on Mental Illness

Posted by medliorator on October 23, 2008

A recent study published in Medical Education demonstrated that undergraduate medical students react less positively towards mentally ill patients in primary care than to patients in good health or with a chronic physical illness, such as diabetes.

Even when they are more difficult to manage they still have a disease comparable to somatic illness or even worse, that should be treated. On emergency rooms these patients also tend to be neglected out of fear or countertransference. Suicidal patients are often seen as a bother on ER department. Also care of their somatic illnesses tend to be under treated and neglected.

The authors suggest that because personal experience with mental illness lessens the negative attitude students have towards mental illness they should attend the presentation of autobiographical cases which allow the disease to be viewed within the context of an individual’s entire life. This can be accomplished by reading autobiographical books or see films such as “A beautiful mind” or talk to these patients and integrate this in the education.

Negative attitude in medical students towards patients with Mental Illness [Neurostimulating Blog]

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Munchausen Syndrome by Proxy (MSBP)

Posted by medliorator on April 30, 2008

Mary E. Muscari, PhD, CPNP, APRN-BC at Medscape

…usually describes the deliberate production, or feigning, of physical or psychological symptoms in another person who is under the individual’s care. …usually involves a mother and young child; however, there have been cases of MSBP involving illness produced or feigned in other adults and even in pets

Research criteria include:

  • Intentional production of or feigning of physical or psychological symptoms in a person under one’s care;
  • Perpetrator motivated by assuming the sick role by proxy;
  • External incentives (such as monetary gain) are absent; and
  • Behavior is not better accounted for by another disorder.[3]

Chronic Munchausen by proxy is characterized by the constant pursuit of attention by inducing symptoms in another person. Individuals displaying chronic MSBP are compulsive, and the behavior consumes most of their lives.

Episodic Munchausen by proxy occurs in spurts. There are intervals when the person experiences symptoms of MSBP and intervals where the person lives a normal life.

In mild Munchausen by proxy, affected individuals fabricate medical histories for their children and lie about their children being sick rather than actively causing sickness. Their motivation is the emotional gratification they receive from medical attention.

In intense Munchausen syndrome by proxy, the person resorts to measures such as inducing vomiting, poisoning, removing blood from the child, and suffocation. The individual is able to induce severe illness in his or her own child, yet remain cooperative, concerned, and compassionate in the presence of healthcare providers

Victims are equally divided between male and female, and children most at risk are those aged 15 months to 72 months. Victims frequently have baffling symptoms and see multiple healthcare providers before a diagnosis of MSBP is made. In 98% of cases, the perpetrator is the biological mother.[6] Characteristics of perpetrators include female, white, experiencing marital discord, having healthcare knowledge or training, friendly and cooperative with staff, very attentive to the child, and may have a history of abuse and/or psychiatric disorders.[7]

Ways that MSBP can present include[6,7]:

  • Complex pattern of illness and recurrent infection without physiologic explanation;
  • Seizure activity that does not respond to medication and that is only witnessed by the caretaker;
  • Bleeding from anticoagulants and poisons; use of caretaker’s own blood or red-colored substances to simulate bleeding;
  • Vomiting precipitated by ipecac administration;
  • Diarrhea induced by laxatives or salt administration;
  • Hypoglycemia from administration of insulin or hypoglycemic agents;
  • Rashes from caustic substances applied to the skin;
  • Hematuria or rectal bleeding from trauma;
  • Recurrent apparent life-threatening events (ALTE) from purposeful suffocation; and
  • Central nervous system depression (usually from drug administration).

Mason and Poirier[6] recommend looking for these warning signs:

  • Illness that is multisystemic, prolonged, unusual, or rare;
  • Symptoms that are inappropriate or incongruent;
  • Multiple allergies;
  • Symptoms that disappear when caretaker is absent;
  • One parent, usually the father, absent during the child’s hospitalization;
  • History of sudden infant death syndrome (SIDS) in siblings;
  • Parent who is overly attached to the patient;
  • Parent who has medical knowledge/background;
  • Child who has poor tolerance of treatment;
  • Parent who encourages medical staff to perform numerous tests and studies; and
  • Parent who shows inordinate concern for feelings of the medical staff.

When should I suspect Munchausen syndrome by proxy in a patient? [Medscape Med Students]

Posted in Pediatrics, Psychiatry | Comments Off on Munchausen Syndrome by Proxy (MSBP)

Bipolar Disorder: In-Home Testing

Posted by medliorator on March 30, 2008

a company is selling a testing kit that you can use yourself, in the privacy of your own home, to see if you have genes that increase the risk of bipolar disorder.


Psynome™ – tests for two mutations of the GRK3 gene that are associated with bipolar disorder.


Psynome2™ –tests for gene mutations in the Promoter L allele gene that predicts patient response to serotonin-based drugs, the most commonly prescribed drug therapies in psychiatry today. These tests are useful to your doctor in making a timely and accurate diagnosis of your condition and prescribing the right medication. The tests can be ordered individually or combined.


In order to know if the test is worth anything, you would have to do some kind of study that shows that the people who get the test, do better in the long run. It is one thing to be able to tell whether the mutations are present. In is another thing to show that the knowledge makes a difference in the outcome of the treatment.


Previous efforts have failed to show clinical utility, even if they are useful in a research setting. Any proposed test will have to meet a high standard before it will make any sense to put it into use. Even then, it is doubtful that it would make sense for a person to do it at home.

In-Home Test for Bipolar Disorder [The Corpus Callosum]

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