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Anesthesiology

Addiction/Psych Rotation


Goals:

  • To appreciate the impact of psychiatric dysfunction in the experience and management of pain
  • To appreciate the scope and impact of psychological addiction in patients with chronic pain
  • To appreciate the critical nature of psychiatrists and psychologists in the multidisciplinary management of chronic pain
  • To foster collaborative institutional treatment of complex patients with pain and psychological comorbidity
     

Objectives:

  • To perform complete psychiatric history with special attention to psychiatric and pain comorbidities, including completion of a mental status exam on a minimum of 15 patients, five of which must be in the presence of a faculty observer, ACGME IV.A.5.1.d
  • To interview and examine patients with common psychiatric and pain co-morbidities, including substance-related, mood, anxiety, somatoform, factitious, and personality disorders, ACGME IV.A.5.1.d.
  • To demonstrate understanding of the principles and techniques of the psychosocial therapies, with special attention to supportive and cognitive behavioral therapies, sufficient to explain to a patient and make a referral when indicated, ACGME IV.A.5.1.d
  • To communicate effectively and professionally with referring providers
  • To formulate pain treatment plans which include, as appropriate: Medications, interventions, therapies, and appropriate cognitive behavioral therapy and coping skills training
  • To learn techniques for inpatient detoxification from opioids and benzodiazepines, including associated risks and benefits of each technique
  • To recognize signs of primary psychiatric disorder (including personality disorders), and methods used to distinguish these from a primary pain disorder
  • To gain understanding of institutional and community resources available for treatment of chronic pain patients with psychological impairment, addiction, and primary psychiatric disorder
  • To treat patients with respect and dignity
  • To take time to educate patients, regarding contributing factors and treatment options related to pain
  • To empower patients to participate in medical decision-making and to take responsibility for their role in the treatment plan
  • To recognize psychological, social, and economic issues which may affect patients and their families, and necessitate adjustment in management plan to accommodate these
  • To encourage patients to reconsider a “successful” outcome as increased functionality rather than decreased pain score

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