Can I be a Psychiatrist if I don't like psychosis?

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SoulinNeed

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I've thought about being a psychiatrist, and I loved my Child and Adolescent Psych rotation, but I'm now doing adult, and while I like dealing with depressed patients, and I don't mind manics to an extent, Schizophrenics honestly freak me out a bit. We had one attack a nurse yesterday, and that was a bit disturbing, honestly. I'm planning on going into PP, and most likely CAP, but I was wondering, should I still go into Psych, if I have such a reticence with psychotic patients like schizophrenics?

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IMO, yes you can. Though you will likely see plenty of psychotic disorders during residency(part of general training); even in some residencies, you can get away with seeing way more personality disorders then other stuff. Lots of psychiatry is outpatient. If I were you, I would consider the fact that you got a very skewed view of schizophrenia, as do most medical students. Of note, stable patients with a dx of schizophrenia can be seen as outpatients and can be some of the most interesting patients; just letting you know some material that med students don't know.
 
There is no specialty where you will like everything you do. But at least you can learn to understand it and manage it. You might love surgery but hate the chronic pain ppl. In psych we learn to manage difficult ppl, rather than just turfing them.
 
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You can work for the military. Sure, you will have some who have their 1st break but they are then medically boarded out.
 
You'll overcome your discomfort. We all had to about some aspect of our chosen specialty.
 
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schizophrenics honestly freak me out a bit. We had one attack a nurse yesterday, and that was a bit disturbing, honestly

No matter what specific area of psych whether it's ER, inpatient, outpatient, consult will you be free of psychotic patients. So my advice is if you have a very serious aversion towards psychosis and want to enter psychiatry you need to get insight into yourself and figure this one out.

I agree with Leo in general but I have seen people with specific aversions so great saying you'll overcome it, while likely right, might not be the case. For most people not liking something is merely the first reaction and with further work you might be able to overcome it, and possible be able to sublimate the discomfort into something positive.
 
Some of the other patients we've seen have had psychotic symptoms, mainly AH, and honestly, they didn't bother me much. This one patient was wayyyyy out there, though, and also violent, and I guess that just freaked me out.

Honestly, though, I would think that being freaked out by that as a med student is perfectly normal, right? Even for psychiatrists?
 
I've thought about being a psychiatrist, and I loved my Child and Adolescent Psych rotation, but I'm now doing adult, and while I like dealing with depressed patients, and I don't mind manics to an extent, Schizophrenics honestly freak me out a bit. We had one attack a nurse yesterday, and that was a bit disturbing, honestly. I'm planning on going into PP, and most likely CAP, but I was wondering, should I still go into Psych, if I have such a reticence with psychotic patients like schizophrenics?
I don't mean this as an attack because it seems to be poorly understood among many, but people don't like being referred to as a disease--especially one that is very stigmatized.

When you say we had "one" attack the nurse, you make it sound as if you've come across a new species you'r observing for NatGeo. They are all human beings, unless you've made some amazing discovery, and everyone interacts with people who have mental illness all the time. You probably don't even know how many times you've talked to someone who has schizophrenia with their symptoms under control or not outwardly manifesting. People with schizophrenia can achieve remarkable states and work in all areas of life.

Here you can read about a woman who is a mental health advocate and lawyer who also has schizophrenia:

https://en.wikipedia.org/wiki/Elyn_Saks

At one point, she was in a hospital having a breakdown. I'm not sure if she was in as great of distress as what you saw, but that wasn't the moment in her life that came to define her. It was a moment she needed help.

A person with schizophrenia could be your patient . . . or your boss one day. So while I recognize that you have a fear, you also have to consider how much you can benefit someone if you don't see a full place for that person in society, which is to say, people with schizophrenia, like anyone else, both need help and give help. I would maybe re-frame the question as: Can I help someone with schizophrenia? If I don't believe I could, why not? If you make it less about yourself and humanize the person and make it about the human and this human's future potential, it might help. This is a moment in their life, but it's not most of the moments.
 
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Some of the other patients we've seen have had psychotic symptoms, mainly AH, and honestly, they didn't bother me much. This one patient was wayyyyy out there, though, and also violent, and I guess that just freaked me out.

Honestly, though, I would think that being freaked out by that as a med student is perfectly normal, right? Even for psychiatrists?
Violent and psychotic people should freak you out a bit. There are strategies and techniques for dealing with this. My number one rule is that the patient has to sit down and be relatively calm before I will discuss anything with them. I make that very clear, remain calm, and don't deviate. I have seen too many people arguing with agitated patients and it can escalate them and create a dangerous situation cause now you pissed 'em off. If they are unable to comply with such a basic request, chemical or physical restraints are likely going to be needed. Most of the time the patient will calm down and talk with you and then you find out what's going on, alleviate the crisis, and strut on out of the ED or inpatient unit saying that's why they pay us the big bucks. :cool:
 
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Can I be a Psychiatrist if I don't like psychosis?

Sure, why not? I'm a surgical resident and I really, really, don't like cancer. I actually belive it's an advantage. ;)
 
Some of the other patients we've seen have had psychotic symptoms, mainly AH, and honestly, they didn't bother me much. This one patient was wayyyyy out there, though, and also violent, and I guess that just freaked me out.

Honestly, though, I would think that being freaked out by that as a med student is perfectly normal, right? Even for psychiatrists?
Just like being "freaked out" by putting a needle in someone's vein*, or sticking a tube into a place that isn't normally on public view...you will learn, and someday you will be the person who other doctors and med students are going to look to for help in handling a violently agitated patient and being able to help them get better.
As a med student, the one thing that really impressed me about my psychiatry attendings was how unruffled and quietly authoritative they would become in a situation like that. I strive to bring that into my patient encounters, too. As birch said above: see the person behind the behavior.

*(I had the pleasure as an intern of supervising an MS3 doing her first blood draw, who then promptly passed out at the nursing station thereafter. It happens... :oops:)
 
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I am sure once you are out of the general part and branch off to Child you will get to see more of what you want.

I am the exact opposite. I rather deal with all psychosis and adults and never deal with child. Or borderlines....

But, we all have to be general to a point and then can tailor our careers as we like.
 
I don't particular like Psychosis either...it's generally why I take medication when my symptoms become unmanageable. ;) Birch is right, you don't always know when you're talking to someone who places on the spectrum of psychotic disorders, and there is a spectrum as I'm sure you know (hence your experience with a violent patient is only one small aspect of that spectrum). If you want to talk to someone with a psychosis based diagnosis (MDD with Psychotic Fx, although thankfully I'm not currently experiencing an episode) in a safe-ish environment (ie this forum) feel free to shoot me a message, or ask me something in this thread, or, you know, whatever. Consider it an offer of exposure therapy. :)
 
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I don't mean this as an attack because it seems to be poorly understood among many, but people don't like being referred to as a disease--especially one that is very stigmatized.

When you say we had "one" attack the nurse, you make it sound as if you've come across a new species you'r observing for NatGeo. They are all human beings, unless you've made some amazing discovery, and everyone interacts with people who have mental illness all the time. You probably don't even know how many times you've talked to someone who has schizophrenia with their symptoms under control or not outwardly manifesting. People with schizophrenia can achieve remarkable states and work in all areas of life.
What you say is technically true (though on that first point it comes off like you borrowed it from the movie Patch Adams) but the sad truth is that the prognosis for patients with schizophrenia is not very good. The great majority of them will not be able to hold high level positions. The woman you linked to on Wikipedia is very much an outlier for patients with her disease and should not be viewed as representative of typical functioning. It could also be that she has bipolar or schizoaffective disorder.
 
Thanks for all the help in this thread. I didn't mean to offend anyone, if anyone took offense. I guess, at this point, I'm just so unsure as to how to approach these patients. I still haven't learned proper interview techniques or where to put up walls. I guess I just got a bit freaked out when someone smiled in my face, gave me this hard stare and told me that god gives them AH set around HI.
 
Some of the other patients we've seen have had psychotic symptoms, mainly AH, and honestly, they didn't bother me much. This one patient was wayyyyy out there, though, and also violent, and I guess that just freaked me out.

Honestly, though, I would think that being freaked out by that as a med student is perfectly normal, right? Even for psychiatrists?

You are very early in your clinical training and naive in your medical knowledge. If you have an escape plan and mind your surroundings (talk to your resident, attendings - approachable in psych!, nurses, and other staff about how to do this)violence isn't an issue. And honestly schizophrenics and even manics (bc they are so labile and distractible) don't really threaten me- it's the more the ASPDs, especially when I am in the ED and it becomes clear that I will not admit them. That said, psychosis is one of the most fascinating aspects of psychiatry. I would suggest reading Fish's Psychopathology (which has nicely summarized the masters of descriptive psychiatry) and trying to identify patterns of hallucinations, the different delusional systems and forms therein, formal thought disorder (and different ways of describing flow of though), negative symptoms, etc
 
You'll overcome your discomfort. We all had to about some aspect of our chosen specialty.

Except for those of us who leave the specialty.

Although I actually like psychotic patients now, doing outpatient. They are so straightforward. Except when they decompensate. But in outpatient that is rare.
 
There is no specialty where you will like everything you do. But at least you can learn to understand it and manage it. You might love surgery but hate the chronic pain ppl. In psych we learn to manage difficult ppl, rather than just turfing them.

Wait - are you saying we can turf difficult people?
 
As a med student, the one thing that really impressed me about my psychiatry attendings was how unruffled and quietly authoritative they would become in a situation like that. I strive to bring that into my patient encounters, too. As birch said above: see the person behind the behavior.

To this day, I am still in awe at how good some psychiatrists are at handling incredibly difficult situations. I find it to be one of the most impressive traits a person can have and will definitely be a lifetime pursuit of mine.
 
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