Do you have to like neuro?

[The Squid]

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I love the psych lectures we've been having (MSII), but I absolutely hated neuroscience last year. I can't stand playing "Where's the lesion?" and I absolutely hated discussing all the tracts. Maybe it's because I suck at neuro. I don't know. But psych is fun. I actually enjoy the lectures and look forward to attending them. I rarely enjoy other lectures and only go because it keeps me on track. One of our professors keeps talking about how the two go hand in hand. I know neuro and psych are very much related, but do you really have to like neuro to be a good psychiatrist? I ask because I think I'd love psych and be good at it (histories and talking to patients is a strong point), but my pscyh rotation is so late in the year next year, that I have to choose my 4th year electives before I even get to try psych 🙁 Thanks for your input.

 

[sga430]

almost in every field u will stuff that does not interest u.

 

[maranatha]

I would say, no. Also, what parts of psychiatry do you like? I would bet that a lot of what you like in psychiatry already has a heavy neuroscience component. Keep in mind, though, that the psychiatry boards have neurology on them.

I personally enjoy much of neurology when reading it from a text. But neurology was, by far, one of my least favorite rotations and if the field of psychiatry didn't exist, I would never do it. Stroke, after stroke, after stroke....

 

[Anasazi23]

I think you'll find that in clinical practice, the "let's play 'where's the lesion'" is thankfully more rare. As mentioned, it tends to be more stroke, peripheral weakness, seizure disorders, movement disorders, mental status changes, r/o conversion, and so on.

 

[Someguy2007]

almost in every field u will stuff that does not interest u.

Spelling and grammar, for instance.

 

[salmonella]

I would say, no. Also, what parts of psychiatry do you like? I would bet that a lot of what you like in psychiatry already has a heavy neuroscience component. Keep in mind, though, that the psychiatry boards have neurology on them.

I personally enjoy much of neurology when reading it from a text. But neurology was, by far, one of my least favorite rotations and if the field of psychiatry didn't exist, I would never do it. Stroke, after stroke, after stroke....

The worst part is, there's nothing much you can do to reverse the consequences of stroke quickly. Just baby sit them, and admire the small neurological findings that have no practical relevance. 😴
The tradition of localizing lesions by neuro exam is quickly becoming obsolete. CT/MRI, radiologists--these are the real deal.

 

[Chewbacca Jung]

I think you'll find that in clinical practice, the "let's play 'where's the lesion'" is thankfully more rare. As mentioned, it tends to be more stroke, peripheral weakness, seizure disorders, movement disorders, mental status changes, r/o conversion, and so on.

I'm on my Neuro Sub-internship right now, and probably 12 out of the 17 people I have followed so far have had serious psych issues that have compounded their neurologic care. Right now I have a patient who has Guillan-Barre and a history of siezures, but has these bizzare fluctuations in mental status that are alleviated by talking on the phone. He also had a pseudosiezure when we confiscated his home meds (including ambien and vicodin)-- I think he's schizotypal, and he's got the bizzarist love triangle I've ever heard. We just had a woman with ataxia who turned out to have a conversion disorder. One woman is here for long-term EEG monitoring who has pelvic thrusting (almost pathonumonic for pseudo-siezure) who also has audio, visual, and olfactory hallucinations.... anyway, there's a lot of psych going on on the neuro-floors. So it's really not quite as boring as stroke after stroke after stroke...It is a little frustrating, though, because noone wants to say the "p-word" at risk of offending the patient.

I would say it's not so much "name the lesion", as stated above, but more:

"stroke, stroke, siezure, stroke, GB, TIA, Stroke, What the hell was that!?!?!?, stroke, siezure..." all with a psych overlay.

 

[maranatha]

I'm on my Neuro Sub-internship right now, and probably 12 out of the 17 people I have followed so far have had serious psych issues that have compounded their neurologic care. Right now I have a patient who has Guillan-Barre and a history of siezures, but has these bizzare fluctuations in mental status that are alleviated by talking on the phone. He also had a pseudosiezure when we confiscated his home meds (including ambien and vicodin)-- I think he's schizotypal, and he's got the bizzarist love triangle I've ever heard. We just had a woman with ataxia who turned out to have a conversion disorder. One woman is here for long-term EEG monitoring who has pelvic thrusting (almost pathonumonic for pseudo-siezure) who also has audio, visual, and olfactory hallucinations.... anyway, there's a lot of psych going on on the neuro-floors. So it's really not quite as boring as stroke after stroke after stroke...It is a little frustrating, though, because noone wants to say the "p-word" at risk of offending the patient.

I would say it's not so much "name the lesion", as stated above, but more:

"stroke, stroke, siezure, stroke, GB, TIA, Stroke, What the hell was that!?!?!?, stroke, siezure..." all with a psych overlay.

Awsome! 👍 Sounds like you're having a much better time then I did. BTW, please tell us about this bizzare love triangle. LOL!

 

[BrianUM]

I'm on my Neuro Sub-internship right now, and probably 12 out of the 17 people I have followed so far have had serious psych issues that have compounded their neurologic care. Right now I have a patient who has Guillan-Barre and a history of siezures, but has these bizzare fluctuations in mental status that are alleviated by talking on the phone. He also had a pseudosiezure when we confiscated his home meds (including ambien and vicodin)-- I think he's schizotypal, and he's got the bizzarist love triangle I've ever heard. We just had a woman with ataxia who turned out to have a conversion disorder. One woman is here for long-term EEG monitoring who has pelvic thrusting (almost pathonumonic for pseudo-siezure) who also has audio, visual, and olfactory hallucinations.... anyway, there's a lot of psych going on on the neuro-floors. So it's really not quite as boring as stroke after stroke after stroke...It is a little frustrating, though, because noone wants to say the "p-word" at risk of offending the patient.

I would say it's not so much "name the lesion", as stated above, but more:

"stroke, stroke, siezure, stroke, GB, TIA, Stroke, What the hell was that!?!?!?, stroke, siezure..." all with a psych overlay.

Sounds interesting. A Neuropsychiatrist could have a field day on that floor.

 

[Doc Samson]

Anyone who's telling you that pelvic thrusting is pathomnemonic of "pseudoseizures" is just flat out wrong. Partial complex seizures of the frontal lobes, the SMA, and multiple other areas can present with pelvic thrusting.

 

[Anasazi23]

Anyone who's telling you that pelvic thrusting is pathomnemonic of "pseudoseizures" is just flat out wrong. Partial complex seizures of the frontal lobes, the SMA, and multiple other areas can present with pelvic thrusting.

Agree, Samson.


http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10636155&dopt=Abstract

 

[OldPsychDoc]

Anyone who's telling you that pelvic thrusting is pathomnemonic of "pseudoseizures" is just flat out wrong. Partial complex seizures of the frontal lobes, the SMA, and multiple other areas can present with pelvic thrusting.

I agree too, even though what you mean is pathognomonic.

 

[Anasazi23]

I kinda like that word...pathomneumonic

What about pathopneumonic?

 

[Chewbacca Jung]

I kinda like that word...pathomneumonic

What about pathopneumonic?

Yes, I was actually referring to air on the brain...😀

Anyone who's telling you that pelvic thrusting is pathomnemonic of "pseudoseizures" is just flat out wrong. Partial complex seizures of the frontal lobes, the SMA, and multiple other areas can present with pelvic thrusting.

let me try it again. for someone on long term monitoring (i.e. hooked up to an EEG) in the absence of epileptiform discharges during involuntary pelvic thrusting, 'pseudoseizures' is a viable hypothesis.

I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it...

I'm not worthy. I'm not worthy. I'm not worthy....

 

[The Squid]

Thanks for the responses. Now I don't feel so bad about my lack of love for neuro.

I would say, no. Also, what parts of psychiatry do you like?

To be honest, I don't really know what it is I like about psychiatry. I particulary enjoyed the lectures on schizophrenia, anxiety disorders, and somatoform disorders. I didn't really enjoy the lectures that focused on neuroanatomy, neurtotransmitters, and biogenic amines. I haven't been able to work with many patients so far, but I have found that I am often more interested in their social problems than I am in discussing their electrolytes. I like talking to patients.

 

[Doc Samson]

I agree too, even though what you mean is pathognomonic.

You are, of course, correct. Just finished writing an article on mnemonics in psychiatry AND a psychiatry review book for step 2... have mnemonics on the brain.

 

[Doc Samson]

let me try it again. for someone on long term monitoring (i.e. hooked up to an EEG) in the absence of epileptiform discharges during involuntary pelvic thrusting, 'pseudoseizures' is a viable hypothesis.

Viable hypothesis? sure. Diagnostic? Depends on the EEG array (surface lead only vs. nasopharyngeal/sphenoidal leads). Even then it's not 100%.

 

[OldPsychDoc]

You are, of course, correct. Just finished writing an article on mnemonics in psychiatry AND a psychiatry review book for step 2... have mnemonics on the brain.

Aw man--I finally know something that Doc Samson doesn't (even if it's just a spelling word), and he has to go and use it as an excuse to tell us that it's because he's busy authoring and stuff....🙁

 

[Anasazi23]

I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it.
I'm sorry for saying 'pathonumonic' with out researching the data and being able to spell it...

I'm not worthy. I'm not worthy. I'm not worthy....

How long has it been since you're last inappropriate differential, child?

I'll let you off easy....Say two Our Father's and 5 Hail Mary's and may God be with you.

 

[Doc Samson]

Aw man--I finally know something that Doc Samson doesn't (even if it's just a spelling word), and he has to go and use it as an excuse to tell us that it's because he's busy authoring and stuff....🙁

Believe me... you know plenty of stuff that I don't.