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Site Evaluation Presentation

For the first evaluation, my group had the privilege of having Dr. Manuel Saint Martin for an in-person evaluation. I presented a case of classic obsessive-compulsive disorder. As I was writing up this case, I had to do some research to understand the differential diagnosis and to develop a treatment plan. To enhance my understanding of this topic, I watched Osmosis videos, watched YouTube videos, and read about it on UpToDate. I thought my write-up for this patient was thorough and comprehensive. However, upon presenting it to Dr. Martin, the first thing he asked was if I knew whether the patient had a history of streptococcal throat infection. I told him that I did not ask that, and that’s when Dr. Martin explained how cases of untreated strep throat can be linked to a concept called PANDAS, which stands for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” This condition links strep infections to psychiatric disorders, particularly OCD and tic disorders. He advised me to do some more reading on this topic and choose an article to present related to it.

For the second evaluation, I picked a Spanish-speaking patient who arrived at the psychiatric emergency room after her son called the NYPD, saying his mother mentioned she would jump in front of a train. The patient denied this, but she was still brought in for a psychiatric evaluation. The patient was newly arrived from South America, so Dr. Martin agreed with my diagnosis of an adjustment disorder with depressed mood due to the stressors she was dealing with. However, Dr. Martin did not agree with my plan. I recommended medication, but an adjustment disorder doesn’t require medication unless a depressive disorder is suspected. I also suggested overnight observation since the patient had alleged suicidal ideation. However, Dr. Martin mentioned that if the patient denies suicidal intention and can be observed at home by family, there is no need to keep the patient overnight.

I also presented my article on PANDAS during my second evaluation, which was the largest cohort study done to date. The article had an interesting conclusion, stating that those with strep throat infection had the highest risk for OCD and tic disorders, but those without bacterial infections also had a higher risk for the same disorders. These evaluations were a great learning experience, and Dr. Martin was very educational. These evaluations were my favorite so far in the clinical year, most likely because I found myself enjoying psychiatry very much.