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Clinical Experience

Geriatric Psychiatry Specialty Clinic

This rotation is a 12 month longitudinal clinical experience focusing on for the care of older patients suffering from cognitive and neuropsychiatric illnesses. Geriatric psychiatry fellows work under the direct supervision of Geriatric Psychiatry faculty. The clinic serves as a training site for medical students from the Yale University School of Medicine, PharmD students, PGY2 Yale residents, Geriatric Medicine fellows, and Neuropsychology trainees. Fellows play an active role in the education of trainees from these diverse disciplines. Case based teaching includes interdisciplinary perspectives and review of pertinent evidence based literature.

The Yale-Alzheimer's Disease Research Unit (ADRU)

Fellows are integral members of an interdisciplinary clinical and research team performing clinical evaluations, providing caregiver support, and conducting research trials. Fellows learn state-of-the-art methods for the assessment of dementia, are exposed to the latest developments in neuroimaging and treatments for Alzheimer’s disease, and learn current theories of the pathophysiology of dementia and the rationale for investigational therapies.

Fellows have primary responsibility for the conduct of structured clinical interviews (global assessments, such as CDR and CIBIC) and neurological/medical examination of patients. The training is enhanced by individual supervision and didactic sessions where fellows learn skills necessary to critically evaluate both research methodology and current findings in the literature.

Nursing Home Consultation

During this rotation, fellows learn comprehensive assessment and consultation skills in the nursing home setting. Fellows gain expertise in the evaluation and management of residents with co-morbid psychiatric and medical illnesses; management of behavioral disturbances associated with dementia is a fundamental task in the nursing home setting. Fellows work closely with nursing home staff to evaluate behavioral problems and develop management strategies. They also collaborate with the patient's medical physician to investigate possible medical causes of delirium or behavioral change. Fellows have the opportunity to learn about the significant psychological and social impact of nursing home placement on an older individual and his/her family, and to gain an understanding of the financing of such care.

Supervision is provided on-site by psychiatry faculty. Opportunities also exist for fellows to assist in the in-service training of nursing home staff.

Home Based Care

This rotation is designed to provide fellows with consultation experience for home-bound elder patients with neuropsychiatric illnesses. Fellows develop an understanding of the array of complex issues facing both the patient and caregiver as they attempt to manage and maintain the optimal quality of life at home. Fellows develop advanced skills in functional home safety assessment and decisional making capacity.

Interventional Psychiatry

This rotation provides in depth training for the indications and application of ECT, rTMS and ketamine treatments.

Neurocognitive Clinic

During this rotation, fellows work closely with Neurology attendings to gain experience in the diagnosis and treatment of neurocognitive disorders.

Consult-Liaison Psychiatry

Fellows work on the C-L service seeing primarily older adults with delirium, agitation and other neurocognitive and neuropsychiatric illnesses.

Primary Care Mental Health Integration (PCMHI)

Under the supervision of a Geriatric Psychiatrist co-located in the primary care clinic, Fellows will perform initial assessments, medication management, and brief psychotherapeutic interventions to Veterans with a broad range of psychiatric concerns referred by their primary care provider. Additionally, fellows will evaluate “warm hand offs,” a VA initiative in which mental health provides same day access to primary care patients with mental illness. Referrals to PCMHI come from primary care physicians, APRNs and Physician Assistants.

Palliative Care

Fellows participate in palliative care assessments in the outpatient setting for patients with moderate to late stage dementias, as well as for patients with medical illness.