2020-21 Geriatric Psychiatry Seminar Schedule

This team is led by a geriatric psychiatrist physician and will be responsible for the management of geriatric psychiatry inpatients on the inpatient psychiatry units at Vanderbilt. Emphasis is placed on complex neurobehavioral problems and treatment-resistant patients. The fellow will be primarily responsible for the diagnosis and management of these patients under the guidance of the geriatric psychiatrist inpatient attending. They will also supervise and teach a general psychiatry resident and/or medical student as part of this experience. The fellow will work closely with social work services and will be involved in discharge planning, placement, and other family-related issues. In addition, they will liaison with long-term care facilities as appropriate to ensure smooth medical transitions and to decrease recidivism. A geriatric psychiatrist will supervise this team. The major portion of this training will take place at the Vanderbilt Psychiatric Hospital.

Inpatient Training will consist of:

1. The treatment of dementia and the specific complications related to this illness.
2. Assessment and treatment of individuals suffering from psychiatric symptoms associated with a neurological disorder (Parkinson’s disease, Multiple Sclerosis, stroke, etc.)
3. ​Assessment and treatment of individuals, ages 50 and older, with chronic mental illnesses, such as Depression, Schizophrenia, or Bipolar Disorder receiving inpatient psychiatric treatment.

These clinics serve a diverse population of individuals for formal evaluation, consultation, and follow-up. Diagnoses are predominantly affective disorders, but also include diagnoses such as anxiety disorders, Tardive dyskinesia, head injury, and Parkinson’s disease. The fellow will become a primary clinician for patients within this clinic under the regular supervision of an outpatient attending geropsychiatrist. They will evaluate at least one new patient per week and will be expected to follow a substantial caseload with a variety of diagnoses. They will work closely with referral sources, including primary physicians as well as outreach clinicians, such as visiting nurse staff. Instruction will be given in the evaluation of geriatric patients, and will focus on family-centered assessments and interventions. In addition to Psychopharmacological management, training will also include supervision in both brief individual psychotherapy techniques appropriate to the elderly and family and group therapy approaches. 

The clinical population consists of new dementia evaluations and follow-ups. In addition to diagnosis and evaluation of dementia, emphasis for the psychiatry portion of the clinic is placed on behavioral disturbances associated with all types of dementia and their management. Cases are evaluated by both attending physicians and fellows. Medical students participate as well. The fellow will participate with attending physicians in new dementia evaluations and ongoing follow-up, particularly for cases that have significant behavioral problems. Generally, they will evaluate one new patient every 1-2 weeks as well as perform follow-ups.The fellow will also work with neuropsychologists, clinical nurse specialists, and neurologists during the assessment and management process to learn how to work within a multi-disciplinary model of dementia assessment and care.

The consultation-liaison experience addresses the needs of medical patients age 55 and older. The annualized demographic profile of the patients the fellow encounters is proportionate to the overall demographics of the hospital. The fellow is expected to learn the role of the consultant geriatric psychiatrist working in the general medical setting. As such, they are expected to interact professionally with professional staff and medical colleagues working within the general medical clinical environment, and assess thoroughly and recommend appropriately interventions for the treatment of medical inpatients referred for consultative opinion.

The fellow will rotate on the Geriatric Evaluation and Management (GEM) unit of the VA Nashville hospital. They will participate in multidisciplinary treatment planning meetings of the GEM team (that includes physicians, nurses, social workers, physical and occupational therapists, dietitians, and other health professionals), consult with GEM staff on the management of complex geriatric-psychiatric inpatients of the GEM unit and follow those patients into long-term care outpatient care.

This team consists of geriatric psychiatrists, psychologists, nurse clinicians, and trainees. The program provides psychiatric consultation at the Alvin York VA Medical Center in Murfreesboro, Tennessee. 

The fellow will become a co-consultant with attending geriatric psychiatrists as part of the team. They will be primarily responsible for consultations and will round weekly with the faculty consultant. They will evaluate referred patients, interview staff and family members, and develop intervention plans, both medical and behavioral. Under the tutelage of the senior consultant, the fellow will then help implement the plan and provide ongoing follow-up with both patients and staff.

During their time working in the long-term care area, the fellow will be assigned 4-8 patients, who will also be followed by a geriatric psychiatry faculty member. Additionally, they will have the opportunity to participate in multidisciplinary treatment teams, as well as performing ongoing consultations on psychiatrically impaired residents who are chronically medically ill. The fellow will participate in patient-family care plan conferences and case specific clinical teaching is provided by the geriatric medicine and geriatric psychiatry faculty. They will also receive separate individual supervision from an attending faculty member at least twice per month, as well as during the family conferences and family therapy sessions.

The fellow will work with the Palliative Care Services at both Vanderbilt University Medical Center and TVHS-VA Nashville and Murfreesboro to evaluate and follow elderly patients in the hospital or community-care home setting. Experience will be gained in evaluation and treatment of terminal patients as well as pain and symptom management, and appreciate the importance of palliative care in advanced disease processes. For patients on hospice within inpatient or hospital settings, the fellow will round with members of the Palliative Care Team from Geriatric Medicine to learn the care of these patients. In selected instances, the fellow will provide additional medical assessment and pharmacological management of patients.

The fellow will assist attending physicians on this service in the performance of ECT/TMS for both geriatric in-and-out patients. The goal is to provide sufficient experience and knowledge for the trainee to independently manage ECT/TMS treatment and to obtain certification.

The fellow will participate in ongoing, externally funded, clinical studies as a member of research teams through the Vanderbilt Center for Cognitive Medicine. At times, there will be the opportunity to participate as a clinical evaluator in ongoing studies. The fellow can elect to participate as a research psychiatrist in one of several ongoing, externally funded research projects. An educational program in research methodology, statistics, and data management is offered in conjunction with the Geriatric Research Education and Clinical Center (GRECC) at the VA, and additional research training is offered through the Center for Cognitive Medicine and the Psychiatry Neuroimaging Program. A publishable scholarly research paper is encouraged by the end of the fellowship. An additional year of research training may be available for selected fellows.