For this rotation, my mid and final site visits were completed via Zoom with my site evaluator and two other students who are rotating at the same location as me.

During the mid site evaluation, I presented one case on a patient who likely had undiagnosed bipolar I disorder and was having a manic episode. This site visit was different in that my classmates and I did not read through our H&Ps like I had done during previous site visits. Rather, our site evaluator asked us to summarize our cases in about five sentences. He paid particular attention to specific components, including the mental status exam and our differential diagnoses, the latter of which we needed to elaborate on why certain diagnosis were less likely than that at which we arrived. We also discussed our treatment plans in detail and the medications that would be the most appropriate.

For the final site evaluation, I presented another case on a patient with methamphetamine-induced psychosis. My differential diagnoses included substance-induced psychosis, brief psychotic disorder, bipolar I disorder, bipolar II disorder, and psychosis, not otherwise specified. My site evaluator then mentioned that neurosyphilis and medication-induced psychosis would also be appropriate to add, as the patient is on Biktarvy and anti-retroviral therapies have been found to induce psychosis. Afterwards, I discussed a related journal article that found that regular use of methamphetamine is neurotoxic to the brain, as it is linked to a prevalence rate over 40% of methamphetamine-induced psychotic disorder.