Rotations

The Integrated Health and Aging Inpatient program at the UPMC Western Psychiatric Hospital provides comprehensive evaluation and short-term hospitalization for older adults experiencing severe depression, psychosis, anxiety, memory loss with behavioral problems, and other mental health and behavioral problems associated with aging. All patients receive a complete medical, psychiatric, and social/functional assessment. Treatment modalities include pharmacotherapy, psychosocial interventions, family therapy, physical rehabilitation, and electroconvulsive therapy.

Benedum Geriatric Center - A Longitudinal Experience

The ambulatory care program of the Benedum Geriatric Center provides outpatient evaluation and treatment for older persons who have complex problems requiring multidisciplinary care. The Benedum Geriatric Center focuses primarily on seniors who have multiple medical, psychiatric, and/or psychosocial problems. Its goal is to preserve their health, independence, and well-being. Services include comprehensive medical, psychiatric, and social assessments; consultation for referring physicians and other community health care providers; environmental planning to maintain the patient’s residence at home for as long as possible; health care education, counseling, and psychotherapy for patients and families. The center averages over 750 patient visits per month and has more than 2,200 active patients. 

Long-Term Care - A Longitudinal Experience

The Geriatric Psychiatry program maintains contracts with a variety of long-term care facilities in Western Pennsylvania and has established several facilities as training sites. Fellows round weekly at their assigned nursing home under faculty supervision during four of the five rotation blocks. Pharmacotherapy and psychosocial/family interventions are the primary modes of treatment. Drug interactions, medical co-morbidity, psychosocial stressors, and medico-legal aspects of treating seniors in long-term care settings are emphasized.

During their Ambulatory Rotation, fellows will gain experience in the long-term care Special Care Unit for residents with severe behavioral problems of dementia or who have serious mental illness and require nursing home level care. This program focuses on behavioral management techniques, working closely with families and nursing home staff.

Geriatric In-Home Support Program

The Geriatric In-Home Support Program currently serves 100 homebound older persons with psychiatric and physical illness who would otherwise not receive care or receive it only in a hospital or long-term care settings. The program’s target population are those chronically and persistently ill older patients (60 years of age and older) who are unable to keep appointments in an outpatient setting and are at risk for institutionalization. These patients are some of the most complex in the region, with medical problems and functional disability, cognitive or psychiatric disorders, and poor social support.

Geriatric Pain Clinic

The Geriatric Pain Clinic at the Pittsburgh VA Health System’s located on University Drive in Oakland is a multi-disciplinary clinic dedicated to the treatment of persistent pain. Physicians, nurses, psychologists, and rehabilitation specialists provide group and individual pain rehabilitation programs. Treatment is both interventional and conservative. Our multidisciplinary team works closely together to educate the patient and their family, and to re-conceptualize their attitude to the management of pain. Fellows participate in seven, half-day clinics during their ambulatory rotation.

Movement Disorders Clinic

Located within the Department of Neurology, fellows provide psychiatric care to individuals with movement disorders and learn assessment and treatment of common movement disorders including Parkinson's disease and atypical Parkinsonism. 

Palliative Care

For two weeks during the ambulatory rotation, fellows gain intensive experience with palliative care services. Fellows accompany the Palliative Care team at the UPMC Presbyterian Hospital on daily rounds. During this rotation, fellows learn to more fully appreciate how an interdisciplinary approach can effectively address the physical, psychosocial, and spiritual needs of patients and families in end-of-life care, and obtain a better understanding of the communication skills needed and utilized when having difficult conversations with patients and their families regarding end-of-life care. They also gain valuable experience in the advanced care planning process through participation in goal-setting discussions with patients and families.

Physical Medicine and Rehabilitation

Fellows gain experience in the evaluation and rehabilitation of patients who suffered stroke or traumatic brain injury.  This is another opportunity to observe the administration of neuropsychological testing and implement the results of this testing in care planning.  Fellows learn about the role of physical and occupational therapy in recovery from these conditions and how to implement rehabilitation principles in their own practice of caring for older adults with psychiatric illness.

Cancer Psychiatry

The Center for Counseling and Cancer Support within the Hillman Cancer Center provides mental health care for patients with cancer and in early survivorship as well as their caregivers. The clinic includes psychiatrists and psychologists providing care in individual and group settings. Commonly encountered primary complaints include: depression, anxiety, personality changes, sleep disturbance, cognitive impairment, subacute/chronic delirium, and side effects of cancer treatment including chemotherapy, hormone therapies, radiation, and steroids. We also work closely with palliative medicine in providing end-of-life counseling. 

Cognitive Neurology

During this rotation, fellows will collaborate with behavioral neurologists in the evaluation of outpatients with cognitive disorders. They will learn how neurologists approach this population and gain exposure to less common dementia presentations. 

Substance Abuse Psychiatry

Fellows collaborate with a substance abuse psychiatrist in outpatient management of older individuals who experience both addiction and other psychiatric disorders. 
 

The Geriatric Consultation/Liaison Service provides consultation and assessment services to older patients with psychiatric or behavioral problems who are undergoing treatment in UPMC’s acute care hospitals and medical and surgical services locations. This program provides consultation and education to all medical and surgical services, for both inpatient and ambulatory care cases. However, given the size of the UPMC health care system and the high volume of requests the Department of Psychiatry receives for consultations, geriatric psychiatry fellows only provide psychiatric consultations to older adults who are admitted to our medical and surgical hospitals. This reinforces the focus of training on late-life conditions commonly seen in hospitalized older adults such as delirium.

The Geriatric Research, Education and Clinical Center (GRECC) located at the VA Medical Center in Oakland provides fellows with the opportunity to work closely with specialists in geriatric medicine and neurology as part of multi-disciplinary teams. This rotation consists of working as part of a multidisciplinary team in an established Geriatric Evaluation Management (GEM) clinic, providing geriatric psychiatry care in a general neurology clinic, and participating in substance abuse treatment clinics for older veterans. During this rotation block, fellows will also collaborate with the medical team, providing care to older adults at the VA Community Living Center. When possible and desired, we will allow fellows to use time during this block to participate in ketamine and rTMS treatments at the VA.

The VA Pittsburgh Healthcare System (VAPHS) provides a unique training experience for geriatric psychiatry fellows. Fellows provide geriatric psychiatry consultations to older patients on the in-patient service, and the VA's skilled nursing facility.