Psychiatry and
Behavioral Sciences–

Stanford Outpatient Psychiatry

Clinics and Services

Stanford Inpatient Psychiatry

Stanford Outpatient Psychiatry

Inpatient Medicine

Stanford Neurology

Palo Alto VA Psychiatry

Menlo Park VA Psychiatry

Community Psychiatry

Kaiser Santa Clara

Bipolar Affective Disorders Clinic - Website
Under the direction of Terrence Ketter, this clinic provides consultation and ongoing treatment for patients with bipolar disorder as well as maintaining a diverse and cutting edge research program

Here residents learn principles and practices of treating outpatients with bipolar disorders using psychoeducation, supportive psychotherapy, and psychopharmacology. By the end of the rotation, residents should have the knowledge and skills to assess a wide range of patients with bipolar disorders with and without other comorbid (particularly substance use and Cluster B personality) disorders. Residents should be able to identify major subtypes of bipolar disorders and be able to manage common clinical scenarios, including emergence of depression, mania, and hypomania, and the transition back into the community following hospitalization. Residents will be thoroughly familiar with the adverse and therapeutic effects and dosing of the standard mood stabilizers (lithium, divalproex, and carbamazepine), neuroleptics, antidepressants and benzodiazepines. In addition, residents should have an introduction to emerging novel management options, including new anticonvulsants and atypical antipsychotics. Given the sometimes unpredictable nature of this illness, residents learn proficiency in crisis intervention by managing exacerbations of illness in outpatients, utilizing more intensive outpatient, partial hospitalization or triage to inpatient services. In addition to their clinical responsibilities, residents will attend weekly didactic presentations on the diagnosis and treatment of bipolar disorders. Residents also attend weekly case conferences and present complex patients for group discussion of diagnostic and management issues.

For more information see the Bipolar Clinic website, Bipolar Research or Dr. Ketters Faculty Profile.

Child and Adolescent Psychiatry Clinic - Website

Child and Adolescent Psychiatry's outpatient services is composed of eight specialty clinics that treat specific disorders within the wider range of childhood conditions.

Our interdisciplinary clinical approach includes a thorough diagnostic evaluation as well as the proposal of a treatment plan. Treatment plans are based on current scientific research and reflect the values, needs, and resources of the child and family. They often include the following therapeutic approaches: individual therapy, family therapy, group therapy, behavioral therapy, parent counseling and medication therapy. Coordination with the child's school is often recommended. The staff of the mental specialty programs and specialty clinics consists of Child Psychiatrists and Child Psychologists and includes both faculty and advanced trainees who are supervised by the faculty.

Geropsychiatry Clinic

This clinic is staffed by two full-time psychiatrists (Clinic Director plus a full-time, fellowship-trained geriatric psychiatrist) and one nurse practitioner. Faculty members have particular expertise in dealing with biopsychosocial problems of old age, refined use of psychopharmacology in the elderly, and dealing with complex issues interfacing medical-psychiatric illnesses. The clinic provides consultation for patients over the age of 65 with various psychiatric disorders. Many of these patients have psychiatric disorders complicated by biological and psychological manifestations of aging. Treatment includes psychopharmacological interventions, short-term cognitive-behavioral therapies and supportive therapy. All patients are at or over the age of 65 and approximately 60% female, 40% male. Most common diagnoses include affective disorders (approximately 50%), dementia (30%), anxiety disorders (15%), and others (5%).

Residents spend the majority of their time learning to evaluate psychiatric disorders complicated by biological and psychological manifestations of aging and to use psychopharmacological interventions effectively and safely. They also learn to use short-term cognitive-behavioral and supportive therapy as an adjunct to medication management. An average resident caseload is 4-8 patient per week for a an average of four patient-hours per week. Every patient seen by a resident is also seen by one of the faculty members, at the time the patient is seen, thus providing supervision every case seen. Additionally, residents spend 2 hours weekly in seminars and case conferences, in addition to 3-4 hours in regularly scheduled seminars.

Individual Psychotherapy Clinic

This clinic is designed to provide residents training in long-term psychotherapy. Residents treat patients with many psychiatric disorders that require long-term psychotherapy and possibly pharmacotherapy. The most common diagnoses are affective/adjustment disorders, including major depression, personality disorders with prominent cluster B symptoms, occasional dissociative disorder or psychotic disorder.

Starting at the beginning of the PGY-2 year residents are assigned patients who have been carefully screened as appropriate for long-term psychotherapy. Residents see 2-5 ongoing therapy patients for the duration of their residency training (PGY-1, 2, 3) and each week receive 1 hour of individual supervision per therapy case. Residents may choose to have any number of supervisors each year, thus affording maximum exposure to psychotherapeutic orientations. . However, residents usually have two or three supervisors, depending on their year in training. Educational methods include indirect supervision with faculty supervisors and may occasionally include direct patient care with faculty supervision in the room with the patient, seminar sessions, distribution of journal articles, texts and other educational materials. Also, residents are also encouraged to pursue more individual work with supervisors, including work at the Psychoanalytic and Jungian Institutes in San Francisco. Many residents have pursued interests that supervisors have fostered, e.g., in existential psychotherapy or transpersonal psychotherapy).

Medical Psychotherapy Clinic

One function of this clinic is to evaluate all prospective liver, heart, kidney, lung transplant patients for psychological suitability to receive a donor organ. However, we primarily serve the psychiatric needs of patients and families of patients diagnosed with serious medical illnesses (e.g. end organ failure, cancer, stroke, HIV, cardiac disease,and diabetes), injuries or somatization/conversion disorder. Treatment includes individual, family and group psychotherapy, psychopharmacology, hypnosis and relaxation techniques. Close communication with primary physician is an essential activity of this clinic. Clinic staff works with patients during all phases of the illness: helping with prevention; coping with a recent diagnosis; adjusting to a new lifestyle or terminal stage disease; and seeing family members through bereavement.

While residents have individual supervision on all cases they are encouraged to formulate and execute individualized treatment plans for each of their patients.

Mood Disorders Clinic - Website

This clinic provides consultation and ongoing management in pharmacotherapy for patients with major depression, dysthymia and anxiety disorders.

The patient diagnostic mix includes 60% major depression, 30% bipolar disorder, 5% anxiety disorder, and 5% schizophrenia and other psychoses. The demographics of this population is approximately 65% female and 35% male; 70% Caucasian, 15% Asian, 10% Hispanic and 5% African-American; age range is 18-65. An average case load is of 8 hours of patient contact per week, consisting mainly of medication management or group consultation interviews. In addition to in-room supervision on all cases, residents have weekly didactics in psychopharmacology, a weekly case conference, and a bimonthly group interview of a complicated consultation.

Moreover, the faculty operates a large research program in mood disorders with 15-30 clinical and basic science protocols at any given time.

For more information see the Depression Research Clinic website, Depression Research or the faculty profiles for Dr C. DeBatista, Dr H.B. Solvason.

Psychopharmacology Clinic

TBD.

Neuropsychiatry Clinic

Residents see patients for 4 hours per week and participate in a 1-hour weekly seminar each fall. Educational methods include direct patient care with faculty supervision in the room with the patient; discussion of treatment protocol for each patient with the resident; distribution of journal articles, texts and other educational materials.

In conjunction with the neuropsychology service we provide evaluation of cognitive functioning and differential diagnosis between personality and organic impairment. Appropriate referrals include patients who may have sustained head injuries or are suffering from possible dementias of senility, neurosurgical or epileptic patients, and those with chronic disease that may be accompanied by cognitive impairment. The service also provides treatment to assist the patient who may be dealing with loss of functional capacity.

Beginning December 1998, one Neurology resident per month will rotate in the Neuropsychiatric Clinic. This will provide an opportunity for interface with Psychiatry residents.

Primary diagnoses in this clinic population include a variety of pronounced psychiatric disorders associated with epilepsy, stroke, Parkinson's Disease, multiple sclerosis and dementia disorders (especially frontal temporal dementia). Patients often have major depression, psychotic or cognitive disorders associated with their medical illness. Treatment includes pharmacotherapy and cognitive behavioral therapy.

The resident is expected to master major biological and psychological issues associated with neuropsychiatric disorders. The resident should be adept at psychopharmacological interventions and neuropsychiatric work-ups and diagnoses, as well as supportive in crisis intervention. Residents are also encouraged to participate in research protocols of faculty and to develop their own research studies during their stay in this clinic.

Obsessive-Compulsive Disorder Clinic - Website
Under the direction of noted OCD researcher Dr. Lorin Koran, this clinic provides evaluation and treatment for patients with a primary diagnosis of obsessive-compulsive disorder or tichotillomania. Many of these patients will also have major depression, panic disorder, alcohol abuse, phobias, or significant personality disorders. Treatment includes medications, behavioral therapies, family counseling, support groups. There are also research opportunities such as clinical drug trials.

Residents see patients for 5 hours per week, participate in OCD group case conference for one hour per week and attend a 1-hour weekly conference related to this and other clinics in the Biological Psychiatry Section. Resident case loads are monitored to assure exposure to different diagnostic groups. Primary diagnoses: OCD 80%, trichotillomania 10%, body dysmorphic disorder 5%, other 5%. Patients frequently are comorbid for major depression, dysthymia, delusional disorder and substance abuse. Treatments include pharmacotherapy, behavioral therapy (exposure and response prevention) and cognitive-behavioral therapy. The diversity of this clinical population is as follows: Adults, aged 18 and older, male (45%) and female (55%), all socioeconomic classes with 25% non-Caucasian. Supervision is provided for 90% of patient visits by faculty in the room. In addition, there is a one-hour group supervision session. Residents are expected to master complex psychopharmacology, behavioral interventions and interventions aimed at improving family understanding and coping with the patient's illnesses. Furthermore, residents are encouraged to participate (in their free time) in clinical research studies of the faculty. Several recent residents have had their work published published in peer reviewed journals and the lay press (e.g. New York Times).

For more information see the OCD Clinic website, OCD Research or Dr Koran's Faculty Profile. Also, see Treatment Groups for information about participation.

Psychosocial Clinic

This section comprises the Behavioral Medicine Clinic, Interpersonal Problems Clinic and Family & Couples Clinic. The clinic is staffed by 3 full-time psychiatrists and 2 full-time psychologists, in addition to 2 full-time staff psychologists and 1 part-time staff Ph.D. The patient population can be described as 70% female, 30% male; 85% White, 5% Hispanic, 5% Asian and 5% African-American. All ages between 18-70, with the majority age 25-45. Approximately 30% anxiety disorders, 25% depression, 20% eating disorders, and 25% mixed between various other difficulties (e.g., primary Axis II disorders, chronic pain, obesity, adjustment disorders, marital problems).

The clinical rotation is ideal for residents wishing to learn more about cognitive-behavioral therapy for specific psychiatric disorders, dialectical behavior therapy for Axis II disorders, integrating cognitive-behavioral therapy with other forms of treatment and family & couples treatment. An average case load consists of 10-12 psychotherapy cases weekly and 8-10 hours of medication cases. Teaching on this rotation takes place in individual supervision, and case loads are monitored to assure that residents obtain an adequate balance of cases. All residents have a minimum 2-hours weekly in regularly scheduled supervision. One meeting is with a full-time faculty psychiatrist with a major focus on psychopharmacology and issues on the interaction of psychotherapy and psychopharmacology. The other meeting is with a psychologist and the focus is on cognitive therapy as applicable to specific cases. Additional supervision is available on an optional basis.

Sleep Disorders Clinic - Website

Founded in 1971 by William C. Dement, M.D., Ph.D., the Stanford Sleep Disorders Center was the first such program in the world. Dedicated to the research, evaluation and treatment of sleep problems As the first program of its kind in the world, the clinic has gained an international reputation for its research and clinical programs. Today, the Sleep Disorders Clinic continues to offer comprehensive evaluation and treatment of all sleep disorders including: narcolepsy, sleep apnea, insomnia, restless leg syndrome, nocturnal myoclonus, sleepwalking, nightmares, night terrors, enuresis, erectile dysfunction. All patients referred to the Sleep Disorders Clinic undergo extensive evaluation. Depending on the diagnosis, we will perform a sleep study or studies and develop an individually tailored treatment plan, which may include medication, light therapy, behavior modification or Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) treatment. Our multidisciplinary team includes psychiatrists, neurologists, and pulmonologists, as well as psychologists and technicians. When appropriate, we can provide patients with instrumentation for ambulatory monitoring and next-day interpretation of results. After further evaluation and treatment, as necessary, we develop a treatment plan. In most cases, we refer the patient back to the referring physician/allied mental health professional for completion of the treatment plan. Our staff remains available for ongoing consultation. Investigational Approaches Research efforts of the Sleep Disorders Clinic are ongoing.

For additional information, see the Center of Excellence website, and the website for the Insomnia and Behavioral Sleep Medicine Program .

Women's Wellness Clinic - Website
The Women's Wellness Clinic specializes in the treatment of psychiatric disorders which affect women, including postpartum depression, Premenstrual Dysphoric Disorder (PMDD), menopause, infertility, and chronic pelvic pain. The clinic population is about 80-90% female, males are seen in couples or partner's therapy. All ages from 18-70 years are seen, with the majority being women in their reproductive years; about 60% are Caucasian, 25 % Asian and 15% African-American.

The average resident assigned to this clinic carries a case load of five patient-hours per week. This represents four hours of psychotherapy with or without medication management and one hour of marital therapy, all with in-room supervision. In addition, residents have one to two additional hours of individual supervision and or informal case discussion, plus weekly psychopharmacology conference. Residents conduct diagnostic evaluations, consult with referring physicians, conduct individual and marital psychotherapy, both short and long term, and psychopharmacology. Residents have participated on an elective basis in educational groups and group therapy and in ongoing research protocols.

For more information see the Women's Wellness Clinic website.

 

Stanford Medicine Resources:

Footer Links: