Behind another desk

Currently, I combine two jobs, one as a researcher and the other as a psychiatry resident. I've been in training to become a psychiatrist for two years now. A year ago, I cut down on my clinical hours to set aside one day for research of study bipolar disorders, a condition that I hope to study further as part of a Ph.D. program.

As a resident, I switch to a different department every six months, allowing me to experience different areas of the psychiatric field and to observe different methods of treatment. What makes this job even more exciting is the chance to see a lot of psychiatry outside of the wards, such as at emergency services at the airport and at police stations. Observing all of these different styles and habits in the treatment of psychiatric patients made me wonder how much of our treatments are actually based on the evidence we have. This question is probably what got me interested in doing research in the first place.

Through my experiences in my residencies, I have developed a special interest in patients with bipolar disorder, as this disorder was completely incomprehensible to me. How is it possible that a patient can lead a seemingly normal life most of the time, but then become completely unable to function due to a radical and sudden change of mood? What fascinates me is the possibility that a patient can lead a completely normal life for most of the time, but can then become completely unable to function due to a change of mood. I decided to approach a professor of bipolar disorders and ask him if I could set up a study with him. He was very enthusiastic and in our first meeting he told me that he was really interested in a new way of thinking in the field of psychiatry, called the staging model. A staging model divides psychiatric disorders into various stages, from mild, prodromal symptoms (stage 1) to a chronic state with, in the case of bipolar disorder, rapid cycling (stage 4). This professor still had a database with retrospective data that had never been published before. This database contained almost 200 life charts, which are graphs that tracked the mood of bipolar patients for years. This data set would be perfect to apply the staging model to.

I have spent countless hours staring at life charts, in order to make data suitable for analysis and to establish a suitable staging model for bipolar disorders. At some point, while sitting all alone late at night behind my desk, drinking my 15th cup of coffee for the day, I almost lost track of what I was looking at. At that point all I could see were lines that go up and down. I can recall one moment during my research particularly well. I was looking at a chart from a patient who had experienced extreme mood swings for over ten years. Suddenly, it hit me, I finally realized how horrible his life must have been. He reminded me of some exceptional cases in the psychiatric clinic, people with extreme suffering that just don't seem to get a stable mood despite all kinds of treatments including medication.

This example shows how easy it is to lose track of what is really important. I am convinced that it is important for any researcher to be in touch with the group of your interest. By combining the clinic with research, a researcher is able to better understand their data and this makes for better studies. And perhaps the same applies in reverse – clinicians might benefit from doing research too.

Afra van der Markt, AIOS GGZ inGeest (EMGO+)

Afra van der Markt