Wednesday, April 16, 2008

The interesting thing about delusions...

No matter how crazy they are, most patients just sort of assume that you believe them.

I was worried about how I would respond if someone busted out with something really nuts and one of those "You gotta believe me, doc!" sort of rants you see in the movies. But really, it's been more like "It's that cat. The one that can smell you and hunt you down and suck out your soul. It's comin' for me."

It is WEIRD.

It is also kind of disturbing how profoundly your mind can betray you. One dude can't even draw a clock anymore; he was totally fine three days ago. It's amazing what a little acute renal failure and oxycodone can do to your brain.

Okay, I have to get back to memorizing the psych dictionary. That's mostly what you are tested on for the psych shelf; it's the DSM criteria, which are basically just long, complicated definitions. You know, stuff like the patient has X if they have 2 from column A and 3 from column B. Which makes for a lot of memorization, since column A and column B are usually not too short and fairly complex. There are also a lot of sister diagnoses, meaning that A is just like B except with (or without) symptom whatever. It is interesting, at least.

So far I only have one diagnosis: generalized anxiety disorder. I keep reminding myself that I am just a little too high functioning to truly have a disorder, but I definitely have most of the symptoms:
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). CHECK!
B. The person finds it difficult to control the worry. CHECK!
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months).
-restlessness or feeling keyed up or on edge CHECK!
-being easily fatigued CHECK!
-difficulty concentrating or mind going blank MEGACHECK!!
-irritability Ask my husband!
-muscle tension OH LORD YES!
-sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) Okay, not this one... KIDDING! ABSOLUTELY!
D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in a Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder. Okay, I may be a little afraid of being embarrassed on rounds, does that count?
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder. Not as far as I know...
F. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. THIS is the one that saves me. I don't think I can say that this one is true.

So there you are. I'm one step away from a psychiatric diagnosis. How come I can't get my hands on any of the good meds?!?


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DK said...

See? Look at that diagnostic panache. You're a born psychiatrist. Pah, dermatology....

Love the spam comment. How do you list that on your resume? "Spam commenter, 2007-present. Duties included making annoying comments on blogs I'd never read while peddling snake oil. Advanced training in HTML links. Excelled at random Google searches."