Diagnosis

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She said she was depressed and anxious.  She was 38, large, and animated, with almost glazed over excited eyes, and talking a mile a minute.

Every person who tells me he or she is depressed gets asked the necessary questions to determine if he or she has manic-depressive illness, otherwise known as bipolar illness. The only way to determine this that I know about is by asking.  Nobody who is depressed and comes in for treatment of same is going to spontaneously volunteer the info I need to make the diagnosis. Read more on Bipolar Could Be Misdiagnosed As Depression…

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We can’t pick our diagnoses like we pick what outfit we are going to wear.

I remember an encounter where the psych symptoms had political overtones, although I’ve handled plenty of other cases that had the same resistance to being diagnosed.

“I’m scared of this bipolar thing,” he said.  “Everyone I know who has it is really sick — like crazy — and I’m not sure I want to take medication for it.” Read more on Great Manics of History…

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I was working in psychiatry at one of those university medical centers, in a big city in the middle of a sparsely populated state. This 54 year old Caucasian farm wife had been referred to me by a surgeon — a rare state of affairs, since most of the surgeons I knew at that time and place did not believe in psychiatry and would not have referred a patient unless out of desperation.  No note, no phone call to the front desk of the psychiatry clinic, no nothing.  She just walked in and explained that the surgeon had basically kicked her out and said she was crazy. I asked her why they sent her.  Her answer is so burned into my consciousness that I can give it verbatim these many years later.

“It really bothers me that I don’t have a belly button.” Read more on Somatization Is Something To Talk About…

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She was 29 and I thought she was beautiful, although nobody else did, I am sure.  No normal scales in my clinic could weigh her, but I would put her between four and five hundred pounds.  Except for someone who brought her to see me ( I think, in the back of a pickup truck, but I did not press the issue) she did not leave the house. Others did her shopping, she had some kind of public assistance.

She was on the standard medication for her depression as well as her panic attacks; paroxetine (Paxil) 40 mg, to lower their intensity and frequency, and a little bit of Xanax, which is supposed to stop such attacks in their tracks.  She used it sparingly, hardly at all — no really — she did not use it.  It did not work.  The most addictive medication doctors give for this sort of thing and she didn’t even want it because it didn’t work.   I love this woman, I loved her candor.  She told me the last  psychiatrists had renewed these medications for the last six months,  even though they didn’t work.

What was wrong??? Read more on Panic and Diabetes…

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I was at a Midwestern medical center, taking internal referrals.  The referring physician was a medical doctor I had never heard of.  Of course, there was no information about why a 70 year old grandmotherly woman with white hair and a surprisingly pleasant smile had been referred.

She told me she had headaches.  She was very happy that she did not have one on that day.  They were horrible and even an emergency room injection of narcotics did not do anything for them once they started.  They were variable, sometimes brief and sometimes lasting a whole day.  They could be on either side, or both, but most often cut a line from above one ear to above the other ear.  They were getting worse and quickly.

One of the smartest things anyone ever told me (It was an ancient professor in France, who was so experienced he had to say smart things once in a while) was that if a patient could not be diagnosed, or did not make any sense, just spend more time with the patient and get more history.  He said that very often patients knew exactly why they had the problems they had. Read more on Unconventional Cure — Leave The Headache Behind…

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He was a new patient to a community clinic.  They warned me to be careful with this 48 year old, thinking he was “really crazy, schizophrenic or something.”  The social worker had tried to do the intake and told me he was confusing, “not your average bear.” Strangely enough, most of my female staff already had told me they were attracted to him; an unusual state of affairs.

I was struck first by his clothes and demeanor.  A little like Michael Douglas as Gordon Gekko.

This is not usually what new patients look like, schizophrenic or not, when they come in. No wonder the front desk staff already had a crush on him (“sigh!”).  We didn’t get men in designer suits in these parts. Read more on Otherwise, The Patient Was Normal…

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One of my special shrink magazines had a story headlined: “DUI offenses may signal untreated Bipolar Illness” in the November 2009 issue.

Since you have to sign up for a free account to read the article, and since they prefer you be a mental health professional, I’ll just tell you about it.

I don’t think you have to have twenty years of medical school and psychiatry training to reach the conclusion that anyone who has DUIs — especially a bunch of DUIs — should be screened for bipolar disorder.  This radical conclusion was reached by Dr. Mark J. Albanese of Harvard Medical School and his colleagues report. Read more on Dual Diagnosis — Two Ways To Describe One Thing…

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I looked at her, better dressed than most of the folks at the clinic where she was seen, with an open mouth.  I had to take a few extra minutes to figure out what I was going to say next.  In case you have not guessed, that is pretty far from my usual state.

“I have a chemical imbalance,” she said.  She looked a little like Sharon Osbourne, hip and trendy but expensively dressed.  “He gave me some medicines that really helped, like Xanax and Ativan, and either of those would be just fine.”

Medicate

I freely admit that psychiatric diagnosis and treatment have a long way to go to meet either the organic precision of the surgical specialties or the subjective enthusiasm of the non-prescribing mental health professionals, such as psychologists or psychotherapists.  But there are practitioners out there who are either so indifferent or so pressured that they rattle off words without meaning and give prescriptions that hinder more than help.

Read more on Chemical Imbalance — A Mythical Diagnosis…

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