She was 28 and pretty and sweet and came in for depression. It was only systematic questioning that confirmed she was manic-depressive. Actually her next-door neighbor had seen a television show on manic-depression and had made the diagnosis a couple of years before, long before this woman had ever seen a psychiatrist. Her episodes had curiously enough been regarded more as amusing than as dangerous, so nobody had ever done anything about treatment.
By the time I knew anything about her, she had already had one child, and was pregnant with her second.I always believe in coordinating forces with the obstetrician/gynecologist when caring for a pregnant woman.I rarely get phone calls returned, but this is the way it should be, especially if someone has brought up the question of psychotropic drugs. She had never seen a doctor; her first child, and this one, had been delivered by a nurse practitioner midwife. The one thing I am absolutely sure this woman did better than any physician (except me) is answer phone calls. She was obviously thumbing through the old chart on the other end of the line when she told me: “After the birth of her last child she ran after her husband with a kitchen knife. She destroyed a bunch of stuff in the house. We did not know whether or not to believe the husband. After all, he had a serious history of drug abuse. They were sent to counseling; there is nothing more in the notes.”
It took all I had to keep from yelling into the phone at the top of my lungs. Read more on “Postpartum Psychosis”…
Filed under depression, Diagnosis by on Nov 9th, 2010. Comment. 
He did have obsessive compulsive disorder. He had been on a variety of medications which one might expect to be helpful with that, but which had not. In my experience this was not uncommon. He was seeing a therapist who was trying to help him with this, but who was doing traditional “insight oriented” therapy. Of course, this did not work. His worries were mainly about cleanliness and order; common ones. I recommended the most recent edition of hte book I have been recommending for years, in its most recent edition. (Bantam Press) Despite my efforts to avoid making his therapist sound like an idiot, I sent him to some of the wonderful free self-help you can find on the internet. But wait, there’s more. He said that he frequently heard, in his head certain lines or phrases of songs he had performed in the sixties. Not whole songs or even parts he liked. Just opening lines, or one line or phrase, that would repeat an infinity of times. He had tried to drown it out, all sorts of things, and yet he felt victim to it. It was frustrating and he did not know how to stop it. This was not conventional obsessive compulsive disorder. Read more on Musical Hallucinosis — Too Much Of A Good Thing?…
Filed under depression by on May 14th, 2010. Comment.