We did not really know where this patient was at. I figured out he was some kind of bipolar, because he talked about mood swings.
When I first saw him, he seemed to have a delusional system that had something to do with idealizing a woman pharmacist and feeling he had offended her and thinking obsessionally about her.
He was starting to idealize me, and commenting on my hair and clothes, and I will admit that I wanted to fix this guy as quickly as possible, so I would not get incorporated into one of what sounded like a series of delusional systems. He had come into the clinic several times, usually with sequentially weakening delusions — always an idealized woman. He gave the impression of being gay — always wearing at least one piece of jewelry that I would have expected to see on a woman. Read more on How To Shock Your Doc — New Uses For A Medicine Bottle…
Filed under medicine, Personality Disorders by on Jan 5th, 2011. Comment.
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…
Filed under depression, Diagnosis, Disease by on Nov 5th, 2010. Comment.
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…
Filed under Diagnosis, Personality Disorders by on Oct 28th, 2010. Comment.
He was 50 and he told me right up front, “I need more of the medications the other doctors give me. You can just renew them for me; that is why I am here.”
That’s probably the second most common thing a patient says to me. The most common is, “Why didn’t my other doctors tell me that?” No, I don’t just renew prescriptions, I explained to him. I told him that I need to get to know my patients, so that I can make sure that I give them the correct medications.
“I don’t want you to do that,” he said to me. “All the other doctors just give me renewals.” I told him I didn’t much care, that was not how I worked, and if he wanted renewals he would have to tell me how he was doing. Read more on Self-Medicating On Pot And Booze As A Life Plan…
Filed under Substance Abuse by on Sep 14th, 2010. Comment.
She was 33, blonde and attractively dressed. She had been stable on some medications for bipolar illness for many months before seeing me for a renewal. She told me her marital relationship was wonderful. They ran a little boutique together in the historic part of downtown. Not getting rich, but doing what she loved.
Only one problem — her husband said she became difficult when she drank too much coffee. I asked for some description of the “difficult.” She noticed she was nervous and had trouble cooling down later. She had “panic attacks,” which had not been a problem before.
They sounded exactly like the description of that disorder in DSM-IV – the one nobody likes applied to them – the “B” word. The things she said her husband had said about her sounded like the criteria for mania. No sleep, loud arguing, anger, nerves, etc. “Let’s look at cutting out the coffee,” I told her.
She normally drank as much as a half-pot in the morning at home before opening the boutique. That may not sound like much, but others have had similar symptoms from less. She had figured out herself that coffee in the afternoon messed up her sleep beyond description.
Caffeine has a LOT of effects on the body. If it had been a modern discovery, instead of the old myth about some frisky goat in the near east chewing berries off a tree and surprising a young shepherd by omitting sleep, caffeine would have caused the FDA a struggle to pass it because it does so many things.
First, coffee is absolutely NOT the only beverage that has it. There is generally more in caffeine-containing cola drinks. Read more on Caffeine As A Bipolar Trigger…
Filed under Stimulants by on Mar 8th, 2010. Comment.
This was the last item I posted on the blog Nov 6 before we took it down a few days later to start the overhaul. In case you didn’t get a chance to read it, I’m reprinting it.
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She was a saleswoman prone to bipolar mood swings, stable on a brand name prescription mood stabilizer. It had originally been marketed as an anticonvulsant and her medication was doing its job. She recently returned to full-time work after a manic attack had cost her both her marriage and the custody of her child.
“I don’t have the insurance I once did; I now sell home decoration instead of heating fuel like I used to. The money is better, but now all of a sudden the cost of my medication is really ridiculous. The generic is lots cheaper.”
Read more on What Happens When A Pill Gets Inside Your Body?…
Filed under Generic drugs by on Nov 20th, 2009. Comment.