Today I had my first behavioral science case conference and it was one of the most captivating experiences I have had yet in med school. A quarter of our class (about 50 students) decked out in our white coats filed into a small room in the behavioral health center at the nearby hospital and watched our professor interview an actual psychiatric patient. I won't share any specifics due to patient confidentiality but I think we were all surprised by the level of delusion we witnessed today.
Some thoughts from that session:
- When interviewing a possibly psychotic patient you must always remain calm and understanding. The patient will be watching to see if you can handle the story they're telling before they are willing to reveal everything.
- When appropriate, only challenge the delusion once - just to see how solid it is. Then back off and regain the patient's trust. Challenge in this case means merely asking if the patient has ever doubted that the delusion is real - not yelling at them or anything truly confrontational.
- You must be careful about your emotions when dealing with medication non-compliance. Whereas it might be frustrating with other more physical medical problems, remember that non-compliance is actually part of the illness with psychiatric disorders.
TIL: Deer Hunter is a messed up movie. I'm pretty sure our professor wanted to teach us about PTSD by giving us PTSD using the most disturbing parts of this movie.
If a person with depression has one manic episode ever, then they are diagnosed as having a bipolar disorder.
Generally, bipolar patients who are undergoing treatment maintain the same level of symptoms throughout their lives while schizophrenic patients progressively decline.
1 in 7 people with untreated depression and 1 in 5 with untreated bipolar disorder will die from suicide. There is an emphasis on untreated here, but these numbers are still frighteningly high.
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