Friday, June 19, 2009

How Do You Know?

ClinkShrink was talking about how it annoys her when a patient says he hears voices, and with no other information, the nurse records a diagnosis of "schizophrenia." One of our readers said they would assume that a prisoner who reported he was hearing voices was seeking specific medications (presumably for reasons other than to stop the voices or directly treat the symptoms of schizophrenia). I read the comment and thought, "Wait, sometimes people hear voices because they have schizophrenia! You can't just assume he's drug-seeking for devious reasons!" Just as one can't assume that hearing voices is 1) an auditory hallucination (it's not if the voices are actually there and the result of real people talking, or if it only occurs in the time right before sleep) or 2) that the voices aren't the result of hallucinogenic drugs or alcohol withdrawal in a prison population, or 3) the result of another psychiatric illness as schizophrenia is not the only psychiatric disorder where people hear voices, well, we can't automatically assume that a patient who hears voices
doesn't have schizophrenia! This is why we take a full history and observe patients over time.

Okay, so I'm sitting with two friends in a restaurant and our waiter is really really skinny. Neither friend is a mental health professional, but we all notice the skinny waiter. One friend says "I wonder if he has anorexia?" The other friend immediately says, "Nah, he's just skinny." I said nothing, but I thought, "How do you know?" He could just be very slim, or he could have an illness (AIDS, cancer, TB, cocaine: they all cause weight loss), or he could have an eating disorder. Really, all we knew was that he was skinny, that he wore a colorful t-shirt, and that he brought us the right food. To figure out any more, about either his medical or psychological state, we'd have to ask questions that just weren't appropriate to the setting. Still, my friend was absolutely certain the waiter didn't have an eating disorder.

Maybe it's human nature that we jump to conclusions, but people do it all the time.


alfavita y2k said...

1 First of all, in case of prison patients, the history of patient should start with the fact that he is able to decieve, steal, murder just for the hell of it.

Secomd you should put in consideration that if th epatient is lying to a doctor, he allready has schizophrenia, and if he is even lying to the doctor in ordre to get free drugs and relax, he might be even mentally retarded.

I wonder how do you expect a psychiatrist to care about symptoms like "hearing voices" in order to start writing Schizoiphrenia, when th epatient is allready a dangerous criminal.

In case of "Hearing voices" it might be the only symptom, taking as a starting point, when we are talking about a regular patient in a regular Psychiatric hospital for civil patients.

2 You should really know english, before writing something, otherwise it ends just with amess of a confused childish blubbblings.

If you are saying someone is "Very skinny", it might be a model maybe. In case you are claiming that someone who was unnaturally skinny fell to uour attention,it means that this said person is sick.

Becouse any person might be naturally skinny or unnaturally skinny. There is a huge difference between the two concepts, and the way you are using words in a childish way, suggests me that probably some illegal drugs were used just before wriring today's blog piece.

In case a person is unnaturally skinny, which means visible signs of any kind of lethal sickness, it is very implausible that he would be serving food in a public place without no customer getting upset.

Anonymous said...

The more important question is, does it matter? Just prescribe Seroquel and be done with it!

Anonymous said...

Wow, ALfa! Is it necessary to be so rude? It's okay to disagree with someone's opinion but you don't need to be nasty about it. BTW before you criticize somebody else's writing, you might want to try using spell check!!

Dinah, I was wondering why you stayed quiet during the conversation about the skinny waiter? Since they are your friends, couldn't you tell them what you just told us? Just curious.

Dinah said...

I figured someone would ask why I stayed quiet!
Well, I couldn't prove that the waiter either did or didn't have anorexia and saying "how do you know?" would probably have backed my friend down and left her feeling under attack (he comment, 'Nah, he's just skinny,' was innocuous enough and we'll never see him again, and a "missed diagnosis" by restaurant patrons has no implications.-- What would be the point? I was already hassling her about something else, and ranting is more powerful if it's targeted and limited to a few causes.

It only made it to the blog because the feeling it invoked coupled with the "he wants meds" sentiment.

TheCrazyMusicLady said...

Made me think of my patients. If every child that came through our doors hearing voices was slapped with a schizophrenia diagnosis, I think we'd have the largest pool of early onset schizophrenia diagnoses ever!

With the nurse in the prison, I think that probably occurs more as a result of lack of appropriate psychiatric training on the nurse's part. Surely if she had paid attention during her rotation with psych, she would have realized that a number of illnesses can cause auditory hallucination as well, not even taking into account your mention of before bedtime voices, and being confused about hearing real people.


alfavita y2k said...

"Hearing voices" there are two basic common situations where a patient might be braindamaged.

1 "Hearing voices" might be a sick state of mind provoked by a huge personal stress, and put the patient in a state of deep alienation that involves loss of conasciounsness and mental retardation. The patients starts talikng to himslef inside his mind in a way thtat resembles the voiceover in old black & white movies about private investigators.

2 "Hearing voices" might be a real state of mental disfunction such as auditory hallucinations thta make th epatient belive thta someone else is talking to him form inside his brain provoking the fake feeling thta he is in telepatic contact with someone who wishes to comunicate with him. And this is not self aware schizofrenia, this is a very dangerous state of madness that makes th epatient dangerous to himself and others.

The second case involving auditory hallucinations exists only as external cause, when the patient was mesmerized during sleep, and waked up under deep hipnosys. IN thi scase the mentally sick condition of th epatient is to be classified as attempted murder as in any case of mesmerized people.

tracy said... certianly are, uh, entertaining....

alfavita y2k said...

I don't think I really am. I just knwo the reality of any prison inmates life.

You should know that if you put two inmates in th esame room, one of two woill certainly try to mesmerize him in ordre to make him his own slave.

They don't care if mesmerization is killing person's brain. It's the wonly way they know to comand each other, becouse they were born in a community of gangsters and prostitutes.

In cases of criminal mental patients you laways should know what exactly is th esocial situation inside the community, before attempting any reasoning in order to make a decent diagnosys based on cause - effect logic.

TheCrazyMusicLady said...

watch out Tracy.. you might be getting sleeeepppyy

kazza26 said...

i get this all the time,most of my friends are lets say over weight.Anyone thats slim they accuse of being anorexic and that includes me.i am 5ft 8 and 140lb so its hardly anorexic.everytime i see them they try and feed me i feel like one of the children from hansel and gretal.Its a waste of time trying to explain i eat normally and just have a good metabolism rate which will probley deline in time.I had to laugh the other day when i saw a really overweight man wearing a t-shirt saying ` i beat anorexia

Anonymous said...

alfay2k, What is your deal? I was starting to think you were a spambot due to the nonsequiters, poor grammar, and typos. Yours appears to be one of the most uninformed, even ignorant, voices on this board. Not trying to hurt your feelings, but maybe you should think before you type.

Anonymous said...

I thought the blog post was well-written. I had experienced same reaction when I read the previously posted comment that the poster would just write "Quel-seeker". That struck me as being as bad as the nurse writing "schizophrenia". I am a patient, but shouldn't an intake nurse write observations, not conclusions and diagnoses? Uninformed people probably jump to conclusions more than well-educated and trained people. Usually the more one knows about a condition, the more possibilities can be thought of.

To other posters: I think Alfa is reporting his/her view of reality. The theme presented today, that hypnosis is the cause of apparent mental illness, has been presented by Alpha before. It does not match our reality, but that does not make it ignorant, just a really different view of reality. Perhaps this conclusion is the result of Alpha feeling he/she has been hypnotized or mesmerized. It could be a conjecture one might make who found oneself in an altered state of mind, that someone evil is responsible, not that it's mental illness.

alfavita y2k said...

I am sorry, are you claiming that evil does not depends from mental illness? Are you saying that some people just prefer spending their life in prison, rather than living a normal life with family at home?

If you don't know, any person born from normal parents is sane in mind and body and will never get sick mentally or physically.

If you see someone having prpoblems on mental or physical level before reaching the senior citizen age, he was simply born from degenerated parents.

Before the 1960s this kind of mentally or physically ill people were called sons of bitches, after the 60s, it become evident that even the highest social class members were degenerates too, and now if you do not know exactly the beginning of the whole story of this epidemics of madness amongst physically goodloking peple, you will never be able to make any progress in psychiatric field.

You see we allready had the infamous Sigmund Freud, who was mesmerized by his stupid crazy parents, and becouse of this he beacme delusional, and was able to write so many bullshit, that even today people consider all psychologists to be some kind of a nutcases.

tracy said...

Sooooooo about you.......? -_- Hee, i <3 you! :)

Liberal Jarhead said...

I would not be able to come to a conclusion without more info. I would not think it likely that the person was med-seeking, because any time I've talked with people who'd been given antipsychotics they didn't need, they've described the effects as pretty unpleasant - the med-seekers in the prisons where I worked were normally trying for benzos, and would try to convince staff that they were out of control emotionally but not that they were delusional or hallucinating. The patients who actually were having symptoms of schizophrenia were more likely to get highly offended at the suggestion they had a problem and to refuse meds.

If a person was malingering by feigning psychosis, the goal was typically just to get housed in the hospital unit instead of general population - usually because it was safer, but once in a while because they had been assigned by gangs to carry out hits on other inmates who were already in the hospital.

A lot of our guys really were experiencing auditory and/or visual hallucinations, though, and it wasn't usually that hard to tell who was who, because the malingerers would present unrealistically, drop the act when they didn't know staff were watching, or make other mistakes.

Retriever said...

In addition to previous mentioned possible causes of auditory hallucinations, I would add possible brain tumor or head trauma. Or some kind of seizure disorder? Quite apart from rapid involuntary detox. That is interesting about some people actually seeking seroquel. People I know who were prescribed it hated it, said it made them feel like fat stupid sloths, no energy at all.

Anonymous said...

If you loose a turn, get a screwdriver.

Bee said...

ROFL @ alfavita y2k

People accuse strangers of having eating disorders all the time due to a lack of understanding about the disease - in all its forms. I believe it is no better to accuse someone of having anorexia as it is to claim that someone is schizophrenic based purely on their appearance. I think you are right in disagreeing with your friend. If I were you I would open discussion about it as it is something that I think needs to be addressed, generally.

You or your readers may find these research articles interesting:

Anonymous said...

apparently your friend is rather ignorant as to exactly how much physical work is involved in the hospitality industry. though it is true that there are many overweight servers, i have never been able to understand how - i've been in the industry myself for ten years and the nature of the job itself always kept me on the thin side. then again, i have a very fast metabolism. still, that job requires near-constant walking. it is rude to assume, also, that every thin person is sick or has anorexia. i find it amusing that our society as a whole doesn't look at a fat person (generally) and start secretive conversations about how "sick" they must be, or how they have a "disorder." it's like everyone is scared of offending fat people, but they make no bones of ripping a thin person to shreds. i don't get it.