psych exams

next monday and tuesday will be my last end posting exams.

i hope i can do well in psychiatry inshaAllah.

please pray for me and my batch.

jazakumullahukhairan kathira.

MDD

at the clinic today i clerked a middleaged chinese lady and diagnosed her to have major depressive disorder (mdd) with anxiety symptoms. i had to spend a long time reassuring her about her condition and convince her to take her medication. she's a teacher so she's educated and has read a lot so it was tough convincing her as she was afraid of the side effects of the medication. she had [sychomotor retardation and couldn't concentrate on what i was telling her.

many people suffer from MDD. i wanna help these people but i have to teguhkan my perasaan dulu or i'll be affected easily.

rase macam terdevelop counter transferance je.

in 2 days i've met 2 female teachers who developed MDD. both were rather of the perfectionist type and worried a lot. i can't make any generalisation but both had an underlying susceptibility to become depressed.

"Ya Allah, please keep my mind healthy and prevent me from getting depression. and please give me the ability and competency to help others in need."

high and low

one of jo's bestfriend

it's amazing what a refreshing nap and a phone call can do to enlighten my spirits.

yesterday i joined Dr Nora's clinic sessions and met many interesting patients. we saw other cases apart from schizophrenia alhamdulillah.

today my group was scheduled to follow the community psychiatric nurse go for home visits. i was expecting an exciting day but had a rather drab one. maybe if i had been less enthusthiastic i would have felt better?

What do you do when...

What do you do when your end posting exams are 2 weeks away and there’s still so much that you don’t know?

What do you do when your ultimate exam that is designed to assess whatever you have learnt for the last 5 years and also evaluate your safety to be given the license to practice is in 5 weeks time and you don’t know what the heck it is that you actually know?

What do you do when you feel that you have been having shortness of breath on exertion (NYHA class 2), restricted airway, fullness of the throat and occasional localized, sudden onset, stabbing left-sided chest pain lasting only several seconds and an ECG and flexible nasolaryngoscopy proved absence of any pathology you diagnose yourself as hypochondriasis with globus hystericus? Oh and on otoscopy your tympanic membrane looked perfectly healthy and the ENT guy says your fit for the exams? Oh and your friends help you by teasing you about the problem?

What do you do when your frustrated with your fiancé who is acting all gloomy, refuses to speak or sms you, you don’t have a clue what is happening yet there are some things that you need to ask him?

What do you do when your posting mate has adjustment disorder because she absolutely hates psychi and cant wait to run back to the OT and her mood is contagious that your mildly infected as well?

What do you do when one of your anak usrah is conveniently uncontactable around peri-usrah (read: before and after) time but somehow can answer your sms at some other time.

What do you do when you think you like psychi but find yourself relating too much with the symptoms that you start to become depressed?

What do you do when you only study because you love spending time with your best friends in the best study group ever?

What do you do when you try to lift your spirits but find it so hard to do?

What do you do when you feel like you wanna break down and cry like you did last time in orthopaedics but it’s all stuck inside?

What do you do when you know you haven’t completed your 6 case summaries and haven’t read through your scribbled notes which you had planned to do last week and your desk is a pile of mess, but don’t feel like doing any study-related activity at present?

I dunno what you would do.

But this is what I did.

I ironed 4 baju kurungs, 4 pants, 1 white coat and 1 tudung while watching 3 episodes of House Season 4 and wrote this entry.

My diagnosis is mixed affective disoreder precipitated by recent life stressors and perpetuated by the upcoming exams and type A personality.

trip to permai

ramblings on psychi and etc

most of the patients who get admitted to the psychiatric ward have either schizophrenia, bipolar mood disorder, major depressive disorder or substance-induced psychosis. other cases like anxiety disorders are seen in the clinic. i've just clerked a few patients je. cane nak jadi psychiatrist nih.

some of my friends are getting very severe reactions to this psychiatric posting and are immunocompromised. at least 4 of them are down with the flu. may they get better iA.

clerking manic patients is very interesting.

there's this one patient with very bizarre delusions about being zat Allah. i'll write about him later. gotto catch some winks first. have been terribly sleepy in class, the only way to prevent it is by offering to write on the whiteboard during dr hajee's class.

..........................................
The statistics on sanity are that one out of every four Americans is suffering from some form of mental illness. Think of your three best friends. If they're okay, then it's you.
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Rita Mae Brown

i think in my case, i'm the only sane one haha.

p.s: joe had some baby cockroaches infestation. i've treated him with some insecticide. hopefully all the bugs have been killed. mebe due to food crumbs in the car. no more snacks for joe.

more psychi

it's my 2nd week of psychi.

in the clinic yesterday, we saw an OA couple with psychiatric problems. the husband has panic disorder whilst the wife has schizophrenia with depression and side effects of the risperidone (anti-psychotic) that she's taking. she has galactorroea (keluar susu), blurring of vision and dysphagia (anti-cholinergic effects). menarik jugak kisah derang utk dipelajari.

hmm, im trying to keep up my enthusiasm in psyhciatry. its rather fading out. i feel like i have some manic and depressive symptoms i.e insomnia, spending spree, tapi low mood and lack of energy. bipolar 1 mood disorder?

anyways, 2 of my best friends will share their wedding dates with me. i always thought i'd be there for them. now i cant, huhu. and they cant be there for me. except maybe hi hi bye bye je.

___________________________________________________

Give a man a fish, and you'll feed him for a day. Teach a man to fish, and he'll buy a funny hat. Talk to a hungry man about fish, and you're a consultant.

Scott Adams (1957 - ), Dogbert; Dilbert cartoons

With a stop light, green means 'go' and yellow means 'slow down'. With a banana, however, it is quite the opposite. Yellow means 'go', green means 'whoa, slow down', and red means 'where the heck did you get that banana?'

Mitch Hedberg (1968 - 2005)

learning points in psychi

Readers beware: this entry contains medical jargon in abundance. If you fail to comprehend any term, do not hesitate to ask, or you can google them up yourself.

After day 4 of life in the psychiatric ward and clinic, this is what I have learnt:

# The psychi ppl like to use short forms too:
o PR: pakar review (talk about campurization)
o TTH: talk to himself
o LTH: laugh to himself
o Setakat ni je yg I jumpe dulu (baru day 4)

# Most of the guys who become psychotic have a history of substance abuse. Glue sniffing is becoming a popular detrimental past time amongst the youngsters (cane anak muda bangsa kite nih? Cemane nak jadi pemimpin?)

# Despite knowing many cases of malay muslims guys who take alcohol, abuse drugs and are promiscuous, I can’t desensitize myself and am still judgmental against them

# Most of the women who suffer from depression are caused by problems with their husbands (yang kahwin lain)

# Schizophrenia in psychiatry is like diabetes mellitus in internal medicine. It’s a chronic incurable disease which can only be controlled with medication. And it is the umbrella body of many psychotic disorders. Most of the patients are diagnosed as schizophrenia.

# I think schizophrenia in adults are like autism in children in that both prefer to live in their inner worlds

# When the doctors (or med students) don’t know what to write as the chief complaint, they put it down as “abnormal behavior”.

# Diagnosis of psychotic patients in psychiatry depends more on how the psychiatrist was trained rather than the clinical presentation of the patient. One of my lecturers is anti-schizo, another diagnoses schizo freely while the third takes the middle road, haha.

#The difference between psychosis and neurosis is loss of insight. In the former, there is a loss.

# Insight include 3 things:
o Awareness of the being ill
o Attribution of the illness; recognize the abnormality of the phenomena is due to mental illness
o The need to seek treatment

# Absolute diagnosis of psychiatric patients is a challenge as there are no confirmatory/ diagnostic tests that can be carried out unlike in other disciplines.

# There are hardly any psychiatric symptoms that normal people do not experience (i. e low mood, feeling elated, spending spree, anorexia, weight gain or loss, anxious, phobias etc ) . What jifferentiates both groups is the degree of the symptoms that they have.

# Since treating patients with mental illness is mentally exhausting, psychiatrist can only see a maximum of 5 cases per day compared to (10-20 cases of in other specialist clinics).

# The psychiatric wardround is a sitting wardround. It’s good for those with flat feet and less stamina.

# The mini mental state examination (MMSE) is an unreliable test unless done at the first presentation or during an acute stage of illness. Otherwise, patients usually have memorized it and tak larat nak layan dah.

# Speech in MSE is assessed whether it is
o Coherent (understandable)
o Relevant (answers the examiners questions relevantly)
o Rational (the answeris correct)

# One’s socioeconomic status does render one susceptible to certain psychiatric disorders i.e
o High SES: anorexia nervosa and bipolar mood disorder
o Low SES: depression and schizophrenia (however banyak jugak educated people who become depressed)

# Stages of grief (by Kubler-Ross)can be remembered by the pneumonic SABDA:
o Shock/ denial: this can’t be happening to me
o Anger: why is this happening to me? Who is to blame?
o Bargaining: make this not happen and in return I will …
o Depression: I’m too sad to do anything
o Acceptance: I’m at peace with what has happened/ is going to happen?

# Delirium
o is a medical emergency (because psychotic patients act on their delusions and hallucinations)
o is under diagnosed as the cause can be any disease under the sun and also because it is usually undetected due to sun downing (worsening of symptoms toward the evening)
o affects extreme age groups (children and the elderly)

a nut case

The following case summary is the result of a conspiracy amongst my friends (faizah, sibah, asma’, syahadah & aishah) against me during one of the psychiatric lectures in the 2-week introduction to psychiatry in year 4.

The case:
This 23 year old malay lady presented with symptoms of attention deficit disorder.

History of presenting illness:

•Drowsy during the class
Duration: from the beginning until the end of the lecture for 4 years
Onset: acute
Aggravating factor: nik aishah
Relieving factor: faizah, eating, talking
Maintaining factors: lecturers voices especially dr umeed’s and dr hajee’s
•Able to sleep even while eating and nodding head
•Dysarthria due to uncontrolled drowsiness with drooling of saliva
•Sometimes associated with aggressive behavior such as attacking other students while she presents in front
•Motor disorder: has stereotype movement (regular, repeated, purposeless movement), normal posture.
•Stupor in class for a few minutes
•Recurrent history of sleeping disorders
•Recurrent history of being detected by lecturers in the class for being sleepy, yet arousable
•Not on any drugs but likes the smell of petrol at gas stations
•History of allergy to lecture halls at IMC, JHC and Temerloh Hospital
•Lack of motivation in class.

Hehe, okay, I can’t deny some of the facts stated above, but I have to say, drooling of saliva in class tak pernah eh :P huhu, inilah dia hasil kerja kawan-kawan baik ku.