TSH: The Bipolar and the Psychotic D/O NOS

Tuesday night: Once again, my patient was one of the sickest of the sick. JF was a 61-year-old author who has developed bipolar I severe mania. Even before I interviewed her she was pissing off other patients by telling them about her conspiracy theories regarding the president and other things, and when I interviewed her, she had many grandiose delusions like how God trusts only her and how she lived in the time of the Nazi occupation and knew that Adolf Hitler had spastic constipation. A nursing assistant sat with me for safety reasons, and we were both taken aback when my patient said I looked like an administrator while she (the NA) looked like a tramp. Dang. After the interview, my patient proceeded to annoy Sital's patient, who had MDD and cried an awful lot. I think she can cry at will just to get attention (which has worked). *sigh* Everyone was relieved when my patient was finally moved to the wards, because she was not making any friends in the waiting room.

Tonight: Today we had a chance to go over our dictations and see how bad (or good) they flowed. Mine was ok, but we all had a chance to correct (revise, refine, whatever) our dictations so that they sounded better. After that, I got the first patient, named AA. She was an interesting yet frustrating case because it was so hard to pinpoint a diagnosis on her. The hospital from where she transferred claimed that she had religious delusions and aggression and had to be sedated, but we saw a withdrawn, quiet woman with flat affect. Her memory was fine and she was very suspicious of some of the questions we were asking her (i.e. are you right handed or left handed? Is there a history of drug abuse in your family) and flat-out refused to answer. This made assessing her all the more difficult. She also kept staring out the window, but whether she saw visual hallucinations or not couldn't be seen. She did not seem overtly psychotic to me, but not quite depressed either. It didn't help that this was her first hospitalization and she had no collateral history from family that would tell us how long she'd had these symptoms. So the diagnosis for now: Psychotic disorder, not otherwise specified. Dictating this one was a real b***h since I had to justify why the patient was NOS, in other words, I had to give reasons why I couldn't rule out MDD, bipolar, or schizophrenia. That took forever.