04-04-2009, 11:02 PM
arlete - 02/05/08 23:55
Besides what you wrote, I would go:
how long has the use been happening,
under what circunstances,
if that's the only recreational drug used,
if there's risky sexual behavior accompanying,
if it's interfering with function in society (sometimes use is not equal to abuse, dependency...),
if some traumatic event happened that lead the patient to start using it.
If the patient is actually intoxicated at the encounter, I would go more for psychosis/schizophrenia type evaluation than depression.
PE:
I would do complete neurological exam,
with mini-mental,
Romberg,
gait, to see how intoxicated he is. Man, that has to be a very good actor!
arlete - 02/06/08 12:52
qs for schizo:
- Have you ever felt the need to isolate yourself from other people? Did you do it?
- Have you ever felt like being unreal?
- How's your appetite?
- How's your personal hygiene (shower, brushing teeth, coombing hair)?
- Have you ever felt a lack of personality, as if you are not being yourself?
- Have you ever had some periods in which you would not move at all? For how long?
- Have you ever felt you had no emotions at all?
- Have you ever seen or heard things that other people couldn't?
- Have you ever talked about things other people could not agree or understand?
- Has anybody ever said to you you were delusional?
- Have you ever created new words people would not understand?
- Have you ever felt your mind is playing tricks on you?
- Have you ever thought you were being controled by external forces?
- Have you ever felt somebody had access to your thougths?
- Have you ever thought people on TV are talking directly to you?
Then ask about drug use, medications, previous psychiatric hospitalizations, family history of psychiatric disease...
arlete - 02/06/08 13:42
You have to ask about DEATH and SHAFT to check how independent/functional the patient is, and check social living conditions. Then you offer the social worker services, to find out what living conditions would be the ideal for him. Tell him you are available at any time if he starts feeling like he's loosing control, that your nurse is going to give him your card with the phone numbers. Tell him to avoid being by himself at any time, and that you would like, if it is OK with him, to talk to a relative about his medical condition.
Besides what you wrote, I would go:
how long has the use been happening,
under what circunstances,
if that's the only recreational drug used,
if there's risky sexual behavior accompanying,
if it's interfering with function in society (sometimes use is not equal to abuse, dependency...),
if some traumatic event happened that lead the patient to start using it.
If the patient is actually intoxicated at the encounter, I would go more for psychosis/schizophrenia type evaluation than depression.
PE:
I would do complete neurological exam,
with mini-mental,
Romberg,
gait, to see how intoxicated he is. Man, that has to be a very good actor!
arlete - 02/06/08 12:52
qs for schizo:
- Have you ever felt the need to isolate yourself from other people? Did you do it?
- Have you ever felt like being unreal?
- How's your appetite?
- How's your personal hygiene (shower, brushing teeth, coombing hair)?
- Have you ever felt a lack of personality, as if you are not being yourself?
- Have you ever had some periods in which you would not move at all? For how long?
- Have you ever felt you had no emotions at all?
- Have you ever seen or heard things that other people couldn't?
- Have you ever talked about things other people could not agree or understand?
- Has anybody ever said to you you were delusional?
- Have you ever created new words people would not understand?
- Have you ever felt your mind is playing tricks on you?
- Have you ever thought you were being controled by external forces?
- Have you ever felt somebody had access to your thougths?
- Have you ever thought people on TV are talking directly to you?
Then ask about drug use, medications, previous psychiatric hospitalizations, family history of psychiatric disease...
arlete - 02/06/08 13:42
You have to ask about DEATH and SHAFT to check how independent/functional the patient is, and check social living conditions. Then you offer the social worker services, to find out what living conditions would be the ideal for him. Tell him you are available at any time if he starts feeling like he's loosing control, that your nurse is going to give him your card with the phone numbers. Tell him to avoid being by himself at any time, and that you would like, if it is OK with him, to talk to a relative about his medical condition.