Caffeine Free in Med 3

neuro is psych w/IVs

I thought when I got out of psych I would go back to seeing patients with so-called 'real' illnesses. The history and physical would be important again, not just the patients perceptions of what was going on. I would be doing physical exams again, carrying my stethoscope and the all important reflex hammer.

On the contrary, here on inpatient psych . . . er neuro, I deal with everyone's favorite patients - the pseudoseizure patient. These patients are having non-epileptic psychogenic seizures. In other words, mental illness is causing them to have these spells. It's not a medical illness per se, it's a conversion disorder, and most of my day is spent weeding out the fake neuro from the real. I've seen a few strokes and LOTS of pseudo seizures.

How do I know that it is a pseudo seizure? Well, for example, if it lasts over 5 minutes (or 3 hours as one patient told me) and the patient did not have brain damage afterward, that would be a pseudo seizure. If there is head shaking, similar to saying 'no,' it's a pseudo seizure. If the patient checks out for a little bit and becomes unresponsive while over the age of 18, it's a pseudoseizure. If the patient has 4 different types of spells, also a pseudoseizure.

And all of that is just from description of the events themselves, let alone before I get the person's family and social history to know all the other psych and emotional problems the patient has. I had one borderline pseudoseizure patient try to manipulate me so blatantly that I had to write it up as an addendum for additional documentation purposes.

Don't call me heartless or angry. I'm just telling it like it is. I'm learning to be a doctor, and as much as patients don't want to hear it sometimes the answer is 'there is nothing we can do for you here because your problem is caused by stress.' I'm sorry if you don't agree, but there is no reason to waste more time and money on a problem that needs to be dealt with outside of my inpatient neurology unit.

For the record, two weeks and two days into my rotation, I have yet to see a real seizure.

Labels: disorder, medication, neurology, seizures

posted by Allie @ 6:26 PM