Some odd disorders...Part Uno

• Trichotillomania: This falls under the category of impulsive disorders and is characterized by compulsive pulling of hair from one's own body [typically the head, sometimes eyebrows/facial hair/other body hair] that leads to visible hair loss, and could potentially lead to social or functional impairments. The compulsions are worse in times of stress or depressed states.
• Koro: an overwhelming belief that one's external genital (males) or secondary sex organs (nipples in females) is shrinking, retracting and will eventually disappear. Some even believe that this will end up causing his/her death. This disorder is prevalent in Eastern Asia.
• Hallucinogen Persisting Perception disorder: visual hallucinations or flashbacks of the experiences felt during earlier use of hallucinogens in life. This is thought to be a result of reabsorption of the hallucinogen years after last use from lipid stores.
• Dissociative Fugue: sudden, unexpected travel away from home along with the inability to recall parts of one's actual identity and past. This will cause the person to assume a new identity and occupation after reaching this new destination. This disorder usually is seen after a stressful life event.

As I was reading my first aid...I came across these and thought they were the weirdest of them all. Initially I was quite skeptical, thinking that people are just pretending/feigning these symptoms for primary or secondary gain...but after a bit of research, these are actual disorders characterized by the DSM Manual for Mental Disorders. There are a few more I thought were pretty intersting... will tell you more about them later.

Winnie the Pooh - mental illnesses?!?!

Couldn't help but post this (hehehehe):

courtesy of: http://www.g33kpron.com/wp-content/uploads/2011/08/winnie-the-pooh-drugs.jpeg

Dealing with psychotic patients

Two weeks into the psychiatric inpatient service I have been exposed to plenty of psychotic patients. This experience however took the words 'mental' to a whole new level.

A little nervous, and very scared, I slowly made my way to the front desk to announce the name of the patient. "Mr. X, will you please come up to the front desk." His back stooped, Mr. X shows up a few seconds later as I studied his disheveled hair and food stains on his shirt, taking note of his appearance, movement and affect. We make our way to the alcove and I sit down across from his chair. Never had I felt so uncomfortable. But as soon as I received the answer to my first question, all my anxiety and fear drifted away.

"So what brings you in Mr. X," I asked. "Well, I haven't really been sleeping well. You see, ever since my birth, I've had this power given to me to take on the world's problems and make sure that I help people everyday, and not just people from this planet, but the planet I hail from as well as other universes too." Clearly, I would not be doing most of the talking. It didn't stop there. I quickly learned that my patient had been brought to this planet in a spaceship by his real parents to save this earth from all evils in 30,000 B.C., since then he has been carrying the troubles of mankind on his shoulders as he tries to rescue good from bad. His own children had become victims of the devil. Mr. X would hear voices of Jesus Christ telling him to act well and give him power. He had a girlfriend, one from another planet, that came to him to borrow money since he had the ability to create money from nothing. He could speak 26 different languages, his Russian was along the lines of "ahoo hee haa haaa hooo heee haaaa." All this and much more was found out in the first 2 minutes of the interview. This, my friends, is called pressured speech with tangential thoughts. You think you're talkative? Wait till you talk to someone with pressured speech, just get them started on a topic and you can sit there for the next hour waiting to interrupt.

What seemed like minutes, turned into an hour and then more. I began to make sense of the terms that I had read in psychiatry under the schizophrenia section. Schizophrenia falls under psychotic disorders. What is psychosis? Medically, it is defined as a disruption in the perception of reality-and symptoms include: delusions, hallucinations, or disorganized thought. Listed below are brief explanations of each of these symptoms:

• Delusions: illogical beliefs that are held despite evidence of being fake & are inconsistent to a person's background/culture
• Hallucinations: sensory perceptions in the absence of any sort of stimulus
• Disorganized thoughts: thoughts that are disorganized...duh. haha just joking; this will include illogical answers to questions, thought derailment, tangentiality, etc.

So in my patient, he had several bizarre delusions: one of which was that he came from another planet, he was saving the world, his children were victims of the devil. His hallucinations were auditory commands since he claimed to be hearing the voice of Jesus Christ. In addition, his thoughts were disorganized, he constantly jumped from one topic to another (tangentiality) and never really finished his thoughts. This patient also presented grandiosity (unrealistic sense of superiority)--he was able to make money, he spoke 26 languages, etc.

All in all, psych has surprisingly turned out to be very helpful, and I'm so glad to have had this experience. A major lesson I learned, and want to emphasize here, is the importance of one's childhood and the drastic impact it has on the rest of your life. Many of the patients admitted into our service, whether its for depression, psychosis, or bipolar disorder, a recurring theme I've noticed is the lack of stability in their childhood years. This includes anything from having abusive people in one's life [physical or sexual] to not seeing one's parents often because they're always working. One of the docs explained how children that were not held and cradled in the first three months of life are more likely to develop psychiatric problems later down the road...

[reference to be found still...]. So, to all the parents out there, take some time out for your kid, play ball, or even just a daily hug can go so far.

Enough for tonight. Will update on more stuff I see super soon...

past two years...

Take a look at most* (not all) of the notes from the past two years. If combined, they are 44" tall. WHAT?! Thousands of pages crammed into the tiny neurons of my brain...maybe.

Starting a new life...ROTATIONS!

So, you can only imagine how busy second year was judging by the number of posts that I have written..haha. That is about to change! Update in life...I PASSED BOARDSSSSSSSSSS (and am very satisfied with my score), and I've recently started my third year rotations and am loving every (...most) moment of it. I just finished my Neurology rotation, and just started my Psychiatry rotation today. Since I'm a month behind on my documenting, I'm going to try and do a bit of psych and neuro in each post.

I'll start off with my first day at psych since its fresh in my head. I'm currently on inpatient and got to see some super crazy (pun intended hehe) stuff today. But more important than that were the lessons I learned. I'll describe two, of many more to come, real briefly.

First was on countertransference. So what is it, you ask? Medically, its having a preconceived judgement of how a patient is going to act based on people or experiences that you are reminded of while interacting with that patient. For example, Billy bob a new patient that I met with today reminded me of Jackie, a noncompliant patient from years ago, and so my behavior towards Billy bob will be change and I assume that Billy bob will also be noncompliant without actual evidence from Billy bob himself. Believe it or not, countertransference is actually very common in doctors. My attending today emphasized heavily that the act of countertransference is not bad, however, it can easily crossover and become harmful if it goes unrecognized and starts getting in the way of doing your job.

The second lesson I learned was not really a lesson; it was more of an analogy: revenge and forgiveness. Revenge is like going to McDonalds and eating a huge meal that satisfies you only for a few hours. Forgiveness is like eating balanced and healthy meal throughout the day, that will keep you full and satisfied for years to come. Random? Yes, but lets just say it was medically related in that it involved the topic of physical abuse.

Enough of my psych lessons of the day. Lets talk Neurology! First and foremost...I MISS IT SOOO MUCCCHHHHH! I cannot get over how fortunate I was to have started off with such a wonderful rotation with wonderful residents and attendings. I went in with alot of interest because I have loved neurology since undergrad. The nervous system is such a vital part of your body and the fact that it controls every single thing that we do [from blinking to biking] just amazes me!

So, I want to briefly touch on a research topics that I had to look up and present on: Cortical spreading depression. Yeah, I hadn't heard of it either. Its defined as a self-propagating wave of depolarization (activation) of brain cells (neurons and glia) that spreads from the back of our brains (occipital region) towards the cerebral cortices. So...it doesnt seem that bad, right? WRONG. It is actually thought to play an important role in pain and auras of migraines. Pain is a result of the depolarization activating trigeminovascular neurons which in turn induces nociceptors (pain receptors) in the overlying meninges (coverings of our brain). In addition, auras are also thought to be related to cortical spreading depression.

For further information, check out: http://www.springerlink.com/content/q2882h12343u37q8/

That's all folks!