Saturday, September 04, 2004

Manic-Depressive

I was in class the other day and we were supposed to learn how to interview psychiatric patients. We've been observing for about 2 weeks now how a real psychiatrist does the interview. This time, they wanted us students to do it. The resident narrated the patient's history. The patient was a 60+ year old female, an RN, with a history of violent behavior and depressive episodes. She was diagnosed twice, in two different hospitals, as having schizophrenia. But based on what I heard, I thought she was only suffering from Bipolar I Disorder (manic-depressive). There was no history of delusions or hallucinations.

The resident asked for a volunteer. My classmates pushed me to do it since I'm class president, and I was chosen by default. Anyway, I sat there waiting for the patient to arrive.

The patient arrived, slowly walking towards the front of the class towards the empty seat near me. She was a thin woman with slightly unkempt gray hair. Her face conveyed an expression of irritation. When she was seated, I introduced myself and told her I was a med student, just like my classmates who were there to observe us. I asked her why she was in the hospital (we knew she had a recent manic episode but then one doesn't tell the patient that). She said that the doctor had to change some of her medications and that she had sleeping problems (this is what we call in psychiatry "poor insight"). When I probed further, she just got more irritated and started to answer me with snide remarks. I asked her about her medications. She knew them all by heart, down to the dosage and frequency. She asked if I even knew what the drugs were for. I was rattled. The resident signalled me to start the Mental Status Exam (MSE; a set of questions and observations one had to do and ask to evaluate the patient). We had an exam right before that interview so I knew the MSE by heart. For the life of me, facing that patient, I couldn't remember the second item on the list! I was just stuck in number one! The crazy lady exposed me for who I really am: a student who knows nothing. Mercifully, the resident called on another student. She did a little better but the patient was even ruder to her than she was to me.

Towards the end of the interview, the patient just started getting more irritable and rude. She even asked if my classmate even knew the definition of "psychiatry"! At that point, I felt what it was like to have "counter-transferential reactions." The patient was irritable and probably hated us for disturbing her rest (transference), and with her behavior, I got mad at her (counter-transference). Then I realized I shouldn't feel that way. She was mentally ill!

We later found out that her real diagnosis was not Schizophrenia but was, in fact, Bipolar I Disorder. I was right. There's hope for me after all.

1 comment:

herniating thoughts said...

Hey Karl, heard about this incident from someone in class. It must have been terrifying. I agree, it's insanely difficult not to experience counter-transference when you deal with a patient like that. It's hard to remember that they are mentally ill when they are trying their darn best to scare you or piss you off. Hehehe :) See you in class! Nice post, btw :) -che