Psychiatry Referral: Fill & Download for Free

As an intern, my resident and I were called to the ER to admit a man with seizures. While the patient was violently shaking all over, my resident asked him if he was having a seizure. The man looked up at the resident and nodded in the affirmative. This is impossible, as consciousness is severely impaired during a generalized seizure.Several years ago I admitted a young woman to the hospital twice for unexplained sores on her legs. When she developed new sores on strong broad spectrum antibiotics, a biopsy was done which showed crystals, a consequence of injections. When confronted, she said it was for a prescribed medicine (not psychoactive or addictive), yet couldn’t explain why she’d neglected to inform us of the fact these sores were precisely where she injected nor why she hadn’t disclosed the drug as a home medication (which we ask of all patients). She declined a psychiatry referral. Several months later she required a heart valve replacement for infectious endocarditis, undoubtedly due to her injecting herself. Her artificial valve later became infected and she died. It’s as rare as hen’s teeth to get endocarditis from SQ or IM injections with sterile needles and the least attention to cleaning the injection site- I suspect it was intentional. Very sad.

A2A.Hypochondriacism, now known as illness anxiety disorder, is a genuine medical (psychiatric) condition with a defined set of diagnostic criteria. So that’s not all that difficult to pick out.If by “faker” you mean a patient who is malingering, that’s a bit more tricky. Some people (especially if they have a healthcare background) are really, really good at it. People who are “faking” it usually do so for one of three reasons:They want pain meds. These are the easiest to point out. If you come in and you ask for a big-gun pain medication by name, my antennae go up. My experience has been that people who are in genuine pain are happy with whatever help they can get. Of course, there are those with conditions that cause chronic pain (e.g., spinal stenosis, RA, etc.)…but those are easy to diagnose and document.They want a doctor’s note to miss work/school. This is fairly benign, if a bit obnoxious. My line of thinking is, if it matters to you that much to get a letter to miss work that you came in to see me, you can have your goddamn letter. A lot of times these people will ask for the letter before they ask for help, whereas a genuinely sick person will want help before asking for a letter.They crave attention. Purely attention. This is also a psychiatric disorder, known as Münchausen’s syndrome. This can be tricky to diagnose, as they tend to read up and can be very good at their craft. But if I run you through the diagnostic ringers and the pieces don’t start coming together, and then I refer you off to my specialist colleagues and they can’t figure things out, chances are you’re getting a psychiatry referral anyway. There’s a maxim in medicine: “When all else fails, refer to psychiatry.”Hope that helps to answer your question.Dr. Paul

Have you been checked for possible symptoms of PTSD. Disturbing and vivid nightmares often are a part of that diagnosis. Please see a physician, keep a log of the nightmares- tell about how they impact upon restful sleep and moods during the day.There is medication for nightmares related to PTSD. I urge you to see your physician for a psychiatry referral.