Archive for the ‘Psychosomatic medicine’ category

Psychiatrists Aren’t Psychics

April 5, 2012

I know the two words sound very similar, but they are most certainly not the same. I recently received a request to see a patient to determine if he could get through a procedure without having a panic attack.

If I could predict the future, I would have won the lottery last week! Sadly, I didn’t.

I suppose I understand that other physicians would like to have psychiatric issues under control so that they can get their work done. That’s why I do what I do. However, psychiatric issues, just like medical issues, can be quite unpredictable. No one gets frustrated when a person has an unexpected bout of asthma, but if someone has a panic attack, the reaction to that is that the person isn’t in control of their behavior. The thing is, although some psychiatric issues certainly stem from voluntary behavioral actions, some presentations are involuntary. Like a panic attack, which is a result of the sympathetic nervous system gone haywire.

Anyway I try not to be rude to those asking for help, but needed to vent a little today. Thanks for reading and hopefully you learned something too!

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Mind Over Matter

August 2, 2011

I work in consults at my hospital, which means that I see medically sick patients who happen to have psychiatric issues going on as well. Common reasons I see patients are for drug or alcohol issues, depression, anxiety, and dementia. I enjoy this work because I really believe in the mind-body connection. For example, when someone’s depressed, they won’t be able to participate in their treatment as well, and physically may not get a whole lot better. Also, sick people get depressed about their health. I feel like I’m able to improve someone’s entire well-being when I address their mental health issues.

One thing that I like to discuss when seeing such patients, is what can the patient do to help themselves in the hospital. A lot of times, we may start a medication, or we may provide supportive therapy in the hospital, but treatment always takes time. While waiting for treatment to start working, what can the patient do on their own in the meantime to start getting better? An expression I like to encourage patients with, is “Fake it til you make it.” Even if someone does not feel at his best, he can remind himself that eventually, things will improve–so in the mean time, why not put in a little more effort, even when it’s hard. Sometimes this works, sometimes it doesn’t, but at least the patient feels he has some control over his own situation. This in itself can be very empowering.

Just some thoughts after a day of seeing patients today. Thanks for reading, and as always I welcome any comments or questions.

Misinformation By Celebrities

July 11, 2011

I’ll admit it–I love Dr. Drew. I’ve watched most of the episodes of Celebrity Rehab and can’t wait for a new season. If you don’t know, Dr. Drew is an internist with a focus on addiction medicine (although I’m not sure if he’s board certified in that specialty or not). He does not focus on neurologic conditions as far as I know, so when I heard him misspeaking about multiple sclerosis, I was bothered. I think celebrities do have a certain obligation to use their fame responsibly. That’s why I find it irritating when I hear celebrities, in particular celebrities who are physicians–which there are a few–who speak authoritatively on topics while providing wrong information!

This started recently while I was browsing the National MS Society website, which had a link to Dr. Drew’s blog, back in May when he interviewed Phil Keoghan (the host of Amazing Race, one of the better reality shows out there). Apparently Phil Keoghan biked across the country and raised half a million dollars–it’s not clear why he picked MS as his charity cause (as he notes in the interview, he only found out afterwards that he has a cousin with MS), but whatever, he was trying to do a good thing with his celebrity. What really bothered me was Dr. Drew’s use of the term “la belle indifference.” He explained it as the “positive attitude” that so many people with multiple sclerosis seem to have.

First of all, that term refers to the indifference (or unawareness) that patients have with something called “conversion disorder.” I find this term very offensive when misapplied to MS patients for a couple of reasons. The thing is, a lot of MS patients walk around and look perfectly healthy, because their symptoms are neurologic. You can’t necessarily see numbness, tingling, fatigue, depression, dizziness, or weakness. So–when you don’t look sick, there’s a sort of pressure to act like you’re not sick. It seems that if you act like you’re sick, people around you don’t really get it.

Now–this term, la belle indifference, refers to people who are converting psychiatric symptoms like anxiety, for example, into a neurologic symptoms. An example is the “hysterical” woman who believes her legs are paralyzed and she can’t walk. When she’s tested, her muscles work fine, though. It used to be thought that this was “all in the head,” and not necessarily in the brain, but recent research is starting to show that certain neurologic circuits are impaired in this disorder. Usually conversion disorder is short-lived (hours to days), and improves when the underlying stress improves. Patients with this disorder typically have poor insight, and use a defense mechanism called “la belle indifference” in which they feel like everything is okay, in order not to deal with the distress that would accompany acknowledging their problem.

I don’t know if that explanation makes sense, but I’ll tell you, that as a psychiatrist who is very familiar with MS, it is particularly bothersome to hear this term misapplied because of the implications of the term–that MS symptoms are “in someone’s head,” and the reinforcement of the pressures MS patients have to pretend that everything is fine. No one can tell someone how to feel, but making assumptions about one’s feelings makes it harder to express them.

Just some food for thought–thanks for reading.