Wednesday, July 28, 2004

French?

On the C-L (Consultation-Liaison) Psych team, we have three consultant psychiatrists. One of them, whom we shall name as "Dr A" left on leave today, as his wife was being induced to birth tomorrow.

Anyway, for a long time, we (me, Sa and Dino) had been wondering whether this guy was French or not. He had a strange accent, which at first sounded Australian, but had something else added to it.

These are the facts:
  1. He told us once in a tute that English was not his first language.
  2. When I was walking with him one time he answered his phone and said: "Yep, yep. But don't put them under my normal name. Put them under Jean."
  3. He took a day off on Bastille Day.
  4. He says he goes to Paris a lot.
  5. If there's any French terms in psych, he pronounces them perfectly, such as echo de la pense.
So I asked him what the deal was.

Me: "Before you go, I have a question that has been burning on our minds for a long time.
Him: "What is it?
Me: "We were wondering if you were French or not.
Him: "Actually, I'm from Mauritius; but they do speak French there.

In Mauritius, the official language is English, but everyone on the street speaks Creole or French. It's strange.

His weird accent was because he moved to Sydney first.

Monday, July 26, 2004

Dementia? Delirium?

Nothing much today. PBL in the morning. The topic this week is organic brain disorders - which pretty much means delirium and dementia.

delirium vs. dementia

  • mode of onset: acute or subacute (Del); chronic or subacute (Dem)

  • poor attention: characteristic (Del); late event (Dem)

  • conscious level: often affected - may be wild fluctuations (Del); normal (Dem)

  • hallucinations and misinterpretations: common (Del); late events (Dem)

  • fear, agitation and aggression: common (Del); not common in the early stages (Dem)

  • totally disorganised thought with palpably unreal ideas: common - often flight of ideas (Del); late feature - usually poverty of thought (Dem)

  • motor signs: postural tremor, myoclonus, asterixis (Del); none, or late feature (Dem)

  • speech: slurred (Del); normal (Dem)

  • dysphasia: none (Del); often present (Dem)

  • dysgraphia: often prominent (Del); if present, in keeping with degree of dementia (Dem)

  • short and long term memomy: poor (Del); often normal until late (Dem)

Key: Del = delirium; Dem = dementia
___________________________________________

For some reason, I was late again today. I'm having trouble waking up - I keep ignoring my alarm clock and going back to sleep, only to wake up again 2 hours later.

It's a bit of a worry!

Sunday, July 25, 2004

Assessment of Suicide Risk

**WARNING: NERDY POST COMING UP**

  1. Suicide Risk – this is an epidemiological risk; a probability. eg people in rural areas have an increased suicide risk (access to firearms)

  2. Suicidal Intent – this is an assessment of the patient, and their
    ‘seriousness’. Divided into 3 stages:

1. Before

  • Planning: did the patient plan the suicide for a long time, make arrangements
    for pets, sort out wills, buy right tools, etc; or did the patient impulsively
    commit the act

  • Location: did the pt choose a place easy or difficult to find? eg in a public place?

  • Timing: Did the pt ensure that it would occur at a time when nobody was likely to find the body?

2. The Event

  • Lethality: How lethal was the attempt? eg overdose vs firearms. Guns and hangings are more lethal.

  • Patient’s Judgement? Especially in children or mentally handicapped pts. Did they actually think they were being lethal? eg a child may think that eating 2 panadols would kill them.

3. Post-Event

  • Ruefulness: Did the pt regret attempting suicide? Were they glad they failed?

  • Anger at failing: On the other hand, was the pt angry that they failed?
    “I can’t even commit suicide properly. I’m such a failure” – watch out for these pts!

  • Suicide Note: May give an insight into the pt’s mental state at the time of the attempt. Were they psychotic? Had they arranged everything inadvance?

A ton of work to do

My life seems pretty boring. All I ever worry about is the amount of work I have to do.

There is a mountain of study that needs to be done before the test on August 13, there's a heap of preparation to be done before the Psych OSCE on the 10th, not to mention the daily study I need to do to not sound like an idiot in front of the consultants.

On another note, this has been one of the busiest summers for Arsenal. Aside from all the speculation about the future of Patrick Vieira, we have been going great guns in the transfer market.

In:
Robin Van Persie from Feyenoord, 4 million
Mathieu Flamini from Marseille, 1.5 million?
Arturo Lupoli from Parma
As well as Jose Antonio Reyes whom we picked up in the January window from Sevilla

Out:
Sylvain Wiltord - free, no club yet
Kanu - free, probably to WBA
Martin Keown - free, has joined Leicester City
Ray Parlour - I think it was free, has joined the revolution at Boro (They've also just signed Hasselbaink, Viduka and Reiziger)

Maybe Arsene should sell everyone?

Options 490

As part of the medical course, we have to undertake a research project, somewhat perversely known as "Options 490". There is no "option" in this at all. It is boring, time-consuming, and completely irrelevant to my future career.

Anyway, the project that I am working on is about Type 2 Diabetes Mellitus. We're analysing a heap of data from patients in Fremantle and seeing how their DM progresses over time.

One powerball...

Saturday, July 24, 2004

Scariness

Saw a schizophrenic patient the other day. He came in because he had some strange hallucinations (which were different to his normal ones). Usually he gets hallucinations of people he has seen - of smaller versions of the originals. He can tell that they aren't real because of this. He also has 2nd and 3rd person auditory hallucinations as well as some somatic hallucinations.

For the last couple of weeks, he has been getting hallucinations that he has been getting rather anxious about. He's been seeing knives in front of people. And he's been thinking about harming other people.

As you can imagine, I was rather afraid after he told me this. Dino and I were interviewing him; and instead of following the normal practice in psychiatry of ensuring that the patient is not between the interviewer and the door, we found ourselves boxed in by this man. With the thoughts of knives and hurting people.

I spent most of the interview thinking about my escape routes. The window beside me looked particularly inviting!

Thankfully, his psychosis was well controlled and we surived the interview.

Hello world

My name is Jinn. This is my blog.