Diagnosis Made Easier, by James Morrison

[rachelmanija]

Morrison’s book is a textbook for mental health clinicians. It is exactly what it says on the tin. It’s easy reading and could be read by a layperson with some knowledge of psychology. He lays out a number of important principles. I’ll just note a few that I find particularly useful

Comments

[egelantier]

OOOOOH. thanks, that's awesome.

[rosefox]

Those are really useful and interesting.

From my own experience, I'd add "Don't automatically discount environmental influences as 'not sufficient to cause problems', especially if the patient brings them up". I've hallucinated from standard doses of pseudoephedrine, had systemic effects (drowsiness, etc.) from topical Benadryl, am psychotic and suicidal on standard therapeutic doses of Zoloft, have drastic mood reactions to antibiotics, need to consume caffeinated beverages one ounce at a time to prevent panic attacks, etc. (This is another thing that sometimes runs in families.) And an event that seems too minor to really affect someone can still be traumatic if it presses just the right button.

[rachelmanija]

At this point I am 100% taking client's word on weird drug effects. I mean, I generally take client's words anyway, but I have now personally experienced that any medication can do anything to somebody. (My psychopharmacology professor, a Russian psychiatrist, had clearly picked that principle as the thing to drill into our heads even if we left the class having learned nothing else. He also made a big point, which was illuminating to me, that this includes ALL medications, not just psychiatric ones.

[jagfanlj]

I'd give your professor an A+ even if that was the ONLY thing he taught! I know someone who gets hives from Benedryl, another who is allergic to Aloe Vera, and a family member is allergic to animal protein of all things. She was a soy baby from the git-go, and she still can't have serums or egg-based vaccines.

btw, Why isn't there an "adverse reaction" section on in-take forms? To be on the safe side, I list the psued. and a couple other things I've had wonky reactions to under "allergies."

[rosefox]

Yes, that frustrates me too! I don't want to claim that I'm allergic to antibiotics, because I'm not--but I also want doctors to know that I have horrible mood reactions to them and really want to avoid taking them if at all possible.

Being allergic to Benadryl sounds like a total nightmare. My sympathies to that person. :/

[naomikritzer]

Does this author talk about evaluating the patient's take on their own situation? (I've known people who were 100% correct about their problems; I've known people who were very much not. Presumably a good diagnostician will pay attention when a patient says, "I was held up at gunpoint last month and now I have panic attacks. I think those two things are related" and apply professional skepticism when a patient says, "there is no connection between the ten drinks a day I'm having, and my marital problems." But there's a lot of space in between these two extremes.)

[rachelmanija]

Yes, he actually has a long section on that. I didn't summarize it because I work in a setting where it's not usually an issue. You automatically take the client at their word unless there's some reason not to, and in my case, the "reason not to" tends to be super-obvious, like the court mandated client in total denial of an alcohol problem when they were referred for their fifth DUI or the obviously dysfunctional parents blaming everything on their completely normal, albeit stressed, kid

Inappropriate Ion Is Appropriate

[jagfanlj]

I'm adding this to my memories. It'll come in handy when writing fan-fic -- and not-fanfic, too.

[resonant]

I wonder if there are cases where someone has two conditions with opposing treatments. Perhaps someone has an eating disorder as a lower-priority issue, and OCD as a higher-priority issue (maybe because it promotes more immediate risks to health), but the SSRIs that would help with the OCD would make the eating disorder worse, making that the higher-priority issue. It'd be hard for the patient and practitioner to come up with a treatment plan in such complex situations.

[carbonel]

I wonder if there are cases where someone has two conditions with opposing treatments.

That's a classic problem with heart and respiratory issues. As a vast simplification, what will improve heart function will often decrease lung function, and vice versa. For a long time, it can be a maintainable balancing act, but at the end stage, there's no way to optimize both, and the patient goes into heart failure and/or respiratory arrest.