Is it the season?

[Celexa]

---

Members don't see this ad.

The largest chunk of my clincial time is spent on inpatient consults at a large academic center.

CL patient lists see a lot of variety of course. Sometimes you're list is almost all delirium/AMS/icu heavy, sometimes it's more 'primary psych', sometimes you hit an inexplicable string of unrelated but thematically similar cases. Had a seizure/post ictal theme week a few months ago. Etc.

Right now the list is the most bonkers combination of insanely aggravating cluster b and c personality disorders (I have a high threshold for personality disorders usually, I actually like working with cluster Bs in outpatient) AND real, horrifyingly severe suicide and self mutilatory cases, some which have truly tried all means of treatment available at the hands of doctors who know what they're doing.

I've heard spring is worse for psychiatric illness. I'm too tired to look up references but I don't have a hard time believing it.

I need a month long nap. Or a magic wand. Ideally both.

 

[Stagg737]

The largest chunk of my clincial time is spent on inpatient consults at a large academic center.

CL patient lists see a lot of variety of course. Sometimes you're list is almost all delirium/AMS/icu heavy, sometimes it's more 'primary psych', sometimes you hit an inexplicable string of unrelated but thematically similar cases. Had a seizure/post ictal theme week a few months ago. Etc.

Right now the list is the most bonkers combination of insanely aggravating cluster b and c personality disorders (I have a high threshold for personality disorders usually, I actually like working with cluster Bs in outpatient) AND real, horrifyingly severe suicide and self mutilatory cases, some which have truly tried all means of treatment available at the hands of doctors who know what they're doing.

I've heard spring is worse for psychiatric illness. I'm too tired to look up references but I don't have a hard time believing it.

I need a month long nap. Or a magic wand. Ideally both.

PRITE says spring is worst, seems a little late for that though. I'm just waiting for the summer heat wave to come through when crime spikes and our ER turns into a s*** show with the combination of that and new resident turnover...

 

[aim-agm]

I propose a clinical trial involving sending these patients to Australia and back every 6 months.

 

[Sushirolls]

Spring/Summer = more outdoors = more daylight = more booze
That's it. I don't think its anything more than that.

 

[clausewitz2]

There is at least one study out there that finds a correlation between incidence of mania and the delta in cumulative sunlight exposure between winter and summer for a given geographical area. So it seems to be something about how much changes happens between seasons rather than just "is it sunny or nah"

 

[comp1]

Also seeing worse suicide attempts/completions right now. I'd definitely second the seasonality aspect. Really depressed people get just enough sunlight for the energy to act on their impulses.

 

[Celexa]

Also seeing worse suicide attempts/completions right now. I'd definitely second the seasonality aspect. Really depressed people get just enough sunlight for the energy to act on their impulses.

I would pay a lot of money right now for a feature in epic that blurs pictures by default. It's been an unpleasant couple of weeks reading surgery notes.

 

[Stagg737]

sometimes you hit an inexplicable string of unrelated but thematically similar cases. Had a seizure/post ictal theme week a few months ago. Etc.

I see this a lot too. Where I'm at the past 2 weeks we've seen a bunch of dementia patients come in because they're becoming agitated and assaulting staff at facilities. We see this a few times a month, but this has been different because a) the assaults we're seeing are serious (different patients: sexually assaulting a tech, assaulted another resident's guest, stabbed a nurse who had to be hospitalized), b) they're already on hefty doses of meds for behavioral modifications including antipsychotics, c) they're coming from the highest acuity facilities available that can typically handle these types of patients. Hoping this ends soon, as this is one of my least favorite patient populations to try and work with and a major reason I didn't consider going into neuro.

 

[allantois]

It's the economy

 

[clausewitz2]

For some reason across two different practice settings this month is intellectual-disability-that-no-one-wants-to-acknowledge month. Perhaps, sir, you did not fail to follow the involved theological discussion in your bible study group because you have ADHD but, in fact, because you have a documented IQ of 77. Have you considered that sometimes you can't focus or follow conversations because you just don't understand what is being discussed? Might this, in fact, be the reason you struggle to perform at jobs chronically when things change and you get put under new and more complicated stressors? No? Definitely ADHD because the psychologist who said he didn't think you'd benefit from therapy said maybe you have ADHD? Okay, well.

 

[aquatic ape]

I see this a lot too. Where I'm at the past 2 weeks we've seen a bunch of dementia patients come in because they're becoming agitated and assaulting staff at facilities. We see this a few times a month, but this has been different because a) the assaults we're seeing are serious (different patients: sexually assaulting a tech, assaulted another resident's guest, stabbed a nurse who had to be hospitalized), b) they're already on hefty doses of meds for behavioral modifications including antipsychotics, c) they're coming from the highest acuity facilities available that can typically handle these types of patients. Hoping this ends soon, as this is one of my least favorite patient populations to try and work with and a major reason I didn't consider going into neuro.

Had recent streaks of 2x suspected NMDA encephalitis, current streak is pseudodementia/ delirium in geriatric patients with significant cluster b traits.

The streak is changing back to etoh use with significant externalized locus of control, unfortunately a pretty routine theme on the service

 

[DOswag]

It's climate change for sure

 

[sloh]

For some reason across two different practice settings this month is intellectual-disability-that-no-one-wants-to-acknowledge month. Perhaps, sir, you did not fail to follow the involved theological discussion in your bible study group because you have ADHD but, in fact, because you have a documented IQ of 77. Have you considered that sometimes you can't focus or follow conversations because you just don't understand what is being discussed? Might this, in fact, be the reason you struggle to perform at jobs chronically when things change and you get put under new and more complicated stressors? No? Definitely ADHD because the psychologist who said he didn't think you'd benefit from therapy said maybe you have ADHD? Okay, well.

“But adderall makes you smarter, doc!”

 

[Merovinge]

Had recent streaks of 2x suspected NMDA encephalitis, current streak is pseudodementia/ delirium in geriatric patients with significant cluster b traits.

The streak is changing back to etoh use with significant externalized locus of control, unfortunately a pretty routine theme on the service

Yeah... thank you for the reminder about being pleased to be in CAP.

 

[DOswag]

For some reason across two different practice settings this month is intellectual-disability-that-no-one-wants-to-acknowledge month. Perhaps, sir, you did not fail to follow the involved theological discussion in your bible study group because you have ADHD but, in fact, because you have a documented IQ of 77. Have you considered that sometimes you can't focus or follow conversations because you just don't understand what is being discussed? Might this, in fact, be the reason you struggle to perform at jobs chronically when things change and you get put under new and more complicated stressors? No? Definitely ADHD because the psychologist who said he didn't think you'd benefit from therapy said maybe you have ADHD? Okay, well.

Don't think I see too many patients with intellectual disabilities or severely low IQ but dang I get tired of so many people coming in because suddenly they're stressed at work, married with kids, taking full load of classes and can't focus. But they think they have "adult adhd" because their friend showed them a tik tok video that they really identified with. No ma'am, you just have 27,000 things on you plate and your bandwidth to handle these things is overloaded. We'll do a qb test that shows they have perfect attention and they don't like that answer... Had a patient leaving my office in tears one time because she was sure she has adhd despite never struggling with any issues with inattention until she's in her mid 20's and she's super stressed out at work and she stated her anxiety was through the roof all the time. Adamant she didn't want an ssri though

 

[clausewitz2]

Don't think I see too many patients with intellectual disabilities or severely low IQ but dang I get tired of so many people coming in because suddenly they're stressed at work, married with kids, taking full load of classes and can't focus. But they think they have "adult adhd" because their friend showed them a tik tok video that they really identified with. No ma'am, you just have 27,000 things on you plate and your bandwidth to handle these things is overloaded. We'll do a qb test that shows they have perfect attention and they don't like that answer... Had a patient leaving my office in tears one time because she was sure she has adhd despite never struggling with any issues with inattention until she's in her mid 20's and she's super stressed out at work and she stated her anxiety was through the roof all the time. Adamant she didn't want an ssri though

I definitely know the sort of patient you're talking about, but gotta say, QB tests for ADHD are pure snake oil.

 

[ObsequiousAplomb]

I definitely know the sort of patient you're talking about, but gotta say, QB tests for ADHD are pure snake oil.

Based on the Google summary, the PPV and NPV ranges both cross 0.5. so it's as valuable as a coin toss. Gross.