How do you guys typically ask the DIGFAST criteria? I'm not at all good with it. When asking about racing thoughts do you guys ask "do you feel like your mind is like energizer bunny?" Some guidance would be appreciated.
Thanks
Thanks
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Manic screen questions?
Started by artorious22
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if you scroll down a bit you will see that there is already an active thread about this where i have posted my thing including how to ask about flight of ideas (i.e. definitely not how you suggest)
Its worth pointing out that screening individuals for mania is never ideal although we do have to do it. If clinical suspicion is high but the pt gives ambiguous responses, collateral from family will usually be the biggest slam dunk for confirming a true manic episode (that or inpatient records from a hospitalization).
Getting collateral that is good and getting the DIGFAST out of family is not so easy.
My attending are changing my diagnosis of MDD to Bipolar Disorder and Schizoaffective disorder all the time without any real explanation, this is frustrating me a lot!
I cannot do my treatment plan properly either. All I see is Zyprexa and Geodon, when I feel they should be on Wellbutrin! Ahh!
Patients get angry about something or someone on the unit and has poor emotional regulation or communication skills and... "aha! Bipolar!". Not saying that is what is happening here, but I've only seen this happen like a million times. Maybe a slight exaggeration, psychiatrists rarely say "aha". 😉
You mean "I don't know. I get mood swings" doesn't satisfy the criteria for Bipolar Disorder?
I remember feeling this way as a resident. I've now seen quite a few patients who were initially dx MDD but had poor response to antidepressants, or got antidepressant induced hypomania, who did much much better once someone thought to put them on a mood stabilizer. Hidden bipolar is a thing and it's easy to miss if you don't ask the right questions.
I try to ask my way into what sounds closest to an episode, try to find the most symptomatic episode, ask about what was going on/functional changes, then probe for symptoms within that specific context. One interesting thing is seeing very depressed, slowed people momentarily get giddy and accelerated when recalling a manic episode.
Oh god, one of my friends has just managed to find a Psychiatrist to change her BPD diagnosis to Bipolar, despite the fact that blind freddy himself could see she doesn't meet the criteria, she's never met the criteria, and the BPD diagnosis was the correct one in the first place. Oh and now of course everything can be excused by 'her bipolar is playing up'.
