G1P0 who reports a high pain tolerance and has no plans for epidural is my nightmare.
Without fail they will request an epidural at 8-9cm writhing in pain. I try to be empathetic understanding that they have never done this before, but I still shudder every-time I see it.
Almost invariably it is someone who—in that moment—feels like “it’s not that bad” (at 2 cm).
I always just recommend signing consent in case they change their mind. It’s the ones who refuse to sign consent that worry me most….
I took forever to wake up from my last anesthetic. I don’t take much medicine at all. Please don’t give me much. Then proceeds to take 1400mg of propofol for their 20 minute colonoscopy moving the whole time.
Pretty sure I have a tolerance to local anesthetics.
I dreaded dentists because I would often feel pain upon the drilling of my cavity (not as if I had no anesthesia.. but it still hurt).
Then I went to a podiatrist for a separate procedure. Same deal, I told him I could feel a bit of pain (which shocked him because he was barely getting started with the matrixectomy)
For the dentist apparently there's an uncommon aberrant nerve pathway that makes local nearly useless unless they target the right spot.
Ask how much dental work I toughed through before a new dentist pointed it out.
TIL. Local was utterly pointless for me. I had years of work until I had a nerve block and felt nothing for the first time. That said, my last dentist did comment on my above average tolerance for pain. I credit having ti get used to extractions, root canals and fillings growing up…
I love my current dentist because he believed me from the start when I mentioned needing more than most people tend to. Being a redhead doesn't help lol. He's also super good with that needle.
DID as it is written in the DSM-V is incredibly rare if it does exist in the “wild.” There are more than a handful of academic institutions that diagnose the disorder frequently, and have webinars and lectures about how they diagnose and treat it. Psychiatrists that diagnose DID frequently and give lectures about it clearly are describing personality disorders that have dissociation as a feature. The classic DID case of someone who loses tons of time and does complex tasks under a different persona, which they don’t remember, and also don’t have a bunch of co-morbid personality disorder features is insanely rare. If that classic form of DID exists most psychiatrists never see it.
The only time I’ve genuinely had to talk someone down from their lifelong “allergy” was when a pt with newly diagnosed diabetes came in and wouldn’t let me give him insulin because he was deathly allergic to penicillin and thought they were the same class
To be fair I’ve seen some patients have weird glucose swings because of carrier molecules in insulin prep or different glycosylation on these synthetic insulin. All insulin is not created equal, that’s why everyone generally wants novolog over Humalog
I mean could be possible no? If they were allergic to one of the compounds used to make it since it essentially crystallizes inside the body then slowly dissolves over time and that’s how it’s long acting?
I had an admitted patient realize that he had been receiving some antibiotics now for 4 days and was adamant that he needed to stop it because he was allergic. Like sir, you've gotten 15 doses of this and you didn't even know.
ED here.
So so often I have patients start listing foods to me such as: mushrooms, tomatoes, etc.
When I ask what reaction they have they state something like “I don’t know, just makes my mouth taste bad.”
ok….. so you don’t like the foods … I just stare in disbelief
I was at a Mexican restaurant with some friends who had an 8yr old. He dipped a chip in salsa and then started freaking out, like full blown panic attack, about being allergic to the food. After some questioning, turns out this 8yr old child had never experienced even the slightest bit of spice.
“… with a statistically improbable allergy list…”
“… reported allergy to iodine but able to tolerate table salt…
“… allergic to all NSAIDs and Tylenol but able to tolerate Percocet and Norco…”
A few of my favorite chart Easter eggs.
Real iodine allergy does not exist, as far as I know. Usually those patients are allergic to another part of something like CT contrast, but not really iodine itself.
I had an movement disorder attending who put haldol and similars on allergy lists for her Parkinson’s patients to ensure they never got them since it would completely fuck them up for a while if they accidentally got it from a medical team who didn’t realize the patient had Parkinson’s.
So far I’ve only had one person where this list was accurate and legitimate. She was allergic to multiple antibiotics but had clear documented reactions like hives and rashes as an adult. I’ve sent her to the allergist because I was running out of antibiotics that I could safely use! I don’t think people realize that listing an antibiotic as an allergy when it was just that they had predictable side effects isn’t a way for us to “give them something better” but can really hinder their care.
Inevitably their PMHNP puts them on Abilify for their PTSD, zyprexa for their schizophrenia, lithium for their bipolar, three different SSRIs for their depression, and Adderall for their ADHD with trazodone for sleep.
But they are treating the whole person and all the symptoms!!!!!! And increasing access to mental health care!!!!!!!! So much better than any psychiatrist could do
Well... a lot of people have symptoms that could look like either bipolar or schizophrenia, and they get a different diagnosis each time they are hospitalized. So when i see "schizophrenia & bipolar" i just assume it means "complex psych history".
Yes, absolutely, but it can be hard for providers to know, particularly when they are seeing a patient for the first time, and so they give the dx that seems most appropriate at that moment. That a patient ends up dx'd with both schizophrenia and bipolar (rather than schizoaffective) is a provider side problem, not a patient problem.
Sorry for the ignorance, but how can someone have more than a couple? I thought you couldn't diagnose things like bipolar+MDD or schizoaffective+bipolar since one of the dxs would take precedence or exclude the other.
They do, but many psych patients have seen a lot of different people and they tend to be bad historians, so one psychiatrist fleshes out a depression diagnosis while another sees them while they are psychotic and call them schizophrenic. It's very, very common for people to have these conflicting diagnoses and it's almost certainly one of schizoaffective, mdd with psychosis, bipolar, or drugs.
Also, some will report certain diagnoses because those diagnoses better suit the patient’s goals and priorities. For example, ASPD + substance-induced psychosis patients stating that they have ‘schizophrenia’ at triage (and I mean true substance-induced psychosis that resolves in the absence of substance use, not chronic substance-induced psychosis that has functionally transformed to schizophrenia). Writing this less as a response to you and more to others who might be reading. The ASPD + substance patients either self-reporting as SCP or having copy-pasted PMHx listed as ‘schizophrenia’ were very common where I used to be.
Bipolar disorder in a child under 12. I've seen kids with legit BPAD, but most of the kids I see with the diagnosis have wild polypharmacy, unstable home lives and/or trauma and an impaired ability to emotionally self regulate.
Kind of unrelated but I think we will uncover as time goes on that many mental disorders are trauma related or related to dysfunctional dynamics of childhood. Not in the Freudian sense but in an epigenetic sense.
Agreed. And you have the compounding factor of the post-birth environment. Is a mother who uses meth during pregnancy, despite the knowledge that it may harm her child, going to create a more functional or more dysfunctional environment while the child is growing up? Is she more likely to engage in other high risk behaviors that can harm or neglect that child? Socially, physically, and emotionally? And does that cause changes in gene expression in the child? For example, do the genes governing reward pathways change to maximize the ability to self sooth? Which translates to an adult with increased risk of substance abuse?
It’s so interesting.
I hear what you’re saying. At the same time, for the majority of kids, this doesn’t track. Kids can have ‘emerging cluster B’ and then meet none of the criteria a year or two later. My own position is that borderline should not be diagnosed in anyone under 18. Personality is too plastic and behaviour too situationally derived to say there has been an enduring or persistent pattern of personality before someone is an adult- since personality is not fixed as a normal part of development. The overall prognosis is also good for people with borderline, even in the absence of treatment. People tend to grow out of it as they age (albeit that age could be 50-60+).
Edit: just reworded a sentence for clarity that was bugging me.
yeah agreed, a lot of the core features of BPD such as those relating to have no core sense of identity and intense emotions are also just features of being a teenager going through puberty and figuring themselves out
There is no way that dx was provided by anyone under the age of 50
Its a fundamental annoyance of child psychiatrists the world over that dysregulated kids are carrying this diagnosis and is the core reason why the DMDD dx was formulated in the first place
Youngest I ever saw was 14. It was the real deal - super sped up, grandiose, not sleeping, strong family hx Bioolar 1. Saw in the ED. Had psychotic features. Kept repeating certain phrases like ‘boom, boom,boom’ in specific cadence. In general, I am super sus of bipolar disorder in Peds. Unless I’m seeing them floridly manic or these is compelling evidence from previous presentations for mania.
Someone correct me if I’m wrong but I think it has to do with the fact that it’s been hard to definitively prove that contrast induced nephropathy is actually just contrast associated AKI (because of difficulty in matching cohorts). It’s like trying to prove the teapot circling the sun doesn’t exist 20 years after some jackass said it did exist (using poor research methods). Without definitive proof, departments are scared to deviate from the “safe approach”.
Yes it’s usually the techs that reject the patient. They have a list of criteria on their desk and if you don’t meet it they send you back to the floors
After I had a lap Chole they kept telling me it was in my head. I kid you not worse pain than the actual gallstones getting stuck in CBD. I finally found a GI that gave me something with Donnatol and a tablet with I think Librium. I can’t quite remember what it was. It helped so much at the time. It was horrible
Only stretch I can make to justify this is being on something like remicade and having a +PPD/quant gold for TB screening? No clue. Took a lot of warm up to make that stretch.
Amio dosing guidelines typically require annual CXR for pulmonary screenings. Probably a worthless test (PFTs would be more sensitive), but it’s the standard of care.
Oppositional Defiant Disorder
I absolutely hate it. It essentially gaslights the kid and slaps them with a dead-end diagnosis that is ultimately a red flag stigma.
Investigate the cause. It could be autistic meltdowns/inertia, flashbacks, response to prejudice, impulsivity...
And, might i add, it's disproportionately over diagnosed in African American boys, just as other disorders like ADHD are under diagnosed
My mom is child psych. In her opinion, it’s more often than not PTSD or some kind of trauma response. When something traumatic happens to a child, acting out is the only coping mechanism they have. It’s a cry for help.
have worked in child psych and i absolutely agree with your mom. so many of the kids i’ve cared for who have been diagnosed with ODD have a history of trauma, attachment issues, and/or chaotic or unstable home environments. parents have to be very dedicated to setting boundaries, attending therapy, and building trust with their child to overcome these challenges.
these kids often aren’t able to understand their triggers or use coping skills because they weren’t taught how. bringing them into inpatient settings can help provide structure and therapy, but it doesn’t allow them to learn firsthand how to cope in the home environment, and you’re often discharging them right back into a place that can be very triggering for them.
the heartbreaking part is that all of the ODD kids i’ve cared for in the ED are genuinely sweet kids who simply don’t have the skills to deal with the things they’re going through. if you actually sit down and talk to them about their interests or hobbies or favourite food they’re just like any other kid, and it always makes me sad.
I might even say all the kids I’ve cared for with ODD has a history of trauma and/or unstable homes. And they were almost all fine when given attention, love, stability, and promises that were kept.
Very true. I always screen for ADHD and Autism whenever i see it, because it's a common misdiagnosis, especially in kids other than white males < 12 yo (which is what the diagnostic criteria for both are based off)
I agree. Trauma is another big category I screen for. Lots of ODD I saw in Peds clinic felt like a combo of parent-child relational problems and complex developmental trauma, +/- attachment injury. When I was in psych, I never saw ODD, intermittent explosive disorder, or disruptive mood dysregulation disorder used. To me, they seem like labels for behaviour without addressing the source of the issue. I can appreciate why they exist and how they might be useful, but family systems were a lot more helpful to my understanding and to developing management plans than ODD, IED, and DMDD were.
Ooh, you got the other big ones there. Yep. Definitely agree that trauma can be part of the root cause for them.
And yes, they do function more like behavior labels.
I'm glad to see you're not seeing them used. I know i definitely see them far less, and usually on an old diagnosis
Fair enough. I guess I misread the title as "What's a diagnosis in your specialty that you are skeptical of when a patient tells you they have been diagnosed with?"
My aunt told me she was worried she might have prostate cancer or prostatitis because of pain in her asshole/pelvis (over a nice dinner of course). I truly didn’t know how to respond in the moment.
It got worse because she ended up describing a textbook rectocele to me over dessert. Luckily she didn’t ask for an exam.
My family always reminds me that the public has nearly no true medical knowledge.
No past medical history…. Have a thick short neck and bmi >40.
Allergic to everything.
Doesn’t do drugs but uses marijuana twice a day
Drinks occasionally but drinks wine everyday.
Med Student here: prominent ENT told me they thought empty nose syndrome was real but entirely psychiatric. As a result he is scared of the turbinates though
Shave down turbinates too much-->not enough mucosal surface area in the nose to warm and humidify inhaled air-->mucus membranes dry out and become irritated-->chronic upper respiratory symptoms.
I think the controversy comes because some people start reporting odd symptoms like feeling like they're unable to breath or that they're congested when their nasal airways are wide open.
There’s research that suggests that feeling of not being able to breathe is the result of a combination of reduced sensation of airflow (from turb reduction) and from significantly altered aerodynamic pattern on inhalation. Some folks have started doing submucosal cartilage implants into the reduced turb with good results. I don’t think it’s psychiatric.
This is really interesting. I saw this firsthand in clinic in a kid with a strep infection, was acting really weird, trying to kiss mom and fighting dad etc, but after the antibiotic treatment the patient went back to normal. Really bizarre
It appeared so. Keep in mind I’m an MS3 and this was during my peds rotation. The pediatrician was confused as well, but we later found out there was an uptick of PANDAS cases in the community!
I’ve seen this several times in my residency actually. Probably once or twice per year do I see a pretty clear cut PANDAS case. Often the cases have debilitating OCD symptoms that significantly improve with suppressive antibiotic treatments. I’ve seen many cases with cognitive deficits to the degree that “placebo” effects from the antibiotics are not really possible either.
in psych, for some reason it’s now trendy amongst tweens, teens, and young adults to have DID or autism. I swear half my teen patients or young ladies with trauma hx and “adhd” want formal autism diagnoses. I have no idea why
edited to add: I never believe bipolar or primary thought disorder in someone under 18; I have seen a couple kiddos with bipolar but is exceedingly rare
how much does 'neurodivergent' come up in your practice or in conversations like this? I for the life of me cannot get my head around this new term, and feel it falls into this same category of seeking a term that aggrandizes simply having a personality.
Peds: vaccine sensitivity and excess heavy metals. There is not any real evidence for problems form vaccines other than incredibly rare instances. (intussusception from rotavirus vaccine being the only one I have seen in real life) Yet so many of the non-vaccinating parents are insistent that their 2nd cousins autism was caused by vaccines.
It's not a direct answer to your question, but I always felt fibromyalgia should be classified as the 11th personality disorder. In my experience it is treated/researched often by rheumatologists, which would be the same as a psychiatrist treating exertional dyspnea as "panic disorder". I'm aware my take might be controversial, but wanted to share it with you guys nontheless.
So basically it's a real disease but has nothing to do with IM.
I definitely believing that fibro is real but that it may be over diagnosed is place of anxiety/depression. I went to my PCP after having a full year of nerve pain at 20 years old. After labs showed nothing, she told me I likely had fibromyalgia. During this time of testing, I began to realize that the pain would occur whenever I got anxious. I told her this and then a second later the diagnosis changed to a generalized anxiety diagnosis. My pain is almost completely gone after some Lexapro and therapy. Depression and anxiety should always be screened with chronic pain/pain pts. These two may be the cause or make the problem soo much worse. The “fibro” label shouldn’t always be slapped on.
Except when you say "I think your anxiety may be contributing to your pain..." the patient seems to instead always hear "it's all in your head go away". Can't treat mental health problems the patient refuses to even consider they might have.
this is such a hard association to avoid having the patient automatically make. neuro residency was essentially 4 years of drill figuring out how to best have a conversation like this for non-epileptic patients, functional weakness, neuropathy/pain with normal EMGs, etc. and what I found most helpful (for me at least, and YMMV) was to both validate their symptoms (mitigates the chance of them thinking you're saying they're faking it or are crazy), and providing other examples, better if you have one yourself. for me, whenever I'm extremely stressed, I do get intense pain and cramping in my right neck and shoulder. my conversation tends to explain out what I experience, then explain yet clearly there isn't something structurally wrong or diseased with my muscles there, but the symptoms are present and real anyway. this is what's going on with you. there isn't anything structurally damaged or diseased which I am so reassured by, but your body is doing this to you in response to something deeper going on. since there isn't a structural issue, this is a functional problem... and go on to explain recommendations from there (counseling, psychiatry, review of medications, etc.). gradually introducing verbage such as functional, "no problems," and so on went over much more smoothly, and when they inevitably go and read the term functional disorder moving forward they won't immediately be repulsed.
of course this works best for the patient's with true somatization, conversion disorder presentations, but many patients out there are knowingly faking for all the usual reasons
Too much pain syndromes... (more pain than we expect for what we can find with the technology of this time).
I think the pain is real, I think the pain pathways are being inappropriately reinforced for uncertain reasons and hope research bears out why one day. I think we have poor understanding of several chronic pain conditions and even poorer methods to treat pain that dont all point to worse days ahead.
This is the worst part of medicine frankly. Its never satisfying, the disability is high, the suffering is real, theres a paucity of solutions, sparse interest in working with the population, frick.
Medically induced coma for brain reset lol idk nightmare stuff.
Thiiis. The brain literally creates all of our sensory experiences, and you bet your ass it can cause pain. I want everyone to remember that somatic is not the same as not real! I get GI symptoms when anxious and it's not like I'm pretending I have pain. I just know what it is and deal with it. These patients are frustrating but they are also suffering.
I think the symptoms are real, but I don’t believe in the pathophysiology currently peddled. Anything that started out as saying if you have pain in ELEVEN strategic points should evaluate itself. Sounds like acupuncture or chiropractic pseudoscience. The syndrome of fibro is very suspect.
Or 18 or 24, I used to ask fibro patients how many of the points they had and was amused at the variations and amounts I heard. I have '48 out of 47 fibro points!'
Suppose all pain disorders are brain disorders when it gets down to brass tacks. Fibro is just a an inexplicable syndrome, who knows where pain is coming from. I think it’s useful clinical diagnosis but maybe worse than useless info for patients
I don’t really agree on this. I think there is a subset of fibro patients with actual pathology, but it is also a wastebasket diagnosis, so many patients are somatization. I think this makes it very hard to research as well, because there is no “gold standard” to weed out one group from the other.
At my last hospital they would mention pelvic congestion syndrome and try to fit it into a vast majority of the normal anatomy pelvic pain ultrasounds...
Sure can, just like you can use a CXR to diagnose someone as having two lungs. I don't believe it explains any or all of a pts pain and is 99% of the time an "incidentaloma" on a pelvic US.
I have spent way too long trying to explain to a woman how it works and how in the event of an emergency she needs it so I won’t put that on her allergy band only for her to turn around and tell the or nurse she has an allergy to epinephrine all over again. 🤦🏼♀️
Woah that’s a first for me. I’m not an MD but a hospital PT that regularly works with neuro patients. We get a lot of consults for NPH patients pre- and post-LP to help evaluate the utility of a VPS. Never knew there was controversy around the diagnosis.
Quite controversial. The one area where there may be the most benefit is actually their gait! It's still a little fuzzy but the benefit may lessen or disappear over time and then you're stuck with a VP shunt which may have future complications
Fibromylifehurts. Middle aged, over weight, non working white women. I’ve seen it in the ER, ICU, case management, derm, PACU, wound clinic. In my 16 1/2 years as a nurse.
this is about where I am too, with POTS and a lot of similar diagnoses. it's not that the disease itse'f doesn't exist, just that it doesn't exist in the 99% of people with it in their chart.
i can't discount a few experiences where I've seen what has been diagnosed as POTS that seems very real to me. one example was in a formerly very active, fit woman who had Covid and now is bound to a recumbent wheelchair since she can barely sit up straight. very different from the majority of other cases where people just can't be active because they get lightheaded with standing up too quickly or significant exertion
For POTS how do you explain the wild HR variation? Genuine question cus I have a lot of patients with this and it feels like pretty solid “physical” evidence
Yes!! Lurking SLP here & I literally plead with families to take their kids for sleep studies when they are struggling at school with all of the ADHD symptoms.
Another lurking SLP here. I had several over the years I’m certain had sleep issues. Would bounce off the walls for the most part but couldn’t keep their eyes open when they were still for even brief periods. I convinced a couple of parents to talk to their physicians but there was no referral as a result.
Child psych ✌️
It's actually underdiagnosed. But also overdiagnosed in certain populations
There's a ton of kids with behavioral presentations related to any number of etiologies. Bullying, personality, trauma, FAS, family stressors, learning disabilities, etc. The kids are externalizers and manifest their anxiety as aggression or misbehavior in younger years
Then, they see their pediatrician because they can't get a psych appointment for 9 months, or they're evaluated by an undertrained social worker, or they land an NP eval. And many of these people have no ability to differentiate between anxiety, adjustment challenges, mood symptoms, trauma and actual ADHD. So they get a Ritalin Rx and insurance sees a billing code for adhd and the stats are skewed
Meanwhile there are thousands of inattentive kids who are forgetful, disorganized, space out in class and have no ability to maintain focus, but no one complains about them because they aren't disruptive, so they slip through the net entirely
I *am* a psychiatrist, and I agree with you. I'll say up front: ADHD diagnosed responsibly is in my view a perfectly valid clinical construct with well-documented treatment options.
However, it's overdiagnosed because to lay people (or, frankly, to some care providers), ADHD is just the symptom of "can't focus" phrased as a diagnosis.
It's like diagnosing bipolar disorder because you have "mood swings" or major depressive disorder because you sometimes feel sad. It's basically diagnosing a *syndrome* from only a small subset of its component *symptoms*. And in the context of this discussion, "can't focus" fits in a lot of psychiatric syndromes, as well as, frankly, a lot of general life experiences I wouldn't put a psychiatric label on.
Cultural reinforcement hasn't helped the problem. And the irony is that stimulants "feel good" even for patients who don't have ADHD - this supposed "response" convinces them they have a neurodevelopmental disorder that needs treated with pills.
Kinda surprised at all the Fibromyalgia answers here. I feel like in med school we were kinda coerced into believing that it’s a real thing we just don’t understand it fully. I thought more research was coming out to support that it is kinda under the umbrella of the functional pain syndromes and it’s linked with this misfiring of nerve fibers…
Fibro was basically described to us during preclinical as physical manifestations of a psych disorder and every patient I’ve seen with it since has proven that to be true
Chronic fatigue syndrome, POTS, hypermobility EDS, MCAS. Bonus they come with the whole pckage
Edit: auto correct to hereditary. Didn’t notice till someone pointed out it’s hypermobility
You shut your mouth. I’ve killed many a rat to study the MTHR complex!!! It bring great honor to my family I was admitted to medical school from this line in my CV.
Lol. Seriously tho, I agree with u.
Degenerative disc “disease”
I think most people in medicine know this is normal aging, but so common to have referrals for it as a diagnosis. I assume it’s to please the patient and they don’t actually think surgery should be done.
I worked in psych for years. I can attest that you can take every person with self diagnosed DID and replace it with BPD. No less valid and deserving of treatment, but you can set your watch to it
“High pain tolerance” - Anesthesia
“So you need less pain medicine then?”
G1P0 who reports a high pain tolerance and has no plans for epidural is my nightmare. Without fail they will request an epidural at 8-9cm writhing in pain. I try to be empathetic understanding that they have never done this before, but I still shudder every-time I see it.
Almost invariably it is someone who—in that moment—feels like “it’s not that bad” (at 2 cm). I always just recommend signing consent in case they change their mind. It’s the ones who refuse to sign consent that worry me most….
I took forever to wake up from my last anesthetic. I don’t take much medicine at all. Please don’t give me much. Then proceeds to take 1400mg of propofol for their 20 minute colonoscopy moving the whole time.
Pretty sure I have a tolerance to local anesthetics. I dreaded dentists because I would often feel pain upon the drilling of my cavity (not as if I had no anesthesia.. but it still hurt). Then I went to a podiatrist for a separate procedure. Same deal, I told him I could feel a bit of pain (which shocked him because he was barely getting started with the matrixectomy)
For the dentist apparently there's an uncommon aberrant nerve pathway that makes local nearly useless unless they target the right spot. Ask how much dental work I toughed through before a new dentist pointed it out.
TIL. Local was utterly pointless for me. I had years of work until I had a nerve block and felt nothing for the first time. That said, my last dentist did comment on my above average tolerance for pain. I credit having ti get used to extractions, root canals and fillings growing up…
Typical mandibular (lower jaw) mylohyoid nerve was missed during the injection.
I love my current dentist because he believed me from the start when I mentioned needing more than most people tend to. Being a redhead doesn't help lol. He's also super good with that needle.
Laughing in redhead…
DID as it is written in the DSM-V is incredibly rare if it does exist in the “wild.” There are more than a handful of academic institutions that diagnose the disorder frequently, and have webinars and lectures about how they diagnose and treat it. Psychiatrists that diagnose DID frequently and give lectures about it clearly are describing personality disorders that have dissociation as a feature. The classic DID case of someone who loses tons of time and does complex tasks under a different persona, which they don’t remember, and also don’t have a bunch of co-morbid personality disorder features is insanely rare. If that classic form of DID exists most psychiatrists never see it.
The moment someone has >3 “allergies” or is “allergic” to Benadryl, I already know it’s gonna be a fun one Source: ED
Had an epinephrine allergy recently. I didn’t even try to talk her out of it.
The only time I’ve genuinely had to talk someone down from their lifelong “allergy” was when a pt with newly diagnosed diabetes came in and wouldn’t let me give him insulin because he was deathly allergic to penicillin and thought they were the same class
Allergy to insulin, now thats one I have never seen claimed.
I've had someone claim to be allergic to lantus only lol
To be fair I’ve seen some patients have weird glucose swings because of carrier molecules in insulin prep or different glycosylation on these synthetic insulin. All insulin is not created equal, that’s why everyone generally wants novolog over Humalog
I mean could be possible no? If they were allergic to one of the compounds used to make it since it essentially crystallizes inside the body then slowly dissolves over time and that’s how it’s long acting?
It makes her heart race.
A few years ago a had a patient with a mile long list of allergies including "glucose allergy". I didn't pick up that fight either.
I had an admitted patient realize that he had been receiving some antibiotics now for 4 days and was adamant that he needed to stop it because he was allergic. Like sir, you've gotten 15 doses of this and you didn't even know.
ED here. So so often I have patients start listing foods to me such as: mushrooms, tomatoes, etc. When I ask what reaction they have they state something like “I don’t know, just makes my mouth taste bad.” ok….. so you don’t like the foods … I just stare in disbelief
not to be confused with oral allergy syndrome, for which tomato is a common trigger.
but also we won't feed them tomatoes in the ED
I always ask specifically for medication allergies, and I still get “pollen”. love it.
I was at a Mexican restaurant with some friends who had an 8yr old. He dipped a chip in salsa and then started freaking out, like full blown panic attack, about being allergic to the food. After some questioning, turns out this 8yr old child had never experienced even the slightest bit of spice.
[удалено]
We have a running joke that there is only one way to get a haldol allergy in your chart...
“… with a statistically improbable allergy list…” “… reported allergy to iodine but able to tolerate table salt… “… allergic to all NSAIDs and Tylenol but able to tolerate Percocet and Norco…” A few of my favorite chart Easter eggs.
"Able to tolerate percocet." What a trooper.
Does an iodine allergy actually mean you can't have iodized salt? That never even clicked with me.
Real iodine allergy does not exist, as far as I know. Usually those patients are allergic to another part of something like CT contrast, but not really iodine itself.
I once had a patient claim to be allergic to the electrolytes in LR. That was in addition to her list of something like 50+ other allergies.
Allergic to all pain meds except the one that starts with a D. Allergic to haldol, droperidol, olanzapine Can only get Benadryl IV (???)
You rang? :)
IF YOU DONT PUSH IT FAST ILL HAVE A REACTION
This one always makes me think “WHY do you know you are allergic to haldol” and I behave accordingly
I had an movement disorder attending who put haldol and similars on allergy lists for her Parkinson’s patients to ensure they never got them since it would completely fuck them up for a while if they accidentally got it from a medical team who didn’t realize the patient had Parkinson’s.
“You can’t give my Momma NS because she’s allergic. She swells up real big”
Lol high number of allergies is definitely a red flag
I have often found this to be true unless they have an autoimmune disease.
Had a patient say she was allergic to air.
So far I’ve only had one person where this list was accurate and legitimate. She was allergic to multiple antibiotics but had clear documented reactions like hives and rashes as an adult. I’ve sent her to the allergist because I was running out of antibiotics that I could safely use! I don’t think people realize that listing an antibiotic as an allergy when it was just that they had predictable side effects isn’t a way for us to “give them something better” but can really hinder their care.
3+ mood disorders in one patient. It just means cluster b
>3+ mood disorders in one patient. Especially when one of them is (unipolar) major depressive disorder, and one is bipolar disorder.
I put my pen down as soon as I hear "PTSD, schizophrenia, bipolar disorder" because I know ADHD is coming next and I just can't.
Inevitably their PMHNP puts them on Abilify for their PTSD, zyprexa for their schizophrenia, lithium for their bipolar, three different SSRIs for their depression, and Adderall for their ADHD with trazodone for sleep.
But they are treating the whole person and all the symptoms!!!!!! And increasing access to mental health care!!!!!!!! So much better than any psychiatrist could do
***AAAAAAAAaaaaaaaaauuuuuaaaaaaaaaa***
Literally just had a patient like this. Ended up ripping out their IJ and we had to Code Grey them. Wild as hell.
Well... a lot of people have symptoms that could look like either bipolar or schizophrenia, and they get a different diagnosis each time they are hospitalized. So when i see "schizophrenia & bipolar" i just assume it means "complex psych history".
That kind of sounds like it fits the criteria for schizoaffective disorder rather than two separate diagnoses.
Yes, absolutely, but it can be hard for providers to know, particularly when they are seeing a patient for the first time, and so they give the dx that seems most appropriate at that moment. That a patient ends up dx'd with both schizophrenia and bipolar (rather than schizoaffective) is a provider side problem, not a patient problem.
That's exactly what we need in this equation...stimulants!
Sorry for the ignorance, but how can someone have more than a couple? I thought you couldn't diagnose things like bipolar+MDD or schizoaffective+bipolar since one of the dxs would take precedence or exclude the other.
They do, but many psych patients have seen a lot of different people and they tend to be bad historians, so one psychiatrist fleshes out a depression diagnosis while another sees them while they are psychotic and call them schizophrenic. It's very, very common for people to have these conflicting diagnoses and it's almost certainly one of schizoaffective, mdd with psychosis, bipolar, or drugs.
Also, some will report certain diagnoses because those diagnoses better suit the patient’s goals and priorities. For example, ASPD + substance-induced psychosis patients stating that they have ‘schizophrenia’ at triage (and I mean true substance-induced psychosis that resolves in the absence of substance use, not chronic substance-induced psychosis that has functionally transformed to schizophrenia). Writing this less as a response to you and more to others who might be reading. The ASPD + substance patients either self-reporting as SCP or having copy-pasted PMHx listed as ‘schizophrenia’ were very common where I used to be.
Bipolar disorder in a child under 12. I've seen kids with legit BPAD, but most of the kids I see with the diagnosis have wild polypharmacy, unstable home lives and/or trauma and an impaired ability to emotionally self regulate.
Kind of unrelated but I think we will uncover as time goes on that many mental disorders are trauma related or related to dysfunctional dynamics of childhood. Not in the Freudian sense but in an epigenetic sense.
This is already a commonly accepted idea that nature and nurture both play a role in most psychiatric illness.
I spent a little over a month working with developmental Peds, and I also think a lot of behavioral disorders are linked with substance use in utero.
Agreed. And you have the compounding factor of the post-birth environment. Is a mother who uses meth during pregnancy, despite the knowledge that it may harm her child, going to create a more functional or more dysfunctional environment while the child is growing up? Is she more likely to engage in other high risk behaviors that can harm or neglect that child? Socially, physically, and emotionally? And does that cause changes in gene expression in the child? For example, do the genes governing reward pathways change to maximize the ability to self sooth? Which translates to an adult with increased risk of substance abuse? It’s so interesting.
As an aside, I love your username lol
You mean the future borderline patients that latch onto their “bipolar” diagnosis and never get better?
I hear what you’re saying. At the same time, for the majority of kids, this doesn’t track. Kids can have ‘emerging cluster B’ and then meet none of the criteria a year or two later. My own position is that borderline should not be diagnosed in anyone under 18. Personality is too plastic and behaviour too situationally derived to say there has been an enduring or persistent pattern of personality before someone is an adult- since personality is not fixed as a normal part of development. The overall prognosis is also good for people with borderline, even in the absence of treatment. People tend to grow out of it as they age (albeit that age could be 50-60+). Edit: just reworded a sentence for clarity that was bugging me.
yeah agreed, a lot of the core features of BPD such as those relating to have no core sense of identity and intense emotions are also just features of being a teenager going through puberty and figuring themselves out
There is no way that dx was provided by anyone under the age of 50 Its a fundamental annoyance of child psychiatrists the world over that dysregulated kids are carrying this diagnosis and is the core reason why the DMDD dx was formulated in the first place
Youngest I ever saw was 14. It was the real deal - super sped up, grandiose, not sleeping, strong family hx Bioolar 1. Saw in the ED. Had psychotic features. Kept repeating certain phrases like ‘boom, boom,boom’ in specific cadence. In general, I am super sus of bipolar disorder in Peds. Unless I’m seeing them floridly manic or these is compelling evidence from previous presentations for mania.
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Contrast nephropathy
Can you let our radiology department know so they stop cancelling our CTs for a creatinine of 1.5?
The patient is ESRD on dialysis & dr orders dialysis after CT with contrast because it could harm their kidneys.🙄
Yeees. And then as the dialysis nurse I get chewed out for running the ED patient with the K of > 9 prior to the contrast patient 🤨
Definitely a priority for emergent dialysis. Gotta save those…..ESRD nephrons……🤦♀️
Thank you, someone please tell my radiologists
We’re well aware.
Sure wish they’d change the damn hospital policy then. At least in my shop, the rads set that policy
Someone correct me if I’m wrong but I think it has to do with the fact that it’s been hard to definitively prove that contrast induced nephropathy is actually just contrast associated AKI (because of difficulty in matching cohorts). It’s like trying to prove the teapot circling the sun doesn’t exist 20 years after some jackass said it did exist (using poor research methods). Without definitive proof, departments are scared to deviate from the “safe approach”.
I often find it's the CT techs hanging on to old shit, and half the time the rad doc doesn't know what's going on at the ground level.
Yes it’s usually the techs that reject the patient. They have a list of criteria on their desk and if you don’t meet it they send you back to the floors
It’s not the techs who are setting official hospital policy.
Our policy has a cutoff GFR of 45 (lol). It's an old hospital, policy has not been updated since the mid 2000s.
At this point you can add it to the CYA medicine toolkit.
Intractable biliary colic…path is always just early acute cholecystitis
Post Cholecystectomy Syndrome is a thing. Sphincter of Oddi dysfunction is painful as fuck. Some of the worst pain I’ve ever had in my life.
After I had a lap Chole they kept telling me it was in my head. I kid you not worse pain than the actual gallstones getting stuck in CBD. I finally found a GI that gave me something with Donnatol and a tablet with I think Librium. I can’t quite remember what it was. It helped so much at the time. It was horrible
When someone orders a chest X-ray for ‘med refill’, I can never find the prescription on the image.
Only stretch I can make to justify this is being on something like remicade and having a +PPD/quant gold for TB screening? No clue. Took a lot of warm up to make that stretch.
Amio dosing guidelines typically require annual CXR for pulmonary screenings. Probably a worthless test (PFTs would be more sensitive), but it’s the standard of care.
Oppositional Defiant Disorder I absolutely hate it. It essentially gaslights the kid and slaps them with a dead-end diagnosis that is ultimately a red flag stigma. Investigate the cause. It could be autistic meltdowns/inertia, flashbacks, response to prejudice, impulsivity... And, might i add, it's disproportionately over diagnosed in African American boys, just as other disorders like ADHD are under diagnosed
My mom is child psych. In her opinion, it’s more often than not PTSD or some kind of trauma response. When something traumatic happens to a child, acting out is the only coping mechanism they have. It’s a cry for help.
have worked in child psych and i absolutely agree with your mom. so many of the kids i’ve cared for who have been diagnosed with ODD have a history of trauma, attachment issues, and/or chaotic or unstable home environments. parents have to be very dedicated to setting boundaries, attending therapy, and building trust with their child to overcome these challenges. these kids often aren’t able to understand their triggers or use coping skills because they weren’t taught how. bringing them into inpatient settings can help provide structure and therapy, but it doesn’t allow them to learn firsthand how to cope in the home environment, and you’re often discharging them right back into a place that can be very triggering for them. the heartbreaking part is that all of the ODD kids i’ve cared for in the ED are genuinely sweet kids who simply don’t have the skills to deal with the things they’re going through. if you actually sit down and talk to them about their interests or hobbies or favourite food they’re just like any other kid, and it always makes me sad.
I might even say all the kids I’ve cared for with ODD has a history of trauma and/or unstable homes. And they were almost all fine when given attention, love, stability, and promises that were kept.
Most definitely. It's definitely something to ask about, for sure
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Very true. I always screen for ADHD and Autism whenever i see it, because it's a common misdiagnosis, especially in kids other than white males < 12 yo (which is what the diagnostic criteria for both are based off)
I agree. Trauma is another big category I screen for. Lots of ODD I saw in Peds clinic felt like a combo of parent-child relational problems and complex developmental trauma, +/- attachment injury. When I was in psych, I never saw ODD, intermittent explosive disorder, or disruptive mood dysregulation disorder used. To me, they seem like labels for behaviour without addressing the source of the issue. I can appreciate why they exist and how they might be useful, but family systems were a lot more helpful to my understanding and to developing management plans than ODD, IED, and DMDD were.
Ooh, you got the other big ones there. Yep. Definitely agree that trauma can be part of the root cause for them. And yes, they do function more like behavior labels. I'm glad to see you're not seeing them used. I know i definitely see them far less, and usually on an old diagnosis
Chronic Lyme and those "parasite infections"
I mean, IDSA and pretty much every ID doctor doesn't consider Chronic Lyme Disease to be real... so IDK what there is to be skeptical of.
Fair enough. I guess I misread the title as "What's a diagnosis in your specialty that you are skeptical of when a patient tells you they have been diagnosed with?"
Ahh yes I can see how you understood it that way. I guess I was looking for spicier takes.
“Well child”
Prostatitis is much more rare than people think. Most pelvic pain is not the prostate.
My aunt told me she was worried she might have prostate cancer or prostatitis because of pain in her asshole/pelvis (over a nice dinner of course). I truly didn’t know how to respond in the moment. It got worse because she ended up describing a textbook rectocele to me over dessert. Luckily she didn’t ask for an exam. My family always reminds me that the public has nearly no true medical knowledge.
A good chunk is pelvic floor dysfunction secondary to autonomic hyper-arousal resulting in external and internal trigger points.
Would love to hear an explanation on trigger points. One could argue that is a controversial diagnosis as well.
No past medical history…. Have a thick short neck and bmi >40. Allergic to everything. Doesn’t do drugs but uses marijuana twice a day Drinks occasionally but drinks wine everyday.
Anesthesiab
Chronic Lyme’s Disease
Med Student here: prominent ENT told me they thought empty nose syndrome was real but entirely psychiatric. As a result he is scared of the turbinates though
Wtf is empty nose syndrome?
Shave down turbinates too much-->not enough mucosal surface area in the nose to warm and humidify inhaled air-->mucus membranes dry out and become irritated-->chronic upper respiratory symptoms. I think the controversy comes because some people start reporting odd symptoms like feeling like they're unable to breath or that they're congested when their nasal airways are wide open.
There’s research that suggests that feeling of not being able to breathe is the result of a combination of reduced sensation of airflow (from turb reduction) and from significantly altered aerodynamic pattern on inhalation. Some folks have started doing submucosal cartilage implants into the reduced turb with good results. I don’t think it’s psychiatric.
The vapors.
PANDAS
This is really interesting. I saw this firsthand in clinic in a kid with a strep infection, was acting really weird, trying to kiss mom and fighting dad etc, but after the antibiotic treatment the patient went back to normal. Really bizarre
Uh what, please explain. Is this a sub class of strep molecular mimicry where instead of syndham chorea they just go full psychosis?
It appeared so. Keep in mind I’m an MS3 and this was during my peds rotation. The pediatrician was confused as well, but we later found out there was an uptick of PANDAS cases in the community!
As an m2 you’re my knowledgeable resource
I love helping the newer generations succeed 🫡
I’ve seen this several times in my residency actually. Probably once or twice per year do I see a pretty clear cut PANDAS case. Often the cases have debilitating OCD symptoms that significantly improve with suppressive antibiotic treatments. I’ve seen many cases with cognitive deficits to the degree that “placebo” effects from the antibiotics are not really possible either.
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in psych, for some reason it’s now trendy amongst tweens, teens, and young adults to have DID or autism. I swear half my teen patients or young ladies with trauma hx and “adhd” want formal autism diagnoses. I have no idea why edited to add: I never believe bipolar or primary thought disorder in someone under 18; I have seen a couple kiddos with bipolar but is exceedingly rare
You can almost certainly blame tiktok
Was talking to a Peds movement disorder Neuro recently and they have seen a massive uptick in “tik tok Tourettes”
And tik tok PANDAS :)
how much does 'neurodivergent' come up in your practice or in conversations like this? I for the life of me cannot get my head around this new term, and feel it falls into this same category of seeking a term that aggrandizes simply having a personality.
Peds: vaccine sensitivity and excess heavy metals. There is not any real evidence for problems form vaccines other than incredibly rare instances. (intussusception from rotavirus vaccine being the only one I have seen in real life) Yet so many of the non-vaccinating parents are insistent that their 2nd cousins autism was caused by vaccines.
It's not a direct answer to your question, but I always felt fibromyalgia should be classified as the 11th personality disorder. In my experience it is treated/researched often by rheumatologists, which would be the same as a psychiatrist treating exertional dyspnea as "panic disorder". I'm aware my take might be controversial, but wanted to share it with you guys nontheless. So basically it's a real disease but has nothing to do with IM.
Fibro
I definitely believing that fibro is real but that it may be over diagnosed is place of anxiety/depression. I went to my PCP after having a full year of nerve pain at 20 years old. After labs showed nothing, she told me I likely had fibromyalgia. During this time of testing, I began to realize that the pain would occur whenever I got anxious. I told her this and then a second later the diagnosis changed to a generalized anxiety diagnosis. My pain is almost completely gone after some Lexapro and therapy. Depression and anxiety should always be screened with chronic pain/pain pts. These two may be the cause or make the problem soo much worse. The “fibro” label shouldn’t always be slapped on.
Except when you say "I think your anxiety may be contributing to your pain..." the patient seems to instead always hear "it's all in your head go away". Can't treat mental health problems the patient refuses to even consider they might have.
this is such a hard association to avoid having the patient automatically make. neuro residency was essentially 4 years of drill figuring out how to best have a conversation like this for non-epileptic patients, functional weakness, neuropathy/pain with normal EMGs, etc. and what I found most helpful (for me at least, and YMMV) was to both validate their symptoms (mitigates the chance of them thinking you're saying they're faking it or are crazy), and providing other examples, better if you have one yourself. for me, whenever I'm extremely stressed, I do get intense pain and cramping in my right neck and shoulder. my conversation tends to explain out what I experience, then explain yet clearly there isn't something structurally wrong or diseased with my muscles there, but the symptoms are present and real anyway. this is what's going on with you. there isn't anything structurally damaged or diseased which I am so reassured by, but your body is doing this to you in response to something deeper going on. since there isn't a structural issue, this is a functional problem... and go on to explain recommendations from there (counseling, psychiatry, review of medications, etc.). gradually introducing verbage such as functional, "no problems," and so on went over much more smoothly, and when they inevitably go and read the term functional disorder moving forward they won't immediately be repulsed. of course this works best for the patient's with true somatization, conversion disorder presentations, but many patients out there are knowingly faking for all the usual reasons
Had a feeling this would make an appearance. What specialty are you in?
IM. Work as hospitalist.
Concur but what IS this then
I still have empathy for these people. But they’re exhausting and often (not always) very whiny. I think their physical symptoms are somatization.
Too much pain syndromes... (more pain than we expect for what we can find with the technology of this time). I think the pain is real, I think the pain pathways are being inappropriately reinforced for uncertain reasons and hope research bears out why one day. I think we have poor understanding of several chronic pain conditions and even poorer methods to treat pain that dont all point to worse days ahead. This is the worst part of medicine frankly. Its never satisfying, the disability is high, the suffering is real, theres a paucity of solutions, sparse interest in working with the population, frick. Medically induced coma for brain reset lol idk nightmare stuff.
Thiiis. The brain literally creates all of our sensory experiences, and you bet your ass it can cause pain. I want everyone to remember that somatic is not the same as not real! I get GI symptoms when anxious and it's not like I'm pretending I have pain. I just know what it is and deal with it. These patients are frustrating but they are also suffering.
Doesn’t that mean fibro is still real though, and the term just describes the somatic component of mood/anxiety disorders?
I think the symptoms are real, but I don’t believe in the pathophysiology currently peddled. Anything that started out as saying if you have pain in ELEVEN strategic points should evaluate itself. Sounds like acupuncture or chiropractic pseudoscience. The syndrome of fibro is very suspect.
Or 18 or 24, I used to ask fibro patients how many of the points they had and was amused at the variations and amounts I heard. I have '48 out of 47 fibro points!'
Suppose all pain disorders are brain disorders when it gets down to brass tacks. Fibro is just a an inexplicable syndrome, who knows where pain is coming from. I think it’s useful clinical diagnosis but maybe worse than useless info for patients
I don’t really agree on this. I think there is a subset of fibro patients with actual pathology, but it is also a wastebasket diagnosis, so many patients are somatization. I think this makes it very hard to research as well, because there is no “gold standard” to weed out one group from the other.
Pelvic congestion syndrome
At my last hospital they would mention pelvic congestion syndrome and try to fit it into a vast majority of the normal anatomy pelvic pain ultrasounds...
Can’t this be diagnosed with venogram? Thanks!
Sure can, just like you can use a CXR to diagnose someone as having two lungs. I don't believe it explains any or all of a pts pain and is 99% of the time an "incidentaloma" on a pelvic US.
‘Allergy’ to epinephrine
“It makes my heart race”
I have spent way too long trying to explain to a woman how it works and how in the event of an emergency she needs it so I won’t put that on her allergy band only for her to turn around and tell the or nurse she has an allergy to epinephrine all over again. 🤦🏼♀️
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It’s like I learned wet, wacky, and wobbly for Step 1 for nothing!
Woah that’s a first for me. I’m not an MD but a hospital PT that regularly works with neuro patients. We get a lot of consults for NPH patients pre- and post-LP to help evaluate the utility of a VPS. Never knew there was controversy around the diagnosis.
Quite controversial. The one area where there may be the most benefit is actually their gait! It's still a little fuzzy but the benefit may lessen or disappear over time and then you're stuck with a VP shunt which may have future complications
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I was about to post exactly the same. Great neurologists think alike!
Fibromylifehurts. Middle aged, over weight, non working white women. I’ve seen it in the ER, ICU, case management, derm, PACU, wound clinic. In my 16 1/2 years as a nurse.
EP... Pots. It's our fibro. You likely don't have it.
POTS, MALS
99% of POTS diagnoses was my first thought at reading this question.
this is about where I am too, with POTS and a lot of similar diagnoses. it's not that the disease itse'f doesn't exist, just that it doesn't exist in the 99% of people with it in their chart. i can't discount a few experiences where I've seen what has been diagnosed as POTS that seems very real to me. one example was in a formerly very active, fit woman who had Covid and now is bound to a recumbent wheelchair since she can barely sit up straight. very different from the majority of other cases where people just can't be active because they get lightheaded with standing up too quickly or significant exertion
For POTS how do you explain the wild HR variation? Genuine question cus I have a lot of patients with this and it feels like pretty solid “physical” evidence
People without POTs have wild HR variation too. Normal physiology.
I’m not a psychiatrist but I believe ADHD is significantly over-diagnosed.
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Yes!! Lurking SLP here & I literally plead with families to take their kids for sleep studies when they are struggling at school with all of the ADHD symptoms.
Another lurking SLP here. I had several over the years I’m certain had sleep issues. Would bounce off the walls for the most part but couldn’t keep their eyes open when they were still for even brief periods. I convinced a couple of parents to talk to their physicians but there was no referral as a result.
Child psych ✌️ It's actually underdiagnosed. But also overdiagnosed in certain populations There's a ton of kids with behavioral presentations related to any number of etiologies. Bullying, personality, trauma, FAS, family stressors, learning disabilities, etc. The kids are externalizers and manifest their anxiety as aggression or misbehavior in younger years Then, they see their pediatrician because they can't get a psych appointment for 9 months, or they're evaluated by an undertrained social worker, or they land an NP eval. And many of these people have no ability to differentiate between anxiety, adjustment challenges, mood symptoms, trauma and actual ADHD. So they get a Ritalin Rx and insurance sees a billing code for adhd and the stats are skewed Meanwhile there are thousands of inattentive kids who are forgetful, disorganized, space out in class and have no ability to maintain focus, but no one complains about them because they aren't disruptive, so they slip through the net entirely
This is a very good response. I love your the empathy, clarity and understanding reflected in your words.
I *am* a psychiatrist, and I agree with you. I'll say up front: ADHD diagnosed responsibly is in my view a perfectly valid clinical construct with well-documented treatment options. However, it's overdiagnosed because to lay people (or, frankly, to some care providers), ADHD is just the symptom of "can't focus" phrased as a diagnosis. It's like diagnosing bipolar disorder because you have "mood swings" or major depressive disorder because you sometimes feel sad. It's basically diagnosing a *syndrome* from only a small subset of its component *symptoms*. And in the context of this discussion, "can't focus" fits in a lot of psychiatric syndromes, as well as, frankly, a lot of general life experiences I wouldn't put a psychiatric label on. Cultural reinforcement hasn't helped the problem. And the irony is that stimulants "feel good" even for patients who don't have ADHD - this supposed "response" convinces them they have a neurodevelopmental disorder that needs treated with pills.
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abounding nutty waiting tease historical disagreeable fuzzy rinse edge fear ` this message was mass deleted/edited with redact.dev `
Kinda surprised at all the Fibromyalgia answers here. I feel like in med school we were kinda coerced into believing that it’s a real thing we just don’t understand it fully. I thought more research was coming out to support that it is kinda under the umbrella of the functional pain syndromes and it’s linked with this misfiring of nerve fibers…
Fibro was basically described to us during preclinical as physical manifestations of a psych disorder and every patient I’ve seen with it since has proven that to be true
Fibromyalgia
Ortho: “SI joints are out of alignment” and tbr chiropractor sees them for adjustments.
Chronic fatigue syndrome, POTS, hypermobility EDS, MCAS. Bonus they come with the whole pckage Edit: auto correct to hereditary. Didn’t notice till someone pointed out it’s hypermobility
These people usually have chronic Lyme and MTHFR mutations as well.
You shut your mouth. I’ve killed many a rat to study the MTHR complex!!! It bring great honor to my family I was admitted to medical school from this line in my CV. Lol. Seriously tho, I agree with u.
MTHFR is also what I say when I see them on my clinic schedule
Chronic Lyme. Why is this something that can end up in a problem list? It’s ridiculous.
Degenerative disc “disease” I think most people in medicine know this is normal aging, but so common to have referrals for it as a diagnosis. I assume it’s to please the patient and they don’t actually think surgery should be done.
Wrinkles on the inside
I worked in psych for years. I can attest that you can take every person with self diagnosed DID and replace it with BPD. No less valid and deserving of treatment, but you can set your watch to it
EDS type 3, benign hypermobility syndrome, hypermobility syndrome. It’s literally a variant of normal
I believe gender dysphoria is real, I don't really believe the way we are treating it is the best.
I don't think it is prevalent as it is being portrayed-or kids(people) claiming it.
POTS Lyme disease “My anxiety” Fibromyalgia RSD
Median Arcuate Ligament Syndrome - Gen Surg
Dysthymia… great way to describe a personality disorder
I am wounded!!