Sharing the busy week I've had. It's always fun being in Psychiatry. I like my job and it allows me to interact with different people.
Patient came in asking for prescriptions for anxiolytics. I checked the record and found them to have been using it way too much and their reason was due to recent frequent stresses. My guess is, they've been using it at the smallest inconvenience overstating a simple discomfort for a panic attack.
When I broke the bad news that the patient could've get anymore prescription meds because they are risking themselves to become addicted to this stuff and that begs another problem, they eventually threw a tantrum.
Imagine seeing in front of you a grown person that was seconds calm then their behavior turned 360 hitting their head and pounding their chest in frustration. They cry inn front of you and yell how much of a bad person you are and how they need the meds to not feel bad.
It reminds me a toddler throwing a tantrum but worse, this one can harm themselves or you. So while they were throwing a fit, I just stared blankly at them with my empathy receptors off the moment they insisted they needed the damn meds and I said no repeatedly and firmly.
My internal head algorithm says:
If I don't feel an empathetic connection when a patient becomes sad or happy during the interview, I'm probably dealing with someone that has a personality disorder and is being manipulative right now.
They tell a sad or happy story but somehow you just couldn't catch up to their vibe and there's that voice at the back of your head saying don't fall for it.
If I'm doubting my safety, I'm probably dealing with a psychotic patient.
There's no "objective" criteria here, it's just gut feel like how any person with common sense could pick up by intuition that something is definitely off about who they're talking to. And from experience, I'm definitely finding this method reliable as it helps me navigate the conversation better.
When others saw my passive attitude towards someone throwing a tantrum, some said I looked like shocked. My internal mind was just anticipating how to catch the patient's head at the right moment before they bang it against the wall or table. Or just expect them to lunge at me in rage.
It resolved on its own and I didn't gave in to their tantrum.
There are patients that show up wanting an excuse from work as "sick leave" because probably reasonable things like bad working environments but not enough to warrant calling them sick. Some patients come in asking for prescriptions for the good stuff, like Benzodiazepines because they've become addicted to these.
Despite having the warning that giving out Benzodiazepines are a short term solution, they would be reliant on these meds at the slightest bit of discomfort but label it as "panic attack". I know patients lie and most of the lies tend to be related to having problems with substances.
By my own guess, I probably dealt with someone that had a personality disorder, referring to the one that gave a tantrum. These types tend to be difficult to treat. I'd take on several psychotic patients and those with mood disorders because these are far easier to treat than people with personality disorders.
How can you treat a person that has lived their life in this setting and has less insights about their actions? Again, these types tend to have poor insight and it takes several sessions of psychotherapy just to make them become more socially functional.
Thank you for your time.