Every patient’s family has the same mentality, hoping that the patient will receive the correct diagnosis and the most effective treatment, and that he or she will recover soon. As a doctor, I feel the same way as everyone else, but the disease is complex and our medical process may not be very smooth. Psychiatry, in particular, is more special, because unlike other departments, there are many tests that can be used, such as a brain CT for cerebral infarction or a chest X-ray for pneumonia, and these tests can be very helpful to our doctors in making a diagnosis. In psychiatry, the most commonly used test is psychological examination, which only serves as an aid to diagnosis. Except for organic mental disorders, where the cause is clear, the majority of mental disorders are of unknown etiology.
So how does a psychiatrist make a diagnosis?
Diagnosis is made mainly on the basis of two aspects.
First, the patient’s medical history information.
That is, the patient has what abnormal performance, need to provide a detailed description of the condition of the family: from when the onset of the disease, the onset of what abnormal performance, (mainly compared with the performance before the disease, the emergence of abnormal performance), how long did it last? What changes in the patient’s morbid manifestations occurred as the disease progressed and time passed?
The patient’s treatment process: where was the diagnosis made? What was the diagnosis? What medications were taken? What was the dosage and duration of medication? What was the effect? What are the side effects? This is of great importance for the doctor to adjust the treatment plan for the patient.
Here I would like to describe what the mental activities of a person include.
1. First, cognitive activities, including.
(1) Perceptual activity: hallucinations and hallucinations are the most common perceptual disorder, commonly seen in schizophrenia.
(2) thinking activities: the process of the brain to passively reflect objective reality, the most common delusions belong to the thinking disorder, such as the patient suspecting that someone is persecuting him, someone is spying on him, or even
The most common delusions are thought disorders, such as the patient suspecting that someone is persecuting him, someone is spying on him, or even calling the police. For depressed patients, it is common to have delayed thinking, feeling that the brain has become dumb and cannot think, while for manic patients, it is manifested as talking incessantly and thinking runaway, which are all thinking disorders.
(3) Attention: whether to focus.
(4) Memory: Can you recall correctly things that are far away and things that are near? The most common and earliest symptom of dementia patients is memory impairment, what to eat in the morning at noon can not remember.
(5) Intelligence: numeracy, general knowledge, reasoning ability, etc. The Wechsler Intelligence Test is the most common form of intelligence testing.
(6) self-awareness: whether you know you have a disease? (6) Self-awareness: Are you aware that you have a disease? Can you analyze your own morbid expression?
(2) Emotional activity: How is the mood? Are the emotions coordinated? Is it consistent with one’s internal experience?
The common ones are
(1) Depressed mood: bad mood, decreased interest, less speech and less movement, and in severe cases, feeling that living is meaningless and suicidal, which is mostly seen in patients with depression.
(2) emotional indifference: mostly seen in schizophrenia, dull facial expressions, lack of affection for family members, the real person has become indifferent.
(3) Emotional incoherence: This is mostly seen in schizophrenia, where one cries for a while and then laughs, giving the impression of abnormality.
There is also the most common anxiety:always worried and nervous, called generalized anxiety. Or the sudden appearance of panic sweating, breath-holding, which is also called panic attacks, mostly seen in anxiety disorders, depression.
3. Voluntary activity and behavior.
Commonly, there is a decrease in volitional activity:
Such as laziness in life, mostly seen in schizophrenia. Behavioral disorders are also relatively common: for example, activities become particularly numerous, see people since the familiar, mostly seen in mania. Strange behavior is more common in schizophrenia, such as a patient who suspects that someone is following him, and he often turns around to see if there is anyone. Suspecting that someone is watching him, he keeps the curtains drawn all day and the house door closed. Patients with OCD often have compulsive behaviors, such as repeatedly washing their hands for 3 hours, which is compulsive behavior.
If a person has a mental abnormality, then he must have abnormalities in these three areas: cognitive activity, emotional activity, volitional activity and behavior, more or less or lightly or heavily. A person who has a mental abnormality generally means that there is a significant difference compared to when he was well, and at the same time contrary to the rules common to most people in society.
Second, another basis for diagnosis: psychiatric examination.
The psychiatrist uses his expertise to talk to the patient and, through conversation, determine what symptoms the patient has and corroborate them with the morbid manifestations provided by the medical history to provide a basis for diagnosis. Psychiatric examination is a basic skill that psychiatrists must master, and the level of psychiatric examination is high for doctors with high levels. Because some patients do not cooperate, psychiatric examinations sometimes do not provide enough evidence for diagnosis, which can make diagnosis difficult.
How do I make the diagnosis?
First of all, according to the medical history information, which is the description of the condition provided by the family, which is the longitudinal basis for diagnosis. I analyze both the longitudinal and transversal bases to make a diagnosis that best fits the patient’s current condition.
Any factor that affects the completeness and correctness of these two bases can lead to a wrong diagnosis, such as incomplete and non-objective reporting by the family, or concealment of the patient’s condition by the patient himself, or lack of cooperation in the psychiatric examination that does not lead to psychiatric symptoms. Sometimes there is nothing we can do about the patient’s factors, after all, he is a patient who does not cooperate, but the family should provide a complete and accurate detailed description of the condition as much as possible, which will bring great help to the diagnosis. Sometimes the correct diagnosis can be made with the medical history information.
Of course, it is best to interview the patient to get the most reliable diagnosis. Sometimes, even after an in-person consultation, the patient may not be diagnosed correctly due to the complexity of his or her condition, and it is necessary to continue to observe the changes in the patient’s condition.
This is the limitation of internet consultation, which can only rely on medical history information to make a tendentious opinion. Therefore, it is important for the family to provide as much detail as possible about the condition to help make a correct judgment.
It should be especially noted that mental illness is very complex and the early manifestations are often atypical, and mental disorders in children and adolescents are also very atypical. As the disease progresses, the patient’s symptoms will change greatly and the diagnosis will change accordingly, which is normal. The diagnosis of mental illness is not a simple matter and requires the joint efforts of doctors and family members.