Comments on: Delusional Behavior

By: Scott Sullivan

Scott Sullivan — Wed, 30 Jan 2008 23:46:06 +0000

Hi Doc, What's your opinion on Prurigo nodularis? Semp Fi, Sully [GD: Never heard of it. Here's an article. Not an ER problem.]

By: Tiny Shrink

Tiny Shrink — Sun, 14 Oct 2007 01:21:16 +0000

On my urology rotation, I saw a patient who was convinced he had a hole in his scrotum through which he leaked urine. Oddly enough, even with a negative retrograde urethrogram and a negative exam (no hole, no fluid), he was still convinced. “But it bothers me so much! I get a quarter-sized spot of fluid on my underwear, and then it’s all wet and uncomfortable! I want surgery!”

My attending gave him pyridium, told him to put a bandage over the “hole”, and if anything orange came out to come back. It was the only way to get him to leave.

By: drshivn

drshivn — Tue, 02 Oct 2007 21:11:52 +0000

I am reminded of an interesting patient we managed. He had multiple medical conditions besides borderline dementia, underwent an incision and drainage of an abscess and was on multiple drugs while recuperating. On rounds next morning when asked how he felt he said he said he felt as if ants were crawling up his penis.The attending and residents thought he was getting delirious and the medicines were pushing him over.But I checked the Foley’s insertion site, and sure enough there were ants making a trail from the Uribag he brought with him from the nursing home. His random sugar was 512!!

By: JC Jones

JC Jones — Tue, 02 Oct 2007 17:05:34 +0000

When I finally surrender to my delusions, I have promised to indulge myself in a little FUGUE STATE. That has got to be the best psychiatric/medical diagnosis EVER…I think I feel it coming on now…unfortunately, I will need to postpone it until my child is fully grown. JC

By: Oh, The Grand Rounds you will have! | Musings of a Distractible Mind

Oh, The Grand Rounds you will have! | Musings of a Distractible Mind — Tue, 02 Oct 2007 05:15:34 +0000

[...] Doctor talks about people whose choices Are based on delusions and make-believe voices At Shrink Rap the numbers do clearly attest It costs lots of money when you are [...]

By: GruntDoc

GruntDoc — Sat, 29 Sep 2007 21:46:52 +0000

Dr. Rob: heh.

By: Rob

Rob — Sat, 29 Sep 2007 21:33:38 +0000

Great. Send them back to the PCP. You EM guys are worthless! Can’t even remove devices secretly implanted in a person’s head. You are the ones with the secret detection and removal equipment. We can’t afford to have that sort of thing in our office. I always send my delusional patients to the ED. I explain to them that you are the only ones with that “special” equipment.

By: healdoc

healdoc — Sat, 29 Sep 2007 18:35:56 +0000

Gruntdoc, i like the way you explain how you treat these patients. It is nice to see how your verbal approach has evolved with experience. appreciate your comments

By: No Acute Distress

No Acute Distress — Thu, 27 Sep 2007 22:38:40 +0000

1) Isn’t it sad that you can’t make the appropriate referral, in this case to a psychiatrist, without genreating a formal complaint which you’ll have to spend too much time responding to?

2)”they don’t want to be told the truth, they want their belief to be validated, real or not, sensible or not.”

In that respect, this holds true for a lot of patients who you couldn’t properly classify as delusional. Some common examples include those patients who come in complaining of yet another “ear infection” i.e. ear PAIN, another “sinus infection” i.e. headache/face pain, another “throat infection” i.e. pharyngeal discomfort, or a “lump in the throat” i.e. GERD. The first three demand antibiotics (and often, opiates). The latter want a CT scan.

By: 911doc

911doc — Thu, 27 Sep 2007 01:29:43 +0000

wow. haven’t seen one in a while who was not schizophrenic. saw a guy once who was convinced that someone at his place of employment was, intermittently, letting small drops of water or mist particles of water fall onto his left shoulder. he was not sure what this meant but was concerned and convinced. seems to me i would prefer a more dangerous delusion.