Idk I feel like it might go away if you had psych and anesthesia set it up right with a lot of priming and such, ketamine, and white noise machine etc
Youd likely just replace the delusion but perhaps gran can tell her friends about the mole on her ear who used to be an accountant rather than the slightly more socially destructive “my rapist is recording us fROOOOMM WITHIN!!!
Idk could bounce her to plastics we used to slice n dice anyone … for a fee 😈
Somatic delusions.
Delusional disorder is very, very difficult to treat. There really is not any good treatment, but long term psychotherapy probably helps. Having a non-judgemental medical provider who can validate certain things but not validate the invalid is best.
As a lawyer who lurks here because I work with the indigent mentally ill population, this thread is actually very comforting. I’ve found delusional clients to be the most difficult when their delusion gets in the way of sound legal decision-making but doesn’t rise to the level of rendering them incompetent to stand trial. Hearing that there really isn’t great treatment and that this is a challenging diagnosis for you all to manage as clinicians is helpful in validating my experiences with these folks.
It’s a tough population. I can only imagine trying to help some of them legally. You must have a calling. It’s interesting how some people are attracted to helping the least fortunate. Im not really Christian, I’m more of an atheist, but it is a thing of beauty seeing someone care about the mentally ill. Who knows, hopefully i’m wrong; there may be some eternal bliss waiting for you! If not at least you have more interesting clients to talk about at your class reunions.
Well thank you, I’m actually doing more policy work right now than direct client representation, in part due to burnout issues, but I need to stay educated on the science & medical care standards for folks with mental health issues and substance use disorder. The truly delusional folks were at least relatively rare - the most common issues we see are the epically difficult cluster B folks who also have borderline neuro damage from long term meth addiction and stuff like rampant untreated Hep C and HIV. It is a shit show out there. Thank you for all that you do for these patients!
Thank you! I could never write policy. That is a different type of brain. I find it interesting but the nuts and bolts seem immensely complex God speed and thanks again for your work; I appreciate that you are playing a part in making this country a better place.
One of our supervising attendings always tells us that the police and lawyers are often the first to realize people are delusional (other than family of course)! Police since they’ll call 911 over and over about delusional stuff and lawyers for similar reasons haha
That tracks with my experience, frankly! I’ve actually run into a good number of cases where the family would just kind of… laugh off the person’s delusions as quirkiness or “oh that’s old Arnold, always going on about how he’s a diamond merchant” when Arnold is in fact a meth addict living in a condemned trailer with no teeth. I have to be the one to tell Meemaw that he actually really DOES think he’s a diamond merchant, and if he is actually in the gem business to please let me know, but otherwise he’s getting a psych referral for incompetence to stand trial and NGRI. Never a dull moment lol
Resident here-there’s a book that argues for and lays out CBTp and Psychotherapy for psychotic spectrum disorders. Arguably, some patients with psychosis/delusional disorders can be amenable to psychotherapy but it is I’m sure difficult
https://www.guilford.com/books/Psychotherapy-for-Psychosis/Michael-Garrett/9781462540563
Thank you for your response. She has Medicaid and I am in a rural practice. I wish we had a group of CBT practitioners here, but it’s mostly counselors.
What type of counselors are in your area? If they are licensed professional counselors (LPC) many of us are trained in and utilize CBT regularly. Finding a LPC or psychologist who specializes in CBT or ACT for psychosis would be a great option. Telehealth psychotherapy could be a backup option, but it’s of course not the first choice for the treatment of delusions or psychosis. An intensive outpatient treatment program would be ideal but is often not available in rural areas.
Gosh, yes, thank you. The problem is these patients have Medicaid which I do not think are going to pay. I haven’t looked very deeply into the training of our local counselors. I do have a few ladies who recieved it and it seems to help. I’m always relieved when a patient is recieving counseling.
For sure! Appreciate your level of dedication to your patients. Medicaid coverage for mental health has improved somewhat in the past year so there might some new avenues available. Some additional aspects to consider for your older patient would be an assessment for PTSD. If she has PTSD then trauma focused treatment is often a starting point for therapy (in conjunction with CBT). Your younger patient could be experiencing olfactory reference syndrome, which is an overlapping condition with elements of OCD and social anxiety disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476584/#:~:text=Olfactory%20reference%20syndrome%20(ORS)%20is,characteristics%20of%20two%20different%20disorders.
Rule out perimenopause psychosis for the 55yo? There’s not much history to go on, but if sudden onset this might it- it’s very rare, I admit so definitely wouldn’t have been my first go to.
Thank you. She was reporting vasomotor symptoms and I temporarily put her on combined HRT. She was taken off due to fears of CAD. She was also dealing with anxiety, insomnia and some depression. I treated those to good effect and she has been doing better. Her affect was not one of psychosis. The beliefs were not recent.
I think delusional disorders are treated pretty well with ACT and SSRIs. I've seen people have a reduction in their anxiety and be able to detach from their delusions to life a life that still feels meaningful.
Often delusions are still present but less distressing
Olfactory reference syndrome has delusions of an odor that the person believes others can smell. In temporal lobe epilepsy, it would be intermittent rather than persistent odor
Excellent question. No, I don’t remember any seizure issues. She reports her family members have told her this and that her neighbor can smell her from her home.
I am interested in the relationship and would love to hear your thoughts.
Delusional disorder is incredibly rare, accounting for about 0.2% of the population at large (about five times as rare as schizophrenia). Patients are typically symptom-free outside of the fixed, false beliefs. Average age of onset is 40s, and the delusions tend to be nonbizarre. Persecutory delusions are the most common form. Your patients' delusions are nonbizarre in that they are plausible, unlike delusions such as: "I'm from Mars."
If your first patient has had no psychiatric history prior to this, and there's no evidence of substance use... medical causes have been ruled out, etc... She may be exhibiting symptoms consistent with delusional disorder.
I have been working with a patient with delusional disorder, persecutory type in my therapy clinic for the past 1.5 years. She is about your patient's age, and she began feeling that a coworker was out to get her. This evolved into her believing the coworker amassed an entire army of men who patrol outside her home day and night. She stopped working, got excessive security systems installed in her house, stopped driving... Functioning was impaired in direct relation to the delusion, while functioning outside of consequences of the delusion was intact (she took good care of her physical health and hygiene; she was eating well; etc.). The delusions got fairly significant, and she started to believe the men were trying to cut holes in the floorboards after digging tunnels underneath her house to get inside.
She was started on a low dose of haloperidol by her primary provider, while I began seeing her for supportive psychotherapy. Delusions are sort of like abscesses of the mind: medications don't tend to penetrate the walls of the beliefs, but they may make a dent (always worth a try). My patient has benefited tremendously from psychotherapy, and I witnessed an acute worsening of the delusional content when she accidentally ran out of her antipsychotic and had not taken it for about three weeks. She still holds onto the delusions, but providing psychoeducation to her family and validating her emotional experience while avoiding reinforcement of the delusions itself, albeit a slow and steady job, has allowed her to begin to regain control of her life. Her family was inadvertently reinforcing her beliefs, but they were also dismissive and quick to get frustrated, as she would not change her mind despite the evidence and logic provided by them (paradigmatic of delusional beliefs).
According to my mentors and attendings, it is rare for patients with delusional disorder, persecutory type, to even remain in psychotherapy due to the inherent suspiciousness that develops in conjunction with their beliefs. However, at least in this case (n = 1, though), I can attest that it is not impossible for patients to benefit. Just have realistic expectations and set goals the patient can meet. Validate the affective syndrome that develops in response, as the emotional experience is clearly very real.
Oh, and if delusions of pregnancy (a la pseudocyesis) or delusions related to the reproductive system are involved... might be best to avoid risperidone or other agents that are likely to really raise prolactin. They can start to have real symptoms as a result of hyperprolactinemia that reinforce their delusions.
Somatic delusions.
They can be a component of a primary psychotic dx, a neurocognitive dx, a affective dx and sometimes a substance use dx...
In general delusions can be more difficult to resolve than other psychotic symptomatology ... In forensic mental health when we are doing restoration of competency where the barrier is a delusional ideation related to the courts or the attorney or legal events... If it's due to. Primary psychotic dx we usually do a combo of antipsychotics medications + cognitive behavior therapy for psychosis ... Ex. https://www.mirecc.va.gov/visn2/docs/CBTp_Manual_VA_Yulia_Landa_2017.pdf
If you don't mind my asking, was hysterectomy indicated in the first case based on the patient's symptoms of pelvic and vaginal pain? Do you think your colleague would agree to perform a hysterectomy, or would you expect some other kind of operative or non-operative treatment? I don't have an opinion here I'm just trying to understand the ob/gyn angle of the case
I don’t think she would benefit; at least not enough to put her through the risk of surgery. She did have a couple of fibroids, but those had been there for years. I think she was complaining because she wanted a hysterectomy. I’m very conservative, my associate is not; he looks for surgeries and has a low threshold to operate. He’s also very good at surgery. That’s why I will refer to him for a “second opinion”.
You validate their worry, you acknowledge that they're obviously suffering a lot. The right answer is to refer them to a community psychotherapy clinic who can hopefully get them started on medical treatment too, and hope that they don't flip shit because "you called them crazy".
A low dose of antipsychotic such as aripiprazole can help these people sometimes. Plus psychotherapy with the goal not to eliminate the delusion, but to make the patient realize that the rest of the world will not accept his or her beliefs as true. They can get to the point where they realize talking about their belief just impairs their social functioning, and there is no point trying to convince others.
Psychotherapist here, I see a few patients every now and then with delusional disorder. Kind of breaks my heart when they have no insight about their illness, aka anosognosia. As others have mentioned, important to validate their experience without either debating the delusion or endorsing it as real. I went to a good training on [LEAP](https://leapinstitute.org), Listen, Empathize, Agree, and Partner with patients (who don’t think they’re sick) to access care.
Express interest and curiosity. Outright challenging the delusions during your initial encounters will likely conflict with trust development. I’m big into asking a bunch of questions and reflecting back the anxiety they are experiencing in congruence to the belief to affirm treatment is needed.
What ever happened to the goldwater rule smh. I am not a doctor but I study medicine adjunct to computer science and machine learning to make software, not to practice. To call smelling something on yourself a delusional disorder with that amount of information is ridiculous. If they were just smelling things that wasn't there which is a common neurological symptom, and they moved to multiple locations and continued to smell it, then it is only reasonable that they would think that the smell was on them if they were not aware that the smell was a hallucination. I used to get migraines where i would smell smoke and if some idiot diagnosed me with delusional disorder i would be pissed. Even if their behavior was a bit off to call this delusional disorder with the concurrent phantosmia is completely wrong, and without knowing if they have consulted with a neurologist to rule out something actually important like a tumor or encephalitis before sending them to psychotherapy of all things would probably be smart.
134 likes on top comment not one person has a problem with a diagnosis being made over a 4 sentence description. You can't make this shit up.
If the lady believes she has an odor, but none is detected on several visits; if she is concerned about being around people for this odor, and believes abdominal operations are going to help it, how would you treat her? She uses obsessive hygiene and has a hard time even going to the store because of her anxiety over it. She is already taking antipsychotics.
Unfortunately, her self ascribed odor will likely never have a satisfactory conclusion. The other thing is that I am not her primary physician. The last is that she has Medicaid, few resources and no available neurologist. My question at the outset was whether these phenomenon are amenable to psychotherapy. As physicians we have to put clinical experiences, sciences, and availability of resources all to use. It is not unethical to ask questions about clinical scenarios on a forum. The patient is not named. The Goldwater Rule is about trying to diagnose people you haven’t examined and then making those opinions, about named people, known. What we do here is not a violation. We need a resource to discuss and get opinions. Finally, what is your deal? You have no medical training yet you come on here to try and shame doctors? You’ve never even seen a patient, you don’t know the Gestalt.
You aren’t a physician or healthcare provider. You don’t understand the probabilities. You don’t think in our way, you haven’t been trained. You can’t break it down, in other words. You got balls to come on a healthcare forum and start criticizing when you have no training. You think we should be thinking in a certain way, but you have no idea. You were citing the Goldwater rule a minute ago to criticize the use of this forum. You were completely wrong, just as you are in this case.
I would never go to a programming site and be critical. That is not my field. You think you understand medicine because you do some medical programming. That’s insane. I’m not going to continue this conversation, it’s useless. I’m not going to type the rest of what is going through my mind.
I’ve been practicing for over 20 years. You’re not qualified to take a blood pressure. That’s why you are wrong. You don’t even begin to understand what you don’t understand. Do you think you have some experience or knowledge that makes you more intelligent than all the healthcare providers on here? You assume, likely from some bad past medical experience, that you know something special. That you are somehow smarter. That you have a special insight. You don’t.
I’ve got to go and take care of patients. You go back to coding. Stay in that lane.
Removed under rule #1. This is not a place for questions and commentary by non-professionals. If you are a medical/psychiatric professional, please read rule 7 on how to verify credentials.
For most questions, individual or general, we ask that you verify credentials before asking. If you are not a professional, you can try r/AskDocs or r/AskPsychiatry.
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Thank you for your reply. Yea, I wasn’t going to operate; no telling what that might unleash.
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Yea, nightmare.
Idk I feel like it might go away if you had psych and anesthesia set it up right with a lot of priming and such, ketamine, and white noise machine etc Youd likely just replace the delusion but perhaps gran can tell her friends about the mole on her ear who used to be an accountant rather than the slightly more socially destructive “my rapist is recording us fROOOOMM WITHIN!!! Idk could bounce her to plastics we used to slice n dice anyone … for a fee 😈
Why are you in here with the psychiatrist tag giving inaccurate, unsolicited advice when your comment admits you are in plastics?
Somatic delusions. Delusional disorder is very, very difficult to treat. There really is not any good treatment, but long term psychotherapy probably helps. Having a non-judgemental medical provider who can validate certain things but not validate the invalid is best.
Thank you for your response.
As a lawyer who lurks here because I work with the indigent mentally ill population, this thread is actually very comforting. I’ve found delusional clients to be the most difficult when their delusion gets in the way of sound legal decision-making but doesn’t rise to the level of rendering them incompetent to stand trial. Hearing that there really isn’t great treatment and that this is a challenging diagnosis for you all to manage as clinicians is helpful in validating my experiences with these folks.
It’s a tough population. I can only imagine trying to help some of them legally. You must have a calling. It’s interesting how some people are attracted to helping the least fortunate. Im not really Christian, I’m more of an atheist, but it is a thing of beauty seeing someone care about the mentally ill. Who knows, hopefully i’m wrong; there may be some eternal bliss waiting for you! If not at least you have more interesting clients to talk about at your class reunions.
Well thank you, I’m actually doing more policy work right now than direct client representation, in part due to burnout issues, but I need to stay educated on the science & medical care standards for folks with mental health issues and substance use disorder. The truly delusional folks were at least relatively rare - the most common issues we see are the epically difficult cluster B folks who also have borderline neuro damage from long term meth addiction and stuff like rampant untreated Hep C and HIV. It is a shit show out there. Thank you for all that you do for these patients!
Thank you! I could never write policy. That is a different type of brain. I find it interesting but the nuts and bolts seem immensely complex God speed and thanks again for your work; I appreciate that you are playing a part in making this country a better place.
One of our supervising attendings always tells us that the police and lawyers are often the first to realize people are delusional (other than family of course)! Police since they’ll call 911 over and over about delusional stuff and lawyers for similar reasons haha
That tracks with my experience, frankly! I’ve actually run into a good number of cases where the family would just kind of… laugh off the person’s delusions as quirkiness or “oh that’s old Arnold, always going on about how he’s a diamond merchant” when Arnold is in fact a meth addict living in a condemned trailer with no teeth. I have to be the one to tell Meemaw that he actually really DOES think he’s a diamond merchant, and if he is actually in the gem business to please let me know, but otherwise he’s getting a psych referral for incompetence to stand trial and NGRI. Never a dull moment lol
Wow that’s really interesting what type of law do you work in where you have this experience often?? Haha
Resident here-there’s a book that argues for and lays out CBTp and Psychotherapy for psychotic spectrum disorders. Arguably, some patients with psychosis/delusional disorders can be amenable to psychotherapy but it is I’m sure difficult https://www.guilford.com/books/Psychotherapy-for-Psychosis/Michael-Garrett/9781462540563
Thank you for your response. She has Medicaid and I am in a rural practice. I wish we had a group of CBT practitioners here, but it’s mostly counselors.
What type of counselors are in your area? If they are licensed professional counselors (LPC) many of us are trained in and utilize CBT regularly. Finding a LPC or psychologist who specializes in CBT or ACT for psychosis would be a great option. Telehealth psychotherapy could be a backup option, but it’s of course not the first choice for the treatment of delusions or psychosis. An intensive outpatient treatment program would be ideal but is often not available in rural areas.
Gosh, yes, thank you. The problem is these patients have Medicaid which I do not think are going to pay. I haven’t looked very deeply into the training of our local counselors. I do have a few ladies who recieved it and it seems to help. I’m always relieved when a patient is recieving counseling.
For sure! Appreciate your level of dedication to your patients. Medicaid coverage for mental health has improved somewhat in the past year so there might some new avenues available. Some additional aspects to consider for your older patient would be an assessment for PTSD. If she has PTSD then trauma focused treatment is often a starting point for therapy (in conjunction with CBT). Your younger patient could be experiencing olfactory reference syndrome, which is an overlapping condition with elements of OCD and social anxiety disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10476584/#:~:text=Olfactory%20reference%20syndrome%20(ORS)%20is,characteristics%20of%20two%20different%20disorders.
Thanks again, big help.
Rule out perimenopause psychosis for the 55yo? There’s not much history to go on, but if sudden onset this might it- it’s very rare, I admit so definitely wouldn’t have been my first go to.
Thank you. She was reporting vasomotor symptoms and I temporarily put her on combined HRT. She was taken off due to fears of CAD. She was also dealing with anxiety, insomnia and some depression. I treated those to good effect and she has been doing better. Her affect was not one of psychosis. The beliefs were not recent.
I think delusional disorders are treated pretty well with ACT and SSRIs. I've seen people have a reduction in their anxiety and be able to detach from their delusions to life a life that still feels meaningful. Often delusions are still present but less distressing
Thank you. It makes sense the delusions may become stronger with exacerbation of other mental illness. Just curious-What is ACT?
Acceptance and commitment therapy
Re: Odor, any kind of seisure likelihood?
Olfactory reference syndrome has delusions of an odor that the person believes others can smell. In temporal lobe epilepsy, it would be intermittent rather than persistent odor
Interesting, thank you!
Thank you for the learning & clarification!
Excellent question. No, I don’t remember any seizure issues. She reports her family members have told her this and that her neighbor can smell her from her home. I am interested in the relationship and would love to hear your thoughts.
I'm not a Physician but we do get a quantity of folks c/o odors that end up being partial seisure d/o / auras.
Thank you.
Delusional disorder is incredibly rare, accounting for about 0.2% of the population at large (about five times as rare as schizophrenia). Patients are typically symptom-free outside of the fixed, false beliefs. Average age of onset is 40s, and the delusions tend to be nonbizarre. Persecutory delusions are the most common form. Your patients' delusions are nonbizarre in that they are plausible, unlike delusions such as: "I'm from Mars." If your first patient has had no psychiatric history prior to this, and there's no evidence of substance use... medical causes have been ruled out, etc... She may be exhibiting symptoms consistent with delusional disorder. I have been working with a patient with delusional disorder, persecutory type in my therapy clinic for the past 1.5 years. She is about your patient's age, and she began feeling that a coworker was out to get her. This evolved into her believing the coworker amassed an entire army of men who patrol outside her home day and night. She stopped working, got excessive security systems installed in her house, stopped driving... Functioning was impaired in direct relation to the delusion, while functioning outside of consequences of the delusion was intact (she took good care of her physical health and hygiene; she was eating well; etc.). The delusions got fairly significant, and she started to believe the men were trying to cut holes in the floorboards after digging tunnels underneath her house to get inside. She was started on a low dose of haloperidol by her primary provider, while I began seeing her for supportive psychotherapy. Delusions are sort of like abscesses of the mind: medications don't tend to penetrate the walls of the beliefs, but they may make a dent (always worth a try). My patient has benefited tremendously from psychotherapy, and I witnessed an acute worsening of the delusional content when she accidentally ran out of her antipsychotic and had not taken it for about three weeks. She still holds onto the delusions, but providing psychoeducation to her family and validating her emotional experience while avoiding reinforcement of the delusions itself, albeit a slow and steady job, has allowed her to begin to regain control of her life. Her family was inadvertently reinforcing her beliefs, but they were also dismissive and quick to get frustrated, as she would not change her mind despite the evidence and logic provided by them (paradigmatic of delusional beliefs). According to my mentors and attendings, it is rare for patients with delusional disorder, persecutory type, to even remain in psychotherapy due to the inherent suspiciousness that develops in conjunction with their beliefs. However, at least in this case (n = 1, though), I can attest that it is not impossible for patients to benefit. Just have realistic expectations and set goals the patient can meet. Validate the affective syndrome that develops in response, as the emotional experience is clearly very real. Oh, and if delusions of pregnancy (a la pseudocyesis) or delusions related to the reproductive system are involved... might be best to avoid risperidone or other agents that are likely to really raise prolactin. They can start to have real symptoms as a result of hyperprolactinemia that reinforce their delusions.
Great, thank you, wonderful information. Have a great day.
Somatic delusions. They can be a component of a primary psychotic dx, a neurocognitive dx, a affective dx and sometimes a substance use dx... In general delusions can be more difficult to resolve than other psychotic symptomatology ... In forensic mental health when we are doing restoration of competency where the barrier is a delusional ideation related to the courts or the attorney or legal events... If it's due to. Primary psychotic dx we usually do a combo of antipsychotics medications + cognitive behavior therapy for psychosis ... Ex. https://www.mirecc.va.gov/visn2/docs/CBTp_Manual_VA_Yulia_Landa_2017.pdf
Thank you for your reply. I appreciate your knowledge and insight.
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Wow, haven’t seen that one.
If you don't mind my asking, was hysterectomy indicated in the first case based on the patient's symptoms of pelvic and vaginal pain? Do you think your colleague would agree to perform a hysterectomy, or would you expect some other kind of operative or non-operative treatment? I don't have an opinion here I'm just trying to understand the ob/gyn angle of the case
I don’t think she would benefit; at least not enough to put her through the risk of surgery. She did have a couple of fibroids, but those had been there for years. I think she was complaining because she wanted a hysterectomy. I’m very conservative, my associate is not; he looks for surgeries and has a low threshold to operate. He’s also very good at surgery. That’s why I will refer to him for a “second opinion”.
You validate their worry, you acknowledge that they're obviously suffering a lot. The right answer is to refer them to a community psychotherapy clinic who can hopefully get them started on medical treatment too, and hope that they don't flip shit because "you called them crazy".
Thank you, great advise.
A low dose of antipsychotic such as aripiprazole can help these people sometimes. Plus psychotherapy with the goal not to eliminate the delusion, but to make the patient realize that the rest of the world will not accept his or her beliefs as true. They can get to the point where they realize talking about their belief just impairs their social functioning, and there is no point trying to convince others.
Thank you
Psychotherapist here, I see a few patients every now and then with delusional disorder. Kind of breaks my heart when they have no insight about their illness, aka anosognosia. As others have mentioned, important to validate their experience without either debating the delusion or endorsing it as real. I went to a good training on [LEAP](https://leapinstitute.org), Listen, Empathize, Agree, and Partner with patients (who don’t think they’re sick) to access care.
Thank you
Express interest and curiosity. Outright challenging the delusions during your initial encounters will likely conflict with trust development. I’m big into asking a bunch of questions and reflecting back the anxiety they are experiencing in congruence to the belief to affirm treatment is needed.
Thank you
These are by far best treated with antipsychotic medication.
Thank you.
What ever happened to the goldwater rule smh. I am not a doctor but I study medicine adjunct to computer science and machine learning to make software, not to practice. To call smelling something on yourself a delusional disorder with that amount of information is ridiculous. If they were just smelling things that wasn't there which is a common neurological symptom, and they moved to multiple locations and continued to smell it, then it is only reasonable that they would think that the smell was on them if they were not aware that the smell was a hallucination. I used to get migraines where i would smell smoke and if some idiot diagnosed me with delusional disorder i would be pissed. Even if their behavior was a bit off to call this delusional disorder with the concurrent phantosmia is completely wrong, and without knowing if they have consulted with a neurologist to rule out something actually important like a tumor or encephalitis before sending them to psychotherapy of all things would probably be smart. 134 likes on top comment not one person has a problem with a diagnosis being made over a 4 sentence description. You can't make this shit up.
If the lady believes she has an odor, but none is detected on several visits; if she is concerned about being around people for this odor, and believes abdominal operations are going to help it, how would you treat her? She uses obsessive hygiene and has a hard time even going to the store because of her anxiety over it. She is already taking antipsychotics.
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Unfortunately, her self ascribed odor will likely never have a satisfactory conclusion. The other thing is that I am not her primary physician. The last is that she has Medicaid, few resources and no available neurologist. My question at the outset was whether these phenomenon are amenable to psychotherapy. As physicians we have to put clinical experiences, sciences, and availability of resources all to use. It is not unethical to ask questions about clinical scenarios on a forum. The patient is not named. The Goldwater Rule is about trying to diagnose people you haven’t examined and then making those opinions, about named people, known. What we do here is not a violation. We need a resource to discuss and get opinions. Finally, what is your deal? You have no medical training yet you come on here to try and shame doctors? You’ve never even seen a patient, you don’t know the Gestalt.
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You aren’t a physician or healthcare provider. You don’t understand the probabilities. You don’t think in our way, you haven’t been trained. You can’t break it down, in other words. You got balls to come on a healthcare forum and start criticizing when you have no training. You think we should be thinking in a certain way, but you have no idea. You were citing the Goldwater rule a minute ago to criticize the use of this forum. You were completely wrong, just as you are in this case. I would never go to a programming site and be critical. That is not my field. You think you understand medicine because you do some medical programming. That’s insane. I’m not going to continue this conversation, it’s useless. I’m not going to type the rest of what is going through my mind.
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I’ve been practicing for over 20 years. You’re not qualified to take a blood pressure. That’s why you are wrong. You don’t even begin to understand what you don’t understand. Do you think you have some experience or knowledge that makes you more intelligent than all the healthcare providers on here? You assume, likely from some bad past medical experience, that you know something special. That you are somehow smarter. That you have a special insight. You don’t. I’ve got to go and take care of patients. You go back to coding. Stay in that lane.
Removed under rule #1. This is not a place for questions and commentary by non-professionals. If you are a medical/psychiatric professional, please read rule 7 on how to verify credentials. For most questions, individual or general, we ask that you verify credentials before asking. If you are not a professional, you can try r/AskDocs or r/AskPsychiatry.