3) Anecdotal self reflections on their internship learning with some video evidence of procedures performed

 MY INTERNSHIP:- 

I am posted in the medicine posting from 31st July to 30 Sept 

Of this 

PSYCHIATRY:- 31st JULY  to 14 AUG 

MY PSYCHIATRY:- 

I came across a patient, who was diagnosed with DISSOCIATIVE DISORDER.

Diagnosis

DISSOCIATIVE DISORDER

Case History and Clinical Findings

CHIEF COMPLAINTS:

EPISODES OF STIFFNESS AND PAIN IN THE LIMBS, INVOLUNTARY MOVEMENTS OF THE BODY SINCE 15 DAYS

THESE EPISODES WERE ASSOCIATED WITH MAKING ANIMAL SOUNDS FOR 5 DAYS

BACKGROUND HISTORY:

ABOUT 5 YEARS AGO, THE PATIENT STARTED HAVING POSSESSION EPISODES ON FESTIVALS.

EACH EPISODE LASTED FOR ~15 MINUTES AND SUBSIDED ON IT'S OWN.

PERSONAL STRESSORS +

ABOUT 10 MONTHS AGO, HE HAD AN EPISODE OF INVOLUNTARY MOVEMENTS OF THE BODY AND STIFFNESS OF LIMBS AT NIGHT FOR WHICH HE WAS IMMEDIATELY TAKEN TO A HOSPITAL. AFTER RULING OUT THE MEDICAL CAUSES, THE PATIENT WAS REFERRED TO A PSYCHIATRIST AND HAS BEEN ON REGULAR TREATMENT SINCE THEN. HE WAS MAINTAINING WELL ON THE MEDICATION WITH AVERAGE OF 1 EPISODE PER 1-2 MONTHS TILL JUNE

2023.

HISTORY OF PRESENTING ILLNESS:

ABOUT 15 DAYS AGO. AFTER RETURNING FROM WORK, HE WAS TALKING TO HIS SISTER'S KIDS, WHEN HE SUDDENLY FELT UNKNOWN FEARFULNESS ASSOCIATED WITH COLD FLUSHING OF LIMBS. HE TOOK THE SOS MEDICATION PRESCRIBED AND WENT TO SLEEP.

THE NEXT DAY WHEN HE WOKE UP HE COULD NOT MOVE HIS LEGS AND WAS IN EXTREME PAIN.

FOR THIS, HE WAS IMMEDIATELY TAKEN BACK TO HIS VILLAGE. VISITED HIS PSYCHIATRIST AND WAS PRESCRIBED MEDICATION FOR THE COMPLAINTS. ABOUT 10 DAYS LATER HE HAD AN EPISODE OF INVOLUNTARY MOVEMENTS OF THE BODY, AND STIFFNESS OF LIMBS AND WAS TAKEN TO HIS PSYCHIATRIST WHERE MEDICATION WAS PRESCRIBED. HE WAS TAKEN TO A NEUROLOGIST WHERE BLOOD TESTS AND NERVE CONDUCT TESTS WERE DONE - ALL WERE WITHIN NORMAL LIMITS. SINCE THE LAST 5 DAYS, OD REPORTS THE PATIENT STARTED MAKING NOISES OF ANIMALS ALONG WITH INVOLUNTARY MOVEMENTS OF BODY AND STIFFNESS OF LIMBS, SOS MEDICATION IN HOSPITAL WAS GIVEN - SUBSIDED. OD REPORTS EACH EPISODE, IF UNTREATED MAY LAST FOR 1-2 HRS, THE NUMBER OF ANIMAL NOISES INCREASES AND EACH EPISODE IS PRECEDED BY PAIN IN HIS LOWER LIMBS AND BACK. THESE EPISODES INCREASED IN FREQUENCY FROM 1 PER DAY TO 2

EPISODES PER DAY IN THE LAST 5 DAYS. HE WAS REFERRED TO KIMS, NKP BY HIS PSYCHIATRIST FOR OBSERVATION AND FURTHER EVALUATION.

SLEEP NORMAL, APPETITE NORMAL

PAST HISTORY:

AS DESCRIBED IN THE BACKGROUND HISTORY

NOT A KNOWN CASE OF DM, HTN, ASTHMA, TB, CVA, CAD

FAMILY HISTORY:

H/O? PSYCHOSIS IN PATERNAL GRANDMOTHER

HO ORGANIC PSYCHOSIS IN BROTHER FOLLOWING A HEAD INJURY 20 YEARS AGO,?ON TREATMENT.

Treatment Given(Enter only Generic Name)

1.   PATIENT AND OD PSYCHOEDUCATION
2.   BRIEF COUNSELLING GIVEN
3.   TAB.PAROXETINE 25 MG + TAB.CLONAZEPAM 0.5 MG(2/8/2023 TO 5/8/2023)
4.   TAB.PREGABALIN M 75 MG(2/8/2023 TO 5/8/2023)

X-X-1

5.TAB,OLANZAPINE 5 MG(2/8/2023 TO 5/8/2023)

6.TAB TOFISOPAM 50 MG (2/8/2023 TO 4/8/2023)

1-X-…_-X

7.TAB. DESVENLAFAXINE 50 MG (2/8/2023 TO 5/8/2023)

1-X-…_-X

8.TAB.CLONAZEPAM 0.25 MG (2/8/2023 TO 4/8/2023)

1--1-……-X

1.   TAB.PANTOP 40 MG(2/8/2023 TO 5/8/2023)
2.     TAB CLONAZEPAM 0.5 MG (4/8/2023 TO 5/8/2023)
3.   TAB BACLOFEN 20 MG(4/8/2023 TO 5/8/2023)

1-……-X-_…_X

1.     INJ.LORAZEPAM 1 ML (2MG)IV/STAT AND SOS
2.     TAB. CLONAZEPAM MD 0.5 MG PO/SOS(2/8/2023 TO 5/8/2023)
3.   RELAXATION AND DIVERSION TECHNIQUES EXPLAINED

Advice at Discharge

1. TAB.PAROXETINE 25 MG + TAB.CLONAZEPAM 0.5 MG

X-…-X-1

2. TAB. DESVENLAFAXINE 50 MG

1--X-_--X

3. TAB.PREGABALIN M 75 MG

X--X-_-1

4. TAB.OLANZAPINE 5 MG

X-_-X---1

5. TAB CLONAZEPAM 0.5 MG

1---1----X

1.   TAB BACLOFEN 20 MG
2.   TAB.PANTOP 40 MG
3.   INJ.LORAZEPAM 1 ML (2MG)IV/ SOS
4.   TAB. CLONAZEPAM MD 0.5 MG PO/SOS
5.     CONTINUE RELAXATION AND DIVERSION TECHNIQUES

REVIEW IN 5 DAYS/SOS IN PSYCHIATRIC OPD.

I monitored him strictly for his episodes

And during my Monitoring, he had 7 episodes in 2 days where I gave lorazepam I.v stat.

I also saw different opd patients of 

   1. DISSOCIATIVE DISORDER 

   2. ADHD 

   3. OCD

1. ALCOHOL DEPENDENCE SYNDROME 
2. SCHIZOPHRENIA 

 AND ALSO VISITED THE DE ADDICTION CENTRE IN OUR CLG 

AND ALSO LEARNED HOW TO MAKE HISTORY 

HOW TO APPROACH THE PATIENT 

And interacted with patients in DAC.

LEARNED 

CBT ( cognitive behavioral therapy) 

After this my 

UNITS STARTED ON 15 Th Aug and it was till 

15 Th sept 

These are the cases I documented in my posting:- 

Case 1:- 

https://nikhilsaikarnatirollno69.blogspot.com/2023/08/36year-male-with-pain-abdomen.html

Case 2:- 

https://nikhilsaikarnatirollno69.blogspot.com/2023/08/a-27-year-old-male-patient-with.html

Case 3:- 

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/a-71-year-old-male-with-complaints-of.html

Case 4:- 

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/a-85-year-old-male-patient-came-with.html

Case 5:- 

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/a-78-ym-with-ho-cad.html

Case 6:- 

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/a-63ym-with-loss-of-consciousness-6.html

My additional works in units :- 

Assisted in 4 intubations 

Done CPR

TOOK SAMPLES 

ABGs were taken by me 

Done procedure’s :- 4 ryles ; 7foleys catheterisation 

Assisted in pleural tap :- 

Then my ICU; NEPHRO AND WARD DUTIES STARTED:- 

WARD:- ( 16-20 Th sept) 

Monitored patients in the NYT

Took samples of FBS ; PLBS; HBA1C ; RFT ; LFT 

MONITORED KCL INFUSION.

NEPHRO :- 21-25 Th sept 

Monitored patients 

Learned about the Dialysis machine 

Taken 7 ABG SAMPLES 

Assisted in central line procedure 

Removed central line (femoral) 

ICU :- 26-30 Th sept