Psyched!

NewFNP is no expert in mental illness, but she does know the difference between normal behavior and off-one's-rocker. 

Here are behaviors which newFNP appreciates as falling squarely outside normal.  Capturing pictures of the following subjects on one's cell phone camera: angels, fairies and elves who just hang out in one's bathroom mirror; heaven and hell (same picture); and men walking through clouds of fog on an urban city street.  Also included in this list are movements so exaggerated that newFNP was genuinely concerned about a major musculoskeletal injury requiring a neck brace.  And finally, a crescendo pattern to her speech on each and every subject addressed during the clinic visit - diabetes, soda, moms, returning to clinic the next day, etc.  

This is a patient for whom her support staff tried to room without a chart - a diabetic patient whose sugar was 'HHH' and, according to newFNP's diagnostic skills, is schizophrenic.   When newFNP finally got the chart, she reviewed the previous clinician's note, which noted in her general evaluation that she had an expressive personality.  Expressive?!?  Salvador Dali is expressive, this lady has severe mental illness.

A question which newFNP employs with some frequency is "Have you ever been under the care of a psychiatrist?"  Readers will not be surprised to learn that this woman's answer was 'yes.'  She told newFNP that she took Seroquel for two years after her mom died.    In newFNP's relative inexperience, atypical anti-psychotics are not first-line for prolonged grief.  NewFNP asked this woman if she thought she might need to resume her Seroquel treatment .  Much to her relief, her patient replied that she thought this might be beneficial.  

Psych referral completed!  Now if newFNP could only get her diabetes under control.