During my internship at the psychiatry residency program, I met a patient during my rotations that attracted my attention. I remember vividly the patient was staying in room 18 but was later transferred to room 25. The patient, old man probably in his seventies, was suffering from insomnia, psychotic disorder and severe depression. The patient was prescribed antidepressants among other drugs aimed at controlling the symptoms and talk therapy. I could tell the patient was Russian due to his heavy Russian accent. Over time, I noticed that despite the improving condition of the patient, he remained depressed and with a sad face. The patient rarely took his treatment without drama. He would often cry and scream at the nurses during treatment. The doctors always used psychotic disorder and severe depression to explain his behavior. However, I wondered if the behavior could be merely as a result of severe depression.
I sought to find whether there could be a deeper medical problem other than depression. I made frequently visits to his room and spent a little more time there. After some time, I won his trust and he began to confide in me his story. He lived alone after losing his wife and all his children were grown up and were living abroad. He was lonely since he lived alone and did not have any friends. Having served and retired in the military, he went on several peace keeping missions including Somalia. The loneliness kept reminding him of those missions during which several of his colleagues died in those war-torn areas. That explained why he was constantly depressed. I was almost convinced that was the cause of his erratic behavior until one day when I asked him directly why he always cried and screamed during drug administration. He confided in me that after taking the drugs he always felt like somebody is hitting his head with a hammer that made him feel a sharp pain and a banging sound on his head. He said he had reported it several times but it was always brushed aside. When I asked the psychiatrist in charge, he told me that the only possible explanation was hallucinations due to his depression. However, I insisted that a CT scan should be conducted to rule out any medical conditions. The scan revealed that he had a brain tumor that was causing pressure on the skull due to the swelling tumor. The patient was put on corticosteroids to reduce the swelling and the pressure, and pain medication. In addition, the patient was referred to a neurologist for further treatment. I left the residency program before the patient was discharged.
That is when I realized that most psychiatric problems are not the ‘primary illness’ but rather a result of a deep rooted medical problem that is often overlooked. Unless those concerns are addressed it may be difficult for a patient to fully recover. My mission is to ensure proper diagnosis and treatment of medical conditions.