-saw a guy, 20+ yr old, accompanied by his uncle
-complaint of nervousness and stomachache for several months
-guy seemed irritated, and uncle kept interrupting
-despite these, could formulate differential diagnosis:
1. to rule out important causes: schizophrenia
2. to prepare for common causes: substance abuse, mood disorder, love affairs, work problems, medication induced
-appearance of guy: hair dyed gold, lip ring, well built, looked irritatied, pupils not dilated, still could talk coherrently
-so making sure no auditory hallucination (with difficulties becasue of the interruption), which was diagnostic of schizophrenia (prevalence about 1% in his age group), went directly to ask about going out to parties
-usually this type of dirrect questioning is very useful, but make sure you appear non-judgmental and understanding
-then went into alcohol, then asked about party drugs
-I did have knowleges of those drugs from postgrad training and the work in ACAN, and was able to communicate with him about the types, and he was taking multiple drugs including ketamine and ectasy
-I noticed that he was well built and used the technique of motivational interview, talking about his wt training, then briefing him about the harm of those party drugs against body building, and harms towards his nerves
-he seemed more interested in the bodily effects than the mood and nerve impacts and went on talking about wt training. Interestingly the uncle seemed enlightened and suddenly stopped interupting, maybe he had not thought of substance abuse, and not thought of asking and admiting so straight forward
-(this is technique! But things might not be as simple like this time.)
-finally, he seemed determined to quit. I gave him some medicine to facilitate and he was much improved in his follow-up
-however, more follow ups needed, referral might be needed. But I guess he would be of good prognosis
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