Volume 8 Issue 3 March, 2018
Consultation Liaison Psychiatry : RADIOLOGY
Here is an example, male patient aged about 35 years agriculturist came to radiology department to get his head scan as he was having severe headache. He did not have any referral letter for scan so I told him to get reference letter from clinician, later he told he had consulted physician, ophthalmologist and ENT specialist and none of them as advised scan, he and his attenders started requesting for the scan repeatedly.
I went through his case file, and I came to know he had history of headache on and off from past 2-3 years, also was diagnosed have mild depression and was on anti-depressants. Now patient gives history of increase in the severity of headache from past 2-3 weeks, for which he was treated with analgesics and told to continue anti-depressants regularly and refer back to psychiatrist.
Since patient’s headache was not relived and he was under the impression that everyone is neglecting his symptoms, and he himself decided to get CT scan head done. After seeing this file even I told him to meet psychiatrist, but he was very particular in getting CT scan brain and made repeated request to go ahead with the test.
At last I consulted our physician and decided to do the CT scan of brain, has his headache was increasing in severity day by day, we did CT scan brain plain study to our surprise, there was a big subdural hematoma with mass effect.
It was really difficult for us to break the news to the patient and his attenders, as even we hesitated to do scan on him initially, once we told report to the patient attenders even they were not accepting the report, started saying that he is a psychiatry patient and they bring him to scan just for his satisfaction.
It was really difficult to convince them to go to higher center for evacuation of subdural hematoma, anyway they were convinced and referred to NIMHAANS, few days post evacuation of the subdural bleed, patient came and thanked our team for believing in his symptom, so to conclude never take any symptom lightly in a psychiatric patient.
Dr. Ravi Shankar, MBBS, DMRD, Consultant Radiologist, Tumakuru
