Thursday, November 13, 2008

New DSM Diagnosis

Post Night-Float Call-Induced Delirium (may also be known as Post-Call Delirium)

Symptom Criteria:

a) disturbance of consciousness--manifested by inability to pay attention during rounds, falling asleep during rounds or morning report (or while driving home), inability to speak coherently while presenting patients, etc

b) a change in cognition or the development of a perceptual disturbance--manifested by forgetting what one was saying in mid-sentence, forgetting to print a copy of one's H&P prior to presenting the patient, not being able to answer simple questions on rounds, delusions of nursing staff conspiring to page q3 minutes while patient is trying to sleep, etc.

c) the disturbance occurs solely on the morning and afternoon after a night of call or night float

d) the disturbance is not better accounted for by an underlying dementia, substance (must rule out caffeine intoxication), or general medical condition

Etiology: directly related to the quantity, frequency, and quality of pages received overnight during the call or float shift. Direct correlation between repeat pages for Vicodin in a patient with "knee injury" that is not addressed in primary team's notes (and primary team d/c'ed the Vicodin) or pages to give detailed prognostic information to a family member after normal hours when the primary team had several discussions with them during the day, and the severity of the patient's symptoms.

Prognosis: good. Encourage night/day orientation (give patient bright light in the day and full darkness at night), re-orient them frequently ("You're presenting Ms. X, remember?"), withhold further caffeination, encourage proper nutrition (donuts and leftover pizza don't count), TURN OFF THEIR PAGER AND ALERT OTHER SERVICES THAT THE PERSON IS NO LONGER RESPONSIBLE FOR EVERY MEDICAL PATIENT IN THE HOSPITAL AS OF 0700, ensure that the patient makes it home safely and does not fall asleep while driving, and encourage a refreshing post-call nap.

I'll be submitting my findings to the DSM-V committee soon.

Addendum: This cracked me up: "It may also be associated with post-call dysphoric disorder, as manifested by irritability and the irrational belief that everything "sucks"."--thanks Midwife With a Knife!

2 comments:

Casey and Chris said...

That sounds similar to what I hear new motherhood is like...Please don't make me do it...I don't know how you do it all the time.

Midwife with a Knife said...

Hah! I love it.

It may also be associated with post-call dysphoric disorder, as manifested by irritability and the irrational belief that everything "sucks".

;)