Wednesday, November 5, 2014

"Today I feel euphorian"

Image courtesy
Back in October, I posted some thoughts about psychiatry and included an Ogden Nash poem at the end. I challenged you, Dear Reader, to write a mental Status Examination for the narrator of “No Doctors Today, Thank You. Here's the poem again, followed by my mental status examination (MSE). Please read with tongue firmly in cheek!
No Doctors Today, Thank You
~Ogden Nash
They tell me that euphoria is the feeling of feeling wonderful, well, today I feel euphorian,
Today I have the agility of a Greek god and the appetite of a Victorian.
Yes, today I may even go forth without my galoshes,
Today I am a swashbuckler, would anybody like me to buckle any swashes?
This is my euphorian day,
I will ring welkins and before anybody answers I will run away.
I will tame me a caribou
And bedeck it with marabou.
I will pen me my memoirs.
Ah youth, youth! What euphorian days them was!
I wasn't much of a hand for the boudoirs,
I was generally to be found where the food was.
Does anybody want any flotsam?
I've gotsam.
Does anybody want any jetsam?
I can getsam.
I can play chopsticks on the Wurlitzer,
I can speak Portuguese like a Berlitzer.
I can don or doff my shoes without tying or untying the laces because I am wearing moccasins,
And I practically know the difference between serums and antitoccasins.
Kind people, don't think me purse-proud, don't set me down as vainglorious,
I'm just a little euphorious. 

Mental Status Examination

Appearance: Patient appears his stated age. He is dressed appropriately in pants, shirt, and tie. He is wearing glasses. Hygiene average.

Behavior/Attitude: Patient demonstrates psychomotor agitation: straddling his chair, pacing around the room, and play-acting. He makes intermittent eye contact but cooperates with the interview.

Speech: Patient uses what sounds like a stage voice. His speech is loud, verbose, pressured, and peppered with neologisms like “antitoccasins” and “Berlitzer.” Language skills above average.

Mood: “Today I feel euphorian.”

Affect: Mood congruent, euphoric.

Thought Process: Confused, with frequent flight of ideas and clang associations (caribou/marabou, flotsam/got some, etc.) bordering on word salad.

Thought Content: Fixated on his euphoric mood. Some delusions of grandeur (agility of a Greek god, being a swashbuckler) and also magical thinking (that he will “ring the heavens”). No suicidal or homicidal ideation.

Perception: Evident visual and auditory hallucinations, as patient speaks and gesticulates as if he were on a stage in front of an audience.

Sensorium and Cognition: Awake. Uncertain orientation to person, place, and time. Memory not formally assessed.

Insight: Fair, in that he knows he can put his shoes on or take them off without un/tying laces; but poor in that he does not think he needs a doctor despite his (hypo)mania and psychosis.

Judgment: Poor, in that he would go outside in the rain without his galoshes.

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