psychiatrically unstable crohn's patient

Specialties Gastroenterology

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Specializes in Neurosurgical ICU, Emergency, Psych, Art Therapy.

Any experience/insight/advice for the treatment of Crohn's in someone who is very psychiatrically unstable? Someone who has about 10+ stools a day, causing a lot of abdominal pain, but also is psychiatrically unwell and denies that they have crohn's but rather says they are cursed with snakes in their stomach? I know this is a strange question but I work with a woman who has been diagnosed with Crohn's in the past (though it is unclear as to how she was diagnosed, she is a very poor historian in regards to medical history) She has had a resection, but there is no clear notation about the details that preceded the surgery. Lab work shows elevated CRP. Due to the frequency of stools we are awaiting a stool sample to test for c-diff but I am almost positive it will be negative. Any other easy tests that might bring clarity to her diagnosis? Due to her resistance to care, denial of crohn's, and guarded nature related to psych issues, the doctors working with her are reluctant to force her into testing she is refusing bc she is currently "stable" however the frequent stools and chronic abd pain are chronic and distressing to her. She does not have any family or outside support to help with medical info or to help with supporting further testing. Any ideas would be greatly appreciated. Thank you!

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Specializes in Hospice.

How do you know she’s “psychiatrically unstable” and not from a non-Western traditional culture?

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On 9/17/2019 at 4:40 PM, heron said:

How do you know she’s “psychiatrically unstable” and not from a non-Western traditional culture?

Good thinking.

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Specializes in Neurosurgical ICU, Emergency, Psych, Art Therapy.
On 9/17/2019 at 4:40 PM, heron said:

How do you know she’s “psychiatrically unstable” and not from a non-Western traditional culture?

She has been one of my patients on and off for about a year now and she was born and raised in Maryland. She has been schizophrenic her whole life. It’s a very complicated and sad situation.

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Specializes in Surgical, quality,management.

No easy answer. IBD Consultation and psychiatric consultation.

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