Shrinking thick charts
Consultation-liaison psychiatrists often are invited in when a patient’s chart grows thick (“Thick chart syndrome: Treatment resistance is our greatest challenge,” From the Editor, Current Psychiatry, February 2010). Some hidden factors in these complex cases include the usual subjects: missed bipolarity, surreptitious substance abuse, personality disorders, and ongoing difficult life circumstances. A detailed history may reveal early trauma, abuse, or neglect or long-forgotten traumatic brain injuries.
If we leave our comfort zone, new approaches may offer considerable benefit. A large database of quantitative EEG results allows us to identify brains that are poorly wired or those with aberrant areas of fast or slow waves, which can be treated with computer-enhanced biofeedback. Stepping further away, we find that energy psychology—manipulating the body’s energy systems to ease distress—could help some patients who respond poorly to various therapies. Using behavioral kinesiology,1 we find that some people who respond slowly test weak in muscle testing where they should test strong, which can be corrected with energy techniques. Patients who change slowly often incorporate their problems into their identities, which should prompt us to address their cognitive styles to free patients from this trap.
It is tough sledding with the thick charts, but we have hopeful alternatives to traditional therapies.
David Tinling, MD
1. Diamond J. Your body doesn’t lie. New York, NY: Grand Central Publishing; 1989.