"Sympathy" is a word that could not be more appropriate to describe the relationship between patients with depression. I once had a patient in Guangxi who met on the Internet and sighed after exchanging his condition with each other.

His illness lasted for 7 years, with two relapses, two suicides, and much suffering. At first, he just suffered from insomnia and felt a feeling of pressure in his chest, and the treatment did not work for two years. Later, headache and dizziness appeared, and the doctor suspected coronary heart disease or blood lipid problems, and performed blood rheology examination, electrocardiogram examination, brain Doppler examination, MRI examination, thoracic and cervical spine examination, liver and kidney function tests, etc., all of which were normal. So, I went to see Chinese medicine, took health products, and invited Daxian, but to no avail. Eventually, it progressed to long-term sleep disorders, frequent headaches, stomach pain, chest pain, numbness in the hands and feet, and the whole body was sick. I tossed and turned for 4 and a half years, until I was lucky enough to meet a neurologist and was diagnosed with depression. Symptomatic treatment, effective after 30 days; The treatment was continued for 2 years and gradually recovered.

I've also been misdiagnosed, but much luckier than him. For the first five and a half months of my illness, I was treated as a single depression, which was ineffective, and progressed from moderate to severe, with almost hypostupor. Later, he found Dr. Jiang Tao of Anding Hospital. At the second visit, he denied the diagnosis of a single depression and diagnosed me with a "depressive phase episode of bipolar disorder", and immediately adjusted my medication on a large scale. After 19 days of changing the dressing, there was no warning or transition, the drug took effect, and I was cured. Just as the light of the sunrise dispelled the darkness, the light came suddenly at this moment.

Over the past few years, I have communicated with many patients and found that most of them have been misdiagnosed once, or even many times. There are very few patients who are diagnosed once and cured within one or two months.

Regarding "diagnosis", the "Chinese Dictionary" defines it as follows: "to make judgments about people's mental and physical states from a medical point of view. "To put it simply, diagnosis is to identify what disease a patient is suffering from based on their symptoms.

Given the unknowns and complexities of human science, it is impossible to make a diagnosis without errors at all. Psychiatric disorders are more difficult to diagnose than physical disorders. This is because psychiatric disorders occur inside the brain, and cannot be tested and explored with the help of instruments, but can only rely on doctors to collect information and make judgments through consultation, and their diagnosis is more subjective.

Many people fantasize about whether it is possible to invent a device that can determine which chemical is lacking in the brain, and then prescribe the right medicine? The answer is not right now. If anyone says they can now, that's a lie.

In October 2011, China's "First Antidepressant Drug Forum" was held in Shanghai, at which a data was announced: the recognition rate of depression in non-specialized hospitals above the prefectural and municipal level was less than 20%, and the misdiagnosis rate of depression was as high as 50%; Even in Shanghai, physicians at general hospitals only recognize depression at a rate of 21%. In other words, nearly 80% of depressions are misdiagnosed or missed.

Accurate diagnosis is a prerequisite for treatment and rehabilitation. How to take this first step?

What should the patient do?

Accurate diagnosis requires the combined efforts of the patient and the doctor.

The most important thing for patients is to face the reality and explain their symptoms to the doctor.

A friend once met me and told me about insomnia, anxiety, lack of appetite, and lack of energy. I said, "I see you are anxious and depressed, so go see a doctor." ”

I saw her again half a year later, skinny and gray. This time, she recounted that she often stayed up all night, could barely eat, and felt that she was completely bored. I warned her, "You're not anxious with depression now, you're depressed with anxiety." Don't delay any longer and get to the doctor as soon as possible. ”

Later, I asked her every two days if she had gone to the doctor. She pushed it today for tomorrow, this week for next week, but she couldn't push it off and went to the hospital. As soon as I walked out of the hospital, he called me and said happily, "The doctor said, it's okay, no need to take medicine." ”

Who wants to have something to do and take medicine? I'm relieved, too. Unexpectedly, after two or three months, I received a call from her again, her tone was frightened, her speech was slow, and her words were sad. I was shocked, asked her in detail, and was anxious: "You should be moderate depression by now!" Why did the doctor say you were okay last time? What the hell did he say? She snorted. I asked, "What did you tell the doctor?" Did you say you had suicidal ideation? She replied, "No." ”

I understood: out of resistance to mental illness, she concealed or downplayed key symptoms from doctors, causing misdiagnosis.

In stark contrast, it is the patient who talks too much and obscures key symptoms.

There are about 30 million patients with depression in China, but there is a serious shortage of psychiatrists, with only 20,000 at present, a shortfall of 400,000. There are too many patients and too few doctors, and the time allocated to a patient by a doctor in a professional hospital is only 5 to 10 minutes. In this precious time, the patient should focus on the description of the condition; Don't babble on the minutiae and mislead the doctor.

I once saw a patient complain that his doctor had a "bad attitude" on the grounds that when he was talking, the doctor repeatedly interrupted him: "Pick what is important!" The doctor's attitude may be difficult for the patient to accept, but the doctor allocates so much time to each patient, and the patient's invalid statement will delay himself and take up the time of other patients.

When I saw a doctor, I knew that these 5 minutes were precious, and I had to do my homework beforehand. I will make a written outline, first outlining the main conditions, and only talking about the facts, not the feelings (the doctor has no time to listen to the patient's complaints); If you still have time, ask questions in order of importance, and ask as many as you can. It wasn't until the doctor slipped the medical records into my hand as a send-off and shouted, "Next—" that I knew it was time for me to stop.

What to do with the doctor

Doctor-patient communication is a skill. Misdiagnosis occurs, and the patient may be responsible, but, in the final analysis, it is still caused by the doctor's "lack of learning". A good doctor should be able to discern which of the patient's self-reports are exaggerated and which are disguised; Which are the key points and which are the last sections.

Typical depression, diagnosis is not difficult. However, many depressive symptoms are insidious or atypical and can be confused with medical disorders; Among psychiatric disorders, depression, anxiety, schizophrenia, and bipolar disorder sometimes overlap and are easily confused.

For example, depression and schizophrenia. Some patients with depression have atypical clinical presentations, and the patients do not answer when they see the doctor, indicating social withdrawal and will decline; If the patient has delusions, hallucinations, etc., the doctor may make a diagnosis of schizophrenia. It is estimated that about 20% of people with depression are misdiagnosed with schizophrenia because of accompanying hallucinations and delusions.

Bipolar disorder is more complex. It refers to a mood disorder that combines manic or hypomanic episodes with depressive episodes. When it is in the depressive phase, it is almost indistinguishable from depression; If the signs of mania are not obvious, it is a "soft bipolar", and it is even more common to be misdiagnosed as depression.

There are also some bipolar patients who are misdiagnosed as schizophrenia because of their manic signs.

A friend once came to me through a introduction. I asked, "Are you depressed?" He smiled wryly and whispered, "More complicated." A doctor, who is also more famous, diagnosed me with schizophrenia. ”

He told me that there was a time when he had hallucinations. Walking on the street, suddenly my thoughts are chaotic, and many meaningless associations rush to me. For example, when a bus drives by, he sees how many buses there are, and he will irrepressibly associate many things from the numbers; On the street, when he sees the traffic, he will also have infinite associations, feeling that the outside world is going to harm him, so he is so frightened that he runs home from the street and does not dare to go out for a few days.

I listened, asked him about the whole situation carefully, and boldly said, "You are not schizophrenic. First of all, your mind is sound, you are aware of your condition, and you are actively seeking treatment. One of the major characteristics of patients with schizophrenia is that they are not self-aware, do not think or admit that they are sick, and do not take the initiative to seek help; Secondly, the hallucinations you are talking about are not the same as the hallucinations of schizophrenia, but the thinking is rushing, because you are still logical. ”

He asked, "So what disease am I?" I said, "I judged it to be bipolar disorder with some psychotic symptoms." However, what I said doesn't count, let's go to the doctor. ”

A few days later, I took him to Valium Hospital. When he stated his condition, the doctor who treated him seemed to be listening, but he deliberately asked a few questions that seemed irrelevant to me: "Do you drink?" "What kind of wine?" "How much to drink?" "When was the last time you drank it?" "What does it look like?" Then he buried himself in "swishing" prescribing medicine.

I seized the moment of time, leaned over, bowed down, and whispered, "Doctor, what disease does he have?" The doctor didn't raise his head, and answered the question: "Go back and take your medicine!" ”

The next patient has already come in. I was not reconciled and asked a little loudly: "Does he have schizophrenia?" ”

This time, the doctor looked up, glanced at me wearily and unpleasantly (the doctor probably did not want mortals to invade their territory), and replied word for word: "Bipolar disorder with psychotic symptoms!" ”

In an interview with me, Dr. Jiang Tao, the attending doctor at Anding Hospital, who is trusted by patients for diagnosis and treatment, concluded that patients with depression, bipolar and schizophrenia have different performances in terms of social interaction, social adaptation and social functioning. A depressed person is closer to a normal person, and when you communicate with him, you can feel that he is very close to a normal person, his thinking is very clear, and his painful experience is also very high; Patients with bipolar disorder have some manifestations that are out of the mainstream, and some psychotic symptoms are mixed in; People with schizophrenia basically have no normal thoughts, have terrible emotional expressions, and are completely outside the normal population. If one were to draw a spectrum for mental illness, then depression was on the far left, schizophrenia was on the far right, and bipolar was in the middle. From left to right, more and more detached from society.

How can doctors do this? Jiang Tao couldn't say why he came up all of a sudden. He was an empiricist who described seeing a doctor as intuitive. He said: "To accumulate experience, you see more patients, and in your heart you divide them into many types; When you see a new patient, you can be classified into a certain category, and combined with the clinical experience of other similar patients, you can form a basically accurate judgment. ”

That being said, it's not easy for a clinician to move from theory to experience, and from experience to intuition! The righteousness of diagnosis is a fraction of a millimeter, and the error is thousands of miles, how can doctors and patients be careless!

People with depression are not in the world. They seem to live in a glass enclosure, and the outside world is real, transparent, and visible, but it is isolated, as if it is too illusory.