Subjective: patient complains of 30-year history of alienation, depression, and isolation. Objective: looks tired, miserable, and lonely Assessment: irritable brain syndrome Plan: permanent commitment to sanitarium
Also associated with anger. Accompanied by a strange heaviness and the senses in all parts become dull and unlively.
Begins with a feeling of emptiness inside. Something starts to ache; something right in the center of the pt feels as if it it's opening up and spreading apart, as though a hole in the pt's skull appears. Then the emptiness starts to throb, at first softly like a fluttering pulse. For a little while that is all that happens; then the pulsing turns into a regular beat and the beat gets stronger and stronger. The hole gets bigger. Soon the pt feels as if there is nothing inside but a vast yawning space surrounded by skin that grabs convulsively at nothingness. The beating gets louder. The sensation changes from an ache to a hurt, and the feeling of emptiness becomes agony. In short while there is nothing left of the pt but an immense, drumming vacuum.