The psychological components of the patient questionnaire are extremely important. Although it can be challenging to broach sensitive topics, it is crucial to thoroughly investigate whether the patient is on any anxiety or antidepressant medications and whether these are effectively managing their condition. In the section addressing body dysmorphic disorder, the questionnaires play a crucial role in addressing the patient’s concerns. The short questionnaire should include questions about body image, such as how the patients perceive themselves, do they feel – too fat or too thin. Additionally, inquire about any history of eating disorders, as current eating disorders can impact healing and lead to malnutrition.
It is essential not to dismiss negative answers to these questions outright. Instead, observe the patient’s behaviour and mood to gain a more comprehensive understanding of their mental state. Look for signs like unexplained displays of laughter or a consistently flat affect. This thorough assessment helps ensure patient safety and appropriate treatment decisions. If a patient appears to be very depressed or highly anxious, it may be prudent to refer them to see their general practitioner (GP) for treatment before proceeding with any cosmetic injections. It is important to explain to the patient that injections, especially during their first experience, can be stressful. Being realistic about the potential challenges is crucial.
For patients who exhibit signs of body dysmorphic disorder (BDD), it is essential to refer them to a psychologist. These patients can present significant concerns during follow-up appointments if their underlying condition is not addressed. One of the key questions to assess is whether their concerns disrupt their work or ability to function as a homemaker. If a patient is preoccupied with their cosmetic concerns for more than three hours a day, continuously or in substantial amounts of time, it may be this is a red flag. In such cases, it is appropriate to refer them for further evaluation. It is important to explain that you are not making a diagnosis, but their response raises some potential concerns.
Never ignore signs of distress, including crying or sad expressions. Including looking away from photographs and poor eye contact. Make it clear to the patient that the assessment is not solely about their cosmetic concerns but also about their overall well-being. Ask them about the stressors they are currently experiencing in their life (ask how life has been lately).
Examination is an extremely important aspect of patient assessment, as it provides valuable insights. Firstly, observing the patient’s demeanour is crucial. Patients who avoid eye contact or appear sad should first be addressed from a psychological standpoint, as discussed earlier.
Patients displaying signs of self-harm should be referred to a senior injector or doctor. Inquiries about when these incidents occurred, and their current well-being are essential. Many individuals with a history of self-harm have overcome these challenges and can be excellent patients once they’ve received appropriate support.
Assessing the patient’s attire can be another indication of psychological disposition. Unusual dress can indicate underlying personality disorders or varying degrees of mania, among other issues. Shabby or unkempt attire may be indicative of early dementia or depression.
Having a basic understanding of common personality disorders, such as borderline personality, narcissistic personality, and histrionic personality, is advisable. Patients with these disorders can be effectively managed with experience. It is important to note that typical explanations and instructions may not be readily accepted or understood by such patients. Starting with gentle treatments like microdermabrasion can help build rapport and assess their response.
Patients with a history of body dysmorphic disorder can be challenging to manage. It is generally best to avoid extensive procedures and consider referring them to outside help or a psychologist.
Psychological assessment and understanding are crucial for stress-reduced clinical practice.
