A 40 yr old female is brought to Neurocasualty with history of severe headache for past 2 days.

She is a known hypertensive on treatment for the same. The neurologist writes a referral to you. The referral states that the patient had an argument with her husband 3 days back and there are no neurodeficits and hence patient may be evaluated and treated under psychiatry. List 2 most relevant aspects of history and examination you would elicit in this case. Prepare a comprehensive response to this referral.

History Ask for other features of organicity

Vomiting Seizures LOC Fever Incontinence If worst headache of life, previous h/o headache

Enquire about stressor in detail; any past h/o similar complaints after a stressor

 Examination
Orientation to T/P/P Check vitals and confirm absence of neurodeficits Fundus examination and Neck rigidity MSE

Check who has referred the patient Inform SR Thank for the referral Date and time when patient seen Brief history Findings elicited on examination and interview Plandecision to take over the case by SR if required if a non emergency, date for review in OPD Signature and designation and case discussed with whom to be mentioned

To The Neurologist, Casualty, NIMHANS Respected Sir/ Madam, Thanks for the referral. Mrs A, 40 yr old lady with acute onset headache has been evaluated. Though there is h/o stressor, on clarification of history and current mental status examination the headache does not seem to be functional in origin. There is no acute psychiatric intervention which is required at this point of time and the patient can be seen in the psychiatry OPD if necessary. Thanking you,