PLAN B: 1. 2. 4-5. 410 Refer the patient to a docto. r within the week. 1. 1 Refer him to a psychiatrist if any of the following are present: l. 2 1. 1. 1 Symptoms have been present for mort:! than six months. 1. 1. 2 Hallucin ations especially auditory one. 1. 1. 3 Delusions or false belief, especiall y one of grandeur (like l. l. 4 1. 1. 5 1. 1. 6 patient bdicves sbe is a queen, a prophet 01· a goddess) Patient has difficulty in thinking as obsetved in bfa. inability to concentrate or in his lack of decisiveness. Patient feds depressed, hopeless, worthless or guilty. He may also be so depressed that he loses interest in living and/or he has withdrawn from work and daily living, either completely or partially. Patient is in an ove,-enthusiastic mood, get involved in so many activities and feels little need for sleep. Patient looks untidy and unkept. Patient is out of touch with reality (he doesn't know who he is or says he is someone else or he says he is in son1e planet, etc. ) Patient has-Oat or inappropr iate emotional reaction to what he/she is saying or doing (like he say that his friend just died aml thill he is sad and yet he is smiling) · 1. 1. 10 Patient's talk is irrelevant nnd/or incoherent or he has sexual or religious preoccupnt-io n. 1. 1. 11 lie is easily clistracted. 1. 1. 12 The insomnia is associated with withdrawal from alcohol or medicine for nervousness like those containing diazepam or lorazepum Refer tbe patient to a general pnictilioner (like the Municipal Health Officer) if any of the following are present 1. 2. 1 Joint pain, 1. 2. 2 Swelling and/or redness of the painful joint 1. 2. 3 Item under 1. 1 are present and there is no psychiatrist available. Refer the patient to a dentist if the insomnia is due to toothache. Determine knowledg e of the pntient or that of his companion on the supportive management of problems presented llascd on 2..0, do the followin g if ll1cre is joint pain and/or swelling: 3. 1 Give/prescribe ovcr-the-couu ler medicine for pain or herbal medicine for arthritis. Srccifying accurately the met. hod of preparn tion (specifically for herbal medicine), the dose and frequency of intake. Tf an over-the-counter medicine for pain is be:i J1g given/prescribed, give/prescribe also an antacid to be taken wit]1 each does of the medicine for pain. H;ised on 2. 0, give/p1-escribe over-the-counter medicine for pain if there is a toothache. Specifyin g accurately the <lose and frequency '<'. >f inta J<c. Give/ prescribe also an antacid to he taken with each does of the medicine for pain. If the patient is very depressed, advise companion to take some precaution 