15 posts tagged “psychiatry”

As an educational endeavor, our department is organizing movie nights every other week. People gather together to watch a movie related to mental health. There is food beforehand and a discussion afterwards. This is what we saw tonight.

Napoleon_dynamite

Afterwards, we talked about Asperger's syndrome and teen angst and right and left brain hemispheres.

I'm still baffled.

Tshirt

Yesterday was the call from hell. I discharged two patients, saw seven in the ER, admitted five. Everything from drug-induced psychosis to schizophrenia to a stroke. ( The patient had a stroke. Call a neurologist. Do NOT call a psychiatrist to make your diagnosis for you, ER people.)

I worked non-stop for twenty hours straight. Then I went to bed.

And woke up three hours later to sign out to today's team.

Tomorrow, I have another twenty four hour call. Then I do house call for consults all next week, and consult call all through next weekend. Gah.

Hubby is on call today. I plan to sleep all day if I can.

I miss Vox...read all the neighborhood posts earlier this morning but could not think of decent comments to write.

Time to recharge my brain.

Running late for the morning research seminar, I have twenty minutes to see the new patient on the floor. Time enough, I think, as I walk in the door.

'Hi, I'm Dr. P, I'll be taking care of you while you're here on our unit.'

She asks for my credentials. I hand her my ID card.

'So, you're a resident.' She might have said vermin.

Uh oh. 'You'll be meeting a senior attending physician later. May I ask you a few questions?'

'Let me tell you something first. You are supposed to be a professional, but your behavior is not. You need to make better eye contact like I am making with you. You also need to stop jerking your head.'

So much for 'empathic' nodding. She goes on for the next five minutes, hard to interrupt.

I already have a diagnosis. Which is good, because she'd rather see a more professional doctor. Later, she tries to incite other patients to a non-compliance strike. Fortunately, her abrasive manner pushes them away. She plays the piano all day long and sings in the hallways. We spend a lot of time calming down other patients.

My attending offers to transfer her to another resident's care, but I can't let this one go. I go back the next day.

'You can be my doctor. I come from a good family. I can see that you are a genius, too. Amen.'

We bargain over medicines. She refuses the sedative she takes at home but agrees to take the mood stabilizer. I couldn't care less about the sedative; the battle is won.

Three days later, she's still grandiose and demanding. But its getting better.

[printed with permission, identifying details changed]

At Furious Seasons, Phillip Dawdy talked about the stabbing of a psychologist in NYC, going by the assumption that the murderer was a patient. That let loose a furore of protests/angry comments/anti-psychiatry posts. He followed with a post about the disturbing comments, generating more comments in turn.

Both the posts and the comments are variously informed, angry, mocking, bizarre, and quite a few are insightful. Recommended if you have an open mind and hard stomach (quite a few readers were angry/disappointed enough to stop following Dawdy, it seems.)

Judith Warner wrote an article on Overselling Overmedication. Phillip Dawdy posted a rather vitriolic post in response. She referred to Peter Kramer's review of Charles Barber's Comfortably Numb- How Psychiatry is Medicating a Nation. He returned to Barber's essay in Washington Post.

Interestingly, all these articles seem to make valid points. I find myself agreeing to parts of all, all of none.

- Medications help those who are sick.
- There are those who are not sick/do not need medications for their brand of sickness, but get medicated anyway.
- Medications have side effects.
- There is much more to recovery than just pills.
- Doctors and patients need to be more judicious in prescribing and taking of pills, respectively.
- America's mental health care system is all effed up.

Go read if thats what you want to do on a Saturday morning.

    The New Jersey Law Journal published this story.

The plaintiffs are suing in federal court in Newark, N.J., on behalf of their minor children, who have been denied benefits by Horizon Blue Cross Blue Shield of New Jersey.

Horizon claims that the children’s online writings, as well as journal and diary entries, could shed light on the causes of the disorders, which determines the insurer’s responsibility for payment. New Jersey law requires coverage of mental illness only if it is biologically based.

Horizon claims the eating problems are not biologically based and that the writings could point to emotional causes. It contends that access to the writings is especially important because the court has barred taking the minors’ depositions.

How to protect your (and your family's ) health information.

-- via psychcentral.com

Hi. I'm a psychiatrist. Your doctors asked me to come by and see you.

Why? Do they think I'm crazy?

No..well, they wanted to see if we could talk about your alcohol use, and if we could help you in any way.

Hm.

So why are you here?

Pancreatitis.

And do you know what's causing the pancreatitis?

The drinking.

Hm..so what would you like to do about it?

Nothing.

Do you think quitting might help?

Yes, I guess.

Would you like to get better? Or is that something that doesn't matter right now?

Oh, hell yeah, I want to get better.

So, in order to get better..would you like to quit?

Not this time.

[ I'm so tired.]

The Public Hospital for Persons of Insane and Disordered minds, Colonial Williamsburg, VA, was the first mental hospital in America. The Hospital admitted its first patient in 1773. It had 24 cells, which were not all filled until the 1800s. James Galt, formerly the keeper of the Public Gaol, was appointed head administrator.

Hospital cell- 1773

This was the era of Restraints. The hospital had two missions. One, to cure the 'curable', and two, to confine the dangerous. The tools used to meet this purpose included a few medications, such as paregoric, ipecac and laudanum, certain old standards such as bloodletting, and free use of metal restraints.

Medicine chest

Tranquilizer Chair

Lancets, scarificators and cupping glasses

Manacles

The hospital closed down in 1781 due to wretched conditions, and reopened five years later with more innovations, including a fenced exercise yard. In 1793, the hospital acquired its first electrostatic machine, to 'shock patients out of their illness.'

The first electroshock machine

The hospital acquired new physicians including John Minson Galt, and continued to expand into the next century. In the 1840s, the Moral Management approach came about. Attempts were made to humanize the treatment methods and the living conditions.

The hospital was renamed Eastern Lunatic Asylum, a place of refuge for people unable to survive in the outside world.

Hospital room in 1845

This was also the era of Phrenology, or the study of the form of human brain to determine character.

Phrenology bust

 In 1841, the hospital acquired a new electrostatic machine.

ECT machine

In the Moral Management era, a non-restraint approach was pursued as far as possible, and patients were often 'rewarded' for good behavior. Treatment became more specialized, and the doctors were devoted to their patients full time.

John Minson Galt II, with twelve other superintendents of lunatic asylums across the US, formed the Association of Medical Superintendents of American Institutions for the Insane, a forerunner of the APA. They also published the country's first psychiatric journal, The American Journal of Insanity.

Patient casebook- John M Galt II

The 1850s saw several changes under the supervision of John Minson Galt II. He publicly declared that the mentally ill were 'our brethren', started accepting slaves in the hospital, and proposed an overhaul of the system, suggesting placement of the mentally ill in the community as boarders. He was a man ahead of his time, and his plans were not well received.

The treatment of the mentally ill still centered around sedatives, and increasing use of Morphia frequently led to chronic constipation.

Enema syringe

In 1862, the Union army took over and the hospital was sacked. It was repaired and re-expanded in 1868. African American patients were segregated to a facility in Richmond. This was the era of Custodial Care. Patients were encouraged to get physically active and worked to maintain the hospital. The hospital housed about 300 patients.

Gradually, the hospital became more a facility for the chronically ill, with fewer and fewer people being 'restored to community' each year. The era of restraints came back.

Leather restraints

Straitjacket

Utica Crib/ Mesh bed

 In 1885, a fire destroyed most of the hospital. The hospital was rebuilt, renamed the Eastern State Hospital and moved to a new location in 1937. It housed almost 2000 patients at this time. The old building was razed down in 1960.

A patient's cup

A ceramic cup belonging to one of the patients was recovered by archaeologists during the site's excavation in 1972.
It said, simply, ' Think of me.'

..to be a chronobiologist, and use phrases like 'rhythmic human' and words like 'zeitstorer'?

In case you really are wondering, read this.

For some odd reason, we ended up talking about hypothetical psycho-surgery today at work. What if we could make a diagnosis, point a little laser pen at a particular spot on the brain, zap a few cells, cure Bipolar, and go home for tea. Would psychiatry still be fun? Probably not..

In a separate incident, I discover this after a month of nightfloat. Nightshifts are carcinogenic, or so they think. Good thing OTC melatonin is cheap. I like that line at the end of the article, though..'Just get a dark night's sleep.'

Amen.

A couple of days ago, I saw this middle aged lady on consults. She has end stage renal disease, and was getting dialysis at an outpatient dialysis unit. She also has bipolar disorder, and is very prone to angry outbursts, verbal aggression and threatening people verbally. One fine day, she ripped off her IV and threatened to 'kill everybody with Hep C'. Her treatment was terminated and she was asked not to return.

Since then, she has been coming to the ER, gets admitted and dialysed, discharged, and then back again in a couple of days. This time she again pulled off her IV and got extremely upset while in the ER, and we were consulted for 'history of schizophrenia, bipolar, and mood disturbances.' She was started on a low potency mood stabilizer (thats the only one she could tolerate, apparently) and she refused Risperdal consta (long-term antipsychotic) shots.

When I went in to see her, she was eating beef jerky, talking on the phone, crying, and immediately told the person at the other end, 'Well, here's another Angel of Mercy to see me. I better see what they want.' She knew she would die without treatment, and that 'the bitterness in my head and my mouth are going to kill me.' The staff up on the floor have already suffered some of her outbursts, and don't want anything to do with her. She had huge gift bags by her bed, full of lotions, perfumes and gifts she had bought for the family who 'don't want anything to do with me because I burnt my bridges.'

I couldn't help feeling sorry for her. She has a creatinine of 14.9 and desperately wants to live. How much of the anger is Bipolar and how much is just her? I don't know. But she deserves a chance at life. The hospital is now going to draw a behavioral contract after which she might get treatment again as an outpatient. I hope.