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Sunday, April 5, 2009

Psychiatry Lock Down

So I started psychiatry rotation this week and it is crazy.. no pun intended. I am working on an inner city psych ward that is locked down. Most of the patients are there or at least put there involuntarily. These patients are fairly sick and represent some of the most severe mental illness pathology that cane be seen.

Walking onto the ward you immediately notice a variety of foul smells. Patients in soiled gowns with poor hygiene make for interesting smells. You also notice people with blank stares roaming aimlessly through the hallways. Every so often you will hear an eruption of emotion. Someone will yell profanities at the wall or at an imaginary person that no one cane see. Occasionally a patient will need to be calmed down and fortunately we have a large staff of trained security that is ready to jump in at any time. 

I am currently assigned to 3 patients that were admitted this week and I work with another 6 that are assigned to my team. One of the patients is a young 28 year old man who was diagnosed 3 years ago with bipolar when he had a manic episode that left him awake for 3 weeks straight. During this time he completely lost touch with reality and dropped out of his masters program. He took all of his money and all of his student loans and jumped into his car to report to spring training in Arizona. He was convinced that he was recruited to start for a major league baseball team and he needed to be at spring training. He had never played a day of baseball in his life. Prior to this episode he had had some issues but was never treated for any specific illness.

After 3 weeks of running without sleep he was arrested and charged with trespassing when he was trying to enter a high-school stadium in Arizona at 3 in the morning. The policed realized  that they were dealing with someone who was not quite right so they took him to the hospital where he was admitted and ultimately treated for his mania. This was 3 years ago. Now fast forward to this week. 

Now this patient moved to Chicago a year ago to work as at a successful accounting firm. Ha has been well managed on his medications and has been doing well. About 1 week ago he started acting a little funny his brother thought when he would call. HIs brother lived in another state and reported that he thought his brother may have stopped taking his medication because he seemed to be a little manic and not quite right. His brother was right. The patient stopped his medications 2 months ago and had become increasingly manic until about 1 week ago when he completely lost touch with reality and again took all of his money and bought a brand new car that he could not afford and went on a week long binge of rock star tyoe activities that included gambling and dance clubs where he celebrated his new promotion as CEO of the company but unfortunately there was no promotion.

His brother flew out from another state to track his brother down but his too late. His brother had been arrested for attempting dance naked in the lobby of a major corporation where he told everyone that they were fired and he was the new CEO. The police brought him to our unit and I was assigned his case. Day 1 he was flying high, unbelievable mania. Hi tox screen was clean so there were no drugs of abuse affecting his mood. He had unbelievable energy and was very happy explaining that these were the best days of his life and that he was the new CEO.

More to come.

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