The Rising of the Phoenix

A few days ago I wrote a brief blog entry entitled "Out of My Mind" which was about a 29 year old female in the midst of a psychotic break. It was hard to give the reader an accurate idea of how psychotic this patient was through words alone. You really had to be there to understand how lost this patient had become. Nothing she said made sense. She nervously scanned the room with her eyes and her limbs twitched with restlessness. As I asked her questions her responses seemed to have zero connection to reality.

I asked "how old are you" and she replied "Surgo is 40, so I am 1, 2, 3, 4 months old" I asked "Who is Surgo?" and she said "Surgo is the top half of my body". These kinds of responses continued for nearly 30 minutes at her intake interview. She was hypersexual and exposing herself and trying to initiate sexual acts with the other residents and some of the staff. 

This psychotic behavior continued for nearly 3 days without any noticeable improvements. Initially we started her on an antipsychotic and after 3 days without improvement, yesterday I doubled her dose. 

This morning when I interviewed the patient I immediately noticed that a complete transformation that had occurred. Today she was fluid and congruent. Her responses made sense. The nervous twitching and restlessness was no longer present. She asked "when can I go home? I feel much better." It was like I was talking with a different person. I asked her about the previous days and some of the statements she had made. She did not recall most of it and simply explained that she had been very confused and scared and knew something was wrong. She was grateful and when I asked her "how do you think you got better" She said, "it is all because of you doctor" I smiled and said "I think it has more to do with the medication, but thank you."

I was walking the patient back to her room and she grabbed my arm and said "everyone will think we are going out" I said "do you think this is appropriate behavior?" She quickly replied "oh come on, I have been telling everyone that we are dating and I do not want them to think I am a liar." She made the statement in a joking manner and knew she was being silly which was a good sign that her insight into her illness was returning. We were at the door to her room and I said you are healing, please continue to take your medicine and we will hopefully be able to discharge you soon. 

These are the cases that make the psychiatrists really appreciate their job. I think all the fields of medicine have patients that make a tremendous comeback and these cases help ease the more difficult cases that do not seem to recover. 

What a great day!