March 4, 2011

White Elephant Alien Army (Psychosis)

Somehow I made it to the end of week 1! After a pretty busy morning, we video-chatted into lectures for a few hours in the afternoon (mandatory) from our condo, then went for a long run around the golf courses nearby.

But don't let that make you think my week was easy - this week I've learned firsthand about psychosis:

What does psychotic mean?

(1) they could have a diagnosis of schizophrenia; 6months or more of either hallucinations/delusions, flat affect, PLUS a significant disruption in the person's life - either in their job or relationships or with the law or all of the above.
(2) schizophreniform disorder, which is basically schizophrenia symptoms for 1-6 months
(3) brief psychotic disorder, which is all these symptoms for <1month
(4) schizoaffective disorder, which is the symptoms of schizophrenia PLUS changes in mood (depression/mania/anxiety)
(5) delusional disorder, which is when someone has a very specific delusion but does not have any of the other symptoms of schizophrenia

you also have to rule out:
(1) bipolar disorder with psychosis
(2) reaction to a medication or a drug (e.g. cocaine, marijuana)
(3) a medical student at the end of her first week of psychiatry rotation.

some direct quotes from my patients this week: (misquoted slightly so as to not violate hippa or anything), and leaving out the more vulgar and disturbing quotes to spare you THAT fun.

"so then after I stopped working on that paper on genetics, I began my research on the white elephant alien army because the words leap of the page and into my head"
- all said in the same perfectly normal tone, affect, and emphasis.

"I am just a bubbling idiot and I am just flying away"
mumbled under his breath over and over

"but I know everything, I see everything, I am everything"
-as a reason why he should be discharged

"I see snakes all over the hallways"
"I hear demonic sounds coming from the walls"

"I just want to go home! why are you keeping me here?!"
- from a man who is homeless, was just discharged a few days before, then came to the ER and demanded to be readmitted to our inpatient psych unit. He is paraplegic and somehow "lost" both his prosthetic and his wheelchair. Leading us to wonder not only why someone would show up at the ER demanding to be readmitted and then protest for keeping him there, not to mention how someone who is paraplegic loses their wheelchair?

what a first week.

one of my grandfather's favorite quotations, and perhaps true in these cases as well:

"insanity is doing the same thing over and over
and expecting different results"

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