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One Flew Over the...

Sunday, March 30, 2014

32 year old Caucasian, female presents to Behavioral Health with 'pseudo' sign language, partially mute and anatomical jerking, whipping her hair back and forth. Patient's husband had her admitted due to her "Bizarre" behavior.  The husband states she has been off her lithium for six months and has been taking OTC lithium and synthroid, stating, "She was trying to go natural." The jerking and sign language began 3 days ago and has progressively gotten worse, including one word answers.  She uses non-sensical words with large gestures. Her actions are hyperactive and lacks eye contact. She appears obese, unkempt and malodorous.

This is just an example of what I have encountered over the past week.  In fact, this was my first in-patient while on the floor. I was blown away by the craziness contained within the behavioral wing. My first day included having a security personal walk the halls due to a particular threatening patient, bulimia and multiple bipolar patients.  Additionally, my proctor is a character that fits the atmosphere. I had to ask myself, "What did I just step into?" 

The staff sit within a central glass case, similar to a fish bowl with locked doors.  The patients, most of them are allowed to walk the halls freely.  Furthermore, every physician's office located on the outside of the 'fish bowl,' is accessed only by key. 

One of my duties, besides taking a H & P is to dictate the given information. I had never used a phone for dictating purposes.  In fact, it was some what intimidating at first.  The timidness came mostly from the fact that I wasn't use to speaking the behavioral med jargon, which I have been studying and trying to incorporate.  I'd be interested in rereading my first few dictations at the end of my rotation, just for a good laugh.

One interesting point about the different behaviors is that a number of times adolescents are given medication to assist their ADHD, but as the teen grows into adulthood it is learned that the patient doesn't really have ADHD.  In fact, the outbursts and distractibility stem from manic phases of bipolar (BPAD I).  One of our patients is being treated for Adderall toxicity.  She was one of these types, firmly diagnosed with ADHD.  We have since prescribed lithium for bipolar and her pressured speech, flighty ideas and irritability have since improved.  Side note, she too wanted to go natural/homeopathic, so giving her lithium was rather easy to do because it is a natural salt (metal.)   

The female at the beginning of this post has since returned to base line.  I'll be honest, I have always been a bit skeptical about psychoses, but after watching her go from bizarre and hyperactive to a calm individual, who can hold a conversation I'm a believer. Seriously, this last Friday, she sat on the bed, looked us in the eye and held a 20 minute conversation!  The crazy part is that she doesn't even remember going through the manic phase! 

Just a few quick notes: I have finished up my first two rotations.  Both of which were Internal Medicine.  We returned to school for a week for tests and lectures and now I am out on my third of ten rotations. My next one, which will begin in three weeks is Family Medicine.   But for now, it's nice to be home though it's only for a short period of time. 


  1. Max and Deanna said...:

    Interesting. You are learning a lot.

  1. Wow, this is fascinating to me, and also very sad! I'm glad you're getting to have these experiences, so you can know how to help people. Such a great thing for you, Chad!! I can relate to the skepticism--I'm sure it's hard for those of us who don't witness it to believe that people can suffer and struggle with these kinds of problems. Go you!

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