“What a Head Case”

This post is inspired by one of Koanic’s comments on another of my posts. It is mostly just a full transcription of the summary of my latest ten day tour in the psych ward; nothing edited, added, or removed and all [sic] intact except for people’s names. I checked myself into the ER at NMCSD at approximately midnight on 4/20/2012 for suicidal ideations. Enjoy.

PROBLEM 1: DISPOSITION …….. TARGET DATE 27APR2012 DATE CLOSED 30APR2012
Disposition: SD VA Psychiatry – Dr. XXXXX 858-###-#####; fax 858-###-####
Evidenced by: Admission to 1 North

Goal and/or Discharge Criteria:
Discharge with mental health follow up plans
Team Interventions:
Social Work Assessment
Recommended Patient Contact Focus:
Discharge Planning

Progress:
20Apr2012: Chart reviewed: No civilian holds, certifications, mandated reporting issues, or domestic violence issues noted. See Social Work Note for clinical encounter(s). Social Worker to follow for disposition plans as indicated by patient’s treatment team. XXXXXXXXX, LCSW
23Apr12: Social Worker contacted VA La Jolla to schedule follow up. Social worker spoke with XXXXXX. Pt. scheduled with Dr. XXXXX Tuesday, 01May12 at 1100. MO and Attending informed of appointment. XXXX XXXXX, LCSW.
24Apr12: Per Treatment Team, patient will discharge Friday, 27Apr12. XXXX XXXX, LCSW
30Apr12: Per Attending, patient not stable to discharge. Social Worker re-scheduled patient with Dr. XXXXX at the VA for Tuesday 08May12 at 0830. Pt. will be referred to Psychology at this time. MO and Attending informed of appointment. XXXX XXXX, LCSW.
Addendum: Per Sub-Attending, patient will discharge [against medical advice]. Pt. reported plan to follow up with Dr. XXXXX next Tuesday, and the VA Sacramento this weekend for labs. Pt. encouraged to contact VA Sacramento to schedule labs. XXXX XXXX, LCSW
Addendum: Per patient, Attending told him he would order labs for Tuesday. Pt. reported plan to come to NMCSD for labs. XXXX XXXX, LCSW

PROBLEM 2: Potential for violence against self or others. Target Date: 30Apr2012 Date Closed: 26Apr2012

Evidenced by:
Pt brought himself to the ER due to “on and off suicidal thoughts for a couple months.”
Goal and/or Discharge Criteria:
Patient will remain free from harm to self and/or others. Patient contracts for safety once a shift, during admission and least [sic] 3 days prior to discharge from the unit. Also, patient will verbalize ways to channel destructive impulses into more constructive expressions prior to discharge from the unit.
Team Intervention:
1:1 Interaction, Recreational Activities, Group Therapy, Scheduled Safety Rounds and Milieu
Recommended Patient Contact Focus:
Crisis Plan, Constructive Communication, Reflection of Current and past behavior, Goal setting and Future Orientation.
Progress:
20APR2012: (+)SI/HI (Suicidal Ideations/Homicidal Ideations) “I am on a fast from food, water, sleep, and medication” (with intent to kill himself this way). Patient refusing to answer this question directly but is requesting to be put into restraints because “I am unsafe right now.” Pt not elaborating on what he might do. “You’ll see when I do it.” Pt not able to contract for safety at this time. Dr. XXXXX aware as nurse, pt and Dr. all present during clinical interaction. 21APR2012: Pt stated in the milieu earlier that he was feeling suicidal. pt stated he was feeling this way because time was going to slow and that he wanted to see the “holy father’s face.” afterwards pt stated he was not feeling this way because the “father” would probably not approv of him killing himself. 22APR12: Pt denies SI/HI and verbally agrees to contract for safety. 23APR2012: Pt denies SI/HI at this time and agrees to seek staff should this change. 24APR2012: Pt denies SI/HI and agrees to seek staff should this change. 25APR2012: Pt denied SI/HI and agreed to contact staff if feeling unsafe or if SI/HI occurs. Pt. reported that he already had five reasons to live and listed them as his country, his family, his community, his friend Max and “the holy father.” **problem closed-patient is not suicidal**

PROBLEM 3: Alteration in mood and thought process Target Date: 30APR2012 Date Closed: (blank)

Evidenced by:
Pt states his mood has been unstable, and that he stopped taking his medication about five months ago. Pt reports having increased motor activity, and difficulty sleeping. Pt presents as religiously preoccupied and makes frequent delusional statements that are religious in nature, he states his goal for admission is “to see Jesus.” and that he must waste his flesh to do this, and that he has been refusing water, food, medication and sleep “for as long as it takes.”

Goal and/or Discharge Criteria:
At time of discharge Pt will be able to state five effective individual coping skills he can utilize to maintain a stabilized mood. Pt will report his mood has been stable for at least 24 hours prior to discharge. Pt will be able to carry on a reality based interaction for at least five min. with no delusional statement or content.

Team Interventions:
One on one staff intervention for at least five min Q shift to asses pt’s mood, provide pt with nsg education on effective individual coping skills he can utilize to maintain a stabilized mood, and on the need/advantages of medication and compliance in the treatment of mood D/O. Milieu groups and activities.

Recommended Patient Contact Focus:
Reinforce and focus on reality, recreational therapy/diversionary activities

Progress:
20APR2012: Pt is religiously preoccupied and continues to answer specific assessment questions with “check for yourself” and then pointing to the Bible. Loose, D/O. 21APR2012: pt has been preoccupied with religion, practicing religious rituals while by himself in the quiet room. pt had stated that during his brief period of feeling suicidal that he does not feel the “father” would approve of him doing so. 22Apr12: Pt states that he is motivated to go back to active duty even though he has already been medically retired. Pt states that he would like to come back as a Chaplain, if he can become stable without any medication. 23APR2012: Pt reports that he has found the way to the truth and it is his job to show others the way. 24APR2012: Pt denies AVH (audio/visual hallucinations) at this time, but remains very fixated on religion. Pt states that he has found the way to the truth and it is his calling to spread the word. 25APR2012 Pt continues to walk around the unit with his bible. Pt continues to read scriptures to people. Pt stated he was “possessed by an evil spirit last week” Pt talked about how this has happened before. 26APR12: Pt is preoccupied with religious ideations; delusional thinking; but redirectable. Pt is medication compliant. 27APR2012: Pt is focused on realistic goals such as getting his parents here to see him and working on discharge. 28APR2012: Pt was very goal oriented asking for step three and looking forward to his father visiting. 29APR2012: Pt stated he was feeling very good today because he was visited by 3 very important people in his life. Pt stated he is ready for d/c. 30Apr12: Pt states that he is ready for D/C and is goal directed. Pt’s mood has been stable at “ok” throughout the shift. Pt is being Discharged against medical advice. ***problem closed***

Here’s the medications I was discharged with. I’ll let someone else do the research (I suggest “uptodate.com”):

  1. clonezePAM 1mg daily
  2. risperiDONE 4mg daily
  3. ESKALITH CR 450 mg daily

Here’s the medication I took at one point or another over the 9 days I was medication compliant, many multiple times in multiple doses:

  • Tylenol 650 mg
  • Benztropine 1 mg
  • Benadryl 25-50 mg
  • Ativan 2mg
  • Maalox 30ml
  • Milk of Magnesia 30ml
  • Pitrex
  • Trazodone 100mg
  • Haldol

And some others I can’t remember.

On Friday May 4, I checked into the ER at VA Sacramento for approximately 5 hours because of nightmares from the medications I was taking. I have since been doing fine.

Your brother,

John

[John 4:24] God is Spirit, and those who worship Him must worship in spirit and truth.

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15 thoughts on ““What a Head Case”

  1. A young man with mood instability really shouldn’t be reading the Bible. You are not trained in proper exegesis. God really does not want you in a psych ward. If you are looking for some sort of guidance I would read some secondary sources. Might I recommend G.K. Chesterton’s Orthodoxy, Ch. 2: “The Maniac” Take care of yourself, and don’t do anything stupid. You have plenty of time to get yourself together.

  2. dont take trazodone, haldol or anti-psychotics

    dunno what Pitrex is but i’d sure as hell palm it

    the others on yr list are relatively benign so relax

    pt stated he was feeling this way because time was going to slow and that he wanted to see the “holy father’s face.”

    eminently sane sentiments, have them myself

    afterwards pt stated he was not feeling this way because the “father” would probably not approv of him killing himself

    yeah probly not eh?

    most mental health issues are traceable to self-absorption; then drugs get added on and it goes pfftt fast

    ignore Chester — keep reading the bible, but focus on the persons and events being described, not on JD … unless youre in lots of physical pain, suicide is pretty cheesy

    religious obsessions are bad, spiritual inquiry is good

  3. Well, it those are the entire notes there is something wrong with the system You are currently on a high potency benzodiazepine, a full antipsychotic dose of risperidone, and a Lithium brand we do not use in NZ.

    And you would not have been admitted here, on those notes. I cannot find an examination or mental state, or a formulation (a summary stating what I think). This is an essential part of the notes — and those notes would not be adequate to defend me if something went wrong.

    Now, concerning Ray: if you cut the Risperidone down fast you have a high likelihood of side effects (such as psychotic rebound) and if you cut the benzos agitation and insomnia can happen. So leave them alone, find a good shrink. (if they exist in the VA).

    Disclosure: I’m an academic psychiatrist who runs a state funded acute ward in the antipodes.

  4. Nah, you are not a head case. Many perfectly reasonable people have tough patches in life, you’ll get through it. Sometimes Christians through prayer or something, need to rest in Christ and let all these worries go…emotions like relationships are humans great challenges. Beware of the medications. Like a politician that can only tax and spend, doctors can only give drugs, manage symptoms and up the dosages. Medicines all reach their saturation points where they do no good in time. Like business, the mental health industry is into labeling people into a submissive state where they are meant to forget who they are or what they were meant to be…

    Based on the data provided you may want to add a great deal of vitamins, improved nutrition and possibly investigate if you are low sugar.

    Consider a book by Robert Mcgee, the search for significance:

    “…we need to affirm God’s truth about him or her: He (or she) is deeply loved, completely forgiven, fully pleasing, totally accepted by God, and complete in Christ. This perspective can eventually change our condemning attitude to one of love an desire to help. By believing these truths, we will gradually be able to love this person just as God loves us (1 John 4:11), forgive him or her just as God has forgiven us (Eph. 4:32), and accept him or her just as God has accepted us (Rom. 15:7). This does not mean that we will continue to see them, but our response to them will change considerably over time, from condemnation to compassion. As we depend less on other people for our self-worth, their sins and mistakes will become less of a threat to us, and we will desire to help them instead of being compelled to punish them [LP ed. or perhaps ourselves].”

  5. I’ve been through a slightly similar situation– not given psychiatric treatment or anything, but my whole life (which had previously been a “success” by conventional standards) did fall apart and I likely would have been diagnosed with bipolar or some other mood disorder had I honestly told a psychologist about my subjective states of mind at the time.

    My advice to you is very simple: good deeds, community/family involvement, and nature.

    Forget about your mystical experiences for the time being and instead volunteer to help old people or orphans or drive for meals on wheels or something; get involved in your local community and spend more time with your immediate and extended family; cut down on internet use, TV, radio etc. and spend some time hiking, fishing, walking, bicycling etc.

    Don’t seek out new mystical experiences. You won’t “lose” the mystical experiences you’ve had (in fact, it’s not possible to lose them), but you probably need a break from them at this time. They’ll always be there later for you to revisit when you’re in a more stable state of mind, and then you’ll be better able make sense of them and separate truth from delusion (the two are likely intermixed in such mystical experiences).

    I would also recommend saying the Lord’s Prayer every morning (but don’t get obsessed and pray so much that you neglect your duties). And go to a church if you can find one that suits you.

    Good deeds, family/community and nature/physical activity.

  6. good advice from al

    (plus, of course, lose the drugs . . . AND the Therapists, AND the Psychiatric Academics, AND all the other Paid Experts whose jobs depend on people like you believing in the “expertise” of people like them)

    good luck

  7. so you went HAMA? I think thats fine since you have self soverignity at least. but what I find wrong in your chart is that they have written so many specific things like they took it directly from NANDA, but they didnt even include:
    (-) s/snx of self flagelation
    (s/snx means signs and symptoms sorry bout that)
    and if there is perhaps it jsut wasnt included here was it? but how did you see your own chart? you stole it? or the staff are too linient?

  8. yoI added a comment that didnt went through. thanks for adding my comments from IMF.
    hehe BTW where did you get that avatar of mine?
    forgot to put you in the blogroll

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