Psychiatry

Hospitalizing people against their will: 4 questions to ask

Conditions
September 4, 2013

Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …

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A ruptured eardrum turns out to be something much more

Physician
July 9, 2013

My shift is over, and I’m ready to head out the emergency department door.  When I walked in 12 hours ago, the department had 20 waiting patients.  I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds.  My partner Dr. Jim looks at me and says, “Get …

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Reflection after attending an Alcoholics Anonymous meeting

Education
June 13, 2013

I’m two weeks into my psychiatry clerkship, sitting quietly in the back of a crowded Alcoholics Anonymous meeting and watching a middle-aged man discuss his past struggles with alcoholism. He starts with his difficult childhood, describing his abusive father. When he was eleven years old, his parents divorced. Soon after, he resorted to alcohol as an escape from his loneliness, drinking to “fit in” and impress his friends at social gatherings. As …

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Being a psych patient in the emergency department

Physician
June 1, 2013

So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security …

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Understanding psychotic and bipolar disorders

Conditions
May 19, 2013

Psychotic and manic depressive disorders can not only disrupt the life of the person suffering with one of these illnesses, but the lives of family and friends as well.

You should seek professional advice if you suspect that you, a friend or a relative or even a spouse may be experiencing a psychotic or bipolar disorder. It’s important not to attempt a diagnosis yourself. There are many external factors that can …

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The controversy over DSM-5 and the cataclysm in mental health

Conditions
May 14, 2013

Here’s a joke I love: A man goes to an old-school psychiatrist who, at the first session, administers some Rorschach tests.

“Just tell me the first thing that comes to mind,” the doctor instructs the patient as he shows him the ink blots.

“Sex,” answers the patient.

“I see,” says the doctor. “And this one?”

“Sex.”

“And this one?”

“Sex again.”

“Well,” says the doctor, “I see we will have to work on your obsession with sex.”

“Me??” …

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The big impact of small changes for DSM-5 ADHD diagnosis

Conditions
May 8, 2013

As chairman of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Work Group on Attention Deficit Hyperactivity Disorder (ADHD) and Disruptive Behavior Disorders, I read the article on ADHD that appeared on the front page of The New York Times on April 1, 2013, with interest and also dismay, which was shared by my colleagues in the work group. We recognize the effort involved …

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The locked inpatient psychiatry unit: What’s it really like?

Physician
April 19, 2013

As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. …

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Violence and severe mental illness: 6 questions to ask

Physician
March 17, 2013

Recently one of our readers posted this comment:

“If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You’ve been in the trenches, it would be great to hear your thoughts.”

Over on Peter Earley’s blog I see that …

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Make patients more accountable for their own health

Physician
February 20, 2013

Let’s talk a little about health accountability.  Two news items have provoked the following rant: why is it always someone else’s responsibility?

The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller.  Such a drug would be a gold-mine for that pharma company because it could …

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Countertransference is a reality that must be grappled with

Education
January 29, 2013

“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”

***

“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”

“Hello? Hello?”

I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.

“I’m sorry, I can come back…” I start to say. …

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The closing of a mental health facility in Newtown

Physician
January 26, 2013

I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds  crowned with stately and handsome brick buildings in a colonial architectural style.  These …

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Why I’m not sure that psychiatric medications work

Meds
January 25, 2013

I have a confession to make.  I don’t think what I do each day makes any sense.

Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me …

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Be the bad guy with good intentions

Education
January 14, 2013

“You’re not sorry.”

Within two days two different patients said this to me, each with hatred in his voice.  Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.

For seven months, I had avoided being the bad guy.  When a patient got upset, he accused my superiors, and I hid behind their …

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Physicians can be better doctors by being patients

Physician
December 31, 2012

Physicians are terrible patients. That fact is one of the few absolutes in medicine. I can remember developing an acute appendicitis as a medical student. I remember the fear, the uncertainty and the discomfort. I can remember wanting someone who was in charge to spend a little time in my room explaining things to me. I can remember the embarrassment I felt when a group of 6 student nurses paraded …

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10 advances that have changed medicine forever

Meds
December 4, 2012

I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …

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Do people need to suffer the consequences of their bad behavior?

Physician
July 19, 2012

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

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Should medical students consider a combined psychiatry residency?

Education
June 19, 2012

“What about combined psychiatry-family medicine-neurology-internal medicine programs?  Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”

Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …

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A medical student’s first patient interview

Education
May 25, 2012

“Um—Hi there, I’m a, uh, you know.  Medical student. First year. For, you know, the Patient-Doctor—err, Patient-Physician course—”

The nurse smiled and turned to a woman of shorter stature with bony, scrunched- up shoulders. “Mary, do you want this first year to interview you?”

Mary was about to set foot in the lounge when she heard this. She let out a sigh and faced me. Her eyes looked worn; I could tell …

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