Psych

Psych is very interesting to me. So little of it is based on science. We don't know for sure why mental illness develops, we don't know why exactly the drugs we use to treat mental illness work, or work in some and not others. The people I am seeing on an outpatient basis are for the most part marginally functional. Most don't have a job and have a stream of ruined relationships trailing behind them. If they have kids, they are often no longer in the picture. Alcohol and drugs abuse are a given at some point in their history. If the law hasn't been involved in their life it likely soon will be. Many with scizoaffective disorder will never be productive members of society. The best hope is that they will be able to function, avoid the law and substance abuse and perhaps hold a job of some sort. Bipolar is pervasive and yet often misdiagnosed. ADHD seems to be in the water here - so many of the adults and children have been diagnosed with it that I wonder if I don't have it. Many of the adults with ADHD, as is common, have a history of self-medicating with cocain and meth. In fact, if an adult w/ suspected adhd has tried either and says that they felt normal when using, that is almost pathognomonic for adhd. I've seen a few medical hold placed on patients - for 72 hours they are under the control of the state.

The inpatient setting is astounding to me. The trend in the US has been to close state hospital and to place the mentally ill in nursing facilities. Now these folks are just tossed in with grandma - they have theri own secure locked portion of the building, much akin to an Alzheimer's ward. The folks here are so ill they have little hope living with their family let alone on their own. schizophrenia is commonest illness in this setting. Since these patients were never compliant with their meds and were often using drugs and committing petty crimes on the street. Some can carry on a conversation, others are psychotic that they can't even look you in the eye. Some find their symptoms troubling while others revel in the hallucinations and delusions that come with their disease. Some are as young as 25 or as old as 75. When dementia sets in these patiens can be moved to less secure setting as they pose a decreased flight risk.

I still haven't actually treated any patients or written an prescriptions on this rotation - I am still a fly on the wall for 99% of this rotation. The docs are all nice. One didn't know what MRSA was when it was brought up in conversation with patient. He's been in practice for 40+ yrs and was able to determine it was an acronym for something however. Another doc defers to me for most medical questions from a patient. The other like to pimp me occasionally but her answers are usually not correct. Finally, the one I with tomorrow is very bland and soft spoken. Dowdy and unengaged would be other terms to describe her. I find it interesting how little the psychiatrists actually want to talk to their patients. At this point they have become dispensers of drugs and little more.