Every honest and complete psychiatric evaluation includes screening for delusions. A delusion is a strongly held belief that is totally without basis in the factual reality that we all use to live our daily lives. I have taken care of several people, institutionalized and not, who have had such beliefs. Medications known as “antipsychotics” can be very effective on the hallucinations — the hearing voices and seeing things and such — that are the hallmark of a lack of mental “normalcy” as is generally expected and accepted in the community. The same medications may be less effective on these delusions, these beliefs. Sometimes, in a particular kind of delusion, a kind that hits folks somewhere between 18 and 90 (average age 40) where there are no hallucinations, just beliefs. They are less frequent. They are also hard to treat, with antipsychotic medicines working maybe about half the time — in those who can actually be convinced to take them. Read more on Screening For Delusions…
He was in his mid-fifties and seemed pretty clueless. What’s more, he had more abnormal movements than any 20 people and looked like he was dancing with an invisible partner.
He sat at home all day trying to get himself involved in things like doing laundry and watching television so that he could get himself tired enough to sleep, focused enough to avoid the voices. He was safe — no forced hospitalization was necessary or even possible here. He promised that he would not harm himself no matter what the voices said, but it became clear that he lived in a world where devils and demons gave him a continuous commentary on everything from why Obamacare would never help him to — the size of his wife’s behind. There may have been some exhortations to harm self or others in the distant past, but they were indeed distant.
He said he had no medicine for the past ten years. I asked how he lived and he said his family was no help, but his woman was. He was married to someone else but this woman was the only person who knew his day-to-day life and she had brought him to the clinic, so I got a release signed and got her in there. I told her he said he had no medicines in say, the past ten years or so. She started laughing.
For the kids who can’t manage to keep appointments — let alone blood tests — there are lots (and I mean lots) who qualify for the anti-psychotics that are also FDA approved as mood stabilizers.
Those who know me as The Renegade Doctor sometimes get the mistaken idea that I am against all prescription drugs and that pharmaceutical treatment should always be avoided. That could not be further from the truth. I believe in the proper treatment for the proper condition. At times, I may disapprove of the methods and conduct of “Big Pharma,” but I will always use the best treatment for my patients – especially if it is FDA approved and a legitimate indication.
My favorite mainstream choice in the above example is usually arapiperazole (Abilify). The case study I’ll share with you is a patient who sometimes hears some voices and would like to get rid of them. So that is the medicine I offer this 22 year old hip hop composer with one of those cylindrical “spreaders” that resembles a manhole cover in his right ear lobe (I wouldn’t have picked it myself, but he told me his girlfriend thought it was real hot). Now sometimes this drug is stimulating and people have trouble sleeping. So my usual suggestion with this would be a touch of Benadryl (diphenhydramine) – an over-the-counter allergy pill – which causes drowsiness and could help him sleep. It’s even available in those “99-cent” stores that dot the countryside. Read more on Promethazine On The Street…
She was twenty four, and beautiful – magazine cover, MTV video beautiful — with long black hair and exotic features. She was telling me about her childhood abuse, her drug abuse, and how she left childhood for pregnancy and married a husband who was in many ways more abusive than her own parents had been with her.
Although the precise details do not matter, this woman gradually revealed herself to be a victim of physical, emotional, and sexual battering so severe that that she actually looked back fondly on her time spent in a variety of foster homes. I rarely hear this. She told about her abuse with a certain flatness of facial expression and vocal tone, a certain acceptance. This is not uncommon in those who have survived a lot of emotional abuse. It is a survival mechanism; a way to put up a wall. I could understand that.
She was actually a fairly reasonable person to interview. She did not have many holes in her memory and managed to answer most of my questions with believable facts. I had to ask about her education. She had been doing well in school when she dropped out because of pregnancy. She had not used contraception then, still didn’t. When I asked her, she told me simply that since her family was Christian, such topics were not discussed. Read more on The Harm Done By NOT Providing Sex Education…