schizophrenia

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By now I think folks on the business management level of health care are at least aware that we Americans spend a lot of money on health care and seem to get very little in return. The author of a provocative piece in Forbes thinks “unnecessary health care” is our worst problem. This statement hit me broadside.  This does seem pretty true for the example she chose, even though it is decidedly outside of my field.

As far as I can figure, this sort of planned emergency delivery she talks about brings nothing to obstetric science or to the quality of human life whatsoever. Around the net, I see estimates of how much of what we do is actually science.  It usually comes out as about 50 or 60%; maybe a little over half. This is happening as part of what seems to be a massive drive towards EBM, known as “Evidence Based Medicine.”

Read more on Too Much Unnecessary Care…

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I remember, several years ago, going to a national drug development meeting; the first time I had been at such a meeting, with drug company folks from the highest national levels. I remember how excited I was.  Maybe someone could develop an antipsychotic that really could escape all those neuromuscular side effects.  Maybe they had new things that were more powerful than antibiotics, which I already knew were not working as well as they ought to. I remember, with characteristic naivete, that it felt impossible to find anyone with whom I could discuss the pharmacology that so impassioned me, for the “big” drug guys seemed to be more interested in the business and politics of the thing. Read more on Could Fish Oil Prevent Schizophrenia?…

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Map of targeted congressional districts from Sarah Palin websiteIt is horrible and terrible and should not have happened, but it did. We have to look at questions we have looked at before.  We claim — all of us at one time or another — that human life is precious, and that its very existence is beyond price, and the quality of such existence is pristinely precious, and then everybody in America has to process this tragedy.

First, let’s take care of the straight medical questions. Congresswoman Giffords is obviously getting the best possible care and the most modern possible care.  People have learned a whole lot about injuries to the brain since yours truly hung out in a semi-rural University Medical Center in Northern France. (I cannot believe it was over two decades ago).

The people taking care of her have told USA Today the basics, so I can only recapitulate.The shot was made at point blank range, estimated by some as 3 or 4 feet. The bullet entered the back of her head on the left side, and exited through the front. It is true that the structures controlling heartbeat, breathing, and basic survival are more toward the middle of the brain, or “brain stem.”  Things like using the senses to put together images of what a human is dealing with are a bit more superficial. Read more on Left, Right, Jewish, Christian — Arizona Shooting Victims Are More Than Political/Religious Pawns…

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He looked different from most of the depressed patients that walk into a psychiatric clinic.  He was 24, thin and spare.  His hair was longer than average and hung loosely over his brow, his clothes were black and macabre –what the young folks call “Goth”.  That style makes everyone look depressed, but I could tell his depression ran deeper than fashion styles.

He was actually a handsome young man, and he had sensibly avoided the face and body piercings that Goths favor.  He was open about his choice of lifestyle, relishing his chance to educate me. But while he was talking, I could see he was so depressed, he could have been the poster child for the diagnostic manual.

But something more was going on here. He told me that he had adopted the Goth look at age 13; that nothing else could express how he felt about life — or rather, how he didn’t feel. Read more on What If Life Is Not Worth Living?…

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His diagnosis was schizophrenia, but this man in his mid forties looked more sad than schizophrenic.  I asked his story. He hadn’t had any of the symptoms of schizophrenia for years; as a matter of fact, he was doing fine; no voices, no symptoms, working as a peer counselor.  But he was sad.

His white hair looked so distinguished; I would have guessed he was a businessman, not a schizophrenic.  But the downcast eyes, the slow shuffle of his walk, told me that sadness had taken over his daily life.  As for the white hair, he told me his hair had turned quickly, at the time of his loss; a story I had heard before.  To me, this was more empirical evidence of the Mind-Body connection — emotions affect bodily functions in a large number of ways. Sometimes we know more about the biochemistry than others, but everything I learn amazes me.

Like many with his diagnosis, he had struggled with relationships.  He thought he had won the game, for he found a woman about whom he cared greatly. Then, she died. Read more on Fighting Grief With Positive Activities…

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He was known by the whole clinic as a tough patient.  He missed appointments, saying he was “busy,” but never explaining with what.

He looked like an obese surfer dude; blond, blue-eyed, always tanned.  He was quiet and polite and said little, very little.  His long-standing diagnosis was schizophrenia.

pledge to end hungerWe knew that he lived with his mom.  She had once monitored his medications, but now she was ill. He did not take well to home visits, so there had been none for a very long time. Most anti psychotic medication makes folks put on weight.  I had seen many obese schizophrenics in many clinics, but his elusive nature made us wonder how sick he really was, what his life was like.  We even wondered if he sold the medicine on the street to make ends meet, as some folks do.

He lumbered in, if irregularly, to get his injection.  He always took it quietly. Mention him at a staff meeting, at least within the last three months during which I had called in to consultant, and every case manager turned their eyes heavenward, groaning.  Everyone agreed, he was frustrating, at the very least. Nothing could be done for him; he wouldn’t listen.  He told contradictory stories about his life. People told me he was a substance abuser –crack, cocaine, pot.  I saw no clinical signs of substance abuse when I visited with this patient.  However, I had only seen him twice, for he did not come to appointments often. “I am a busy guy.  I drive around; I do things.” He couldn’t tell me what.  “For my mother.  Sometimes, I like to be with my girlfriend.” Read more on The Starving Surfer…

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