Friday, March 30, 2007

End of psych

Psych is now over. Next up: clinical procedures. I should get to do a lot of intubating and IV starting—I think we’re supposed to learn how to run codes too.

The family meeting w/ the patient and his mother was postponed as the patient went back into depression because he was so nervous about it. So I’m not going to see what his mother is like. He was going to look at an apartment last Wednesday—right before the social worker was going to take him the apartment called and said they had turned him down because of his criminal record. Interestingly, something that has come up is that his depression and acting out has gotten much worse over the last six months—as his mother’s health has declined. The current hypothesis is that all this rage, depression, and wanting to move away from his mom is due to the fact that he’s actually scared sick of losing her. Another psychiatrist on the ward interviewed him to give a second opinion, and she believes that once the mother dies he is going to be at a pretty high suicide risk, which makes sense, because I honestly don’t think that he can function on his own. He has no friends or family aside from his mom, and she currently does everything for him. Very sad.

In outpatient, I saw a thirteen year old boy with severe ADHD, but more interestingly with enuresis (wetting the bed) and encopresis (passing stool in his pants). The encopresis dates back to when the kid was three years old and being toilet-trained. One day (and this story was confirmed by his parents), at the exact moment he was sitting on the toilet, the boiler exploded, all the water rushed out of the system, and the sudden change in pressure created a suction that literally sucked the poor kid into the bowl! He was so badly traumatized that he still avoids the toilet.

Another patient was a teenager with ADHD and Asperger syndrome, which is similar to autism but without intellectual deficits. Before being medicated he apparently could not sit still, and was constantly doing silly things and making ridiculous comments about everything to everybody. When we saw him, he sat and read “Left Behind” as we were talking to him and the social worker, and every once in a while he would make random silly comments without looking up. Here’s part of the interview:

Psych: How is he getting along with the other kids?
Soc Work: He’s fine. Most of the other kids realize he’s just an intrusive guy and they accept it.
Psych: Right, it’s not like he’s ever mean or anything.
Patient: (never looking up from book) No, I’m just annoying.


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