So I have started my psychiatry rotation. Once again, I am at the veteran's hospital, only now I am in North Little Rock, a nice half hour drive twice a day. Granted, I know some make much long commutes daily to and from their jobs, but I think they too fall in the crazy category. Starting on January 7th, I did three weeks of outpatient clinic where I saw patients who mainly suffered from depression and/or PTSD. I saw a patient who was at least manic, if not bipolar, who denied his condition despite a recent episode of wandering neighborhoods all night and hiding in peoples' bushes. I saw a schizophrenic in clinic who, while currently well controlled on antipsychotic medication, continued to report the voices of demons telling him he was the son of Perdition and the Antichrist. Those two together are a might heavy charge, if you ask me. Now, and for the next two and a half weeks, I will be working with the patients who are committed because they are super crazy, are super depressed, or have super PTSD symptoms. So I currently have a schizophrenic patient who is NOT well controlled on his medications. His retard Christian Evangelist born-again psychologist, likely from the hills of Deliverance, told him to stop taking the meds as they were causing his diabetes. While this may be true, it's better to have easily controlled diabetes than psychotic symptoms requiring hospitalization. He came in, self admitted, with grandiose delusions about how God worked through him in such a way that he was to communicate with high religious figures to spread information about the Antichrist. Again, a crazy claiming connection to the bringer of everything evil. Is there really a connection? He also thinks the police and millions of others are constantly surveilling him, just waiting for him to slip up and say the name and whereabouts of the Antichrist. It's him and "his people" versus the rest. I haven't yet asked what side I am on for fear of my life. He also sweats blood, much like Jesus and the apostle John, and doesn't want meat even though he knows animals are God's gift of meat to us. More medications, I say.
I would also like to bring up something educational. I saw to patients receive ECT, or electroconvulsive therapy, this morning. Let's dispel some Hollywood misconceptions, shall we? ECT does deserve its criticism, IF YOU LIVE IN THE PAST! It used to be a very barbaric procedure, and overused, such as we have seen as follows:
Jack Nicholson in One Flew Over the Cuckoo's Nest
Or, more recently, this one:
Ellen Burstyn in Requiem for a Dream
Notice, these people are awake and either strapped down or several people are holding them down. This is so far removed from the case of today, it's hard to imagine a time like this. Now, people are under full anesthesia, intubated so that they may breathe, and have been given a paralytic agent so that the induced seizure doesn't cause physical harm or kidney damage. The seizure lasts between thirty seconds and two minutes, ideally, and the only indication of its presence is an EEG (a machine which monitors electrical activity of the brain) and a seizing foot. The physician puts a blood pressure cuff around ankle to keep the paralytic agent out of the muscles of the foot to give the team a physical indicator of seizure activity. There may be some facial grimacing as preventing this would require far more paralytic agent. When the procedure is done, the paralytic agent is reversed with another drug, the patient is woken up and extubated. Simple (and boring) as that.
To be fair, here is a link to a pamphlet opposing ECT: http://www.antipsychiatry.org/ect.htm
There are MANY things wrong with this pamphlet. First, the website itself. I at first thought this was by a Cruise-lovin' scientologist based on that alone. Nope - it's a blood sucking lawyer, perhaps even worse. Second, he quotes books and articles dating as far back as the 30's up to the nineties, with a few updates at the bottom. Outdated information is a sign of poor research. Thirdly, amongst all his listed sources and recommended readings, ALL are opposing pieces. A well-written stance provides information from both sides. Now, there are some M.D.'s out there who also oppose ECT - psychiatrists in fact. Fair enough. But since when does any psychiatrist know an inkling about how their treatments really work? Fourthly, the "author" uses more quotation marks than Lisa Ramsey on a crack "binge" - simply "annoying." Sure there is some short term memory loss - as in they might forget the morning of the treatment, maybe the day before hand. Any more than that is exceedingly rare. Sure they may be in a trance for a bit after the procedure, but so are most seizure patients. It's called being in a post-ictal state, and it always passes without harm. There is no good evidence for permanent brain damage, especially since chronically depressed patients, the only patients in whom it is used, likely have brain damage anyway. It is NOT used as a scare tactic for patients - that's just crap. All the patients I have seen involved in it chose to do it on their own accord, and it's a rare enough procedure that the possibility of them being scared into it by others is highly unlikely, if not impossible. Here's what ECT IS:
1. More effective than taking a pill every day.
2. A VERY good option for those who have recurrent, severe depression unresponsive to other medications.
3. A last resort.
4. It can, and does very well, turn this:
Notice, these people are awake and either strapped down or several people are holding them down. This is so far removed from the case of today, it's hard to imagine a time like this. Now, people are under full anesthesia, intubated so that they may breathe, and have been given a paralytic agent so that the induced seizure doesn't cause physical harm or kidney damage. The seizure lasts between thirty seconds and two minutes, ideally, and the only indication of its presence is an EEG (a machine which monitors electrical activity of the brain) and a seizing foot. The physician puts a blood pressure cuff around ankle to keep the paralytic agent out of the muscles of the foot to give the team a physical indicator of seizure activity. There may be some facial grimacing as preventing this would require far more paralytic agent. When the procedure is done, the paralytic agent is reversed with another drug, the patient is woken up and extubated. Simple (and boring) as that.
To be fair, here is a link to a pamphlet opposing ECT: http://www.antipsychiatry.org/ect.htm
There are MANY things wrong with this pamphlet. First, the website itself. I at first thought this was by a Cruise-lovin' scientologist based on that alone. Nope - it's a blood sucking lawyer, perhaps even worse. Second, he quotes books and articles dating as far back as the 30's up to the nineties, with a few updates at the bottom. Outdated information is a sign of poor research. Thirdly, amongst all his listed sources and recommended readings, ALL are opposing pieces. A well-written stance provides information from both sides. Now, there are some M.D.'s out there who also oppose ECT - psychiatrists in fact. Fair enough. But since when does any psychiatrist know an inkling about how their treatments really work? Fourthly, the "author" uses more quotation marks than Lisa Ramsey on a crack "binge" - simply "annoying." Sure there is some short term memory loss - as in they might forget the morning of the treatment, maybe the day before hand. Any more than that is exceedingly rare. Sure they may be in a trance for a bit after the procedure, but so are most seizure patients. It's called being in a post-ictal state, and it always passes without harm. There is no good evidence for permanent brain damage, especially since chronically depressed patients, the only patients in whom it is used, likely have brain damage anyway. It is NOT used as a scare tactic for patients - that's just crap. All the patients I have seen involved in it chose to do it on their own accord, and it's a rare enough procedure that the possibility of them being scared into it by others is highly unlikely, if not impossible. Here's what ECT IS:
1. More effective than taking a pill every day.
2. A VERY good option for those who have recurrent, severe depression unresponsive to other medications.
3. A last resort.
4. It can, and does very well, turn this:
In to this:
So there you have it, my standing on ECT. Just thought I would dispel some common myths about it. Soon, I will give my standing on the presidential candidates based on their standings on health care issues. Our good friend connection in Chicago, Carrie, hasn't yet reported on individual health care opinions, and I need to be informed. I fear for the future of medicine.
8 comments:
Excellent "Requiem" tie-ins. Now I really want to watch that flick.
Great blog, and you've inspired me to write some issue-themed blogs.
Rachel - Thanks! Let's do it! (Watch Requiem)
Carrie - Thanks! I took a survey the other day and realized I just don't know enough about where folks stand on healthcare.
You could argue that without movies/books from the fifties and sixties like One Flew Over the Cuckoo's Nest and Woman on the Edge of Time, that the health care situation would never have improved.
On the other hand, I'm willing to bet that if you looked at the doctor's perspective more sympathetically, you'd find out that they lacked money and facilities/equipment/proper medication to treat patients properly and were just doing the best they could.
In another hundred years, children will hear horror stories about how "doctors" used to cut patients open in order to fix internal injuries. (See Star Trek Episode IV: The Voyage Home for more details).
Is that the one where they put that bug in that one guy's ear?
Oh no, that was Wrath of Kahn.
In Harry Potter world, wizards think that Muggle doctors are "nutters who cut people open". There may be some truth in that, but we have to work with what we know.
Star Trek IV was the one were Dr. Bones gave a lady a pill and she grew a new kideney.
Chekov fell in the USS Enterprise (the boat) and had a brain swelling (don't know the medical term) for which the only treatment was (is? this was the 80s) to drill holes in his head to relieve the pressure.
To which Bones said "You're going to drill holes in his head? What are you, a barbarian?!" or something similar, in typical crotchety Bones manner. Then he put a little metal thing to Chekov's head and viola! he was cured.
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