Discussion of Psychological Disorders
Write 3 – 4 paragraphs and show that you are presenting new FEC from the source you are using.
Violence and Psychiatric Disorders
When I worked on an acute care inpatient psychiatric unit, we had about two dozen patients and a turnover averaging about 28 days. So we saw plenty of admissions, with patients coming and going every day. Never knew what the place would look like on a Monday morning, since there were always admissions over the weekend of patients in bad shape.
There was a difference between patients on their first admissions and those on their second, third, or even more, admission. One difference was hope, another the fatigue of caregivers and of course the prognosis. The earlier the first episode, the worse likely outcome for the patient. Multiple admissions also correlated with a poorer prognosis.
I want to mention two young men who lived at home, cared for by parents, who repeatedly were brought to the hospital. Peter would refuse his medications a few months after discharge, fall apart (decompensate) and become a management problem at home. His mother even tried crushing the pills and putting them in mashed potatoes. Eventually, he became aggressive enough that she called the police and he was hospitalized – again. He spent about half his time in the hospital for seven years, until a psychiatrist struck a bargain with him. The young man would live in a supervised apartment and take an injectable medication every two weeks. That deal had several advantages. Peter had odd dietary habits, badly suited to the food in a hospital cafeteria. Mother had been bringing him food on a daily basis. So he looked forward to preparing the foods he wanted as much as to being out of the hospital. The injections eliminated the need for supervising his taking pills and made it obvious if he skipped an appointment. Peter was successfully maintained as an outpatient on that regimen for the six years I worked with him. I never got much farther with him, though, and several attempts at lowering his medication resulted in our trips to the emergency room for an injection.
Sam was less successful. He was a big fellow who lived with his parents, would stop his medications and become very, very unmanageable. His parents were getting elderly and could not tolerate violent outbursts in the house. On the inpatient service Sam was stubborn as a mule; he only wanted to go home. His parents badly wanted someone to take responsibility for him. What made it more difficult was that we were working to get a promising patient into a residential placement upstate. So Sam’s parents expected us to do the same for Sam. Obviously, no program would consider an individual who immediately said that he didn’t want to live there.
I overstepped my place and told them we couldn’t take responsibility. An administrator had a talk with me and told them that if they would not take him home, he would be placed through the Department of Social Services. They agreed and he was put up in an SRO – a single room occupancy. That lasted less than a week and they took him back, to continue the cycle. I do not know the outcome of that situation because I left the inpatient service.
So, while violence is not common among psychiatric patients, they can become a serious problem when they are not taking medications, especially if they add some alcohol and other drugs to the mix. The young chronic patients were especially prone to that and frequently got themselves into trouble.We had many episodes in the inpatient service when patients were out of control and had to be restrained. They usually received an injection of medication prescribed to be used as needed (‘prn’) and had a short stay in an isolation room. The episodes were sudden, chaotic and very disturbing to staff and any patients who observed them.
As a final note, it is a great deal safer to deal with a psychotic person in the structure of an inpatient unit. In the community, one usually does not know history, medications, or substance abuse, and there is always the possibility of weapons.