Mental Health Monday–Length of Stay for Teens

I was SO stoked when Georgia McBride of YALITCHAT.ORG and Month9Books fame asked me to answer some writerly psych questions.

One question was (paraphrased):

How long would a 16 year old with “hallucinations” be hospitalized on an inpatient psych unit? 


Inpatient hospitalizations for children vary from a few days to 30 days (sometimes more, depending on the severity of symptoms). Reasons for hospitalizing a child include: out of control behavior, self-injurious behavior, suicidal ideation/gestures, and aggressive/assaultive behavior toward others. 

If the child has severe and chronic symptoms that don’t significantly improve with extended hospitalization, the child may be discharged to a long-term facility to live and go to school. If the child has broken the law, they may be sent to a juvenile detention center (those stays can be months to years).

It’s important to remember that once the child becomes stable, they would need to be discharged with outpatient treatment set up for them. Without it, they’d be at risk of relapsing (having recurrence of symptoms). 

Remember, these posts are for writing purposes ONLY and are NOT to be construed as treatment or advice. 

Check out Lydia’s Medical Monday and Sarah’s The Strangest Situation for more medical and psych related topics!

Mental Health Monday–Zombies ARE Real

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All the buzz about Zombies has me freaked out. Like for real. I can handle vamps, werewolves, even ghosts. But zombies? No. Way.

And here’s why!

Zombies. Are. Real.

Named after Jules Cotard (a French neurologist who first described the condition in 1880), Cotard Syndrome is a delusion where the sufferer believes they are dead, or are putrefying, or have lost their blood or internal organs. Sometimes (rarely), it includes delusions of immortality (so in that regard, vampires are real too!)

Related to Capgras Syndrome, Cotard Syndrome can occur in Schizophrenia and Bipolar Disorder. It can also be a (rare) side effect of Acyclovir (an anti-viral medication).

Treatment includes pharmacotherapy (medication) with anti-psychotics and mood stabilizers. ECT (Electroconvulsive Therapy) has also been used.

Has anybody encountered any literature including a character who believed they were dead, decaying, or that their organs were gone?

Be sure to check out Lydia’s Medical Monday and Sarah’s The Strangest Situation.

Remember, these posts are for writing purposts ONLY and are NOT to be construed as medical advice or treamtent.

Let me know if you have a writerly mental health question and I can address it here on Mental Health Monday! 😉

 

Mental Health Monday–Capgras Syndrome

Capgras Syndrome is a delusional disorder whereby the sufferer believes that a friend, family member, spouse, or someone else they know has been replaced by an identical-looking imposter. Most commonly associated with Schizophrenia, the disorder has also been seen in brain injury and dementia. 

It was first labeled in 1923 by French psychiatrist Dr. Joseph Capgras, whose patient believed “doubles” had replaced her husband and others she knew. (Thank you, Wikipedia, for that bit of information.) 🙂

Treatment includes medications such as anti-psychotics (Haldol, Zyprexa, etc).

What books or movies have you seen where a character believes others have been replaced by imposters?

Check out Lydia’s Medical Monday and Sarah’s The Strangest Situation.

Remember, these posts are for writing purposes ONLY and are NOT to be construed as medical advice or treatment.

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Mental Health Monday–Othello Syndrome

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There are several psychiatric syndromes with some, well, intriguing names. Today, I’d like to comment on Othello Syndrome.

Aptly named after Shakespeare’s Othello (where Othello murders his wife because he believed she cheated on him), Othello Syndrome is a delusional (fixed, false belief) disorder whereby the sufferer believes their spouse or partner is being unfaithful. Often times, there is little to no evidence to substantiate this belief.

It can be associated with other mental illness such as, schizophrenia, delusional disorder, bipolar disorder, alcohol dependence, sexual dysfunction, and other neurological illnesses. It can also be associated with stalking (which can include multiple “interrogations” of the partner, repeated phone calls to work, surprise visits, and hiring a PI to follow the partner) and, at times, violence (either in the form of suicide attempts to harm toward others).

Different theories have arisen regarding the cause of this disorder. Some believe it is morbid jealousy whereby the sufferer’s memories are subconsciously changed and their partner’s actions are misinterpreted. Or, those with an “insecure attachment style” may be fearful and extremely anxious about their partner’s commitment.

Treatment includes anti-psychotic medications for the delusions as well as anti-depressant medications if there’s associated depression or anxiety. It is also important for the sufferer to engage in psychotherapy.

What examples of Othello Syndrome have you seen in the books you’ve read?

Be sure to check out Lydia’s Medical Monday and Sarahs’ The Strangest Situation!

Remember, these posts are for writing purposes ONLY and are NOT to be construed as medical or psychiatric advice or treatment.

 

Mental Health Monday–Drug-Induced Psychosis

Writer Colleen Rowan Kosinski asked about Substance-Induced Psychosis.

Here are the basics:

Drugs (legal and illegal) and even some herbal supplements when taken in excess can cause psychosis. Common offenders include alcohol, marijuana, cocaine, heroin, amphetamines (meth), and hallucinogens such as LSD and PCP. Prescribed medications such as prednisone, isoretinoin, scopolamine, L-dopa (used for Parkinson Disease), and anti-epileptics can also cause psychosis.

Substance-Induced Psychosis is something we see frequently in the inpatient psych unit and psychiatric ER (crisis unit). Obtaining a thorough history (from the patient and collateral sources) as well as getting a urine drug screen can identify which substances the person ingested. Some aren’t so easy to detect however.

New to the scene are synthetic marijuana (K2) and “spice” or “incense” (with mephedrone as the active ingredient). The psychosis caused by these substances tends to be more…intense. People can become severely psychotic, with paranoia, hallucintations, disorganized and fragmented thoughts, confusion, disorientation, and a tendency toward violence. Their symptoms are also less likely to respond to medications such as anti-psychotics. They end up spending a long time on the unit and don’t necessarily recover completely.

So what’s the best treatment for someone suffering from substance-induced psychosis?

  • Keep them safe (usually in the ER or on the psych unit)
  • Try to reduce stimuli as much as possible (dark, quiet rooms)
  • Provide structure (the same routine every day helps orient them)
  • Give anti-psychotic medication such as Haldol, Risperdal, Zyprexa, etc.
  • Use adjunctive medications to help with anxiety and withdrawal symptoms, if present; Clonidine, Motrin, Immodium, Benadryl, Ativan, etc.

Like Mr. Mackey from South Park says:

Drugs are bad, M’kay?

Just don’t do it! 😉

DO check out Lydia’s Medical Monday post and Sarah’s The Strangest Situation!

Remember these posts are for writing purposes only and are NOT to be construed as medical advice of treatment.

Happy New Year!

So, 2012 is here. If the Mayans are right, we only have a few months left to do whatever we plan to while on this planet.

The natural follow up to this is a discussion on goals. (Never mind that I’m not really buying the whole Doomsday in December thing.)

Last year, I wrote a list of writerly goals. I met about half of them. But I’m not disappointed, considering I had a huge change in my work responsibilities and I had a huge battle with my mojo over the past couple of months.

This year, I’m not going to write down goals. Why?

I don’t wanna.

Some may think that’s lame, but I don’t. I know what my overall goal is:

GET PUBLISHED.

BUT, I can’t put a timeline to that. All I can do is try my best every day. If that means slamming out 5000 words or doing absolutely nothing, that’s gonna have to be good enough.

Tell me folks, what’s your approach to goals?

Be sure to send me a writerly related psychiatric question so I can address it here on Mental Health Mondays. Check out Lydia’s Medical Monday (she’s talking about telekinesis today. Cool!!!) and Sarah Fine’s The Strangest Situation.

Cheers!

Mental Health Monday–Veritaserum Muggle-Style

Author Lynn Rush asks:

Are there any drugs out there that would make someone more susceptible to mind control/brain washing?

The quick answer is no.

HOWEVER, in the 1930’s and 1940’s, the Amytal Interview was used mainly in psychotherapy to draw up information from the unconscious (AKA subconscious) mind. Some thought it helped patients recover “forgotten memories.”

Sodium Amytal (amobarbitol) is a barbituate drug that can induce similar effects to alcohol intoxication (drowsiness, slurred speech, distorted sense of time, a feeling of warmth) and those given the drug can enter what’s called the “twilight” state (which is between sleep and wakefulness).

(Those of you who watched Hannibal Rising remember the scene where Hannibal injects himself with a drug to remember the men who murdered his sister, right? Well, that’s the idea.)

Further research found that people can actually fabricate (lie) information while in this twilight state. Therefore, the idea that truth will be told when in a relaxed, drugged state is NOT accurate.

Bummer, right?

Er, I mean, it would make a nice plot device in any novel, but is not reality. 😉

A “fun” fact: Soldiers were given Sodium Amytal to treat “Shell Shock” (now called Post-Traumatic Stress Disorder) in World War II. It allowed the soldiers to return to the front lines. Yay for them. O_o

Remember, these posts are for writing purposes only and are NOT to be construed as medical treatment or advice.

Check out Lydia Kang’s Medical Monday post and Sarah Fine’s The Strangest Situation.

Mental Health Monday–Pleading Insanity

The Oxygen network plays a Snapped marathon every Sunday. I often find myself watching case after case of women “snapping” and killing their parents, husbands, boyfriends, etc and then trying with all their might to get out of any punishment.

Some defense attorneys go for the Insanity Plea as a way to avoid jail time for their clients.

There are two major criteria that someone must meet in order to use insanity as a defense.

  1. You have to suffer from a major mental illness
  2. You have to lack understanding and consequences of the crime you commit (in other words, you don’t know right from wrong at the time you engage in the crime)

Without these two things in place, you can’t successfully plea insanity.

So, when your character is under fire and might stand trial for murder, consider this if you’re gonna try to get them off with the Insanity Plea.

Remember, these posts are for WRITING PURPOSES ONLY and are NOT intended to treat any illness or to be medical (and in this case legal) advice.

Check out Lydia Kang’s Medical Monday and Sarah Fine’s The Strangest Situation for more fantastic writerly information!

Mental Health Monday–Character Analysis: I Hear Voices…No, Really

Stina Lindenblatt asked me to give a run down of treatment for her character. He hears voices, but they are real (in a paranormal way). They end up driving him to cut his wrists. And Stina wants to know what would happen next.

In the state of New York (where I live), someone can be admitted to a psychiatric facility on an Emergency Admission. Also known as an Involuntary admission, people who are a danger to themselves or others can be admitted for treatment, even if they don’t want to be. (We also admit people voluntarily, of course.) I bring this up because not all states have this law.

So, if Stina’s character showed up in my ER, let’s say, and has cut his wrists and reports hearing voices, I’d recommend inpatient hospitalization for his safety and stabilization. Treatment would include keeping him in a safe environment (in the hospital), offering him medication, individualized therapy, and group programming.

Medication varies by diagnosis and symptoms, but someone experiencing auditory hallucinations (voices) would be given an anti-psychotic. “First-generation anti-psychotics” (so called because they were identified and produced first) include Haldol, Thorazine, and Prolixin. They are fast and effective, and though Stina’s character would likely be sleepy for the first few days he’s on them, he’d also note resolution of symptoms within a few days to a couple of weeks. “Second=generation anti-psychotics” (so called because they were developed after the first generation ones and were touted to have less side effects (despite causing other side effects like metabolic changes)) include Risperdal, Seroquel, Zyprexa, and Abilify. Also quick-acting, these agents would resolve Stina’s character’s symptoms within a few days.

One may assume cutting of wrists indicates a suicide attempt and therefore means the person is depressed. (This isn’t always the case, but let’s go with that assumption here, okay?) So, in addition to the antipsychotic, Stina’s character would be offered an anti-depressant like Zoloft, Prozac, Celexa, Wellbutrin, or Effexor. These medications take several weeks to kick in. A person doesn’t have to stay in the hospital for that length of time, by any means. We just need to see their mood begin to stabilize out.

Before leaving the hospital, it would be important for Stina’s character to have follow up treatment with a psychiatrist and counselor scheduled. This would allow for outpatient monitoring of his medications and symptoms. Antipsychotics (if symptoms are resolved and thought to be part of a depressive episode) can be discontinued within a few weeks or months. Anti-depressants should be taken for at least a year to fully treat the current episode and prevent future ones.

If someone has chronic symptoms and history of depressive episodes, they’d more than likely need to stay on medications long-term. If someone has chronic psychosis, they’d need to stay on the medications long-term as well.

Stina’s character is 17, which may alter his management a bit…however, in this case, he’d likely be given the same medications as an adult.

Based on Stina’s description of her character’s clinical presentation, I’d diagnose him with Psychotic Disorder Not Otherwise Specified (he doesn’t necessarily meet criteria for DSM-IV diagnosis) and perhaps Depressive Disorder Not Otherwise Specified.

Other potential diagnoses include: Brief Psychotic Episode, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, and Major Depressive Disorder with Psychotic Features. Any medical conditions or drug use would have to be considered as well.

I hope this is helpful, Stina!

I’d be happy to answer any follow up questions as well. There’s a lot of information in this post and I could certainly go on, but I won’t cause your eyes will start crossing soon. 😉

Be sure to check out Lydia’s Medical Monday post about what plant in your garden could kill you.

Remember, these posts are for WRITING PURPOSES ONLY and are NOT to be construed as medical treatment or advice. Happy writing!

Mental Health Monday–Loner Style

Amanda (writer and blogger–A Fortnight of Mustard) asks:

My character is a loner. He’s afraid to get close to people. He wasn’t neglected as a kid, but he’s lost most people close to him in [an epic tragedy]. Is this attachment disorder?

GREAT question, Amanda!

Attachment Disorder means there is a failure to form normal attachments to others. It is often associated with early experiences of neglect and abuse by primary care givers (ex. parents), or abrupt separation from caregivers between the ages of 6 months and 3 years, or frequent change in caregivers, or lack of a caregivers response to the child’s efforts to communicate.

An example of an attachment disorder is Reactive Attachment Disorder. This is evidenced by a toddler who fails to stay near familiar adults in a new environment or failure to be comforted by a familiar person OR by a six year old who displays excessive friendliness and inappropriate approaches to strangers.

Attachment theory posits that infants will attach to a caregiver as a means to protect itself from danger or as a means of survival. (This is an evolutionary theory.) This is not the same as love and affection, although those behaviors are needed to create a strong bond. 😉

Each person has his or her own Attachment style (or pattern of relating to others) based on early childhood caregiving experiences. The styles include: secure, anxious-ambivalent, anxious-avoidant, and disorganized. These styles are not in and of themselves disorders, but can lead to problems with relating to others, based on how prevalent the style is and which type.

I’m sure my dear friend Sarah Fine, who is a child psychologist, writer, and blogger (The Strangest Situation), can give a much better explanation of all the jargon I just threw at you.

I included the above discussion to state that it doesn’t appear your character has an Attachment Disorder because he wasn’t abused and he was normal before this traumatic incident.

However, there are several other things that could be going on, which I’ll touch on now.

Someone who goes through a severe trauma is susceptible to developing Post-Traumatic Stress Disorder. To be diagnosed with PTSD, the person has to be exposed to something that is PERCEIVED as life-threatening. They can develop flashbacks, nightmares, hypervigilance (ex. looking for any potential foe wherever they are, sitting in a corner to watch the exits, planning an exit strategy wherever they are, checking over their shoulder every few seconds), hyperarousal (ex. startle response–jumping when the phone rings), numbing of emotions, and avoidance (of talking about the situation, avoidance of others, avoidance of any stimulating situations).

Amanda, your character displays avoidance and perhaps numbing of emotions. He lost several people close to him and so it would seem that he’s at risk of having PTSD. I don’t know if he has intrusive, recurrent memories (flashbacks) or nightmares of the incident or if he has hyperarousal, so it’s difficult to do a formal diagnosis.

Additionally, you mentioned he is (or can be) reckless and go headlong into dangerous situations. So, it could be that though he is traumatized by what happened, he is also desensitized to horrific experiences. Interestingly, soldiers who are exposed to combat become more effective in that environment than in a civilian environment. They have in a way become adapted to staying in the hyperaroused state (for survival) and then can’t handle things when the danger is gone.

Finally, loss is one of the most difficult things a person can experience. I wouldn’t be surprised if your character also experiences significant bereavement, grief, or even depression secondary to loss. This can last years. AND it would be advantageous, in a way, to avoid getting close to others because then he wouldn’t have to face the agony or terror of losing someone else.

I hope this was helpful!

Keep your questions coming, folks! And check out Lydia Kang’s Medical Monday while you’re at it. Remember these posts are for writing purposes ONLY and are NOT intended to be medical diagnosis, treatment, or advice.