tag:blogger.com,1999:blog-26666124.post5258540776092704741..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: What's A Psychiatric Emergency?Unknownnoreply@blogger.comBlogger70125tag:blogger.com,1999:blog-26666124.post-39974785046109599612014-11-30T17:59:29.101-05:002014-11-30T17:59:29.101-05:00I am interested in this forum although I haven'...I am interested in this forum although I haven't read it all.I was in enormous insomnia hell last night--following a migraine and possibly a bad med interaction. As the hours went by through the long night, I became distraught and agonized. Not E.R. material, but had no one with whom to communicate at 3 AM, "the dark night of the soul." I am a high functioning clinician myself, but that doesn't mean I have a psychiatrist at my beck and call. Wee hours Interventions available ranged from E.R.s to BEST teams, and although I FELT like hell, those are not levels of care I require. <br />As a seasoned therapist myself, I don't take middle of the night calls from my own patients, but wonder how the generic "go to your nearest emergency room" is helpful to those who are not suicidal, homicidal or psychotic. A playwright friend of mine once called a play "Self-torture and strenuous exercise." <br /> Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-43600562057786971192013-04-14T10:17:16.544-04:002013-04-14T10:17:16.544-04:00Thanks for the forum. It seems that, in general, ...Thanks for the forum. It seems that, in general, people know no limitations these days and have no tolerance for discomfort. An example might be a patient who calls an emergent phone line to say she cried at work and couldn't stop. (Actually, I think I've cried at work as well...) Is being unable to self-soothe an emergency?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88380004376273013342012-01-17T06:09:23.357-05:002012-01-17T06:09:23.357-05:00My doctor does a lot of research, so I don't k...My doctor does a lot of research, so I don't know how many patients he sees. I don't remember what his message said when he was a resident, but now his voicemail says. <br /><br />"You've reached X in the department of psychiatry at Y. If you are a private patient and are experiencing a psyhiatric emergency between 8AM and 6PM, please call Tel number and ask for me to be paged. If it is after hours or a weekend, please go to your nearest emergency room. For all other non-urgent matters...."<br /><br />But we've talked quite a bit about what this means in practice and what ER I should go to if I needed to. (The one at the hospital where he trained, still has a part-time appointment and where my PCP is. He's known there and they would probably know how to get in touch with him under certain circumstances.)<br /><br />In 6 years, I think I've paged him twice -- other when the reception people page him to let him know that I'm there or I do it, if I'm 5 minutes away-- (once was when he was really late--30 minutes or something.)<br /><br />I was reading this thread, because I was trying to figure out what I thought was an emergency (which he's decided to leave up to me, for the most part), because my sister seems to be exhibiting some psychotic symptoms, and it's really affecting my own functioning. I'm not quite sure how I'm going to make it through the day.<br /><br />I do already have an appointment scheduled for this evening, so I can wait.Anon in Bean Townnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-72413610866031970322012-01-01T12:48:20.838-05:002012-01-01T12:48:20.838-05:00My sentiments mirror Lockup Doc's. There's...My sentiments mirror Lockup Doc's. There's a beauty in the balance you've created for yourself Dinah - which I'm sure you've refined over the years. <br /><br />When I think about my own shrink - his system could be so refined... but instead he has multiple phone lines and fax machines, and he could be running a dog-race business for all I know!boya badanahttp://www.boyacibadanaustasi.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-45376155162428452372010-09-16T07:21:55.845-04:002010-09-16T07:21:55.845-04:00This article made me realize that psychiatric eme...This article made me realize that psychiatric emergency does exist and a lax schedule of a psychiatrist does help rather than a rigid one. Though a rigid counseling with a psychiatrist provides a constant support to the patient, most of us could not place an hour or two in our schedule. Other psychiatric problems may mimic physical problems such as heart attack, to know whether or not it is one, Read the article <a href="http://overcomingpanicattacks.com/wp-admin/post.php?post=77&action=edit" title="Edit “Anxiety Panic Attacks – Relax! It's Not Schizophrenia Or A Heart Attack”" rel="nofollow">Relax! It's Not Schizophrenia Or A Heart Attack</a>andrewjmarshttps://www.blogger.com/profile/02112279015804741252noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-36340033025269844882010-08-11T00:33:36.495-04:002010-08-11T00:33:36.495-04:00Too many people have access to far too many drugs,...Too many people have access to far too many drugs, especially those of the psychiatric variety including prescription antidepressants, anti-psychotics, seizure medications (for people who don't get seizures), sleeping pills, ADHD drugs and more. This sets the stage for prescription drug abuse, chemically-induced suicide and violence and unintentional overdose. We must put a stop to all this over-advertising and over-prescribing. We seem to be rapidly sending our culture down the tubes.<br /><br />Please fill out my survey for a book I am writing about FDA reported side effects of prescription drugs. It's at http://PrescriptionDrugProblems.comMeridithhttp://PrescriptionDrugProblems.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-48008634946662311722010-03-24T01:22:00.094-04:002010-03-24T01:22:00.094-04:00Enlightening post and comments. As a resident in a...Enlightening post and comments. As a resident in a University psych program, I imagine your accessibility and definition of emergency varies a lot depending on where you work. <br /><br />I have some patients who think that getting C instead of A on a test is an emergency, and then there are those who don't call when they have serious side effects/are suicidal even though I've asked them to.<br /><br />My voice mail clearly states that I check it twice a day and will return calls the same day or the next. I advise them to call 911 if they need help, or to call the central helpline, where a doctor is available every 24 hours. I added the 911 message after hearing from colleagues that a patient called 911 after hearing the message, and that it saved their lives. We are told in our program never to give out cellphone/home numbers.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-21752101659050420262010-02-17T16:02:40.447-05:002010-02-17T16:02:40.447-05:00I've been hesitant to report a potentially dan...I've been hesitant to report a potentially dangerous one, as I'm not entirely sure it's related to my psych med - I've been on topirimate for some time, Topamax before it was available in generic form as of April '09. Used as my mood stabilizer. Prescribed dosage is 200mg a day, but for along time I'd been lazy and only taking one, sometimes 1 & a half but it had effectively gone down to 1, & I'd never really ramped it up to the full 2 a day for long periods of time.<br /><br />Anyway, I recognized that hey, I'd better get back to my "usual" dose of 150, because I'm gonna be under a lot of stress. So, up to 150.<br /><br />Then, about halfway or maybe I think perhaps 3 weeks into January at least, I'm pretty sure, I decided to go up to the full dose. So, 200mg/day, there we go.<br /><br />Well, as of about two weeks ago I noticed a dry area, that was maybe a rash pretty quickly a day or two later, on my left wrist/forearm, above where a general hand-washing roughly ends . . this being the winter, I thought, well, that's probably why that's there, then, because maybe some soap is left there and not rinsed off, or whatever, maybe you need to wash farther up . . or dry winter months, which sometimes DO make my hands get dry and red. Occasionally hand soaps do that too, but only when it's a different formula than usual, & this isn't.<br /><br />Still, it wasn't an IMMEDIATE response to upping the topirimate dose, and I can't remember if I went up to 200mg 2 weeks into Jan. or 3 to 3.5 weeks in - I'm fairly certain it was a later Jan. decision, though.<br /><br />Anyway, so the last time I had a rash reaction to any med, let alone a psych med, was WAY back when I was first seeing a psychiatrist, & he tried me on Lamictal. They pulled me off of it fast.<br /><br />But see, this time, I'm currently NOT under a psychiatrist's supervision, the dry/red skin COULD be just because of winter & the location is different than last time, although it has started to appear on the other wrist/forearm in the same location, about 5 days ago, & so I decided to down dose to 150mg. As of this morning, it's starting to look light brown, so I think it is going away.<br /><br />Which means that it may very well be because of the med. As well, I wonder if it's because it's the generic form, since I'd never been on 200mg of the generic, & I'd been on 200mg of the brand name - OR it could just be that the dry skin is responding to my attempts to wet & wash the area better too, but . . my gut is saying, it's quite possibly the med. After 3 days of a lower dose (I'd have to check my records, because of all the pain pills I'm taking, I write down ALL the meds I take, or try to, and what time I take them. See upcoming blog post - what I started to type here became too long, so since I just posted a post on another subject, my next post on Pain Management, will come within a day or so.)<br /><br />I've still been trying to wash farther up the arm, though.<br /><br />I DO NOT RECOMMEND NOT CALLING YOUR DOCTOR WHEN YOU HAVE A RASH AND ARE ON any MED - IT'S A POTENTIALLY LIFE-THREATENING REACTION - I AM ALSO NOT A MEDICAL PROFESSIONAL OF ANY KIND AND WILL NOT BE HELD LIABLE IF POSSIBLE FOR ANYTHING IN MY COMMENT, I AM JUST SAYING off the cuff WHAT I HAVE BEEN DOING to check out if said dry red skin would go away in my personal situation.<br /><br />I have been afraid that my doc woulda just yanked my mood stabilizer, when I've been doing fine on it forever. At 150 and 100. I told myself, that if I sense ANY change in my breathing, I am calling 911 right away (ie, potential furthering of allergic or life-threatening syndrome reaction to med), if this rash does not start to get better within a few days, I'm calling the doc, etc.<br /><br />HUGE irony - original word verify is itchout, not that it's been itchy.Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-35394948403473746542010-02-17T15:33:44.404-05:002010-02-17T15:33:44.404-05:00Thank you, Nicole, and again, my heart goes out to...Thank you, Nicole, and again, my heart goes out to you.<br /><br />It also helps me to know what it is that you need from the government, because even if we aren't in the same country (BAD me if I can't remember that we're in the same one, lol! altho if you see me blog you'll see I'm a bit stressed myself right now) when I DO feel strong enough to advocate a little, those are things that are going on the list. It is my eventual goal to be able to talk to government people about stuff like this.<br /><br />I actually did, once, on a radio call-in, to the Governor of my state - Governor Jon Huntsman, who is now of course the Unite States Ambassador to China. Quite a thing for a former Governor of Utah, and one so young, but he speaks the language and even has children adopted from that land.<br /><br />His father had strong ties to the country too, I think he had performed some official capacity a long time ago to there as well but I digress . . . . and I even took my ADD meds, ugh!Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-10013362634510415052010-02-16T21:55:26.159-05:002010-02-16T21:55:26.159-05:00Wow you doctors seem awesome! i would love to have...Wow you doctors seem awesome! i would love to have similar doctors like you!! My shrink never answers a phone call.. And never call back if you leave her massege,, and You can't have her direct phone number.. And is just so hard to deal with her.. I thought all doctors are the same.. but reading what you are writing makes me feel that my doctor is not good in communication with her patients at all..Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-62185545619291738882010-02-16T07:54:53.215-05:002010-02-16T07:54:53.215-05:00Re when to call (not for an "emergency" ...Re when to call (not for an "emergency" but just between sessions), I agree that calling for bothersome side effects is wise, to nip them in the bud and prevent an ED visit. Can't tell you how many consults I've done on people admitted to the hospital, there for 3-4 days, big work-up, and then they call me in and I find that it is all from <a href="http://en.wikipedia.org/wiki/Serotonin_syndrome" rel="nofollow">serotonin syndrome</a>, or the <a href="http://en.wikipedia.org/wiki/Hyponatremia#Symptoms" rel="nofollow">hyponatremia</a> is from Celexa, or the severe headaches and jitters is from Lexapro <a href="http://en.wikipedia.org/wiki/SSRI_discontinuation_syndrome" rel="nofollow">withdrawal</a> after running out of it 3 days before admission.<br /><br />If one is having active depression symptoms, <i>in general and ideally</i>, these folks should be seen every week or every other week.Royhttps://www.blogger.com/profile/08735111026336537653noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-82385528430777192662010-02-16T02:01:12.732-05:002010-02-16T02:01:12.732-05:00If I call my doc I get a phone machine message tha...If I call my doc I get a phone machine message that says she will call me back in 2-3 day. So calling her is pointless.<br /><br />The best way to get a docs attention is to show up in their drive way at home and honk you horn. At least that is what I have been taught by my experiences with HMO and medicare docs.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-28157151954210609052010-02-15T23:57:43.669-05:002010-02-15T23:57:43.669-05:00I have to comment on Dinah's brain surgeon wit...I have to comment on Dinah's brain surgeon with side effects. Side effects are rarely emergencies, but I like patients to call me about them even after hours because they are so much easier for me and the patient to handle with a quick phone call and rarely justify an ambulance or ER visit. Many can wait until the next business day, but even if you're not a brain surgeon, I don't want you to suffer.moviedochttps://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-16198930953548025722010-02-15T23:31:49.472-05:002010-02-15T23:31:49.472-05:00Last anon: One doesn't need an "emergency...Last anon: One doesn't need an "emergency" per se to phone-a-shrink. It seems to me that "I'm not doing well" is a fine reason to call. I think the thing that differentiates an "emergency" is the request for an immediate call back, a same day appointment even if the doc's schedule is already full, or the request for a phone intervention at night or on the weekend. Having trouble at work might be a business hours hours problem and warrent a between-appointments call. I say 'might' because a brain surgeon who is having a bad reaction to his meds and has to perform emergency surgery on Sunday might be justified in calling his shrink with an "emergency" on the weekend. It's really hard to generalize this stuff. <br />But it seems to me that people do call with non-emergencies and this is fine.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-6296330358775192512010-02-15T23:14:58.002-05:002010-02-15T23:14:58.002-05:00Seemed to have joined the party a little late... ...Seemed to have joined the party a little late... To me it is clear that certain things constitute an emergency, but when it comes to those of us who suffer from just plain old run of the mill debilitating depression, when is that? I have often wondered at what point I should call my shrink -- when is it enough of an emergency to justify bothering him? Is it justifiable to call when I can no longer function at work? When I can no longer function at work and people are starting to notice? When I can't get out of bed? Does the level of emergency depend on the time of day (early vs late) or the day of the week (work day vs weekend)? Ultimately, I always err on the side of not calling - and I am sure I am not the only one who does so.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-71273184244576463332010-02-15T22:20:19.455-05:002010-02-15T22:20:19.455-05:00Sara, please don't feel down by my post. I'...Sara, please don't feel down by my post. I've met a lot of bipolar people during my travels and most of them are not like my mother. Her delusions last a long time (months) but then disappear and she is "sane" or whatever the technical term is. The problem with our relationship lies in the history of our struggle and my mother's own personality. It's not only the illness that causes us to struggle. She has some definite personality quirks that I don't think are related to her illness because they're always manifested no matter what state of mind she is in. These quirks do more damage than the periods of illness which are easily forgiven. Mostly, my mother wants more than I can possibly give. She asked to move in with me when I was engaged and only 24 years old. It's one thing to take care of an elderly parent during their last few years and it's another to do it for 30-40 years. My marriage would not survive that stress. I need my mother to maintain her independence during her long periods of sanity, and I need a strong support system (family and governmental power)to help her during the few months every 2-3 years when she is not. Not having either of these things is what makes me feel so alone and bitter. <br /><br />Ugh, again rambling...My point is this: Our situation is unique to us and is complicated. Your experience may be different. Despite all that has happened, I am in school for my Master's, own my own home and am happily married with a wonderful son. I was raised by a very flawed individual (not a reference to her illness) but was well loved, and I turned out well (IMO). Don't look at my periods of frustration and generalize it to be the big picture because it's not.Unknownhttps://www.blogger.com/profile/09699218859340555097noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-11142105743419096412010-02-15T21:10:19.215-05:002010-02-15T21:10:19.215-05:00Part of me wonders, if I survive another 23 years,...Part of me wonders, if I survive another 23 years, if Nicole is gonna be my daughter, 23 years down the line . . . . and if my siblings will be how her Aunts and Uncles are. They already aren't a support system anyway, so . . .<br /><br />Not that I run around naked, and I'm not judging anyone for doing so.<br /><br />I just . . . well, I just doing see me being around, 23 years from now; it's hard, with my physical medical prognoses, let alone with the mental medical health stuff.<br /><br />I would quite possibly be too crippled from arthritis pain, to do much of anything. Increasing pain and decreasing function, and MORE PARTS WILL GO. And that's just over the next 10-15 years, although that time period was a guess, two years ago, it has turned out to be a sorry damn accurate one, as the other knee has gone too . . . . and an ankle is feeling about oh I'd say, if it's anything like the knees were, about roughly 4 years out from going, if I'm lucky . . . I don't know what they can replace in an ankle?<br /><br />Anyway. ALL respect to you Nicole. From my point of view, as much as I can sympathize, I do. And I am horrified, to feel that I might become that kind of burden, in addition to the other kinds of burdens that I am. But I already suspected this kind of thing, for awhile now. It's just a little bit harsh, to get a peek at what my future might be like.<br /><br />Then again, maybe therapy and medication will help me more, I don't know. <br /><br />I sure hope some laws will get changed to help YOU and your mother, Nicole, I do.<br /><br />Sara (hoping I haven't been insensitive)Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-86262508761135658692010-02-14T13:10:08.976-05:002010-02-14T13:10:08.976-05:00Thanks, Roy, for responding so quickly. I apprecia...Thanks, Roy, for responding so quickly. I appreciate your advice and understanding. I would love to lobby my government for this type of change but I'm not much of a mover or a shaker and I'm quite busy getting my master's, working part-time, and raising my 2 year old and 60 year old mother. lol I realize the doctors' hands are tied, but it's just so frustrating for me. I want to help, but I can't really do anything. So I find that I tend to just withdraw from her until that day comes when I get the ER call. It's just too emotionally draining to watch and deal with so then she gets all angry and bitter because I'm not paying attention to her. Sorry for rambling. No one around me understands and all my aunts and uncles can't be bothered to deal with her anymore so it's just me and my husband.Unknownhttps://www.blogger.com/profile/09699218859340555097noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88490169731772387962010-02-14T12:02:47.313-05:002010-02-14T12:02:47.313-05:00Nicole, I'm sorry to hear about your mom's...Nicole, I'm sorry to hear about your mom's (and, thus, your) situation. Unfortunately, I see this frequently. It's not the doctors who can help (bound by legal limitations of your state or province), it's the law-makers. Go to them to explain how the current laws don't protect your mom, ask them to make changes. These changes would include outpatient commitment laws and advance directives with actual teeth (most current Advance Directive laws permit a patient who is actively psychotic or manic to cancel what they previously wrote in their AD when they were thinking normally).<br /><br />The trouble with these is balancing freedom and autonomy with safety and self-direction.Royhttps://www.blogger.com/profile/08735111026336537653noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-14851991760171747512010-02-14T11:20:56.270-05:002010-02-14T11:20:56.270-05:00Thank you for being the caring doc that understand...Thank you for being the caring doc that understands that psychotic episodes are dangerous just for the fact that they are unpredictable. My mother is bipolar with persistent delusions. She is currently lapsing into a manic, delusional episode (her last one was 2 years and 3 months ago-coincided with my son's impending birth). Unfortunately, despite the fact that I know my mother better than anyone on this planet, her doctors still ignore my recommendations and repeat the same non-answer, "Well, unless she's an imminent danger to herself or others then we can't do anything. Call us when she's worse." By that time she's pissed through her savings, left her rent unpaid (thus depleting my son's college fund) and is running around the town naked. THEN she gets hospitalized but the damage is already done. I have power of attorney and heath proxy but still got nothing. ARGHUnknownhttps://www.blogger.com/profile/09699218859340555097noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-49222776794267242362010-02-13T21:04:41.587-05:002010-02-13T21:04:41.587-05:00i meant "doctors work as doctor because they ...i meant "doctors work as doctor because they "WANT" to help patients..Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1946910545331710182010-02-13T21:02:39.529-05:002010-02-13T21:02:39.529-05:00I agree with Dinah, i think that saying "if t...I agree with Dinah, i think that saying "if this is an emergency call 911" is not a good idea,, it is like insulting the intelligence of the patient.. if the patient has an emergency, they would know that they need to call 911 b/c 911 would respond faster!! <br />And i don't think that there is anything wrong with giving the patient home phone number or cellphone.. patient-doctor relationship is not buisness relation,, there is health and trust involved, The doctor works as a doctor b/c they won't to help patients.. And patients even if they have the phone number of the home of the doctor, they are not stupid,, they won't call for no urgent need.. And i also feel that when a doctor calls the patient from a unknown or blocked number, i really feel that this is not respctful to the patient.. I know a doctors who they would not answer a phone call at all or return it and who they would not like and complain if the patient called them for an urgent matter one minute before 5:00 pm.. because they finish their responsibility at 5:00 pm!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-29269132348038323412010-02-13T13:13:17.877-05:002010-02-13T13:13:17.877-05:00When it comes to psychiatrists and cell phones, I&...When it comes to psychiatrists and cell phones, I'm with itsjustme. My psychiatrist gives his cell phone number to patients, but I only call it if he specifically tells me to (for example, one of us is away and he wants an update on how a particular medicine is working) or if something goes wrong with the medicine (bad side effects like mania or anxiety, for example). Otherwise, no way am I calling him, no matter how awful things get.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-85769479090074145162010-02-12T08:09:11.331-05:002010-02-12T08:09:11.331-05:00Regarding interruptions during a session, my shrin...Regarding interruptions during a session, my shrink once ripped the cord out of the wall to stifle what I think was his landline. It was weird. I was speaking and the phone would ring, and I would pause because it was distracting and I didn't want to be drowned out, and then I'd continue with the rest of my sentence, and another ring, and another ring, and then the doc calmly walked over to the phone jack and gave the connection a good yank. That made me feel special, I guess. I don't know what happened to the caller. I wonder if s/he got voicemail or a busy signal.<br /><br />Surely, he's perfected his phone system by now.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-25779241954320979422010-02-12T01:21:20.559-05:002010-02-12T01:21:20.559-05:00Dinah...yes, the coffee spilling victim sued for m...Dinah...yes, the coffee spilling victim sued for medical expenses, and was awarded $200,000 plus punitive damages equal to 2 days of coffee sales at McDonalds. The 700 complaints was actually 700 claims of burns in the 10 years preceding this incident. At the time this occurred, McDonalds had a written policy of keeping the coffee at 180-190 degrees Fahrenheit! The victim in this case was 79 years old, and suffered full thickness burns over 6% of her body. She was hospitalized for 8 days and had to undergo skin grafting. McDonalds coffee temperature is substantially lower now!Battle Wearyhttps://www.blogger.com/profile/01503957693970441332noreply@blogger.com