I don't feel like a 'doctor' :(

[digitlnoize]

I assure you all I'm not a troll. I am genuinely concerned about the use of force in psychiatry and the lack of any scientific justification to do so.

I agree with the general consensus here that you have no idea what you're talking about.

What force are you speaking of? Interestingly, I've seen FAR more force and restraints used on Medical Wards and in the ICU than in any of the Psychiatry Wards I've worked in (this includes a state adult hospital, a state children's hospital, 3 large University psych wards, and 1 community psych ward...in other words, a wide variety of places, both in location and environment.)

In fact, just this week I have, as part of the psychiatry consult service, been educating the medical team about the proper use of restraints in a patient with dementia. They want to (and have) tied her down because she's being combative when they try to give her enemas or stick her for blood. I'd probably be combative too.

The proper techniques are orientation, redirection, avoidance (for example, just don't give her enemas), etc. Any psychiatrist worth their salt can engage in these techniques and de-escalate most tense or near-violent situations.

In the Children's Hospital I worked in, it was very common for the teenagers to get agitated and aggressive. I never once saw violence or restraint used by the medical team. Instead, redirection, procedures, and avoidance were used with great results.

Please support your accusations with examples. Terminator 2 does not count.

Try explaining your research to a person handicapped in a wheelchair because they were given drugs against their will just because they said a metaphor or recited the lyrics of a song.

This doesn't make sense to me. How does one become paraplegic from improper administration of what I assume would've been an antipsychotic?

I do take your point about improper diagnosis. Fortunately, this is something I've rarely seen. Criteria to be diagnosed with a psychotic disorder (say, schizophrenia) requires FAR more than simply reciting lyrics to a song, even if this was misinterpreted as psychotic-type rambling.

For example, I once had a kid who kept saying "My head is a lunchbox." We thought that was an interesting saying, and were intrigued by it, but it did not have any bearing on his diagnosis of schizoaffective disorder, which was more based on his negative symptoms (look it up), responding to internal stimuli and history of suicide attempts. Turns out, that in inner-city DC, where he was from, "lunchbox" is urban slang for having a clouded sensorium (feeling "high" or lightheaded). He was trying to describe that he was feeling over-medicated. We reduced his doses a bit and he felt much better. +1 for Urban Dictionary!

Does misdiagnosis happen? Of course it does! We're human. We are not perfect. We get things wrong too, especially when dealing with the most complex organ, the brain. Other doctors screw up all the time too. How many times does "Hypetension" actually turn out to be something else, say...renal artery stenosis. More often than you'd think. Just head of a guy who had been diagnosed with schizophrenia for years because he described hearing voices. Turns out he actually had PTSD and the "voice" he was hearing was related to his trauma. Received PTSD treatment and got better. His obesity and diabetes were also relieved with cessation of the primary care prescribed antipsychotic. Fixed by a psychiatrist using correct diagnosis.

The point is that we all agree with you that no one should be treated with a medication they don't actually need. That being said, a grandma who is hearing voices telling her to kill her grandchildren probably needs that Seroquel.

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[shan564]

I assure you all I'm not a troll. I am genuinely concerned about the use of force in psychiatry and the lack of any scientific justification to do so.

The reason people are labelling that as "trolling" is because it's based on such little experience. If you're making a point like that, it's clear that you've never had to manage a person with schizophrenia or a manic phase or one of many other illnesses.

I can understand your concern, but I can say with 99% certainty that your concern will be resolved if you do a med school rotaiton in psychiatry.

 

[Leo Aquarius]

I assure you all I'm not a troll. I am genuinely concerned about the use of force in psychiatry and the lack of any scientific justification to do so.

What you are doing is called trolling. You are a case-book example. An unknown party entering a board in the middle of the dialogue, attempting to make inflammatory comments with no justification, hijacking the conversation. This thread is about resident psychiatrists discussing how much or how little of medicine they are encountering, not some random person entering and flaming why they hate psychiatrists. You are hijacking the thread.

Don't feed the troll. Pre med 2014 is a disgruntled former psych patient, or one that needs a psychiatrist. Don't feed the troll, especially when the troll makes sweeping generalizations that are untrue and attempting to be insulting to a medical profession. Don't feed the troll.

 

[Leo Aquarius]

Trolling is a violation of the Term of Service of SDN and should be reported by clicking on the exclamation sign of the troll.

 

[GOINGDUMB]

Naw let him speak. This trololololol is packing lols.

Pre med ProTip: Go volunteer or tech at a regular ER it will look good on your resume and you can share your scientific experiences. bahahahahahahahahahahahahahaha

 

[hamstergang]

I assure you all I'm not a troll. I am genuinely concerned about the use of force in psychiatry and the lack of any scientific justification to do so.

If you mean "involuntary commitment" when you say "the use of force in psychiatry," it is very much justifiable, and I would argue it's even unethical NOT to do so. If someone poses a threat to their own safety or to the safety of others as a result of their mental illness, then it would be unfair to them to allow the mental illness to make them get hurt/hurt others. The idea is that we can treat the mental illness to give the person control of their life back so they can make the decisions, instead of the disease making the decisions that would end up getting someone hurt.

I don't know what scientific justification is missing. We can show that some people pose a risk secondary to a mental illness, we can show that the illness can be treated in a hospital, and we can show that the person then poses less of a risk. Without the hospitalization phase, the patients in question wouldn't take the meds and wouldn't be taken to a safe environment where they pose less of a threat while we wait for the treatments to take effect or the dangerous thoughts to pass.