Doctors Lounge - Psychiatry Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Psychiatric Topics
|chelseabearcouture - Sun Jan 11, 2009 4:48 pm||
This is about an 18 year old male, who in good health is 100 lbs.
-gets B12 shots every month, because of necrotizing entercolitis
-oral surgery to remove wisdom teeth and a growth on his tongue; used a general anesthesia and was given follow up meds(Ibuprofen, amoxicillin, and methylprednisolone)
Day after surgery:
-insomnia (he didn’t sleep at all)
-had to settle for a liquid for his mouth to heal, but then began to lose his appetite completely… when he did try to eat, he made facial expressions that made it seem as though its flavor was unpleasant, but this could be due to the sores
-grew paranoid over his health and insisted on getting multiple tests done, but tests showed no unusual results
-he had lost 9 lbs since surgery. It was to the point where sit was uncomfortable on his tailbone… and this worried him.
-continuation of symptoms above
-discontinued surgery meds, because we felt that he might’ve been having a bad reaction to it
- same as above
-began going around to his friends and family, saying “I love you” in a sad/fearful manner
-pacing around and showing signs of much anxiety
Later that night:
-went up to his brother and said “this is the night, I’m going to die”
-began to have a psychotic episode:
~began to cry
~told us to stay away from him, get out of the house, “get away from me, I might hurt you”, “im going to die”… later…”are the cops coming?”, “don’t do it”, “don’t kill me”… etc…. he was trying to make himself vomit… was making a “dry heave” noise??... like metal music… etc black metal growl noise… ???
~was dragging himself around the room… and at a certain time, was trying to bang his head against the wall
~still no sleep that night
-seemed to have calmed down
-took him to a psychiatrist, and he got nervous…
-blank stare, but responded to his name…
-said he wasn’t hearing voices when we asked
-stiffened up when nervous
-wanted to go home, repeated it, continuously asked “where am i?”..
-responded only to the family and closer friends
-psychiatrist suggested to take him to a college psych hospital
Car ride to ER:
-one of his favorite songs came on the radio, and he started to dance… and began to act like he was at a party and started to get excited and told us to dance with him… we got excited and started to play along… this lasted until the music was turned off… immediately after the music was shut off, he calmed down and was quiet again.
-nervous… stiff… but able to play tetris on gameboy…
-was given benadryl and atavan(sp?) and calmed down to the point where he could explain to us that he remembers everything. Described the past few days as a dream, explaining that the dream was vivid and at times he even thought of himself as an alien…
-while talking, he seemed to be normal, but a little nervous about being in the ER and was acting a little loopy… possibly due to the meds or the fact that he still hasn’t slept at all…
-psych evaluation member came to evaluate his mental state… wrote down that he was hearing voices even though when asked he said “no”
Taken to the psych hospital:
-anxiety and nervousness stiffened him up a bit, but with comfort from his brother, he calmed down a bit…
-when the family left the psych hospital, he seemed even more normal than how he acted at the ER, except he mentioned that he dreamt of dying in that very place
Day 2 of psych hospital:
-stiffened up, still no sleep.
-we were told that he was pacing around the hospital… probably at an extremely slow pace
-seemed to have reverted back to an out of reality experience, but did respond to family… however his responses had slight delays…
-we arrived to find that he was taken to the ER because his pulse shot up to 200+
-family to ER, doctors tried to give him meds to calm down, restrained him to bed because he was stiffening up and freaking out and the doctors thought that he was going to hurt them… but he began to calm down when he saw his family..
-they later gave him benadryl and atavan and a tranquilizer in an attempt to make him sleep… at first, he was fighting sleep. While he was still awake, they got a urine sample. A staff member from the psych hospital who was there to monitor threw away the sample “thinking that it was already tested”. He later slept for about 4 hrs… I believe he was also hooked up to an IV, but not positive…
-woke him up for ANOTHER urine sample and CAT scan
-while awake, he was anxious and delusional… most likely hallucinating because he was saying that he was doing things that he really wasn’t…
-once again calmed down once his family talked to him then he was given the same meds to calm him down from before
-he attempted to sleep but he would often wake up every few minutes while they were waiting for the test results from the urine sample
-when the test was finished he got the clear to return to the psych hospital
-he was returned to the psych hospital
-When I visited him he was unable to walk w/o help, he trouble
eating, he was back was arched back, very tense, he kept his arms up (in a similar manner to a t rex), he was rigidly bobbing his head, when he tipped over his chair he was unable to help him self back up, he was mumbling to himself the same phrase over and over
-That night he stayed in the psych hospital
-He was sent to the ER once again for another CAT scan
-he is going to get a spinal tap to check for brain infection
-afterwards, he was given something to calm him down… I’m not exactly sure what it was, but he got some sleep
-spinal tap results came in negative… it did show that he had one extra pus cell
Due to the fact that we aren’t allowed inside until visiting hours, we do not know at this point what his current state is…
|Marceline F, RN - Mon Jan 19, 2009 8:55 am||
I do not know what relationship this unfortunate young man is to you, but an educated guess is that you are his mother.
With the facts that you present, and the fact that apparently an infectious brain process has been ruled out, it may very well be that this young man has just had his first "psychotic break" as a schizophrenic. 16 - 19 years old is a time that we frequently see this first emanation occur. Why that is I do not know. There are various suppositions, but the reason is not clearly known. It also appears that he may be suffering from a type of psychosis called paranoid schizophrenia. I would need more details to decide if everything you witnessed was related to this, or may also or instead be unwanted side effects to certain medications that are used to treat schizophrenia (such as the rigidity.)
The good news is that it is usually quite treatable. And the sufferers can go on to lead productive and normal lives. A simple web search can link you with much information that may relieve your fears and give you hope. Please keep asking questions of his doctors and learn as much as you can about the treatments they are recommending.
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.