Wednesday, January 13, 2010

Placebo


Placebo:
a. A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well.
b. An inactive substance or preparation used as a control in an experiment or test to determine the effectiveness of a medicinal drug.
C. Something of no intrinsic remedial value that is used to appease or reassure another.
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A 27 year old male came in from the psych ER for eval of seizures. He was brought in by police for psychotic behavior. The psych ER called and asked for help b/c he "was in status" and wouldn't stop seizing.

I have seen some really interesting seizures in the past. Some will even fake urinating on themselves. This guy was great. He did make his whole body shake...but the rhythm was sooo organized it was obviously not seizure activity. But the biggest issue was his face. This guy would talk to you and look at you during his "seizures." He would jerk all over, and during the shaking would say "Look...it's happening to me! This is a bad seizure huh?"

After his seizures temporarily stopped...we had a discussion about his seizure meds. He said no meds would work on him. He tried them all. Dilantin didn't work, or Keppra.......nothing in my PDR.

"Sir, what then does help you?" I said.

"There is only 1 drug that helps me. It is secretive. It is an experimental drug in phase 5 research trials" he said.

Even though I knew this guy was FOS....he had my attention. "What is the name of it?"

He said, "The name of it is called... Placebo. Placebo is the only seizure medicine that can help me. I have been off of it b/c they kicked me out of the trial. Now I am in withdrawl."

I promptly got a Tylenol tab, told him it was Placebo, watched his seizures melt away, and sent him back to the psych ER.

CHECK OUT THIS GREAT VIDEO ABOUT PATIENT FAKING A SEIZURE!!! http://www.youtube.com/watch?v=_m64cy1MMPg

-ER Doc

9 comments:

Anonymous said...

How fortunate for him that you were given access to the secret stage 5 research trial drug known as Placebo.

Anonymous said...

I once had a schizophrenic patient who told me his medications, "...and placebo, which is a pill that doesn't do anything, as I understand it from the nurse..."

Smocha said...

That's a good one.

My brother was epileptic and NEVER did he converse during a grandmal seizure.

Josiah O. Morris said...

Wow.

What might it suggest about my character that these kinds of stories actually draw me in closer towards emergency medicine?

Anonymous said...

I have heard that an injection of NorMALsaline can work wonders too. Especially for EMTs who don't happen to have any thing else. Sometimes they even have to hang a whole bag of it and infuse it at a steady rate to give a constant dose.

DreamingTree said...

Yep - NorMALsaline works wonders. I used it once when I had a patient start seizing because he didn't get the dilaudid he asked for. Told him that I had something that would help him feel better. Pushed it real slow...for effect. It's truly a wonder drug.

StorytellERdoc said...

Ouch, good post and touchy subject. I trained where my superiors mostly felt placebos were deceptive. And why does everyone do a google search before coming in except this guy? Get him a dictionary so he can look up placebo..save you all time.

Trust us....we're doctors said...

Nowhere will you see as much fake medical problems as a psychiatric floor.

I have seen the weirdest, funniest "seizures", "priapisms", etc.

But let me remind everyone that psych patients get sick too. I have proved numerous physicians wrong when psych patients have had events that are minimized because the staff say "Oh, it's a psych patient, they are faking it."

Remember that psych patients can get sick as well.

-Psych Doc

Trust us....we're doctors said...

p.s. I treat patients with placebo all the time. It's called psychotherapy, a.k.a. "pretending like I give a sh!t for 45 minutes"

-psych doc