I had a 23 year old truly manic female come in by EMS. She had been manic for days. Off her lithium and talking a mile a minute. EMS was called by a neighbor when she stormed into his apartment and started throwing his stuff off his balcony because she felt it was all evil.
Me: "Hello ma'am, my name is ER Doc."
Patient: "I know who you are. You were in my dream."
Me: "Oh really?" (expecting a compliment)
Patient: "Yes, you were satan burning on the cross!"
Me: "Who me!? Are you sure you don't have me confused with someone else?"
Patient: "No, you were definitely satan burning on the cross. You are evil."
Me: "But I am nice. And it is the day before Easter. I was even going to go to church tomorrow. Maybe I was an angel going to save the person burning"
Patient: "No you are satan and you were burning on the cross.
Me: "OK, well I will have to call Psych Doc then."
-ER Doc
9 comments:
Hmm... need to find out why she keeps thinking everyone and everything is evil.
She had been manic for days.
Days? One should be so lucky in some necks of the woods.
Just a curious question - How do you tell the difference between someone in a manic state or someone who has been taking drugs (I am thinking speed, about your talking a mile a muinute)? No tests just are their any characteristics (besides pupils). I have a family member that is a drug addict but we also believe she has some serious mental health issues as well. It would be nice if we could figure out differentiating them so if she says she is clean (I know, I know, addicts always lie) and might be manic we don't put forth accusations.
There's manic state and there's maniac state. Wow!
That sucks. I always think of manic depression as the "asshole disease" because everyone thinks you're an asshole. You make friends easily, but then you lose them when you start acting like a huge bitch/fuckup to them. Most of the time meds work for such unlucky people. Sometimes they don't.
Sounds like you've got everything down but the "make friends easily" part, Anon.
And, really, allow me to clarify. Hypomania can be very charismatic, especially if it's coming from someone more intelligent than you are. If one takes the attention to be a sign of personal validation and, you know, feeds on it for a while, yes, it's entirely likely to backfire into something inconvenient. Manic episodes! They're so fun until the "asshole disease" phase!
Go fuck yourself in the eye with a stick, Anon, or at least stay the hell away from people with the temporarily charming trait of seeming to be able to see right through you. You might find out that they can.
How do you tell the difference between someone in a manic state or someone who has been taking drugs?
Do a drug screen. Take a history. Must have mood symptoms in the absence of drugs. This is the tricky part of most major psych diagnoses and why so many have a "NOS" option (not otherwise specified).
Anon,
People with bipolar disorder usually aren't assholes. They may do wild stuff while manic, or be terribly inert when depressed.
The general public thinks that a bipolar diagnosis can be used as an excuse for being borderline, antisocial, or just a jerk. Multiple times per day, patients come into the office/psych ER wanting to be diagnosed bipolar.
"My wife says I'm bipolar."
"I have mood swings, I must be bipolar."
"I ran up a $2000 credit card bill, now I can't feed my kids, I must be bipolar."
If someone needs medicated for being an asshole, the diagnosis is: Asshole.
If someone meets DSM criteria for bipolar disorder, that is a different story.
-Psych Doc
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