Manic Often?

I got a chance to deal with my first "real" psych inmate today. Sure, lots (maybe most) of the folks in jail have psych issues - diagnosed or not - but this was my first opportunity to do intake on a person who was completely in the grip of an unmedicated manic episode.

**I have to thank Crazy Tracy for writing such moving stories of her life and often manic times. Her thoughts and feelings led me to a deeper understanding of mania than any textbook ever could, and added texture to my own experience and attitude when I interacted with this inmate. I admire Tracy and thank her for her ability to share such a personal part of her with the rest of us.**

It really isn't much of a story. I took him back to the exam space and asked him about some of the things he had mentioned to the officers. You have to understand this is the EXTREMELY ABBREVIATED version. I just don't have enough time in the day to type as fast as he was talking. BTW, we chart in SOAP (different than hospital charting!) and this was the S part.

He said he never did drugs - his booking sheet said he told them he did "ALL" drugs.

He told me he had no history of SI/SA - he told them he had.

He told me he didn't have ADHD - he told them he did.

"Alright! So tell me is there anything I need to know about while you're here? Anything medical?"
"I got shot in the leg while these gangsters were invading my house and looking..."
"Do you have a scar you can show me?"
"Oh, yeah!" (rolling up pants leg)"The gangsters broke in and stole all of my stuff..."
[Hx GSW to RLL...]
"Yes, I see the scars. So how does this affect you?"
"It doesn't - I'm fine"
"No problems moving or anything?"
"Nope. It's perfect"
[Hx GSW to RLL "but fine now"] (sigh)

He told me he DID have a closed head injury (noted + on the booking questions)- flying 36 feet through the air during an MVA and hitting his head on a rock. I'm scribbling furiously: [Hx closed head injury r/t MVA ejection...]
"But that's all better now"
"What did the doctors at the hospital tell you about the injury?"
"No, I never went to the hospital. Just a concussion, but I'm fine"
[I/M Hx closed head injury r/t MVA ejection "but fine now"]
(ok, good save)

"I'm really looking for anything medical that's affecting you right now. I need to know so we can help you. So basically, you sound like besides the psych issues we've discussed you're medically ok?"

"I have a weak heart"
"A heart problem - that's important. What sort of weak heart do you have?"
"I don't know. I just have a weak heart."
"Are you taking any medication for it?
"My mother did."
"Your mother had a weak heart also?"
"My mother has the weak heart."
"Do you have a weak heart also, or is it just your mother?"
"It's just my mother."
"So you think you might have a weak heart because your mother had one - but has anyone ever told you that you have a weak heart also?
"No."

I sort of decided shortly after that that any further questioning would be useless unless we could get him back on his meds. Some of what he said was delusional and other parts were what I think is referred to as "flight of ideas", although I could follow and re-direct if need be. His vital signs were stable and he was in no apparent distress, so he had to go to psych eval. Luckily, I verified the meds easily and he's going to get his first dose tonight.

Like I said, that really is a lot less than what actually went on, but I had to stop and interrupt him so many times. The stories he was telling just went on and on. It was scary and fascinating at the same time, because I kept thinking about Tracy. I thought "So this is what it really looks like".

I have to thank God I don't know what it feels like.


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