The Impulsive/Compulsive talk proposes a new grouping of these disorders that recognizes the commonalities. The new DSM 5 diagnosis of Binge Eating Disorder (BED) fits in with this group, and he actually (yes, it was Stahl himself giving it, the rock star) spent half the talk on new obesity drugs that could be used off-label for BED. Of course, sitting in this talk, I'm seeing that the other primary eating disorders (anorexia and bulimia) really fit into this new paradigm too. It's an area receiving a lot of research and attention, which could help my patients.
A psychiatrist from the California Prison system talked about Inpatient Aggression. They had a staff member murdered by a patient last year, so they really overhauled their whole assessment system and it seems to have improved things. Two big points she made were that they found about 25% of their patients were antisocial, which is often termed "psychopath". These people had no other true mental illness (except maybe SUD - substance use disorder, yep, lots of alcohol and drugs) and they were incredibly predatory -- carefully planning and executing acts of aggression on the units. This percentage was higher than they expected, although honestly it didn't surprise me. It was consistent with what I saw working on a Psych ICU that had 1/3 indigent patients. Anyway, the other thing she said is that you never, never mix predator and prey. That is, you do not take those antisocial patients on a unit with the seriously mental ill - those hallucinating and delusional. And gee, that's exactly the scenario of the PICU I worked on. I mean, no wonder it was so dangerous.
The third fun seminar was all about these new synthetic drugs - you know, Spice and Bath Salts. I used to get those mixed up, now I know that Spice is synthetic marijuana and Bath Salts is synthetic stimulant (speed or meth). These are drugs made in labs with ever-changing formulas to stay one step ahead of the laws that restrict them. And OMFG they are bad news. I already knew that, having seen it in my patients. In fact, it's rare to have a death on the PICU but we had one with a very young man who had wrecked his brain by smoking lots of Wet (marijuana dipped in formaldehyde) and Spice. He couldn't speak, in fact he drooled and wet his pants. He went into respiratory arrest on the unit - just went to bed and stopped breathing. So what are the long-term consequences of using these gee-whiz newfangled drugs? Hey, well, some great stuff there - for Spice, it's cognitive impairment (hence the drooling). For Bath Salts, it's depression/suicidality unresponsive to treatment, and sometimes permanent psychosis.
Tonight we are going to Ester's Follies. One of my co-workers is a dance teacher on the side, and she leads a group called the Tap-Dancing Grannies and they are performing. Ester's is an improv troupe on 6th Street that is a true-blue Austin tradition. I haven't seen one of their shows since the 1980's and it's just time to go back. I'll offer my report in the next post, expecting some great scandalous action. And in 3 weeks, Dani and I are going to Amsterdam for a week. She picked the place, and then I (oh so reluctantly...right, ha) agreed to go with her. She booked us at this bed and breakfast. And we'll see how that goes. Expecting good things, again. Maybe not quite so scandalous.
I had my 90 day review at work. Yes, I am off my probationary period and I DIDN'T GET FIRED. Yay! It's funny, but knowing that they fired the person right before you certainly does have an impact. Anyway, things are wonderful, I love my job, I am so fortunate. And my new doc is slammin'. He's great, very genuine and caring and seems to be able to answer all my questions. It's also kind of cool that I know some things he doesn't - like where the file cabinet is! Yes, I've learned something in 90 days! Even the patients like the new doc. And I thought that could be a slight problem, I mean he's around my age and he's a guy -- would adolescent girls and young women really connect with him? Well, I'm happy to say that he works that pretty well, and several patients have told me (when he's not around) that they like him. He does have some decidedly different preferences for meds, so I'm learning all of that.The owners of our center, who live in another state and run a treatment center there, are coming for a big week-long dog and pony in early December. Hoo boy. I already have 2 dinners planned and lots of time booked for yakking. I'm just waiting for the order to warm up PowerPoint.
Anyway, busy times. Great times. Can I say it again? I love my work. And we did half-moon pose in yoga this morning - my favorite. I think it's a good sign.
