Psychosis: A Taste of Insanity

White woman laying on floor with face in trash bin

Inpatient Care

Psychosis, a taste of insanity minds you no time

It’s no longer the dominant factor

Your mind has discovered the matrix and does as it wishes

Hallucinations or reality, that no longer matters

Feeling good and partaking in the psychotic realm becomes the agenda

Psych patients often become violent when you’re interfering

Inpatient care isn’t easy when they’re freely swinging

You offer them medications but they’re freely swinging

Psychosis: A Taste of Insanity, Part II

Imagine a football team about to tackle them

Those sharp needles entering their body; they become spent

Sometimes four-point restraints don’t even provide a dent

Psychosis doesn’t give a damn; immovable hallucinations become the trend

To the patient this is nothing but part of the experience

You try to educate them but they continue their resistance

Psychosis is their best friend, but sometimes their best enemy

Satan enters their mind and tricks them into a deeper insanity

What can you do besides have potent drugs handy

Blank white psychotic face with hands on head

Do you see how Tricky Psychosis can be?

Many recover but many remain dormant

In the psychotic experience in which they keep roaming

Is there a cure to this madness?

Medications work but sometimes they flop

You keep pushing intramuscular injections

The patient becomes sedated and begging

“I want more, give me another shot”

You tell them they’ve had enough

They lose it even more banging against the wall

Their bleeding forehead leads them to their downfall

You order another injection to calm their nerves

By the time the nurse administers it

The patient is already on the floor hurt

After the chaos calms down you become relaxed

The staff becomes happy and you expect some claps

But who are you kidding

These patients are mentally ill

You didn’t do much besides feed them a pill

Psychosis, will you ever accept a cure?

Or will you keep torturing these human souls

Keeping their psyche in a stir

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Dealing With Mental Health Labels

Portrait of insane abstract face

When psychiatrists inform you of your diagnosis, they are not doing it with the intention of labeling you. No one is denying that dealing with mental health labels can be difficult, but it’s important to also understand what a diagnosis is. A diagnosis is given to inform you of what we think may be going on and as a guide for treatment. Psychiatric diagnoses do not define you as a person. It’s important to mention this because many patients experience an uncomfortable feeling when certain psychiatrists slap a diagnosis on them. Informing patients of their diagnosis is very important when it comes to delivery of the information. Empathy and being nonjudgmental are crucial to making patients feel comfortable. At the end of the day, we are here to help you overcome your symptoms.

Dealing With Mental Health Labels: The Diagnosis

When a patient first becomes diagnosed with a mental disorder, it can be very uncomfortable and frightening for them. There’s a tendency by some patients to believe that a label or diagnosis makes them less human than others. First, let’s clarify the difference between a label and a diagnosis. A diagnosis is the assignment of a mental disorder unto a patient based on the symptoms he or she is experiencing. Psychiatric diagnoses were created based on the observation of human experiences. They help to classify patients with different disorders so that physicians can more effectively treat them. A psychiatric diagnosis is an objective term while a label is subjective.

Depressed man dealing with mental health labels

So What Are Labels?

A label is like someone saying, “you are crazy” or “he’s weird, he’s got schizophrenia or something.” A label is like a tag that someone identifies you with and usually in a negative manner. Mental health labels are used by the public who is not formally educated in psychiatric diagnoses. You can imagine that the labeling of patients can be very embarrassing and difficult for them to experience. This is especially true for children and adolescents who are still very much in the mindset of fitting in to get approval by their peers.

Just remember that as a psychiatrist, we don’t label you. We give you a diagnosis if we think you have one based on your symptoms and experiences. I know it can be difficult to sometimes accept a diagnosis, but at the end of the day, it doesn’t define who you are as a human being. A diagnosis is just a definition of your symptoms that allows us to provide you with the correct treatment so that you can improve and no longer suffer. In a nutshell, the public does the labeling but mental health workers provide the diagnoses.

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Mental Health Podcast

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Stepping Outside Your Comfort Zone Dr. Alexander's DSMReady

We become used to our comfort zone, preventing us from trying new things in life. Whenever this happens, we experience pain, sadness, frustration, annoyance and many more emotions. You are the one in control of your decisions; if you want to do something, just get out there and do it. By holding yourself back, you are complicating your life. Just do it. — Support this podcast: https://anchor.fm/doctoralexander/support
  1. Stepping Outside Your Comfort Zone
  2. The Stabbing Pain of Insecurities
  3. Negativity is Contagious
  4. Opening Up About Your Mental Health Symptoms
  5. Exercising For Your Mental Health
  6. Social Media Toxicity
  7. Psychiatric Labeling
  8. Analyzing Your Life
  9. Manipulating Your Mental Health
  10. Experiencing Panic Attacks

In this mental health podcast, Dr. Alexander discusses issues and concerns that most of us face in our everyday experiences. Mental health is like physical health in that we experience it all the time, but don’t pay attention to it as much as we should. For example, most of us are aware that our diet can use some improving and that we’re also not exercising enough, but we continue the same habits. These habits affect our physical health by contributing to an elevated body mass index, high blood pressure and elevated blood glucose and triglyceride levels. The same applies with our mental health; we experience stress, anxiety and depression but we don’t do anything to prevent them.

Mental health podcast - microphone next to iPhone

A Mental Health Podcast for Humanity

Dr. Alexander discusses topics such as analyzing your life, mental health labeling, negativity and insecurities. Not everything has to be related to a mental illness. A lot of what we do in life affects our mental health, from negative automatic thoughts to self-sabotaging behaviors. Without addressing these experiences, we go through life living in pain that chips away at our mental wellbeing. Some people continue to live in pain but don’t develop a mental illness, while others become diagnosed with a mental disorder. This podcast is not meant to give you intensive, psychiatric information. You can find that on websites such as WebMD, Healthline and the Mayo Clinic.

This podcast delivers you information that anyone can relate to, especially if you don’t have any knowledge or background on mental health. It’s easier to connect with people by discussing topics that we can all relate to. This is especially important because of the existing mental health stigma that prevents many people from seeking the care they desperately need. If Dr. Alexander can touch one person who is affected by mental health stigma, then it’s a win.

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Angry Patient

Angry caucasian female patient holding fists in air

I Want a Second Opinion

Sometimes patients blame their psychiatrist for worsening symptoms. An angry patient may say things such as, “I don’t think the medication is working; my suicidal thoughts have gotten worse since starting the antidepressant; I want a second opinion!” Patients will split with their psychiatrist for various reasons:

  • Age and immaturity
  • Lack of patience
  • Frustration and wanting to take out their anger on their psychiatrist
  • Unconscious inner conflicts
  • Boredom with therapy
  • Drug use

As a psychiatrist, you have to understand that it’s better to allow the patient to seek another provider’s care rather than trying to convince them to stick around. Patients, you have to understand that we are not perfect and cannot always effectively help you with your problems. As a patient, you should also understand that seeking a “second opinion” does not mean that you will be satisfied. You might actually set yourself a few steps back, because that means you’ll have to start all over with a psychiatrist who does not know you.

Angry female patient screaming and holding hands against head

How to Treat the Angry Patient

The best recommendation for psychiatrists is to stick by their professional expertise and utilize empathy as much as possible. It’s very easy to get annoyed with your angry patient and dismiss their complaints. Don’t make the mistake of losing your patient to follow-up because of your countertransference. Countertransference is when a patient says something that reminds you of a family member in your past who said something similar. This happens on an unconscious level and influences you in the present. For instance, if an angry patient starts blaming you all of a sudden, what they say can remind you of when your uncle blamed you for something when you were 12 years old. This might cause you to react in a negative way towards your patient.

When experiencing countertransference, do your best to hold anything back that may be offensive to the patient. Therapy is not the place for you to express your negative emotions. Leave this space for the patient to vent and express their frustrations. The patient will appreciate you more if you remain within your professional boundaries, rather than becoming confrontational. It’s not easy to treat angry patients, especially when they are venting and you did nothing wrong. Try to understand where they’re coming from and adopt an empathic stance. You’re here to help the patient with their symptoms and this includes their random angry outbursts.

Recommendation for Patients

The best recommendation for patients is to trust their psychiatrist and avoid making impulsive decisions based on frustration encountered during therapy. Your psychiatrist is not a punching bag. They are human too and do their best to help you. Keep in mind that psychiatrists have many patients. It’s not easy for them to treat so many patients and also encounter agitation, psychosis and anger. Do your best to maintain your anger within appropriate boundaries. Don’t allow your anger to jeopardize the therapeutic alliance you have built with your psychiatrist. Help the psychiatrist better understand you because you’re the one who needs help at the end of the day.

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Psychosis Meaning

Abandoned psychiatric asylum

What is Psychosis?

One thing to keep in mind with psychotic patients is their very unpredictable behavior. The unpredictability of psychosis is very obvious; they can literally be having a pleasant conversation with you in one moment, and then yelling, cursing, and agitated in the next. You scratch your head and wonder, “What in the world? I was just talking to them and everything seemed to be going well!” Psychosis could care less if everything was going well. When it wants its patient to terrorize, it will unleash all hell’s dogs to get its fix. This doesn’t mean that you should always expect psychotic patients to become dysregulated and violent. Just be aware that the chances of that happening are higher than with other patients. What’s a psychosis meaning? Let’s expand below.

Psychosis Meaning – Unpredictable Patients

You should never assume that you’re on the good side of a psychotic patient. This is because their psychosis does not care if you’re nice, treat them well or say good morning every day. Their psychosis is unpredictable even when you think they’re doing well. They can snap at any moment and randomly assault you when you least expect it. The unpredictability of psychosis is not always due to their treatment. Many patients are on multiple antipsychotics and mood stabilizers and still become aggressive without anyone expecting it. A combination of factors is responsible for their aggressive behavior: receiving bad news, fluctuating hormones and neurotransmitters, not taking their medications or a psychotic break. You don’t want a taste of psychotic aggression.

Even with stable outpatients, you never know how they’re really doing. They can present to your office in one way, and a totally different way when out and about. Keep in mind that patients with psychosis often abuse tobacco and drugs, in particular cheap drugs such as K2 and synthetic smart drugs. My point is that you should never underestimate their mental status. Sometimes you don’t suspect them of using any drugs and that is when they can snap and become violent. Always keep your guard around a person with a history of psychosis. This applies to families, friends and healthcare workers who spend time with psychotic persons.

Psychosis meaning - disheveled girl holding knife

There is Hope

Now this doesn’t mean that psychosis can’t be treated. Many people suffered from psychosis at one point in their lives and successfully recovered. Some people experience drug-induced psychosis caused by the abusing of drugs. They may be psychotic for a few days to a week after stopping the drug and become normal again after the drug clears out of their system. Others suffer from psychotic depression, bipolar depression, brief psychotic disorder, schizophrenia, etc. All of them have the potential to become violent! But they also have the potential to become normal and lead successful lives again. The beauty of psychiatry is that medications work and we have a lot of great mental health professionals who demonstrate a lot of empathy and patience.

Have you experienced psychosis or do you know anyone who has?

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Unpredictability of psychosis GIF face

Give Mental Health Patients A Chance

Black and white photography of two adult hands shaking with two child hands holding adult arms

Not Giving Up On Mental Illness

Many people continue to view mental health patients as “the crazies; the no good for nothing weirdos who do weird things and are just weird!” But this couldn’t be farthest from the truth. With a little medication and some talk therapy, you can unmask the most beautiful flowers that you will ever come across; more beautiful than many people who don’t have a mental illness. Remember that it’s not what goes inside one’s mouth that makes or breaks an individual; it’s what comes out because what comes out is from the heart.

With mental illness, it’s easy to erroneously believe that one’s heart is wicked, rotten or broken from the start. But it’s not their heart; it never was. It’s their mind which is malfunctioning, giving the appearance of a bad heart. It’s often easier to fix one’s mind than it is to fix one’s heart; once the heart goes astray, only God has the ability to help their poor soul. But with the mind, many wonderful opportunities are available if an individual with a mental illness is given a chance.

Many mentally ill patients suffer from a chronic disorder, giving even the most experienced psychiatrists loss of hope for return to a stable state of mind. But loss of hope is the difference between those who don’t achieve from those who conquer the highest mountains. Treating a mental illness may prove to be challenging at times, but what is more challenging is finding the strength to believe in your patient when your patient doesn’t believe in themselves.

Patients must always be given a chance no matter how chronic their illness is. As psychiatrists, we don’t rely on miracles but experience, knowledge, art and faith. As Jesus Christ once said, “The people of today want a miracle. I will not give them one.” We don’t need a miracle to see improvement; we just need empathy, on-point psychopharmacology and the belief that our patients will improve.

Sometimes we have to believe for our patients when they lack the belief in themselves. Sometimes we have to give the people who we know in our lives more opportunities to access mental healthcare, especially when the opportunities lie down the street or around the corner. Sometimes we have to extend a hand and place our interests aside for one day. Sometimes we have to let go of our ego and focus on helping someone else out, even when we don’t feel like being of help.

Sometimes we just need to give someone a chance, for a chance is all that they are asking for. Sometimes a chance is all they need to recover from their mental illness.

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Malingering At Its Finest

Gangster man with three silver rings smoking cigar

Malingering And Substance Abuse

Psychiatric patients who malinger do not necessarily have any psychiatric issues to begin with. Often times, they have a history of antisocial behavior such as criminality, spending time in the prison system, homelessness and getting involved with heavy substance use. They may have a history of psychiatric-like features, but even then, they’re often secondary to substance abuse or malingering for the sake of secondary gain.

What is secondary gain? This is when a malingerer wants to obtain something of personal interest, such as spending time in the hospital in order to avoid upcoming court dates. Malingerers are street smart; they know what to say and how to act in the emergency room in order to earn themselves a night or two in the hospital.

The problem with malingerers is that if they tell a psychiatrist in the emergency room that if they do no get admitted, they will cut their throat, jump off the bridge or OD on substances, it puts the psychiatrist in a corner; this corner often leads to the psychiatrist admitting the patient for the sake of the patient’s life.

Even though you may suspect someone to be a malingerer does not mean that the person won’t actually try to kill themselves. For instance, if as a psychiatrist you decide not to admit the malingerer to the hospital and they go and jump in front of a train, there can be potential liability if their family pursues a legal investigation.

That’s because anyone that actually shows up to an emergency room and talks about depression and suicidal ideations is already in a state of mind that is not considered normal. Unfortunately, you have people who abuse the system such as those who are homeless and want a bed to sleep and food to eat when it’s 10 degrees outside.

It’s very difficult as a psychiatrist to accept or deny malingerers into a hospital. Accepting them is difficult because you suspect that they are playing you for a fool, but you also don’t want to take a chance with legal liabilities and them actually harming themselves. Denying them is also difficult because you are now taking a chance that they won’t actually kill themselves.

Believe it or not, even after a malingerer obtains a hospital admission, they may decide to cut their hospitalization short due to getting annoyed over something such as “cold food.” So even though they have a place to sleep, food, psychiatric medications and round the clock care and comfort, they may ask for a discharge the very next day for reasons not even worth further mentioning.

Unfortunately, malingerers are part of the healthcare system and they have to be dealt with. But even for them I feel bad because at the end of the day we are all human beings!

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Psychiatric Patients Are Unpredictable

Angry man dressed in black sitting at table pointing finger

Expect Anything

If you don’t have patience talking and listening all day, then the field of psychiatry is not for you. Not anyone can become a psychiatrist and be good at it; it requires patience, determination, excellent listening skills and lots of empathy. Lots and lots of empathy! As any psychiatrist knows very well, the unpredictability of patients is something that they must be prepared for on a daily basis, even when you think that patients are doing well.

In the field of psychiatry, you must expect anything; anything less and you are in for a surprise. What many people don’t understand is that it’s not necessarily the patients’ fault when they become agitated, disruptive or physically assaultive; unless sociopathy is at play, mental illness is often the driver behind their madness. When mental illness takes control of you, you almost become a passenger wrestling to take back control of the wheel that the drunk driver is joyfully playing with.

But how do you help such patients when most of the time they cannot even help themselves? Patience and lots of it. And believe it or not, psychotropic medications work very well on mental pathologies; they just require the right dose and length of time in the patient’s system. Psychiatric medications aren’t something that you take for a month and discard with the hope of being “fixed.”

The stigma of psychiatric medications is still prevalent, but thankfully it’s decreasing. People are starting to realize that these medications work; they can fix your anxiety, depression and psychosis! People are also realizing that there should be no shame in taking them; there is nothing wrong with having a mental illness.

Sure it doesn’t feel good having one and no one enjoys suffering from depression or hallucinations, but the more that we normalize mental illness, the easier it will become for the world to be treated. People will no longer have to remain in hiding because they are too ashamed to get treated by a doctor.

As physicians, all we can do is continue treating our patients with empathy, professionalism and dignity. And as human beings, all we can do is continue to spread acceptance, love and hope into the world.

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Only Eighteen And Depressed

Young depressed person sitting on ground with leaves by stone wall with head down

Multiple Failed Suicide Attempts

One of the saddest things to see in the field of psychiatry is depression that hits the lives of young ones. Anyone young is considered 18 and below because they’re either barely an adult or still an adolescent or child. Think back to when you were 18 and how you felt like you were on top of the world, mature and an adult able to make your own decisions. At the time, you weren’t able to recognize your immaturity.

But now that you are older and look back at how you used to think and behave, you quickly realize without a shadow of a doubt how immature and potentially dangerous your decision-making was back then. Now as a psychiatrist, seeing an 18 year old suffering from severe depression and two failed suicide attempts breaks my heart.

Many of these young folks already have depression running in their family; in other words, they are genetically loaded. But it’s not like they’re born depressed or it just comes out of the blue. Most of the time, it’s environmental triggers that bring out the depression. Once it comes out, because they are so young and predisposed to experiencing it, the depression hits hard.

It’s interesting because these patients can tell you about some potential triggers to their depression, but do not exactly know what caused them to become depressed. In other words, they often state that it just came upon them and it doesn’t necessarily have to be around the time of the triggers; it can be months later.

Generally, the younger the age of onset of a mental illness, the higher the chances of a worse prognosis. In the case of severe depression, suicide attempts are not a surprise. Many of these patients won’t necessarily tell you that their intent was to end it all; they either feel ashamed and embarrassed or do not know the reason themselves due to the severity of their depression, which impairs their judgment, impulse and even insight sometimes.

The hard fact is that depression kills many lives every day all around the world. That’s why we must continue to remain strong and come together to share our stories, thoughts and feelings on a daily basis.

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Schizophrenia Gone Wild

Schizophrenic woman wearing face mask staring out the window

Coronavirus Affecting Stabilized Psychotic Patients

Many psychotic patients who were previously stabilized on their medications are beginning to decompensate from the coronavirus. It’s not necessarily that they are becoming exposed to it. It has more to do with them watching the news at home which is causing them to become worried and paranoid that they will get it. Some actually develop symptoms of COVID-19 and stop taking their medications, wrongfully concluding that their medications are causing the symptoms. This is schizophrenia gone wild.

Psychotic patients have a very fragile line of stability that they often walk on. Things such as stopping medications, environmental stressors, changes in their lifestyle or relationship disputes can be enough to put them over the edge and cause them to decompensate. When they do decompensate, it’s very obvious to family members; this is not a small and irrelevant change in behavior.

They will start to display odd or unusual behavior such as:

  • Believing that their deceased parents are calling them from the window
  • Shouting and arguing with loved ones
  • Making verbal and even physical threats
  • Calling random people at 2 am
  • Becoming catatonic and remaining mute for long periods of time

. . . and the list goes on. These are not behaviors that all patients experience; it was just a list provided for you to get an idea. When a schizophrenic patient decompensates, it doesn’t mean that they necessarily start to hear voices in their head or see things that aren’t there. It can simply mean that their behavior and thought process are disorganized. They may continuously shift positions in bed, flop their hands, ask if the apple juice on the table is alright in that position and even claim that it’s hot outside at the beginning of April in New York City.

It’s really sad to observe and talk to decompensated schizophrenics because you get a glimpse into their world and how much different their behavior is compared to people who don’t have a mental illness. Perhaps in their eyes they are not suffering but in ours they clearly are; they cannot function in society when they are decompensated. That’s why they’re in the hospital in the first place!

But keep in mind that even though a schizophrenic may not be currently at their baseline, does not mean that they cannot hold a conversation with you. Many can hold fairly normal conversations but they may make odd remarks. They’ll usually be able to answer all of your questions and many remain calm and pleasant during an interview. Just because a person has the diagnosis of “schizophrenia” does not mean that they cannot hold a normal conversation with you.

Schizophrenics are actually pretty cool!

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