Lockup Doc

It may surprise some people to hear that not all inmates, not even the ones who see psychiatrists, have difficulty coping with incarceration. Certainly some do, but many others are more stressed about family/relationship issues, financial problems, or the prospect of being unemployed felons upon release. Some inmates have found positive approaches to incarceration that make it less stressful and more productive while others struggle and often find themselves in undesirable situations.

Since I regularly see prisoners with a wide variety of effective and ineffective approaches to their incarcerations, I decided to compile a list of suggestions for how one could make prison or jail time more palatable. This list is not all-inclusive and is in no particular order. I offer no guarantees and hope that you will never seriously need a list such as this!

1. Stay busy and healthy: Some inmates do virtually nothing in prison, and I believe this is a mistake. Although freedoms are limited, there are still many things inmates can do to make the time pass more quickly, stay physically and mentally healthy, and better themselves. Go to the prison library regularly and read lots of books. Earn your HSED/GED or take college classes if they are available. Do not pass up the opportunity to go to recreation. As your health permits, work out regularly. You’ll feel better, be less likely to be a target, sleep better, and you’ll likely be healthier.

2. Don’t draw attention to yourself: “Lay low” is good advice. Try not to come up on the radar Read more…

This is a more personal post than most for me, but it seems right during the holiday season. I’ve written before about the field of correctional psychiatry. In that particular post, I mentioned some of the appealing factors of working as a correctional psychiatrist. I realize that some people find it difficult to believe that there are intrinsic rewards to working with inmates. If there weren’t, though,  none of us would do what we do. There is no doubt that there are also many challenges. Many inmates, for various reasons, test even the most seasoned clinicians’ patience.

However, one does not need to be a health care professional in corrections to work with difficult people. In fact, one does not have to be working at all. Everyone must deal with rude, aggressive, demanding, or irrational people to varying degrees in different life situations.

I do believe, though, that Read more…

One of my favorite news stories this year was about a lovely woman who lives in a nursing home in England. Her name is Ivy Bean. She turned 104 this fall and is the oldest user of Twitter (Twitter name: Ivybean104). As of this post she had over 54,000 followers. Prior to using Twitter she used Facebook heavily and maxed out her 5,000 friend limit.

There is a CNN article about her here. The article mentions how she always has an open mind and is willing to try new things. I’ve personally noticed the positive tone of her Twitter posts. Okay, open mind and positive attitude, 104 years young and enjoying life. Maybe there’s a lesson there for the rest of us!

Moving on, the other two people are Read more…

HOPE. It’s a big word. A word that’s easy to forget about.

There is so much wrong in our world. And, with 24/7 news bombarding us with violence, accidents, human rights atrocities, and scandals, it’s easy to get sucked into the sinkhole of negativity and pessimism. The focus always seems to be on what’s wrong and not on what’s right. Since the media doesn’t often focus on the positive, we often need to remind ourselves that it’s not all doom and gloom.

We often forget about all that is right in the world. All of the acts of kindness, the natural beauty of our planet, the innocent smiles on children’s faces, and dogs that greet us at home with unconditional enthusiasm.

We live in an era where Read more…

It’s no secret that the pharmaceutical and medical device industries have been under scrutiny for offering biased continuing medical education (CME) to health care professionals.

The Institute of Medicine, who recently released a report, “Redesigning Continuing Education in the Health Professions,” recommended this year that industry-supported CME eventually be discontinued. Most health care professionals likely have already noticed that free or inexpensive CME is getting harder to find.

I am all for improving the quality and objectivity of our CME. And, I can get by without the free pens and lunches. Within reason, I don’t mind paying more for my CME.

However, I can’t help but wonder if Read more…

Clinical Psychiatry News (Nov. 2009) published an article by Drs. Jan Leard-Hansson and Laurence Guttmacher entitled, “Treating Peginterferon-Induced Depression.” In order to determine the best evidence-based antidepressant treatment, the authors reviewed 170 studies but ultimately narrowed these down to 4 to include only randomized controlled trials.

Chronic hepatitis C virus (HCV) infection is not an uncommon health condition among prison inmates. The three most common HCV genotypes that occur in North America are 1, 2, and 3. Genotype 1 is treated with a 48-week course of weekly IM peginterferon and daily oral ribavirin. Types 2 and 3 are treated with a 24-week course. Approximately 1/3 of patients undergoing peginterferon treatment develop depression. Of this 1/3 who develop depression, 3/4 become depressed within the first 8 weeks of treatment.

Anecdotally I have found that citalopram works well for most patients. I have found it fascinating to treat patients with no mental health history who have abruptly developed Read more…

Malingering, which means to feign or exaggerate symptoms for secondary gain, occurs in all medical settings but is especially prevalent in jails and prisons. While it essential for all health care professionals working in corrections to become proficient in detecting malingering, even those working in non-correctional environments will be better clinicians if they learn this skill.

In the December 2009 issue of Current Psychiatry, Lawrence Reccoppa, MD, a correctional psychiatrist from Florida, wrote a brief article entitled, “Mentally ill or malingering? 3 clues cast doubt.”

The “3 D’s,” as he calls them: Read more…

(The following is a fictional vignette based on thousands of real patient encounters. Any resemblance to an actual person is purely coincidental.)

The heavy door slammed with an echo he’d never forget. He thought he could trust her, but he had been proven wrong. He should’ve known not to trust anybody in prison. In fact, throughout most of his life he’d known only a few people he ever could trust. Naked, cold, humiliated and feeling as though he had been violated again, “David” now wanted to die more than ever. He didn’t care how; it didn’t matter if it hurt. He just needed to end it all. But, he would soon realize that it would be nearly impossible to do. Nearly ever imaginable method of suicide had been removed from him. He was now “safe” in the eyes of the prison, but he sunk into a deeper depression.

It was David’s first time in prison. He had spent a few days in jail prior to his current age of 22, but it was remarkable that he hadn’t gotten himself into more trouble. His father was a career criminal who had repeatedly emotionally, physically, and sexually abused him as he was growing up. David had grown up far too fast. He had had few boundaries and rules and almost no adult supervision in his younger years. He started smoking cigarettes at age 10, started drinking at 12, and was using marijuana regularly by 13.

Despite having the deck stacked against him, David was Read more…

Grand Rounds, the weekly roundup of medical blogger posts, is now up – check it out at Florence dot com!

Many thanks to Barbara Olson, MS, RN, FISMP, for hosting and for including the Lockup Doc post, “Should Patients With Borderline Personality Disorder Be Told Their Diagnosis?”

Photo credit: Kilarin

Over the past year we all have been bombarded by media reports of the primary care shortage. It’s bad now but expected to get much worse in the coming decades.

What is not discussed as frequently but ultimately may have just as much negative impact on the future quality of American health care is the dire need for more geriatricians.

This topic is of personal interest to me because I completed a geriatric psychiatry fellowship and am board-certified not only in psychiatry but also in geriatric psychiatry. During my fellowship, I worked alongside the geriatric internal medicine fellows.

During my training and in practice, I’ve treated many elderly patients. I’ve seen them in the nursing home, outpatient, and inpatient settings. Whether a physician comes from an internal medicine, family medicine, or psychiatry background, I understand first-hand the added value of a geriatrics fellowship. I know without a doubt that I am a better physician for having completed this additional training.

Additionally, geriatricians are Read more…