Lockup Doc

To be effective and enjoy working as a psychiatrist in any setting requires unique personality traits. Likewise, to be effective and enjoy any type of work in corrections requires unique personality traits. But, working as a psychiatrist AND doing so in jails and prisons narrows down the field even further.

For the right candidate it can be a very rewarding career. For others, frustration and ultimately burnout may result.

Here are a few personality traits that I believe are important:

1. Having a Strong Sense of Independence: One needs to be able to organize and prioritize many different tasks without having to ask for advice and reassurance often.

2. Having Patience: Prisons and jails work on their own schedules. The primary priority is always security. Health care is an ancillary service in corrections, not the primary mission. There will be frequent delays and inconveniences that arise. One must be able to shift gears, adapt, and still make the best use of the time available.

3. Having a Sense of Humility: Psychiatrists make more money than most workers in correctional settings and also must work hard to earn the respect of other staff since those providing “help” in corrections are often seen as enablers. Walking in with an attitude will assure a psychiatrist even higher doses of resentment and passive-aggressive behavior from 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…

Seroquel (quetiapine), an atypical antipsychotic medication, is FDA approved for the treatment of schizophrenia, mania, bipolar depression, and maintenance treatment of bipolar disorder. It is used off-label for many different reasons. In a prison environment, it is often used to target problems with anxiety, sleep, and impulse control.

In the early 2000’s, Seroquel came up on the radar of my correctional system primarily because of cost. Not only was it expensive to use, but it was being greatly over-prescribed.

Shortly thereafter, it was recognized as not only costing money but also as likely being abused and diverted.

This suspicion was further validated when a somewhat famous letter to the editor of the American Journal of Psychiatry was printed in September 2004 detailing the extent of Read more…

Attention deficit hyperactivity disorder (ADHD), characterized by such symptoms as hyperactivity, impulsivity, and inattention, was previously thought of as a childhood condition that children eventually would outgrow. In recent years, we have realized that ADHD symptoms do not necessarily disappear or lessen by adulthood for many.

In the highly structured prison setting, untreated ADHD does not typically impair daily functioning to the degree that it might for those in the community. Nonetheless, some inmates with untreated ADHD may get into altercations with others and receive conduct reports for violating prison rules because of their impulsivity. Likewise, others may not do as well in prison educational and rehabilitation programs because of difficulty concentrating and staying organized. Read more…