involves being delirious, whereas lack of attention involves memory. The group decides that she was not disoriented but did have trouble recalling things, even though she could pay attention to some extent.
Of the many countervailing currents in this event, I will mention only a few. On one side lies the legitimacy of religious practice, which is often at odds with the routines of daily life; on the other lies the worry that her religious practices line up with other extreme aspects of her behavior to indicate a serious psychological condition. On one side is her feeling that previous treatment was not explained to her and she felt coerced (together with her preference not to be at this event at all); on the other is the staffâs concern that she was subdued because she was out of control and that being presented at rounds might lead to some new ideas about how to treat her. On the one side is her resistance to taking a test based on schoolroom activities, knowing that her mental state will be assessed on the basis of it; on the other is the doctorsâ need to find out if her thought process is disordered so they can recommend appropriate medication. What is at stake here, among other things, is which side of the DSM distinction between cognitive and emotional disorder she belongs on, or where in between. The rounds presentation is a moment in an ongoing discussion among the staff about whether she is manic depressive (and so best treated with lithium, as well as an antipsychotic like Zyprexa), schizophrenic (and best treated with an antipsychotic alone), or, alternatively, whether her psychosis was caused by the combination of drugs she had been taking on admission.
(7) Maybe He Is a Normal Variant
Resident: Mr. Anderson is an economics professor at a university in a nearby state. He is Bipolar 1, not presently controlled by medication. He is a rapid cycler. He is married, but it is a conflicted marriage, and his wife is narcissistic and whiny. He was on lithium for twenty years and did well. Then he got renal insufficiency, evidently from the lithium, and was told by his nephrologist to go off the lithium. Then he was all over the place. He was sexually inappropriate with students at a party while drinking, and experienced a general decrease of his social inhibitions. He has tried Depakote, Neurontin, Seroquel, and Tegretol.
His teaching became poor, he was nasty in class, and he pushed at the desk in anger, which students found intimidating. He would break into song in the middle of lecturing (and he teaches one of the core courses). There were student complaints. As of this January, he was relieved of his teaching duties. He is a renowned economist, and he has written textbooks. When he was up, he experienced higher spending than usual, low impulsivity, irritability, and pressured speech. When he was down, he needed increased sleep and he experienced anhedonia. The cycles were every four to five months to hourly.
Mr. Anderson came in, looking drawn and gray, with a shaggy beard. Wearing a casual plaid shirt, jeans, and a cardigan, he walked with a shambling, erratic gait and jerky limbs.
Dr. Dean: How are you doing today?
Mr. Anderson: I am where I want to beâI am getting better so I can function in a productive way. I went off lithium in 1996. Since then, things have been erratic, I have had trouble sleeping, Iâve been waking early and feeling irritable, talking fast, with slurred speech; Iâve been making mistakes, getting mixed up at the blackboard, but I have great energy and I think I am superman. I am committing myself to grand research projects and big research problems.
My department upgraded the curriculum, and this put my courses out of date. My math is not good enough to handle the newer techniques, and this causes me great anxiety. One of the students complained I put a question on the exam I myself had not been able to answer during class, but I thought that was OK, that students
Of the many countervailing currents in this event, I will mention only a few. On one side lies the legitimacy of religious practice, which is often at odds with the routines of daily life; on the other lies the worry that her religious practices line up with other extreme aspects of her behavior to indicate a serious psychological condition. On one side is her feeling that previous treatment was not explained to her and she felt coerced (together with her preference not to be at this event at all); on the other is the staffâs concern that she was subdued because she was out of control and that being presented at rounds might lead to some new ideas about how to treat her. On the one side is her resistance to taking a test based on schoolroom activities, knowing that her mental state will be assessed on the basis of it; on the other is the doctorsâ need to find out if her thought process is disordered so they can recommend appropriate medication. What is at stake here, among other things, is which side of the DSM distinction between cognitive and emotional disorder she belongs on, or where in between. The rounds presentation is a moment in an ongoing discussion among the staff about whether she is manic depressive (and so best treated with lithium, as well as an antipsychotic like Zyprexa), schizophrenic (and best treated with an antipsychotic alone), or, alternatively, whether her psychosis was caused by the combination of drugs she had been taking on admission.
(7) Maybe He Is a Normal Variant
Resident: Mr. Anderson is an economics professor at a university in a nearby state. He is Bipolar 1, not presently controlled by medication. He is a rapid cycler. He is married, but it is a conflicted marriage, and his wife is narcissistic and whiny. He was on lithium for twenty years and did well. Then he got renal insufficiency, evidently from the lithium, and was told by his nephrologist to go off the lithium. Then he was all over the place. He was sexually inappropriate with students at a party while drinking, and experienced a general decrease of his social inhibitions. He has tried Depakote, Neurontin, Seroquel, and Tegretol.
His teaching became poor, he was nasty in class, and he pushed at the desk in anger, which students found intimidating. He would break into song in the middle of lecturing (and he teaches one of the core courses). There were student complaints. As of this January, he was relieved of his teaching duties. He is a renowned economist, and he has written textbooks. When he was up, he experienced higher spending than usual, low impulsivity, irritability, and pressured speech. When he was down, he needed increased sleep and he experienced anhedonia. The cycles were every four to five months to hourly.
Mr. Anderson came in, looking drawn and gray, with a shaggy beard. Wearing a casual plaid shirt, jeans, and a cardigan, he walked with a shambling, erratic gait and jerky limbs.
Dr. Dean: How are you doing today?
Mr. Anderson: I am where I want to beâI am getting better so I can function in a productive way. I went off lithium in 1996. Since then, things have been erratic, I have had trouble sleeping, Iâve been waking early and feeling irritable, talking fast, with slurred speech; Iâve been making mistakes, getting mixed up at the blackboard, but I have great energy and I think I am superman. I am committing myself to grand research projects and big research problems.
My department upgraded the curriculum, and this put my courses out of date. My math is not good enough to handle the newer techniques, and this causes me great anxiety. One of the students complained I put a question on the exam I myself had not been able to answer during class, but I thought that was OK, that students
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