Treating the psych side

Words could never adequately describe the grief and astonishment most of us feel about the massacre of 12 innocent people that took place in the Navy Yard in Washington on Sept. 16. We can identify with the victims, just ordinary people going about their ordinary routines. They were just like us. This could happen anywhere, anytime.

What makes a person snap and go on a shooting rampage with the intent to slaughter innocent people, and how can these tragedies be prevented in the future? According to news reports, the father of Aaron Alexis said the shooter suffered from posttraumatic stress disorder after the 9/11 terrorist attacks. He participated in the search-and-rescue efforts after that tragic event. Subsequent to 9/11 he had his first documented violent outburst when he shot out the tires of a construction worker who he felt had disrespected him.

While it is virtually impossible to get inside the head of an individual who is capable of performing such a heinous act, truth be told, many mass murderers were once "normal people." I’ll never forget the words of wisdom I received one day on rounds during my residency when my attending reminded us then-green physicians that the No. 1 cause of death of psychiatric patients is a medical illness.

Why is that germane? Because we all treat patients who suffer from PTSD, paranoid schizophrenia, psychosis, and a host of other potentially volatile psychiatric illnesses. And, if we are honest with ourselves, most of us would have to admit that these psychiatric illnesses are relegated pretty low on our priority list when we are busy treating more acute issues, like multilobar pneumonia or acute coronary syndrome. However, when the dust clears, we have the opportunity to address their psychiatric conditions as well.

No, we are not trained to adequately treat those conditions. The medications used are beyond the scope of our training in most instances, but we can confirm with our patients, and sometimes even their family members, whether they are stable on their current regimen.

We can confirm that they have appropriate follow-up, that they can afford their medications, that they are taking their medications as prescribed, and that they are not a volcano waiting to explode.

We can get a case manager or social worker involved if there are any issues with access to psychiatric care or affording their medications. We can consult our in-house psychiatrist if we are remotely concerned about the stability of any of our patients.

Sometimes we have "problem" patients – the ones who scream, curse, and maybe even throw things. Nurses literally beg us to discharge them as soon as possible. No one wants to go into their room. And maybe, deep down inside, we secretly go above and beyond to stabilize them so they can be discharged quickly. But perhaps these are exactly the patients we need to hold onto for an extra day or two, just in case they are on the verge of a meltdown that could prove catastrophic to them and whoever just happens to be in the wrong place at the wrong time.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

Words could never adequately describe the grief and astonishment most of us feel about the massacre of 12 innocent people that took place in the Navy Yard in Washington on Sept. 16. We can identify with the victims, just ordinary people going about their ordinary routines. They were just like us. This could happen anywhere, anytime.

What makes a person snap and go on a shooting rampage with the intent to slaughter innocent people, and how can these tragedies be prevented in the future? According to news reports, the father of Aaron Alexis said the shooter suffered from posttraumatic stress disorder after the 9/11 terrorist attacks. He participated in the search-and-rescue efforts after that tragic event. Subsequent to 9/11 he had his first documented violent outburst when he shot out the tires of a construction worker who he felt had disrespected him.

While it is virtually impossible to get inside the head of an individual who is capable of performing such a heinous act, truth be told, many mass murderers were once "normal people." I’ll never forget the words of wisdom I received one day on rounds during my residency when my attending reminded us then-green physicians that the No. 1 cause of death of psychiatric patients is a medical illness.

Why is that germane? Because we all treat patients who suffer from PTSD, paranoid schizophrenia, psychosis, and a host of other potentially volatile psychiatric illnesses. And, if we are honest with ourselves, most of us would have to admit that these psychiatric illnesses are relegated pretty low on our priority list when we are busy treating more acute issues, like multilobar pneumonia or acute coronary syndrome. However, when the dust clears, we have the opportunity to address their psychiatric conditions as well.

No, we are not trained to adequately treat those conditions. The medications used are beyond the scope of our training in most instances, but we can confirm with our patients, and sometimes even their family members, whether they are stable on their current regimen.

We can confirm that they have appropriate follow-up, that they can afford their medications, that they are taking their medications as prescribed, and that they are not a volcano waiting to explode.

We can get a case manager or social worker involved if there are any issues with access to psychiatric care or affording their medications. We can consult our in-house psychiatrist if we are remotely concerned about the stability of any of our patients.

Sometimes we have "problem" patients – the ones who scream, curse, and maybe even throw things. Nurses literally beg us to discharge them as soon as possible. No one wants to go into their room. And maybe, deep down inside, we secretly go above and beyond to stabilize them so they can be discharged quickly. But perhaps these are exactly the patients we need to hold onto for an extra day or two, just in case they are on the verge of a meltdown that could prove catastrophic to them and whoever just happens to be in the wrong place at the wrong time.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.

Words could never adequately describe the grief and astonishment most of us feel about the massacre of 12 innocent people that took place in the Navy Yard in Washington on Sept. 16. We can identify with the victims, just ordinary people going about their ordinary routines. They were just like us. This could happen anywhere, anytime.

What makes a person snap and go on a shooting rampage with the intent to slaughter innocent people, and how can these tragedies be prevented in the future? According to news reports, the father of Aaron Alexis said the shooter suffered from posttraumatic stress disorder after the 9/11 terrorist attacks. He participated in the search-and-rescue efforts after that tragic event. Subsequent to 9/11 he had his first documented violent outburst when he shot out the tires of a construction worker who he felt had disrespected him.

While it is virtually impossible to get inside the head of an individual who is capable of performing such a heinous act, truth be told, many mass murderers were once "normal people." I’ll never forget the words of wisdom I received one day on rounds during my residency when my attending reminded us then-green physicians that the No. 1 cause of death of psychiatric patients is a medical illness.

Why is that germane? Because we all treat patients who suffer from PTSD, paranoid schizophrenia, psychosis, and a host of other potentially volatile psychiatric illnesses. And, if we are honest with ourselves, most of us would have to admit that these psychiatric illnesses are relegated pretty low on our priority list when we are busy treating more acute issues, like multilobar pneumonia or acute coronary syndrome. However, when the dust clears, we have the opportunity to address their psychiatric conditions as well.

No, we are not trained to adequately treat those conditions. The medications used are beyond the scope of our training in most instances, but we can confirm with our patients, and sometimes even their family members, whether they are stable on their current regimen.

We can confirm that they have appropriate follow-up, that they can afford their medications, that they are taking their medications as prescribed, and that they are not a volcano waiting to explode.

We can get a case manager or social worker involved if there are any issues with access to psychiatric care or affording their medications. We can consult our in-house psychiatrist if we are remotely concerned about the stability of any of our patients.

Sometimes we have "problem" patients – the ones who scream, curse, and maybe even throw things. Nurses literally beg us to discharge them as soon as possible. No one wants to go into their room. And maybe, deep down inside, we secretly go above and beyond to stabilize them so they can be discharged quickly. But perhaps these are exactly the patients we need to hold onto for an extra day or two, just in case they are on the verge of a meltdown that could prove catastrophic to them and whoever just happens to be in the wrong place at the wrong time.

Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.