Antisocial violence vs Psych

[heyjack70]

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What are you're experiences working with patients who have antisocial PD and their propensity to become violent? Specifically, have you seen any violence directed to psychiatrists when certain medications are not prescribed (like demanding benzos or stimluants), or they are involuntarily detained (and pissed about it) following suicide attempts or being violent?

 

[whopper]

I got a lot of experience in this.

Specifically, have you seen any violence directed to psychiatrists when certain medications are not prescribed (like demanding benzos or stimluants),

One thing you didn't mention, but I have seen are patient who commit suicide when given large amounts of benzos and/or pain meds and then the doctor put the patient into a state of addiction and dependence. If the doctor suddenly cuts off the medication without a taper down, I've noticed suicide could be a result. I've seen this occur when another attending did it and by going over several suicides from the coroner's office in a research project I'm working on.

I'm on a forensic facility, and I've had my share of antisocial patients.

I had one particular patient that aw recently discharged. The guy was erroneously diagnosed with schizophrenia (he did not have it, trust me). The diagnosis was tagged on as a kid and people connected with his care told me they only allowed it because he needed services that he otherwise wouldn't have gotten.

I didn't give him the benzos he wanted. He intentionally caused a ruckuss every few days in a vain attempt to get benzos. I told him if he caused a ruckuss he'd get Thorazine, but I told him the best way was to handle his anger using coping mechanisms.

He caused a ruckuss on the unit while I had him (2 months) on the order over every 2-3 days at first, but later every 1-2 weeks. Each time I gave him Thorazine usually by needle because he wouldn't calm down on his own and refused oral meds. With each ruckuss he caused, his agitation went down and down in frequency. IMHO this was a product of years of being given the Ativan he wanted by other doctors. HE intentionally caused problems to get a hit of Ativan.

During each incident, he figured out it was me that decided not to give him Ativan, and he was out to get me. I had to stand behind the nurses station with each episode. Outside of the episodes, I only talked to the guy so long as he was at least a few yards away from me.

 

[heyjack70]

Do you ever worry about these patients getting really angry at you, holding grudges, and tracking you down once they get processed through the system?

 

[whopper]

The only guy I thought might come after me (and he was not a patient) I evaluated for the court. He remembered the names of every single doctor that every involuntarily committed him and he had a grudge against them. He was also stalking a local celebrity.

I reported to the court that in my opinion, the guy met commitment criteria. I saw the guy on the units here and there afterwards and he told me he was not mad at me, but I always thought if there was going to be a first guy stalking me, he'd be it given his long history of stalking and grudges.

So a few weeks later the guy was discharged (and in my opinion, the doctor doing the discharge was off of a few things). I was thinking the guy might end up doing some tricks to annoy me like he did to others.

So I'm watching the news, and it's about 1 month after the discharge, the guy's neighbor shot and killed him. The guy, it turned out, was playing mind games on his mentally ill and well armed neighbor who then shot him.

I'm watching it on the news, and my immediate emotional reaction was "yes!, now I don't got to worry about being stalked!" Of course a few minutes later I felt bad I had that reaction.

I've never had anyone as far as I know stalk me even with my exposure to forensic psychiatry and criminal cases. Most of the patients I have, even the malingerers that I exposed and reported to the court as such didn't seem to hold a grudge against me. If anything, I figure they'd hold a grudge against the prosecutor because it's his or her face, not mine the person sees all the time voicing against him/her. The expert witness usually does not play the major role against someone in court but is merely directed by the prosecution or defense attorney. Nonetheless, the thought has crossed my mind that one of them one day may stalk me.

I actually feel less safe in outpatient than I do in the forensic facility. In the facility, I wear a button on my ID necklace where if a patient does anything even remotely dangerous, and I press it, the cops are there in 30 seconds. In outpatient, although I never deal with criminals, I did on occasion have enmeshed family members try to hold me hostage (not holding holding a gun but refusing to leave the office even though the time's up).

It hasn't happened to me yet, but some psychiatrists I know that specialize in addiction refused to give a patient a medication of possible abuse, and then the patient called up the office giving messages that could be interpreted as dangerous but not enough for the cops to act upon. E.g. "Hey doctor, did I tell you I'm an expert sniper and I have a sniper rifle? People better not mess with me."

The thought crossed my mind of getting a gun, but I refuse to get one unless I actually do the lessons. I've fired guns several times and I terrible at shooting a pistol. Rifles, I can do no problem, but I'd rather have a pistol. In any case I don't have the time now for lessons, and I've never seen a situation where a forensic psychiatrist needed one (yet).

 

[heyjack70]

Well, that's good news. By the way, what's a good IM thorazine dose?

 

[whopper]

I'm sure you're joking, but I had a guy the other day that was given an IM of 300 mg of Thorazine and he was still up and at 'em. (BTW, don't ever give out that amount unless you have very good reason to do so!)

 

[flash]

During Psych Sub-intern on inpt, I worked extensively with very sick pt:scz-affective, +AH, +SAx3, lot of self-injurious behavior, impulsive, whatever. It was a formative experience for me and at end of my elective she made this nice card thanking me and wishing me well during art therapy. This was 4-5 months ago.

Last month. I see her from time to time (I assume she has outpt appointments now), generally say hi, how are you. One afternoon I see her walking toward me and says "He wants me to go to the ER", I was a bit like "whats going on" to myself, and before I know it says "did you just call me a bitch", lifts a rock she already had in her hand and says "I'm going to bash your head". I create space quickly...she doesn't chase. Notify hospital police when I head back into the building, assume she would be tended to (read: CPEP or Psych ER).

Same day, leaving building after work, turn into my parking lot and hear "I got you now, bi*ch". It's her, all 400lbs, and a larger 5ft branch. She proceeds to chase (slow speed) me around the parking lot as I am on the cell with 911. NYPD responds, ambulance responds, she is now appropriate admitted again from what I hear.

Lesson: Never be complacent wrt safety. And 2, I love Psych.

 

[whopper]

That's a reason why I've always felt safer in a hospital than doing private practice despite that the hospital practice is mostly very psychotic patients with criminal histories vs outpatient where I'm seeing mostly functioning members of society (work, own a home, etc...)

Hospital: campus police show up in literally seconds.
Outpatient: police don't show up for 0-30 minutes depending on how close the closest police car is to the office when you call.

 

[nitemagi]

During Psych Sub-intern on inpt, I worked extensively with very sick pt:scz-affective, +AH, +SAx3, lot of self-injurious behavior, impulsive, whatever. It was a formative experience for me and at end of my elective she made this nice card thanking me and wishing me well during art therapy. This was 4-5 months ago.

Last month. I see her from time to time (I assume she has outpt appointments now), generally say hi, how are you. One afternoon I see her walking toward me and says "He wants me to go to the ER", I was a bit like "whats going on" to myself, and before I know it says "did you just call me a bitch", lifts a rock she already had in her hand and says "I'm going to bash your head". I create space quickly...she doesn't chase. Notify hospital police when I head back into the building, assume she would be tended to (read: CPEP or Psych ER).

Same day, leaving building after work, turn into my parking lot and hear "I got you now, bi*ch". It's her, all 400lbs, and a larger 5ft branch. She proceeds to chase (slow speed) me around the parking lot as I am on the cell with 911. NYPD responds, ambulance responds, she is now appropriate admitted again from what I hear.

Lesson: Never be complacent wrt safety. And 2, I love Psych.

I just love the visual of being chased by the 400 lbs woman.

 

[flash]

that is what every says when I share the story..add me yelling "stay away from me" over and over while backing up to the visual and it's funnier. Add the fact that she is missing 4 of her upper middle teeth and it's up there with the best Dave Chapelle(sp?) skits.

 

[Apollyon]

I had a guy the other day that was given an IM of 300 mg of Thorazine and he was still up and at 'em.

At least he didn't have any hiccups any more!

 

[skybliss]

What are you're experiences working with patients who have antisocial PD and their propensity to become violent? Specifically, have you seen any violence directed to psychiatrists when certain medications are not prescribed (like demanding benzos or stimluants), or they are involuntarily detained (and pissed about it) following suicide attempts or being violent?

this is going to be really strange, but i seriously have a question for you guys about antisocial PD.

My ex girlfriend who really messed up my head, actually, I think she has antisocial personality disorder. Almost everything she ever told me about herself was a lie. She is a compulsive lier. She is extremely manipulative. All of the nice things she does is completely planned out as well. Whenever we were together, it never occurred to me, but she never seems to have a conscience. She is extremely self-centered. Even when she hurts someone else, she is completely upset because she sees it as if they intruded on her rights.

Anyways, there's a lot more. But basically, she ****ed me up in the head and it took a while for me to get back on track. I haven't been able to find any other sources that talk about people who have accidentally dated antisocial PD people before.

Any feedback on what the pattern is?

 

[whopper]

We can't offer advice on specific people on an internet forum. It goes against the rules of the profession and the rules of the forum.