During residency, the only issues that bugged me when listening to people's woes was when I had a Cluster B patient.
However with time, I learned how to manage their symptoms & draw the line & not be manipulated by them. After that, dealing with Cluster B stopped bugging me.
My tolerance for these patients is pretty high. I'm currently running a female forensic unit with a lot of Cluster B patients. The previous psychiatrists just ignored them and dealt with them minimally, and it shows. I don't think they were being medicated right.
However since I've taken over, I've instilled rules on the patients--no one is allowed to talk to me while I'm talking to another patient (several of them used to rudely demand I interview that person while I was still interviewing another patient), I'll medicate one of them if they become agitated--this was something the previous doctors weren't doing. They know it I'll do it, and the agitation has decreased big time. A lot of that agitation was pure Axis II.
However having about half my patients with borderline or histrionic DO is demanding.
The new thing that's causing me some emotional frustration is having to court order medications on psychotic patients whose concentration & memory are fully intact. When you court order meds on a psychotic patient who is disorganized, the meds will clear them up & they won't remember what happened. If they do happen to remember, they're usually thankful you did it because they'll notice the improvement in their thinking. When you do it to a patient whose concentration & memory are fully intact-well they remember you did this to them & they get upset at you & stay upset at you.
Some of the lesser experienced people here may argue-why force medicate someone whose concentration & memory are intact? Well Schizophrenia-Chronic Paranoid Type-this is often times the case. I got a patient right now and she thinks she's got computer chips in her head giving her messages, that an evil person from Washington DC is responsible for this, and she put a minor in danger because of her delusional belief in this computer chip conspiracy, yet she is fully cognizant & organized. I put her on court ordered meds because she is refusing antipsychotic medication. I can't discharge her because she's dangerous. She stated she's going to go to Washington DC to attack the monster that put the computer chips in her head. I have enough evidence to believe she'll attack some random innocent person, thinking that person is the evil-doer who surgically implanted the chips in her head.
She now hates me and compares me to a Nazi doctor for experimenting on her. Interviewing her is difficult and I really sympathize with her because she believes she is correct.
Most of my patients are thankful for the treatment I give them--or will be within a few days to weeks after they clear from their psychosis. In her case, I'm fearing that even with the right antipsychotic treatment, her delusions have been with her for years, and they may be fixed-in which case getting her discharged is going to be very difficult. She is a highly educated woman who had a productive life before she was committed. She frequently complains about being on a unit with low functioning psychotic people and I sympathize with her situation. She's been stuck on the unit for several weeks because I couldn't start medications until the court heard my case. They didn't schedule the hearing for weeks. IMHO, this is an injustice to patients. Its not the fault of the medical system but the legal system. If a patient fits the necessity for court ordered meds, and the court will not hear the case for weeks--even months-it forces an extension in the duration of inpatient involuntary commitment.
I just had a case today on a different patient where court ordered meds were requested months ago, but they only heard the case today. Making it worse, I had to drive over an hour to get to the court, then the judge ruled to have it delayed because the defense attorney didn't do his homework and wanted to read the chart more--so now the case is going to happen about 3 weeks later. Geez, ok screw the fact that they just wasted 4 hours of my time and I still have just as much clinical responsibilities I need to get done in 40 hours a week, this poor patient has to stay in her psychotic state, for a few more weeks with no improvement because someone didn't do their homework?
For the past week the situation was bugging me, but I can't do more to accelerate her improvement to get her out.
