Doc Samson - Custody Excited Delirium?

[Anasazi23]

Was wondering your opinion (and others') on this.

http://www.knoxnews.com/kns/national/article/0,1406,KNS_350_5504713,00.html

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[OldPsychDoc]

Was wondering your opinion (and others') on this.

http://www.knoxnews.com/kns/national/article/0,1406,KNS_350_5504713,00.html

Sounds like the same defense the LAPD used after they beat Rodney K. to a pulp...

 

[Hurricane]

NPR did a two-parter on this issue recently:

http://www.npr.org/templates/story/story.php?storyId=7608386

Background: a few years ago the Cincinnati police attempted to subdue a very large man on PCP and cocaine, and he died in custody, and it was caught on film. I remember they talked a little bit about excited delirium in the media at the time, but the main focus was equipping the police with tazers after this incident.

youtube video: http://youtube.com/watch?v=NsR5CP1XQ6A

 

[Doc Samson]

Was wondering your opinion (and others') on this.

http://www.knoxnews.com/kns/national/article/0,1406,KNS_350_5504713,00.html

Why call it delirium? Why not mania or psychosis? It seems to have more in common with those diagnoses than with delirium. I didn't seem to notice any results of tox screens on these people - I agree with Hurricane, it does sound an awful lot like PCP intoxication, especially the super-human strength and fighting to the death. I once saw a guy intoxicated on PCP rolled into the ED on a gurney in locked leather 4-pts. He then promptly tore the railings off the gurney and tried to fight security with them still lashed to his wrists and ankles - looked kinda like Mothra from the Godzilla movies.

 

[Anasazi23]

I hear what you're saying.

I have had a couple cases, though, where the patient explains that shortly after they were placed in a cell, the thought of them not being able to get out caused them to enter a psychotic rage. Now of course the term here 'delirium' is a misnomer and I think you're right...this is due to underlying axis I or character pathology.

Just curious. In the example you gave about the man who tore the gurney railings off....are you in support of this type of person have police involvement and assualt charges brought against them? This is assuming no other non-substance use Axis I disorder exists.

Working in NYC, I too have seen lots of stuff like this, and can't help but think that simply that because someone was fortunate enough to have been brought in by ambulance instead of to a holding cell after being subdued, they will detox and more than likely have no long-term consequences for their abuses and assaultive behavior.

 

[Doc Samson]

My rule of thumb is I do not involve the police if someone's behavior can be directly attributed to an Axis I diagnosis (Axis II blurs the boundary a little - MR excluded, obviously). I've seen non-psychiatry ED nurses file charges after a psychotic pt punches them, and it never goes anywhere... By the time the police show up, the pt is on an inpatient unit, the charges eventually get to court (exacerbating the baseline illness due to the stress), and then the judges throw them out. A massive waste of time and money for everyone. I tend not to draw too much of a distinction between substance abuse DOs and other Axis I pathology... I just don't buy that "it's a choice they're making" argument.

 

[Anasazi23]

Interesting.

I'm somewhat less sympathetic toward substance abuse-induced assaults myself. On only one occassion did I have police involvement initiated by me about threats made by a patient. That was a case of a malingering depressive who was basically an antisocial drug addict and was refusing to leave the hospital. He nearly assaulted me and made threats to me and my family.

The only problem I have with your statement is that it leaves the potential for psychiatry to become overridden with any and all intoxicated people brought for evaluation or treatment rather than legal punitive measures imposed upon them.

The protypical example is the beligerent drunk who knocks his wife teeth's out in an inebriated state. Just this week I had a patient who was screaming at his wife so intensely, she actually required sutures on her nose since his screaming was so literally "in her face" that his teeth cut her nose pretty bad.

I'd call it my countertransference but I'm fully aware of my feelings toward these people/patients and my reactions.

 

[Doc Samson]

Interesting.

I'm somewhat less sympathetic toward substance abuse-induced assaults myself. On only one occassion did I have police involvement initiated by me about threats made by a patient. That was a case of a malingering depressive who was basically an antisocial drug addict and was refusing to leave the hospital. He nearly assaulted me and made threats to me and my family.

The only problem I have with your statement is that it leaves the potential for psychiatry to become overridden with any and all intoxicated people brought for evaluation or treatment rather than legal punitive measures imposed upon them.

The protypical example is the beligerent drunk who knocks his wife teeth's out in an inebriated state. Just this week I had a patient who was screaming at his wife so intensely, she actually required sutures on her nose since his screaming was so literally "in her face" that his teeth cut her nose pretty bad.

I'd call it my countertransference but I'm fully aware of my feelings toward these people/patients and my reactions.

Just because you're aware of it doesn't stop it from being your countertransference.