Toughest Patients?

[MJD503]

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I have come across an extremely tough patient to treat for a variety of aspects. He is very sedated it seems, ocd/schizoaffective, has made very little progress in his year stay in the state hospital and basically we're running out of options. Clozaril is the next step because it seems like it could be warranted eventually but parents are scared due to past experience.

Anyone else have any stories, advice or otherwise to share. Sympathy, Empathy?

 

[DrFocker]

I have come across an extremely tough patient to treat for a variety of aspects. He is very sedated it seems, ocd/schizoaffective, has made very little progress in his year stay in the state hospital and basically we're running out of options. Clozaril is the next step because it seems like it could be warranted eventually but parents are scared due to past experience.

Anyone else have any stories, advice or otherwise to share. Sympathy, Empathy?

I'll take a refractory ocd/shizoaffective over a borderline anyday. 😉

 

[ptolemy]

I'll take a refractory ocd/shizoaffective over a borderline anyday. 😉

I agree, borderline PD has to be one of the most difficult things to treat in medicine.

 

[bosky]

I just happen to have a patient similar to yours, but not schizoaffective - maybe this reference would help?.... Poyurosky et al. Obsessive-Compulsive Disorder in Schizophrenia - Clinical Characteristics and Treatment. CNS Drugs 2004:18(14) 989-1010.

Borderlines are pretty bad. But, I recently had a 40-ish needle-sharing homeless IVDU with 20-30 year drug dependency problems (opiate, EtOH, crack, xanax). Significant brain damage. I didn't feel much hope for him and felt his chance of a any outcome beyond a quick death was minimal.

 

[ptolemy]

Borderlines are pretty bad. But, I recently had a 40-ish needle-sharing homeless IVDU with 20-30 year drug dependency problems (opiate, EtOH, crack, xanax). Significant brain damage. I didn't feel much hope for him and felt his chance of a any outcome beyond a quick death was minimal.

thats sad, but not difficult to deal with... maybe slightly emotionally, but not in terms of management, you already know the outcome... I actually had a drug dependance, multiple incarcerations, borderline pt.- that was fun..

 

[MJD503]

Borderlines are not as hard as any of the schizophrenias to me. You might have trouble with borderlines because your thinking of treating them as 'doctor'. It helps me immensley to step down and put myself in the shoes of the person with Borderline PD. Why would I do what they are doing? What is this persons thinking like, in their terms, not in psych speak.

Schizophernia patients on the other hand do get better quicker and usually respond much,much,much better to medication than any BPD patient.. However, the real task is in finding ways to keep them out of the hospital and on there medications. In addition, you'll never understand what it is exactly what they are thinking or how it feels. Thus it's harder to treat the current issuse(s) or inflictment that brought on the thinking. I feel this is much more possible with borderline PD.

Just my .002