Psych

I've been relaxing with my family over the holidays, so no new medical updates. Overall, Psych wasn't a bad rotation. I would get to the hospital at 7:20 AM and return home before 4 PM. In between I would spend most of my time talking to alcohol/drug addicts. Crazy people on Thursdays. Once I had a psychotic patient who told me "I'm a werewolf. Please don't be afraid. I'm not a bad wolf. I'm a good wolf." This was a teenager admitted a week after the release of "New Moon." Coincidence?¹ If this was a shelf question and the the patient continued to talk about werewolves, would you...

A. Neither affirm nor deny the delusion, but gently redirect the interview
B. Ask the patient if vampires sparkle in daylight, to further categorize the mythology behind the patient's delusion
C. Assess lycanthropy status by pressing sterling silver against the patient's skin and monitoring for severe contact dermatitis
D. Reveal that you are a member of the undead and the patient's sworn enemy to test his resolve
E. Recognize that your werewolf/vampire jokes are a coping mechanism for dealing with the pain of watching a young life torn apart by mental illness

...?

I had a tense half-second when the patient I'm describing made a sudden movement that made me think he was going to bite me, but he did not. (I thought up more werewolf jokes to process that one too.)

However, the only time I was genuinely afraid of a patient was with a short, elderly woman who hated black people. I don't know how much of it was mental illness or her underlying personality, but after five minutes on the genetic superiority of the 'German race' (her race?) and the depravity of 'Africans' I was actually nauseated. This woman's care was managed on an outpatient basis. I am glad I am not her physician, because as I fall asleep I still occasionally think of her out there, setting someone's house on fire.


1. Ayche RC, et al. Twilight series makes people literally crazy: case study of first break schizophrenia in a teenage male. N Engl J Med 2010 Jan 7; 362(1)