"Pleasantly Psychotic"

I've learned a lot about inpatient psychiatry so far in medical school.  I feel like the "real" psychiatry rotation is one where you do adult inpatient psychiatry.  On admission, many patients have florid mental illness, but what is rewarding is seeing them get better and seeing them respond to medicine.

I've been surprised sometimes at the stark difference.  Sometimes it's surreal seeing a patient suddenly become organized, with good insight, and very decreased signs and symptoms of schizophrenia.

But there have been many tense moments on the inpatient unit.  I've been scared about being harmed several times and I have been stalked around the unit several times.  I think the unpredictability of the unit gets to me sometimes.

My perception of mental illness has changed drastically.  I think the media depiction is terribly unfair and overstigmatizes things like depression, and even schizophrenia.  Put a psychotic patient on risperidone or paliperidone, and then see how their thoughts become clear, and their symptoms are reduced dramatically.  They become conversational, relaxed, with better concentration, attention, eye contact.  Their speech becomes organized, they stop hearing voices, and so on.

I've been so used to following patients who have psychosis with a homicidal ideation or who were very irritable and aggressive, but one time I followed a patient with psychosis who seemed to retain their very kind and polite personality.  I actually feel like you'd never pick up on them as a person with an illness unless you had really gotten to know them outside the unit.

The patient was special to me, probably because there was a lot of positive countertransference.  They always had a compliment for you and those around them and they were rather upbeat.

I'd never choose psychiatry as a career, however.  It's so emotionally draining and constantly monitoring your countertransference and your patients' transference provides additional wear on you. Also hearing stories about ghastly trauma patients have gone through (abuse, violence, etc) is hard.

The hours are fantastic, though.  I think this has been my most enlightening rotation, as well.

Thank you for your readership.