Interesting day for a PMHNP

  1. After many years of inpatient work, I took a job as a consultant in various LTC facilities in the area.

    One of the places was an Assisted Living program where many of the residents are chronically mentally ill. Many residents have a history of institutionalization. The state facilities here have been closing beds now for decades.

    The documentation and previous records available to me were scant, at best, and many of the residents are poor historians and have no relatives to contact for collateral information.

    Such was the context of meeting Bill. He had been prescribed Zoloft, but schizophrenia was mentioned previously in his very thin chart.

    Upon interview, his demeanor was somewhat odd. He was slovenly. He appeared to have either an intellectual disability, or cognitive impairment related to chronic mental illness. His engagement with me was poor. Yes and no type answers. I didn't get much. The diagnostic picture was unclear.

    Since he was behaviorally stable, I decided to do nothing and just watch him, which I did for the next 2 years.

    After a while, I made it a point to greet him by name whenever I saw him, and strike up a brief conversation if possible.

    In 2 years, I never saw anything that convinced me he needed anti-psychotics.

    Over time, I was beginning to establish a little rapport.

    One day, he asked me when was my birthday.

    Of course, in replying to any personal questions, one has to use caution, but I decided this was pretty safe. "August" I replied. It was six months away.

    "What day?" he asked. I told him.

    Without missing a beat, he said "it's a Wednesday".

    I didn't have my cell phone with me, but when I got home, I looked it up. Indeed, a Wednesday.

    From there, I started doing a little more research. The staff were intrigued, and we tested him on various dates, birthdays, wedding anniversaries, Christmas, etc.

    He was 100% accurate.

    This is how I learned that Bill has an autism spectrum disorder, and not schizophrenia.
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    About Oldmahubbard

    Joined: Dec '17; Posts: 680; Likes: 1,362

    6 Comments

  3. by   Jules A
    I had an elderly patient in a group home environment with a psychotic disorder diagnosis who it was quickly evident simply had a low end IQ and was somewhat impulsive back in the day when it was frowned upon to be labeled a loose woman. It was sad because she had been medicated within an inch of her life for decades and later did quite well on only a SSRI for anxiety.
  4. by   ruby_jane
    That's amazing! And encouraging. Thanks for sharing.
  5. by   inthecosmos
    Great work!
  6. by   yogagal
    Thanks for sharing, it really is amazing the things you will learn about a patient if you know them for a few years. Continuity of care really does matter!
  7. by   NutmeggeRN
    Quote from Oldmahubbard

    This is how I learned that Bill has an autism spectrum disorder, and not schizophrenia.
    I bet if a big study was done, there would be many of our elderly identified as being on the spectrum. Back years ago they were just the "odd Aunt Mary" or "crazy Uncle Joe"...
  8. by   hrnurse
    There's a definite increase in the number of elderly diagnosed with a mental illness , and the meds to go along with it . Trazodone and Risperidal used to be seen once in awhile on a MARS , now its every other pt .

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