Interesting day for a PMHNP

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.