The Turtle Suit Cure and "Tad"

Suicide Protection Gown and Blanket

When an inmate is suicidal, they are admitted into the Y-dorms aka Self Harm Observation Section (SHOS).  They are further stripped of their own identity and made so wear a dark green shroud.  Maybe shroud is the wrong word.  Imagine a dark green hospital gown without sleeves and is somehow padded.  In order to wear it, the turtle suit must be attached by velcro.  (See picture). To add to the comfort of an inmates new living quarters they are given a matching padded blankets and twin sized plastic mattress on the floor.  Like they're not depressed already.  Forget meds, these guys are acutely suicidal.  One inmate was admited to the Y dorms last night and miraculously after one night in that turtle hell he was cured.  When asked how he was feeling, he was just fine and ready to return to general population.  I'm telling you, all you need is a night in a turtle suit to cure you of suicidal tendencies!  His neighboring inmate was not as blessed.

We had two follow ups and an admit today.  I'll tell you about the more interesting case that also let me show off some skills on my psychotropic knowledge.  Let's call him Tad (don't ask, I like the name and it suits him).
It wasn't until his first visit to a juvenile detention center, at age 8, that it was discovered that he was schizophrenic.  He's been in and out of facilities since then.  He presented to us today for severe akathisia, which is a movement disorder side effect of his antipsychotic medication.  He was on such a low dose of antipsychotics because of his movement disorder that he was having active audio visual hallucinations while being interviewed.  I genuinely felt bad for him.  I have no clue what he did to arrive at the prison, nor do I really care.  I did care however that the residents were contemplating on giving him a new medication to control his movements not realizing that a side effect of it was to cause or worsen psychosis!  So yes, I said something to that effect.  One resident immediately got out his Synopsis of Psychiatry to look it up for himself and low and behold there it was in black and white.  One point med student.  I continued by making mention of another (cheap formulary) medication that was used to treat the movement disorder that had minimal side effects, a beta blocker.  And yes, it felt great that when they were on the computer googling it they found recommendations stating that a trial a beta blockers be done for akathisia. Two points.

Needless to say, besides flat out falling asleep at my chair this morning even after having coffee, it felt good to show that I knew something and am more than just an observing student.  Also, I look forward to following Tad's case.  Interesting doesn't even scratch the surface on this guy.