Got Me Feeling So Crazy Right Now

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Welcome to M4 Medicine, mystery,
mayhem, and sometimes murder.

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I'm Andrea Marciano and RN with
35 years of experience across

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various fields.
From direct patient care in

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hospitals to home health,
geriatrics, and injury medicine,

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I face life, death, and
everything in between.

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And I'm Crystal Miller and RN
with 13 1/2 years of experience.

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My work spans home health,
Hospice, emergency care,

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geriatrics, and occupational
health.

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From the chaos of trauma based
quiet moments with patients,

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I've seen stories that defy
explanations.

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We've been friends for over 25
years and as nurses we've shared

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countless stories that have left
us and our families speechless.

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Now we're bringing those stories
and many more to you in

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medicine, mystery, mayhem, and
sometimes murder.

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Each week, we'll uncover cases
that challenge the boundaries of

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medicine, sharing the human
stories behind the science.

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From puzzling medical mysteries
to shocking real life crimes,

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we'll bring you stories that'll
leave you questioning everything

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you thought you knew while.
We're both experiencing these

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nurses.
We want to make it clear we're

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not here to give medical advice.
This podcast is about

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storytelling, education and
exploration, not diagnosing or

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treating medical conditions.
This is medicine, mystery,

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mayhem and sometimes murder.
Let's dive in.

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Hey Crystal, how are you doing?
I'm doing well.

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How are you?
I'm well, thank you.

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Anything exciting going on?
News of the day something.

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I wouldn't call it exciting, but
I won the rock, paper, scissors

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to not have to go grocery
shopping today.

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Who was in contest?
Who was the?

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Other person Holly's now grocery
shopping.

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Yay for Holly on a Sunday.
Yep.

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Oh dear.
For our listeners, we usually

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record on Sundays, so this
Sunday to me is one of the

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busiest grocery shopping days
and I almost never go.

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Not in Utah.
Well, that's true.

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At least it didn't used to be.
In Utah, because it was much

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less busy.
This is true.

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I you don't like grocery?
Shopping I hate grocery shopping

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and part of what I hate about it
is not just the shopping itself,

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but it's the fact that every
time I bring groceries home, my

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kids just eat them and then I
have to do it again those.

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People.
So I wish I had AI, wish I had a

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grocery conveyor belt that I
could just have push a button.

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Jetson's right where?
Where are our Jetson times, man?

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Well, I feel, I feel that's
called Instacart.

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I know that's usually I usually
use Instacart or or sorry

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everybody, Walmart delivery
because I don't I actually don't

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have time for it.
You know what I mean?

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I got a lot of stuff going on
and it's nice to get steps in,

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but it usually wears me out so.
Yeah, I get that.

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Dude.
I went to get a new provider

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lately talking about steps in
around our property, which for

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those who haven't been here,
it's about 11 acres.

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And we don't walk all of it, but
I walk between 4:00 and 5:00

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miles a day.
You know.

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And I don't lose weight and I
said what not?

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Fair.
With that, and she said, well,

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unfortunately now four or five
miles of walking a day is your

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baseline.
That's not fair.

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It is not.
And I told her that.

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I said that's just rude.
And she said, I know.

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And I said, well, I, I didn't
say this, but I was thinking,

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well, so maybe I should sit
around like a slug for about a

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month and then maybe I'll lose
weight.

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I just thought.
And then we talked about

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menopause, which we've talked
about a few times.

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And I said, well, this is bogus.
She said, Yep, and this is not

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right.
Yep, Yep.

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Like this is not good.
You're not helping me.

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This isn't fair.
It's not fair and I said that

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several times during our
appointments anyway.

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So when you go when back to the
grocery shopping thing, when

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Holly is grocery shopping, do
you guys make a list when you go

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shopping?
We have a running list that the

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kids can all add things to in a
notebook.

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Actually just sits on our dining
room table.

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A physical notebook.
What kind of people are you?

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Gen.
X, yeah.

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I've got I've got a notebook but
it's called Alexa.

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Well, yeah, we don't have Alexa
or anything.

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So, and we're always adding
stuff to the list.

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And when our granddaughter was
here, she added, what was it?

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She added?
She added it about four times

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every time.
I can't remember what it was

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that she always oh, bagels she
wanted bake.

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She'd say add bagels to the
Costco list, which it might be

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doing right now, but.
We get bagels every time.

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Bagels are a big thing in my
household.

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I started cooking my own.
They're actually pretty easy to

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do and they're delicious.
I.

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Should try that.
I'm coming to I'm in a cooking

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and baking mood right now.
I tried to make Amish friendship

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of an Amish friendship bread
starter but I think I killed it

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so I threw away.
Remember back in the day when we

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kept getting those and I Oh my
gosh, I had it.

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It seemed like for about 3 years
I was getting it every week from

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somebody.
I got the recipe online from

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somebody who has their starter
from 1987 still and I'm like.

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I my my sourdough start is
almost that old but I use

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sourdough all the time.
That Amish friendship bread is

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really good, but it is in no way
healthy so.

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Yeah, yeah, no kidding.
Well, 5:00.

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Cups of sugar.
We named it Freddy Krueger, so

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it was a lot of fun.
So we'd be like, I massage

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Freddy Krueger today.
And then I had to announce on

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the last day I said Freddy
Krueger died today.

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Sad.
Sad day.

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Oh my golly, that's hilarious.
Oh my gosh.

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Well, anyway, what do you have
for us today?

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Today I have an interesting
topic.

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I think this one's going to get
a little more technical than

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some of the ones we've done.
Hopefully it's not too technical

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that it's still interesting for
our non-technical, non clinical

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listeners, but it is
misdiagnosis of psychiatric

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conditions.
My main sources are all from or

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based on Susanna Callahan.
So she has a book called Brain

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on Fire, My Month of Madness 1,
called The Great Pretender, the

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undercover mission that changed
our understanding of madness.

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And then she was interviewed for
an interview in the Guardian

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called Susanna Callahan.
What I remember most vividly are

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the fear and anger.
And then I'll put the rest of

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the, I'll put the rest of the
sources in the show notes.

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There's actually quite a few
more.

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I'm not going to list them all
off SO.

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Wow.
OK, great.

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Yeah, this story is really
interesting to me.

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And like I said, I hope I can
keep it interesting for for our

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listeners.
So psychosis often sits at the

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uneasy border between psychiatry
and neurology, between medicine

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and mystery.
It's a condition where

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perception, belief and behavior
can break from reality itself.

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But what happens when the
diagnosis is what's disconnected

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from reality?
In hospitals around the world,

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homeless patients are diagnosed
every year with schizophrenia,

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bipolar disorder or substance
induced psychosis.

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Many of those diagnosis are
accurate, but some are

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tragically wrong.
The consequences of these errors

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ripple across lives, unnecessary
medications, stigma, lost years,

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and in some cases, near death
experiences.

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Perhaps no modern story
illustrates this better than

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that of Susanna Callahan, a
young journalist whose Month of

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Madness air quotes revealed not
a psychiatric disorder but a

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misfiring immune system.
Her journey from respected

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reporter to psychiatric patient
to medical mystery exposed how

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easily psychosis could be
mistaken for mental illness when

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the true culprit lies in the
brain itself.

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Psychosis is not a single
disease.

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It's a syndrome.
Sorry, it's a syndrome, a

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cluster of symptoms that can
appear in many disorders.

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Some of these symptoms are
hallucination, delusions,

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disorganized thoughts, bizarre
behaviors.

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Lot of those can stem from
schizophrenia or bipolar

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disorder or depression or
substance use or brain injury or

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autoimmune illness or the
metabolic dysfunction.

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And you can see already all of
these, all of these things that

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are overlapping like this is the
Venn diagram from hell, right?

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So diagnosis does not rely on
lab tests or brain scans, but on

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the interpretation of what the
clinician sees, hears, and

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believes.
So without clear biological

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markers, psychiatry often works
by exclusion.

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That lack of objectivity leaves
enormous room for error.

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A2024 review found that
psychiatric misdiagnosis remains

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among the most common and
consequential forms of medical

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error.
So that was a statistic that

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really surprised me.
That's wild, and it's so

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difficult too, because moment to
moment it can look different,

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even each person.
Exactly, exactly.

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Psychosis then, becomes both the
medical and philosophical

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problem.
It tests not only the limits of

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our diagnostic tools, but also
the boundary between mind and

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body.
So in 2924, year old journalist

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Susanna Callahan was thriving at
the New York Post when strange

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symptoms began to creep into her
life.

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At first it felt like the flu.
Fatigue, irritability,

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headaches.
Then came paranoia.

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She was convinced her boyfriend
was cheating, that her father

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had harmed her stepmother, and
she soon begin having

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hallucinations, seizures and
losing track of time.

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Doctors searched for
explanations.

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One thought it was bipolar
disorder.

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Another alcohol withdrawal.
Still others labeled it a

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psychotic break.
Callahan's condition

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deteriorated rapidly.
She became violent, incoherent

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and catatonic.
EE, GS and MRI's appeared

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normal.
Psychiatric words loomed to

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everyone, including her family.
It looked like she was losing

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her mind.
But beneath the psychosis,

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something else was happening.
Her immune system had begun

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attacking the NMDA receptors in
her brain, the receptors that

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are vital for memory, emotion
and reasoning.

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Neurologist Dr. Sohail Najar
changed everything during an

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evaluation.
He handed Callahan a blank sheet

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of paper and asked her to draw a
clock.

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She clustered all the numbers on
the right side, an unmistakable

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sign of right hemisphere brain
dysfunction.

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Are you familiar with the clock
test?

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Absolutely.
And it's, it's most often that

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I've seen used for things like
Alzheimer's and stroke and yeah,

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stroke and also other dementia.
A Spinal Tap revealed

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inflammation test confirmed anti
NMDA and cephalus colitis, a

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rare autoimmune brain disease
only recently identified.

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Treatment with steroids, IV
immunoglobulin and plasma

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exchange saved her life.
Within months the quote UN quote

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madness vanished.
She would She later learned she

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was the 217th person in the
world to receive this diagnosis.

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Oh my gosh.
Yeah, so like I said when I was

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mentioning my my sources.
Her story told him brain on

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fire.
My month of madness became a

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best seller and a warning to the
medical world.

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Callahan's experience, though
extraordinary, is not unique in

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principle.
Studies reveal consistent

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reasons why psychosis is
misdiagnosed.

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Moose, Moose.
Moose.

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Moose have a real problem with
it.

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Moose have a real psychotic
problem.

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I understand that they are kind
of weird.

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Mood disorders and schizophrenia
can both feature hallucinations

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or delusions.
In early phases, they may look

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identical.
In one study, nearly 60% of

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bipolar patients were initially
misdiagnosed with schizophrenia.

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This also stunned me because
those are as far as the

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difference in the gravity of
those two diagnosis, right?

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A patient with bipolar, although
they may have hallucinations and

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delusions, is not not going to
have the same problems that a

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person with schizophrenia,
untreated, I should say

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schizophrenia, is going to have.
I'm sorry, it was just going to

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ask.
The one thing that I remember

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schizophrenia having a really
big aspect in is the voices

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telling a person to do XY or Z,
right?

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00:11:44,840 --> 00:11:47,040
Is that schizophrenia?
Yeah, that's schizophrenia.

232
00:11:47,040 --> 00:11:48,960
That's one, one form of
schizophrenia.

233
00:11:48,960 --> 00:11:50,640
Yeah.
First of all, I wanted to say

234
00:11:50,640 --> 00:11:52,240
I've been diagnosed with
bipolar.

235
00:11:52,640 --> 00:11:54,800
I don't have hallucinations, or
at least I don't think I do.

236
00:11:54,800 --> 00:11:56,600
Or delusions, maybe.
Maybe I do.

237
00:11:56,640 --> 00:11:58,040
I don't know.
I've been meaning to talk to

238
00:11:58,040 --> 00:12:01,600
you.
But I can't imagine initially

239
00:12:01,600 --> 00:12:06,040
being diagnosed with
schizophrenia that would that

240
00:12:06,040 --> 00:12:08,520
would scare me.
You know, just like that just

241
00:12:08,520 --> 00:12:11,600
seems so much more serious, for
lack of a better word.

242
00:12:11,760 --> 00:12:14,760
Well, do you feel like you it's
an accurate diagnosis for you?

243
00:12:15,000 --> 00:12:18,960
I didn't until it was my sleep
doctor that suggested it as we

244
00:12:18,960 --> 00:12:20,520
were talking about my sleep
habits.

245
00:12:20,520 --> 00:12:24,960
Then I went to my psychiatrist
and she said that I'm going to

246
00:12:24,960 --> 00:12:28,000
misquote her probably.
So if you interview our

247
00:12:28,000 --> 00:12:30,400
psychiatrist that I'm saying
this wrong, this is my

248
00:12:30,400 --> 00:12:33,000
remembrance and I'll admit it
probably not perfect.

249
00:12:33,000 --> 00:12:37,600
But I believe she said what
because your sleep doctor

250
00:12:37,600 --> 00:12:39,360
suggested it.
One of the best ways to figure

251
00:12:39,360 --> 00:12:42,560
it figure it out is to actually
medicate you by bipolar and see

252
00:12:42,560 --> 00:12:44,280
if it makes a difference.
And it did.

253
00:12:44,920 --> 00:12:48,480
So, well, and I think that for
me, when I think of bipolar, I

254
00:12:48,480 --> 00:12:50,480
think of it being much more
extreme than I've ever

255
00:12:50,480 --> 00:12:52,600
experienced you being.
And you know, we've known each

256
00:12:52,600 --> 00:12:54,440
other a long time.
It's actually not.

257
00:12:54,520 --> 00:12:57,960
That's a huge misconception.
Misconception.

258
00:12:57,960 --> 00:13:03,000
Misconception that it is always
extreme it's actually much more

259
00:13:03,000 --> 00:13:07,080
common for it to be not so
extreme like we what we see in

260
00:13:07,080 --> 00:13:09,400
the news and what we see in the
movies and stuff that's the

261
00:13:09,400 --> 00:13:12,320
extreme end of it.
But for me, so so my biggest

262
00:13:12,400 --> 00:13:15,480
like what did being treated with
medication due for me, it made

263
00:13:15,480 --> 00:13:17,800
me sleep better.
So now I'm not staying up for 12

264
00:13:17,800 --> 00:13:21,880
days in a row or, you know, RIP
Van Winkling for three days in a

265
00:13:21,880 --> 00:13:23,240
row.
Oh yeah, because that would have

266
00:13:23,240 --> 00:13:25,080
been manic and then depressive.
Episodes.

267
00:13:25,240 --> 00:13:26,640
Yeah, exactly.
Exactly.

268
00:13:27,240 --> 00:13:30,440
I didn't put it together.
I think you've seen me Rip Van

269
00:13:30,440 --> 00:13:36,080
Winkle for sure.
So for those who don't don't

270
00:13:36,080 --> 00:13:38,320
understand what I'm saying, my
sister calls it RIP

271
00:13:38,320 --> 00:13:40,480
bandwinkling.
When I sleep for like 17 hours

272
00:13:40,480 --> 00:13:44,080
straight or 26 hours straight,
It's just like, but I haven't

273
00:13:44,080 --> 00:13:47,040
done it since I once I started
being medicated and I also like

274
00:13:47,040 --> 00:13:49,400
can get to sleep at a normal
time and I wake up at a normal

275
00:13:49,400 --> 00:13:51,280
time and I hate it.
Nobody's day should start at

276
00:13:51,280 --> 00:13:52,240
8:00 AM.
That's just.

277
00:13:52,280 --> 00:13:55,040
I know I've been noticing that
you've been sending me texts at

278
00:13:55,040 --> 00:13:57,200
morning time that I thought why
are you awake?

279
00:13:58,760 --> 00:14:01,840
I figured medication.
I know I figured you must have

280
00:14:01,840 --> 00:14:04,480
meetings and last night when and
I was messing to you and I knew

281
00:14:04,480 --> 00:14:05,960
it was late for you.
I'm like, well she's awake

282
00:14:05,960 --> 00:14:09,240
anyway so it didn't occur to me
that you could actually be

283
00:14:09,240 --> 00:14:11,840
asleep.
That's great though, if that's

284
00:14:11,840 --> 00:14:13,520
helping your sleep.
Yeah, totally.

285
00:14:13,760 --> 00:14:16,520
Anyway, thank you for that.
You're very welcome.

286
00:14:16,720 --> 00:14:20,320
So drugs, infections, autoimmune
conditions, metabolic disorders,

287
00:14:20,320 --> 00:14:23,520
or even sleep deprivation can
induce psychosis like symptoms.

288
00:14:23,560 --> 00:14:26,600
Substance induced psychosis are
especially common in emergency

289
00:14:26,600 --> 00:14:28,440
settings.
That's one of the things.

290
00:14:28,520 --> 00:14:31,280
OK, so I tell the story a lot.
I don't know.

291
00:14:31,480 --> 00:14:34,000
It doesn't matter to me, but I
like to tell it because I think

292
00:14:34,000 --> 00:14:36,920
it's funny.
When I was working at a nursing

293
00:14:36,920 --> 00:14:40,800
home and I was the ADON
assistant director of nursing,

294
00:14:41,000 --> 00:14:44,360
there was a time I came into our
stand up meeting and I had been

295
00:14:44,360 --> 00:14:47,120
awake for 12 days straight.
And the reason I think it's

296
00:14:47,120 --> 00:14:50,920
funny is because the Guinness
Book of World Records, at least

297
00:14:50,920 --> 00:14:52,400
last time I checked, it was 11
days.

298
00:14:52,400 --> 00:14:55,880
So I'm like I said, I we need to
get a spec of world records that

299
00:14:55,880 --> 00:14:57,720
didn't even know it because I
didn't find out about it until

300
00:14:57,720 --> 00:14:59,720
years later.
But anyway, I remember I was in

301
00:14:59,720 --> 00:15:02,120
the stand up meeting and and
that's just the beginning

302
00:15:02,120 --> 00:15:04,520
meeting of the day, kind of get
the day sorted and what are we

303
00:15:04,520 --> 00:15:06,000
going to do today and etcetera,
right?

304
00:15:06,000 --> 00:15:07,240
What do we need to focus on?
Whatever.

305
00:15:08,040 --> 00:15:12,880
And I remember my boss asked me
something and I just responded

306
00:15:12,880 --> 00:15:15,720
with absolute gibberish.
I mean, not English at all.

307
00:15:16,000 --> 00:15:18,480
And he was like, are you OK?
And I was like, I haven't slept

308
00:15:18,480 --> 00:15:20,400
for 12 days.
And he was like, I'm taking you

309
00:15:20,400 --> 00:15:23,840
home, not not to his house, back
to my house right now.

310
00:15:24,160 --> 00:15:27,200
And you need to go to sleep it.
When he took me home, I, I was

311
00:15:27,200 --> 00:15:29,920
actually able to sleep.
Yeah, it's just like.

312
00:15:30,000 --> 00:15:33,200
And so I have personally
experienced sleep.

313
00:15:33,560 --> 00:15:37,840
I'm being dyslexic today too.
Sleep deprivation psychosis or

314
00:15:37,840 --> 00:15:41,280
or the very least sleep
deprivation hallucinations,

315
00:15:41,320 --> 00:15:44,240
right.
Just it was very strange.

316
00:15:44,280 --> 00:15:46,880
When there's been a lot of
studies on people that have been

317
00:15:46,880 --> 00:15:50,840
put into sleep deprivation
situations and how they respond

318
00:15:51,120 --> 00:15:54,280
and a lack of sleep actually
seems to have a greater impact

319
00:15:54,280 --> 00:15:57,120
on reflexes and things like that
than being drunk.

320
00:15:57,720 --> 00:15:59,800
Not that, not that you know you
can.

321
00:16:00,120 --> 00:16:04,120
You can actually receive a
parking or excuse me, a moving

322
00:16:04,120 --> 00:16:08,000
violation for being overly tired
because you're still in a

323
00:16:08,000 --> 00:16:09,840
reckless way.
You just aren't drunk.

324
00:16:10,320 --> 00:16:13,440
Yeah, I think that's why some
states have DUI driving under

325
00:16:13,440 --> 00:16:16,440
the influence instead of DWI
driving while intoxicated,

326
00:16:16,440 --> 00:16:20,560
because it does open the door
for things other than just drugs

327
00:16:20,560 --> 00:16:24,480
and alcohol.
Yeah, could be, but it's still,

328
00:16:24,480 --> 00:16:27,200
it would fall into the impaired
driving at least.

329
00:16:27,520 --> 00:16:31,480
Yeah, which is, I know that I
saw something once where there

330
00:16:31,480 --> 00:16:35,560
was a group of people who wore
those drunk glasses when they

331
00:16:35,560 --> 00:16:39,600
were tired and they had the same
vision with and without the

332
00:16:39,600 --> 00:16:41,760
glasses when they were that
tired.

333
00:16:41,760 --> 00:16:44,240
Like with 12 days, most people
would have fallen over.

334
00:16:44,400 --> 00:16:46,560
Yeah, I don't even know.
I didn't live far from work, but

335
00:16:46,560 --> 00:16:48,960
I don't even know how I drove
into work that day, honestly.

336
00:16:49,000 --> 00:16:51,760
Yeah.
So I want to talk, or I want to

337
00:16:51,760 --> 00:16:54,440
point out a little.
The effect of clinician bias and

338
00:16:54,440 --> 00:16:58,200
systemic shortcuts, time
pressures, anchoring bias, and

339
00:16:58,600 --> 00:17:02,400
and lack of interdisciplinary
collaboration lead to premature

340
00:17:02,400 --> 00:17:06,599
labeling of of psychosis or
schizophrenia or other mental

341
00:17:06,599 --> 00:17:09,040
illnesses.
Racial disparities compound the

342
00:17:09,040 --> 00:17:10,599
issue.
Black patients are over

343
00:17:10,599 --> 00:17:13,720
diagnosed with schizophrenia
even when mood symptoms

344
00:17:13,720 --> 00:17:15,640
dominate.
When you said the first thing

345
00:17:15,640 --> 00:17:18,520
about lack of collaboration, I
mean, we do know that people of

346
00:17:18,520 --> 00:17:22,079
color tend to have worse
outcomes in so many different

347
00:17:22,079 --> 00:17:25,000
ways in the medical field.
But what do you mean with a lack

348
00:17:25,000 --> 00:17:26,680
of collaboration at what does
that mean?

349
00:17:26,680 --> 00:17:28,079
Are you going to go into detail
on that?

350
00:17:28,359 --> 00:17:32,080
Lack of collaboration, like with
a psychiatrist, speaking to a

351
00:17:32,080 --> 00:17:35,760
neurologist or psychiatrist,
speaking to a family care

352
00:17:35,760 --> 00:17:40,480
provider, even even Speaking of
interdisciplinary collaboration,

353
00:17:40,480 --> 00:17:43,560
but even maybe speaking to the
person's family additionally,

354
00:17:43,560 --> 00:17:47,760
like psychiatry.
I think this comes up later in a

355
00:17:47,760 --> 00:17:51,280
minute since I read this, but
over but psychiatry is all

356
00:17:51,400 --> 00:17:55,000
opinion because every all the
information you're getting is

357
00:17:55,080 --> 00:17:58,480
subjective.
There is really not a lot of

358
00:17:58,480 --> 00:18:01,920
objective data for psychiatric
diagnosis.

359
00:18:02,160 --> 00:18:06,040
Yeah, I was listening to podcast
recently where a psychiatrist

360
00:18:06,040 --> 00:18:11,240
had diagnosed the the accused of
a certain disorder and it turned

361
00:18:11,240 --> 00:18:15,120
out that he a had only spent a
couple of hours with him and

362
00:18:15,120 --> 00:18:18,400
some of the tests he used are
known to be inconsistent or

363
00:18:18,400 --> 00:18:21,000
inconclusive, especially when
they stand alone.

364
00:18:21,040 --> 00:18:23,280
So that's interesting.
And also, I would think that

365
00:18:23,280 --> 00:18:25,960
some of that collaboration goes
back to where you were talking

366
00:18:26,480 --> 00:18:28,720
where if it was just a
psychiatrist, they might have

367
00:18:28,800 --> 00:18:32,080
not have done a Spinal Tap.
It was just a position, may not

368
00:18:32,080 --> 00:18:34,440
have done any of the psychiatric
evaluations.

369
00:18:34,920 --> 00:18:36,560
So I get that.
That makes sense.

370
00:18:36,760 --> 00:18:40,440
And The thing is too is that
early air quote psychosis may

371
00:18:40,440 --> 00:18:43,680
change form.
What begins as psychotic

372
00:18:43,680 --> 00:18:47,640
depression may evolve into
bipolar disorder or like in

373
00:18:47,800 --> 00:18:50,400
Susanna Callahan's case, reveal
A neurological disease.

374
00:18:50,840 --> 00:18:54,920
So antipsychotic drugs, while
life saving for true psychotic

375
00:18:54,920 --> 00:18:57,840
disorders, can cause serious
side effects, metabolic

376
00:18:57,840 --> 00:19:00,400
syndrome, tremors, tardive
dyskinesia.

377
00:19:00,400 --> 00:19:02,600
Do you want to describe what
tardive dyskinesia is?

378
00:19:03,080 --> 00:19:06,360
Yeah, that's something that when
I was working for a long term

379
00:19:06,360 --> 00:19:08,720
care facility, we had a lot of
people on antipsychotic

380
00:19:08,720 --> 00:19:11,240
medications.
So we had to watch for tardive

381
00:19:11,240 --> 00:19:14,440
dyskinesia, which is involuntary
tremors.

382
00:19:14,800 --> 00:19:19,480
And often what's interesting is
that the gate that they have can

383
00:19:19,480 --> 00:19:22,400
look like Parkinson's.
That's sort of a shuffling gate.

384
00:19:22,680 --> 00:19:25,720
But the rest of them, they'll
have movements in their hands or

385
00:19:25,720 --> 00:19:28,000
their faces, especially their
faces.

386
00:19:28,000 --> 00:19:30,080
They'll have twitches and
tremors in their faces.

387
00:19:30,360 --> 00:19:34,160
And then they have, it reminds
me when I see someone who's

388
00:19:34,160 --> 00:19:37,520
heavily involved in drugs does
some of the same sort of weird

389
00:19:37,520 --> 00:19:40,240
hand movements where it's
uncontrolled and doesn't make

390
00:19:40,240 --> 00:19:43,360
sense to what's going on.
And that's one of the there's

391
00:19:43,360 --> 00:19:45,800
times that people get to work
together to figure out what,

392
00:19:45,800 --> 00:19:48,240
what is it.
And unfortunately, tardive

393
00:19:48,520 --> 00:19:51,560
dyskinesia is usually not
curable.

394
00:19:51,680 --> 00:19:53,880
Once a person gets it, they're
usually in it.

395
00:19:54,480 --> 00:19:56,880
But taking away the medications
doesn't make it go away.

396
00:19:57,200 --> 00:19:59,600
Correct.
And it was very well known when

397
00:19:59,720 --> 00:20:01,200
people were taking a lot of
lithium.

398
00:20:01,200 --> 00:20:04,160
That was one of the very common
side effects with lithium, Yeah,

399
00:20:04,320 --> 00:20:06,640
which was used for
antidepressant experiences.

400
00:20:06,840 --> 00:20:09,880
There's a lot of psychiatric
medicine going into old people

401
00:20:09,880 --> 00:20:12,000
in nursing homes.
There really is.

402
00:20:12,800 --> 00:20:15,320
Yeah, that's a whole other
tangent.

403
00:20:16,280 --> 00:20:19,440
So obviously when prescribed to
someone who doesn't need them.

404
00:20:19,440 --> 00:20:22,720
So antipsychotic drugs can
worsen suffering without

405
00:20:22,720 --> 00:20:26,760
benefit, right?
Another thing is that a lack of

406
00:20:26,760 --> 00:20:30,200
collaboration with other
disciplines can delay proper

407
00:20:30,200 --> 00:20:32,440
treatment.
So, for example, in autoimmune

408
00:20:32,440 --> 00:20:35,960
encephalitis, time is brain.
And so the longer the

409
00:20:35,960 --> 00:20:38,200
inflammation continues, the
higher the risk of permanent

410
00:20:38,200 --> 00:20:41,160
damage.
Early immunotherapy is crucial

411
00:20:41,520 --> 00:20:45,000
and Susanna Callahan spent a
month under the wrong diagnosis

412
00:20:45,000 --> 00:20:47,320
before being treated and.
She's like, it was only a month,

413
00:20:47,320 --> 00:20:48,200
really.
Right.

414
00:20:48,200 --> 00:20:49,600
She really is.
She's very lucky.

415
00:20:49,640 --> 00:20:52,760
And she's very lucky that she
did not have more serious side

416
00:20:52,760 --> 00:20:54,120
effects.
She's lucky that she can still

417
00:20:54,120 --> 00:20:56,240
write, write and read and all of
those things.

418
00:20:56,240 --> 00:20:59,880
You know, I'm, I'm very happy
for her that it was not worse.

419
00:21:00,000 --> 00:21:02,960
And remind me how old she was.
I believe she was 23, but let

420
00:21:02,960 --> 00:21:04,440
me.
Yeah, I thought she was young

421
00:21:04,560 --> 00:21:06,680
and.
And that makes me feel like

422
00:21:06,680 --> 00:21:10,760
they're. 24 She was 24 years
old. 24 And I feel like the fact

423
00:21:10,760 --> 00:21:14,080
that she was young probably and
was involved in her good

424
00:21:14,080 --> 00:21:17,080
recovery where if you were older
and had other search of brain

425
00:21:17,080 --> 00:21:19,920
lesions and things like that, it
might not have been as good.

426
00:21:19,920 --> 00:21:22,800
And that is theory by Andrea.
I have no basis on that other

427
00:21:22,800 --> 00:21:24,680
than just knowing that there's
already potential essentially

428
00:21:24,680 --> 00:21:26,600
brain damage with an older
person.

429
00:21:26,880 --> 00:21:30,960
And so when asked what was the
scariest part, Callahan said

430
00:21:30,960 --> 00:21:33,400
that the scariest part was not
losing control.

431
00:21:33,400 --> 00:21:37,680
It was losing herself and
gaining labels that she knew

432
00:21:37,760 --> 00:21:40,560
could potentially alter
relationships, employment, and

433
00:21:40,560 --> 00:21:42,360
even her own self self worth.
Right.

434
00:21:42,480 --> 00:21:46,160
Like I had just recently said,
being told one has schizophrenia

435
00:21:46,560 --> 00:21:48,400
can be scary.
And it's not just scary for the

436
00:21:48,400 --> 00:21:51,600
person receiving the diagnosis,
it can be scary for those that

437
00:21:51,800 --> 00:21:55,000
are around that person, right?
I mean, I, I think that most

438
00:21:55,000 --> 00:21:58,120
people, if you were to ask them,
when you think of schizophrenia,

439
00:21:58,120 --> 00:22:00,560
what do you think of?
They're probably going to say

440
00:22:00,840 --> 00:22:05,000
serial killers or harm people
who harm other people or crazy

441
00:22:05,000 --> 00:22:06,680
people.
And it's just there.

442
00:22:06,880 --> 00:22:10,680
We have a stigma.
We have a stigma based on the

443
00:22:10,880 --> 00:22:15,840
label of schizophrenia,
schizophrenia and whether we

444
00:22:15,840 --> 00:22:18,960
like it or not, the labels that
we create and that we pass

445
00:22:18,960 --> 00:22:21,920
around other people state their
self concept.

446
00:22:22,160 --> 00:22:24,240
So.
Yeah, No, it's true.

447
00:22:24,240 --> 00:22:28,760
And and when we hear about the
big bad guys, they have one of

448
00:22:28,760 --> 00:22:31,640
these disorders often and that
doesn't help.

449
00:22:31,720 --> 00:22:34,680
And you know, we so often talk
about a spectrum.

450
00:22:35,120 --> 00:22:38,040
And I think this is like
anything where there are stages

451
00:22:38,040 --> 00:22:40,640
and grades of whatever the
disorder is.

452
00:22:41,200 --> 00:22:44,720
So some people will have it in
association with other things.

453
00:22:44,960 --> 00:22:47,240
Some people will have it in a
mild degree.

454
00:22:47,360 --> 00:22:50,440
Now with this Suzanne, right?
Susanna.

455
00:22:50,720 --> 00:22:52,120
Susanna.
Oh, yeah.

456
00:22:52,160 --> 00:22:54,680
Was she aware of what was
happening?

457
00:22:54,680 --> 00:22:58,800
I mean, did she have knowledge
of kind of losing her grasp or

458
00:22:59,000 --> 00:23:01,000
did she know this was happening
to herself?

459
00:23:01,280 --> 00:23:03,240
I didn't mention it.
Yeah, she did.

460
00:23:03,520 --> 00:23:07,600
But I mean to a point, like like
I said, she basically lost

461
00:23:07,600 --> 00:23:10,000
herself.
And so she could feel as she

462
00:23:10,000 --> 00:23:12,200
experienced the losing of
herself.

463
00:23:13,760 --> 00:23:16,760
And, and it's funny, I've, I've
gotten ahead of myself a little

464
00:23:16,760 --> 00:23:20,680
bit in this podcast, but I
wanted to just say that not only

465
00:23:20,680 --> 00:23:24,720
does misdiagnosis threaten
people's health and well-being

466
00:23:25,800 --> 00:23:30,840
emotionally, medically,
culturally, etcetera, it wastes

467
00:23:30,840 --> 00:23:33,840
medical resources.
We have unnecessary admissions,

468
00:23:33,840 --> 00:23:37,280
inappropriate drugs, long term
care and it diverts attention

469
00:23:37,280 --> 00:23:41,200
from real underlying diseases.
Well, and also many of these

470
00:23:41,200 --> 00:23:44,960
antipsychotic or antidepressants
or all of those drugs take a

471
00:23:44,960 --> 00:23:47,520
period of time to get to a
therapeutic level.

472
00:23:47,760 --> 00:23:52,400
So even if a person is diagnosed
with a psychiatric disorder and

473
00:23:52,400 --> 00:23:56,880
giving a medication, it can take
weeks to months to even know if

474
00:23:56,880 --> 00:24:00,640
the dosage is therapeutic, which
is high enough.

475
00:24:01,000 --> 00:24:04,240
And then if it doesn't work,
then you're back to square 1

476
00:24:04,240 --> 00:24:06,320
going OK, so is the diagnosis
incorrect?

477
00:24:06,320 --> 00:24:08,560
And you usually have to wean off
of those drugs.

478
00:24:08,720 --> 00:24:11,200
Most psychiatric drugs you can't
just stop taking.

479
00:24:11,520 --> 00:24:15,080
And so you have to wean back off
of those drugs as you wean back

480
00:24:15,080 --> 00:24:16,960
onto another drug.
And then you're taking both of

481
00:24:16,960 --> 00:24:20,640
those drugs at the same time.
I mean, it's, it's scary

482
00:24:20,640 --> 00:24:23,360
business.
Yeah, it certainly is,

483
00:24:23,360 --> 00:24:27,800
especially because as you say,
it can be so subjective with a

484
00:24:28,000 --> 00:24:30,520
what I'm reporting.
So if I come in as the patient

485
00:24:30,520 --> 00:24:33,240
and I report this and that, my
family might have noticed

486
00:24:33,240 --> 00:24:37,000
something different, the the
psychiatrist might be hearing

487
00:24:37,000 --> 00:24:40,040
something different based on any
personal internal bias or

488
00:24:40,240 --> 00:24:42,600
whatever.
And so we can go off track in so

489
00:24:42,600 --> 00:24:44,920
many different ways, which is
true really at any kind of

490
00:24:44,920 --> 00:24:47,760
diagnosis.
However, I think there are more

491
00:24:48,160 --> 00:24:51,040
immediate tests that can happen
because there aren't a lot of

492
00:24:51,400 --> 00:24:53,320
tests.
I mean, I can't in most cases do

493
00:24:53,320 --> 00:24:56,080
a blood draw and say, Oh yeah,
psychotic, right?

494
00:24:56,320 --> 00:24:58,400
I mean, it does.
It doesn't work that way as far

495
00:24:58,400 --> 00:25:01,840
as I know.
So what the suggestions are,

496
00:25:01,840 --> 00:25:06,720
there are a few lessons we can
learn from Susanna's case, and

497
00:25:06,720 --> 00:25:10,560
one is never stop at psychiatric
when neurological signs such as

498
00:25:10,560 --> 00:25:13,320
seizures, abnormal movements,
autonomic instability are

499
00:25:13,320 --> 00:25:15,280
present.
If I'm having seizures, if I'm

500
00:25:15,280 --> 00:25:19,720
having, you know, tardive
dyskinesia, then let's check out

501
00:25:19,720 --> 00:25:21,320
the neurological side of it as
well.

502
00:25:22,280 --> 00:25:24,400
Psychosis can have a physical
cause.

503
00:25:24,520 --> 00:25:28,440
Autoimmune encephalitis like
Susanna had thyroid disease,

504
00:25:28,440 --> 00:25:32,520
lupus infections, just sepsis
can make you have psychotic

505
00:25:32,760 --> 00:25:35,800
symptoms, right?
Metabolic imbalance.

506
00:25:36,000 --> 00:25:38,880
Like I was saying before,
families are data.

507
00:25:39,200 --> 00:25:41,760
Her parents insistence on
further testing saved her life.

508
00:25:42,040 --> 00:25:44,640
If it hadn't been for them, she
would have been probably

509
00:25:44,640 --> 00:25:46,640
institutionalized and that would
be that.

510
00:25:46,640 --> 00:25:48,320
Essentially for forever.
Exactly.

511
00:25:48,320 --> 00:25:51,600
A diagnosis is a process, not a
verdict, and I loved that one.

512
00:25:52,600 --> 00:25:55,320
In her second book, The Great
Pretender, she broadens the

513
00:25:55,320 --> 00:25:57,400
inquiry.
If she was my excuse me?

514
00:25:57,520 --> 00:25:59,680
If she was misdiagnosed, how
many others are?

515
00:25:59,680 --> 00:26:03,080
In it, she re examines the 1973
Rosenhan Experiment, where

516
00:26:03,080 --> 00:26:06,080
healthy volunteers feigned
psychosis and were all admitted

517
00:26:06,080 --> 00:26:08,200
to psychiatric hospitals.
I remember that.

518
00:26:08,400 --> 00:26:11,400
Decades later, her investigation
suggests that psychiatry still

519
00:26:11,400 --> 00:26:16,200
struggles to separate sanity
from sickness, so misdiagnosis

520
00:26:16,200 --> 00:26:20,520
happens everywhere from New York
to Nairobi to the Taj Mahal.

521
00:26:20,600 --> 00:26:22,880
Although they're probably not
being being diagnosed in the Taj

522
00:26:22,880 --> 00:26:25,880
Mahal.
I have a vision of that people

523
00:26:26,080 --> 00:26:29,880
wandering through.
Anyway, I'm not going there.

524
00:26:32,240 --> 00:26:35,960
And it often mirrors system
systemic inequalities, racial

525
00:26:35,960 --> 00:26:39,360
bias, lack of mental health
resources, stigma that

526
00:26:39,360 --> 00:26:43,880
discourages second opinions.
A systematic review found that

527
00:26:43,920 --> 00:26:49,480
only 28% of initial psychosis
diagnosis diagnosis made by non

528
00:26:49,480 --> 00:26:52,280
psychiatric physicians were
accurate after psychiatric

529
00:26:52,280 --> 00:26:59,640
evaluation. 20 Only 28% of
psychosis diagnosis made by

530
00:26:59,640 --> 00:27:02,680
doctors who were not
psychiatrists were accurate

531
00:27:02,720 --> 00:27:04,880
after a psychiatrist evaluated
the patient.

532
00:27:05,000 --> 00:27:08,720
So let me put that the other
way. 62% were inaccurate.

533
00:27:08,760 --> 00:27:11,600
Oh my gosh.
And therefore medicated and

534
00:27:11,600 --> 00:27:14,280
potentially high hospitalized
and potentially blah blah blah.

535
00:27:14,280 --> 00:27:18,600
Oh my goodness, that's wild.
It is so so.

536
00:27:18,600 --> 00:27:20,320
The data suggests the universal
truth.

537
00:27:20,320 --> 00:27:23,800
Psychosis is easy to label but
hard to understand, right?

538
00:27:24,480 --> 00:27:26,280
How could we prevent
misdiagnosis?

539
00:27:26,360 --> 00:27:29,960
We can start with a
comprehensive evaluation, a full

540
00:27:29,960 --> 00:27:32,840
medical and neurological workup
including blood tests, imaging

541
00:27:32,880 --> 00:27:35,840
and cerebral spinal analysis to
accompany any first episode

542
00:27:35,840 --> 00:27:38,920
psychosis.
This hit me really hard and I, I

543
00:27:38,920 --> 00:27:41,640
will be the first to say that
our healthcare system in the US

544
00:27:41,640 --> 00:27:46,600
sucks and that actually even
being able to have all of these

545
00:27:47,080 --> 00:27:50,640
to use, utilize all of these
steps may not even be possible

546
00:27:50,640 --> 00:27:53,040
in our system.
And don't edit this out Andrea.

547
00:27:53,200 --> 00:27:56,480
Healthcare for profit is a crime
against humanity anyway.

548
00:27:56,480 --> 00:28:00,680
Like I but you know, in an ideal
world where we could be treated

549
00:28:00,680 --> 00:28:02,640
the best possible.
I don't know how to say it, but

550
00:28:03,120 --> 00:28:05,160
so we would want, I'm going to
say it again because it hit me

551
00:28:05,160 --> 00:28:07,720
so hard.
A full medical and neurological

552
00:28:07,720 --> 00:28:11,440
work up, including blood tests,
imaging and cerebrospinal

553
00:28:11,440 --> 00:28:14,960
analysis should accompany any
first episode psychosis.

554
00:28:15,040 --> 00:28:17,120
Well, that makes sense, because
then it does.

555
00:28:17,320 --> 00:28:21,560
You're ruling out other stuff
right up the front, and it gives

556
00:28:21,560 --> 00:28:24,720
the person a chance to have a
much better option to have the

557
00:28:24,720 --> 00:28:28,560
correct diagnosis, then go again
for months and months or even

558
00:28:28,560 --> 00:28:32,560
years in the incorrect
diagnosis, having other types of

559
00:28:33,000 --> 00:28:35,720
physiological problems.
But then they'd probably have

560
00:28:35,720 --> 00:28:37,600
died by then too if that was the
case.

561
00:28:38,880 --> 00:28:41,960
So next step is specialist
collaboration.

562
00:28:42,280 --> 00:28:45,320
A study in the Journal of
Adolescent Health in 2021

563
00:28:45,680 --> 00:28:49,880
indicated that early referral to
first episode psychosis clinics

564
00:28:49,920 --> 00:28:53,080
or multidisciplinary teams
improves accuracy and outcomes.

565
00:28:53,080 --> 00:28:55,640
Same sort of thing, right?
Don't just see the psychiatrist,

566
00:28:55,640 --> 00:28:57,320
see the psychiatrist and the
neurologist.

567
00:28:57,320 --> 00:28:59,440
See the psychiatrist and the
orthopedist.

568
00:28:59,440 --> 00:29:00,520
I don't know that I made that
up.

569
00:29:00,800 --> 00:29:02,720
Endocrinologist.
That's a better one, right?

570
00:29:02,760 --> 00:29:09,680
But like, let's have the.
Let's have the psychotic, unless

571
00:29:09,680 --> 00:29:12,920
of course it's a behavioral
issue and that makes and that

572
00:29:12,920 --> 00:29:14,320
makes sense.
And one of the things that I was

573
00:29:14,320 --> 00:29:18,280
thinking about is how many
people who have these sorts of

574
00:29:18,320 --> 00:29:22,760
thoughts or symptoms are the
first reporters?

575
00:29:22,880 --> 00:29:27,040
Because I think because of the
stigma of mental health, which

576
00:29:27,040 --> 00:29:29,400
is getting better because more
and more people are talking

577
00:29:29,400 --> 00:29:31,960
about it and saying it's just,
it's the same as any other

578
00:29:31,960 --> 00:29:34,080
disease.
It just effects a different body

579
00:29:34,080 --> 00:29:36,880
part.
However, it's been such a strong

580
00:29:36,880 --> 00:29:42,400
stigma that many people don't
say anything and then they go

581
00:29:42,400 --> 00:29:44,880
longer and longer being not
treated.

582
00:29:44,880 --> 00:29:47,800
So if they have a metabolic
thing versus a psychiatric

583
00:29:47,800 --> 00:29:52,640
thing, they may have more
permanent outcome problems than

584
00:29:52,720 --> 00:29:54,720
if they had been treated right
away.

585
00:29:54,720 --> 00:29:58,000
Self reporting may or may not be
common.

586
00:29:58,080 --> 00:30:01,640
Yeah, that's definitely true.
The next step is bias awareness.

587
00:30:01,640 --> 00:30:04,160
And we talked about this a
little bit, but clinicians must

588
00:30:04,160 --> 00:30:07,600
be trained to recognize how
race, culture and gender bias

589
00:30:07,600 --> 00:30:10,320
affect diagnosis.
And I would even say beyond

590
00:30:10,320 --> 00:30:13,160
that, there are, there are so
many other things that could

591
00:30:13,160 --> 00:30:17,400
affect diagnosis, you know,
gender identity, sexuality,

592
00:30:17,400 --> 00:30:23,120
sexual preferences, even obesity
can be something that creates A

593
00:30:23,120 --> 00:30:24,920
bias.
And I think the important thing

594
00:30:24,920 --> 00:30:28,600
here is that we have to focus on
the word trained.

595
00:30:28,640 --> 00:30:31,400
They have to be trained to
recognize it, to just say to a

596
00:30:31,400 --> 00:30:34,160
clinician now make sure you're
not biased against people of

597
00:30:34,160 --> 00:30:38,200
color and you know this and that
and that there has they, we have

598
00:30:38,200 --> 00:30:42,680
to give them the tools that they
need so they can use them to

599
00:30:42,840 --> 00:30:45,520
reduce their their biases,
right?

600
00:30:46,040 --> 00:30:49,440
Right, because most people who
are biased aren't going to say,

601
00:30:49,440 --> 00:30:52,600
Oh yeah, totally, I'm biased
because they don't want to admit

602
00:30:52,600 --> 00:30:55,880
it to themselves.
And if it's an inherent bias

603
00:30:55,880 --> 00:31:00,480
where maybe it's because I was
raised just for example, in the

604
00:31:00,480 --> 00:31:03,960
South, I may have some biases
that I don't have if I was

605
00:31:03,960 --> 00:31:06,560
raised somewhere on the West
Coast, which tends to be more

606
00:31:06,560 --> 00:31:09,040
open minded.
And I mean, that's a blanket

607
00:31:09,040 --> 00:31:10,360
statement.
And no, no, it's not true for

608
00:31:10,360 --> 00:31:14,880
everyone in any of those places,
but it is more likely to have

609
00:31:15,080 --> 00:31:18,320
something based on your cultural
upbringing that you may or may

610
00:31:18,320 --> 00:31:19,920
not even and recognize, like you
said.

611
00:31:19,920 --> 00:31:22,040
So they get to be trained to
look at it.

612
00:31:22,040 --> 00:31:24,400
I know that I had, I can't
remember where it was, but a

613
00:31:24,400 --> 00:31:28,720
test about bias, implied or
implicit bias that made me think

614
00:31:28,720 --> 00:31:32,520
about some stuff.
Was I looking at this, that or

615
00:31:32,520 --> 00:31:35,720
another sort of thing in a way
that I might make a decision

616
00:31:35,720 --> 00:31:38,560
differently than I would for
someone of another group?

617
00:31:38,600 --> 00:31:39,080
Right.
Yeah.

618
00:31:39,120 --> 00:31:41,400
So I was confirming my
suspicion.

619
00:31:41,480 --> 00:31:46,440
Susanna Callahan is a, an
attractive young white woman.

620
00:31:46,640 --> 00:31:50,440
I mean, I can tell you based on
scientific results and studies,

621
00:31:50,800 --> 00:31:54,880
she probably got better
treatment than somebody who was

622
00:31:54,880 --> 00:31:57,840
not a pretty white young woman,
right?

623
00:31:57,840 --> 00:31:59,480
That's just and, and good for
her.

624
00:31:59,480 --> 00:32:02,360
Don't get me wrong.
When we talk about privilege, I

625
00:32:02,440 --> 00:32:04,880
we have to remember that just
because we have privilege

626
00:32:04,880 --> 00:32:07,640
doesn't mean we have to.
We should use our privilege to

627
00:32:07,640 --> 00:32:09,560
make things better for the
people who don't have privilege

628
00:32:09,560 --> 00:32:11,760
because we're going to have the
privilege whether we like it or

629
00:32:11,760 --> 00:32:13,640
not.
So that's my soapbox on that

630
00:32:13,640 --> 00:32:16,240
one.
And then next step is follow up

631
00:32:16,240 --> 00:32:18,760
and, and reassessment.
Psychiatric diagnosis should be

632
00:32:18,760 --> 00:32:21,800
provisional and revisited over
time as symptoms evolve.

633
00:32:21,800 --> 00:32:25,280
And I know I know of a lot of
people, a lot of people.

634
00:32:25,320 --> 00:32:27,720
Well, first of all, let's talk
about the fact that family

635
00:32:27,720 --> 00:32:30,480
doctors are managing their
psychiatric symptoms.

636
00:32:30,560 --> 00:32:34,880
I was never against that until I
got a psych psychiatrist.

637
00:32:34,880 --> 00:32:37,480
Well, there were a few things,
but one of them was getting a

638
00:32:37,480 --> 00:32:40,640
psychiatrist to manage my
medications rather than a family

639
00:32:40,640 --> 00:32:44,960
doctor and all of like how how
much different that was and just

640
00:32:45,240 --> 00:32:47,000
somebody being like, oh, you
have depression.

641
00:32:47,000 --> 00:32:48,960
Here's this common
antidepressant.

642
00:32:49,000 --> 00:32:52,000
And so that's one of the things
like, and then what I was going

643
00:32:52,000 --> 00:32:54,040
to say is how many people just
get, you know, their

644
00:32:54,040 --> 00:32:56,240
antidepressant from their family
doctor and then it never comes

645
00:32:56,240 --> 00:32:58,160
up again.
And their doctor does the three

646
00:32:58,160 --> 00:32:59,680
month assessment with the
questionnaire.

647
00:32:59,680 --> 00:33:01,000
They don't really look at it
right.

648
00:33:01,000 --> 00:33:03,840
They just continue with that
dose for who knows how long.

649
00:33:03,840 --> 00:33:08,080
What point is a patient supposed
to be able to say, Hey, wait, I

650
00:33:08,080 --> 00:33:11,080
don't feel as good as I used to.
I should go back to my doctor.

651
00:33:11,080 --> 00:33:13,560
They shouldn't, they shouldn't
be held responsible for that

652
00:33:13,560 --> 00:33:15,120
now.
They should be held responsible

653
00:33:15,120 --> 00:33:16,880
for their own health in the
sense of like, if you're not

654
00:33:16,880 --> 00:33:19,440
feeling as good as you were, you
should go to the doctor.

655
00:33:19,440 --> 00:33:22,240
But it should.
We should always be following

656
00:33:22,240 --> 00:33:23,040
up.
I mean, really, you should be

657
00:33:23,040 --> 00:33:25,040
following up with a doctor for
anything you're prescribed.

658
00:33:25,040 --> 00:33:26,200
That's my opinion.
Yeah.

659
00:33:26,240 --> 00:33:29,240
Well and and our symptoms can
change the efficiency and

660
00:33:29,240 --> 00:33:31,840
efficacy of the medication can
change our.

661
00:33:31,880 --> 00:33:33,680
Metabolism can change.
Right.

662
00:33:33,680 --> 00:33:35,800
Exactly.
There's so many, so many things.

663
00:33:35,800 --> 00:33:39,320
If a provider is not necessarily
trained on all of the things to

664
00:33:39,320 --> 00:33:42,480
watch for, they may not have
even told the patient.

665
00:33:42,480 --> 00:33:44,120
Watch for this, that, or the
other thing.

666
00:33:44,120 --> 00:33:46,640
If you notice any sort of
tremors, if you notice anything

667
00:33:46,640 --> 00:33:49,960
like that, let me know
immediately so that medications

668
00:33:49,960 --> 00:33:52,760
can be changed.
Because they may not, they may

669
00:33:52,760 --> 00:33:55,480
not even be as aware of it as
they should be.

670
00:33:55,480 --> 00:33:58,760
And when you've got somebody who
specializes in everything that

671
00:33:58,760 --> 00:34:00,640
it's hard to remember
everything.

672
00:34:01,120 --> 00:34:02,360
Right.
Yeah, exactly.

673
00:34:02,480 --> 00:34:04,200
And no shade to family doctors,
by the way.

674
00:34:04,800 --> 00:34:07,200
They're they're.
Certainly a wonderful starting

675
00:34:07,200 --> 00:34:10,480
point for anything that does
need further specialization

676
00:34:10,560 --> 00:34:12,719
especially.
I was, it's funny, I was talking

677
00:34:12,719 --> 00:34:17,120
to Holly yesterday about going
to my primary care provider,

678
00:34:18,080 --> 00:34:22,320
family doctor, same difference.
And I was like, I realized I I

679
00:34:22,320 --> 00:34:26,320
realized how old I'm getting
when I said to her, not in these

680
00:34:26,320 --> 00:34:29,320
words, but through the course of
conversation, it came out that I

681
00:34:29,320 --> 00:34:33,239
have a sleep doctor, a breast
doctor, doctor, colon doctor,

682
00:34:33,239 --> 00:34:37,760
orthopedic doctor, an eye
doctor.

683
00:34:38,040 --> 00:34:40,600
Let's see, I got to do a body
scan here real quick.

684
00:34:40,719 --> 00:34:42,480
And I think, yeah.
And then her and then her.

685
00:34:42,480 --> 00:34:45,239
I don't know.
OBGY well, 9, I don't do OB

686
00:34:45,320 --> 00:34:47,199
anywhere.
And a gynecologist, 7 doctors.

687
00:34:47,239 --> 00:34:48,920
I'm old.
Right.

688
00:34:49,239 --> 00:34:52,159
Yeah.
And, and also though it's not

689
00:34:52,159 --> 00:34:56,360
just because you are as old as
the hills, it's being, I can say

690
00:34:56,360 --> 00:35:00,720
that I'm 10 years older, but
also because physicians are

691
00:35:00,720 --> 00:35:05,840
specializing so, so tightly that
we have to, we can't see our

692
00:35:05,840 --> 00:35:09,680
orthopod in our rheumatologist,
which you may have as well as at

693
00:35:09,680 --> 00:35:11,760
the same time because.
Oh, I have an endocrinologist

694
00:35:11,760 --> 00:35:13,360
also.
Dang it, there's another.

695
00:35:13,520 --> 00:35:14,960
And a weight doctor.
Oh my gosh.

696
00:35:15,080 --> 00:35:17,840
Oh my gosh, yeah.
You don't even have time for

697
00:35:17,840 --> 00:35:19,440
doing anything.
How can you be sleeping?

698
00:35:19,440 --> 00:35:22,600
With all these providers.
Pretty funny it is.

699
00:35:22,600 --> 00:35:24,520
Oh, it didn't even include my
psychiatrist.

700
00:35:24,520 --> 00:35:27,800
Dang, that's 10.
Man, you've got more than I do.

701
00:35:27,800 --> 00:35:30,720
That's why I'm going to have to
start collecting a few more.

702
00:35:31,040 --> 00:35:32,480
Yeah, you need to collect a few
more.

703
00:35:32,840 --> 00:35:35,440
I guess.
So the last step is patient

704
00:35:35,440 --> 00:35:37,000
empowerment.
Patients and families should

705
00:35:37,000 --> 00:35:39,240
keep records, ask for
explanations, and request

706
00:35:39,240 --> 00:35:43,000
reevaluation and 2nd opinions
when things don't add up.

707
00:35:43,000 --> 00:35:45,880
And that was probably another
thing that really benefited

708
00:35:46,360 --> 00:35:49,920
Susanna, Susanna Mohan, is that
her parents stood up for her

709
00:35:49,920 --> 00:35:51,640
when she could no longer stand
up for herself.

710
00:35:51,920 --> 00:35:55,000
By the way, I didn't say it, but
she didn't just think, believe

711
00:35:55,000 --> 00:35:57,080
that her dad had harmed her
stepmom.

712
00:35:57,080 --> 00:35:59,200
She was convinced that her dad
had killed her stepmom.

713
00:35:59,720 --> 00:36:03,200
So imagine believing that for
however long it took.

714
00:36:03,280 --> 00:36:05,840
Oh my gosh.
Well wait, was her stepmom

715
00:36:05,880 --> 00:36:07,160
unavailable?
I mean.

716
00:36:07,560 --> 00:36:10,480
I have no idea.
It seems like one would notice

717
00:36:10,480 --> 00:36:12,440
if she was standing in the
kitchen that she was not dead.

718
00:36:12,600 --> 00:36:14,560
I have no idea.
I didn't get, I didn't get that

719
00:36:14,560 --> 00:36:16,960
deep, but isn't that wild?
It is.

720
00:36:17,320 --> 00:36:19,800
That would be disturbing on so
many levels.

721
00:36:19,800 --> 00:36:25,120
So I have a friend who when I
first met her she was on some

722
00:36:25,320 --> 00:36:28,960
psychiatric medications.
It was like it seemed pretty

723
00:36:28,960 --> 00:36:32,920
similar to like what I was on
mostly just an antidepressant I

724
00:36:32,920 --> 00:36:36,800
think.
And she had an episode where she

725
00:36:36,800 --> 00:36:40,160
threatened to harm herself and
me and her, her boyfriend took

726
00:36:40,160 --> 00:36:41,600
her to, well, mostly her
boyfriend.

727
00:36:41,600 --> 00:36:46,080
I met them there, but took her
to an institution and had her

728
00:36:46,080 --> 00:36:49,440
checked in.
And anyway, she started getting

729
00:36:49,440 --> 00:36:51,680
prescribed more and more drugs,
more and more drugs, more and

730
00:36:51,680 --> 00:36:54,880
more drugs.
And just, I mean, she just was,

731
00:36:54,880 --> 00:36:57,800
according to all of her
diagnosis, she was crazy as

732
00:36:57,800 --> 00:37:00,320
hell, right?
Just like, holy wow.

733
00:37:00,480 --> 00:37:03,000
Holy, holy smokes.
And one of the drugs she ended

734
00:37:03,000 --> 00:37:05,840
up taking long into this
process, years into this

735
00:37:05,840 --> 00:37:08,080
process.
We, you know, we all read about

736
00:37:08,080 --> 00:37:11,800
her mental stability and this
sort of thing because she was so

737
00:37:11,880 --> 00:37:14,960
brittle with her mental health.
One of the drugs she started

738
00:37:14,960 --> 00:37:17,480
taking, like I said, years into
the process, actually made her

739
00:37:17,480 --> 00:37:20,120
lactate even though she'd never
been pregnant, pregnant,

740
00:37:20,120 --> 00:37:22,520
pregnant in her life now.
Yeah.

741
00:37:22,880 --> 00:37:26,840
So now she's feeling crazy and
now and lactating and, like,

742
00:37:26,880 --> 00:37:29,960
what do you do with that?
Anyway, to make this Long story

743
00:37:29,960 --> 00:37:34,280
short, she eventually told her
her, her doctor, and her

744
00:37:34,280 --> 00:37:36,480
therapist that she wanted to
wean off the medications and

745
00:37:36,480 --> 00:37:38,160
start from scratch.
That makes sense.

746
00:37:38,440 --> 00:37:40,400
And so they agreed to let her do
that.

747
00:37:40,440 --> 00:37:43,120
And lo and behold, once she was
weaned off all of the

748
00:37:43,120 --> 00:37:46,600
medications, she felt great.
And it turned out all she had

749
00:37:46,600 --> 00:37:50,320
was ankylosing Spondylosis.
And like, I don't know if that

750
00:37:50,320 --> 00:37:53,520
was giving her psychiatric
symptoms, but it's the only

751
00:37:53,520 --> 00:37:55,560
thing she currently has a
diagnosis for.

752
00:37:55,560 --> 00:37:58,240
Hasn't been on any psychiatric
medicines in a decade.

753
00:37:58,240 --> 00:38:01,160
Probably.
Doing great great life great as

754
00:38:01,160 --> 00:38:03,240
a kid now.
Well, I'm glad she is.

755
00:38:03,280 --> 00:38:06,640
And that speaks to the fact that
there is no medication that has

756
00:38:06,640 --> 00:38:09,840
zero side effect.
Every single thing has a side

757
00:38:09,840 --> 00:38:12,360
effect.
So we take one medication, have

758
00:38:12,360 --> 00:38:15,040
to take another one just to
combat that side effect, then

759
00:38:15,040 --> 00:38:17,600
another one, another one,
another one, which this speaks

760
00:38:17,600 --> 00:38:19,120
really strongly to.
Yeah.

761
00:38:19,200 --> 00:38:23,040
I the first bipolar medication
that I tried increased my

762
00:38:23,040 --> 00:38:26,360
appetite and I gained like 30
lbs and I was like I am not

763
00:38:26,360 --> 00:38:28,280
doing this man.
I'm I literally have a weight

764
00:38:28,280 --> 00:38:30,160
loss drug.
I'm not taking this medication.

765
00:38:31,080 --> 00:38:33,720
And it was weird.
Because I, I, I could see, I

766
00:38:33,720 --> 00:38:36,360
could recognize that my appetite
was so much bigger.

767
00:38:36,400 --> 00:38:39,480
And I was like, this is really
weird to be hungry like this.

768
00:38:39,520 --> 00:38:41,840
Yeah, I do not like it.
And so when I I just happened, I

769
00:38:41,840 --> 00:38:43,920
didn't realize it was a side
effect of this drug.

770
00:38:43,920 --> 00:38:45,880
And I happened to mention it to
my psychiatrist.

771
00:38:45,880 --> 00:38:47,880
And she was like, oh, yeah,
that'll do that.

772
00:38:48,400 --> 00:38:50,240
We could try something different
that doesn't do that.

773
00:38:50,240 --> 00:38:53,880
I'm like yes please.
Well, and that is a common side

774
00:38:53,880 --> 00:38:57,840
effect for for psychiatric drugs
is an increase in appetite.

775
00:38:57,840 --> 00:39:01,240
And I don't know why it is.
I've never looked into it

776
00:39:01,240 --> 00:39:06,160
because I haven't had to take
any of them, but it I know that

777
00:39:06,160 --> 00:39:09,440
has been a common side effect.
Yeah, how does this, how does

778
00:39:09,440 --> 00:39:13,320
this topic fit into medicine,
mystery and mayhem, you may ask?

779
00:39:13,640 --> 00:39:16,360
I may how does it?
Well, Callahan's Urbil embodies

780
00:39:16,360 --> 00:39:17,960
all three themes of this
podcast.

781
00:39:18,080 --> 00:39:21,120
It it includes medicine, the
science of neurology and

782
00:39:21,120 --> 00:39:23,840
immunology ultimately solved the
Riddle.

783
00:39:24,440 --> 00:39:26,360
Mystery.
For weeks, doctors couldn't

784
00:39:26,360 --> 00:39:29,120
explain her descent into
psychosis and mayhem.

785
00:39:29,280 --> 00:39:32,720
The chaos that misdiagnosis
wrought in her life lost

786
00:39:32,720 --> 00:39:36,160
identity, Fear.
Hospitalization was nearly

787
00:39:36,160 --> 00:39:38,240
fatal.
Fortunately, there was no

788
00:39:38,280 --> 00:39:39,760
murder.
She's alive.

789
00:39:40,240 --> 00:39:43,520
Her story reminds politicians to
balance humility with vigilance.

790
00:39:43,520 --> 00:39:46,040
And it tells listeners that
madness isn't always mental.

791
00:39:46,160 --> 00:39:49,040
Sometimes it's medical.
Wow, I like the way you tied

792
00:39:49,040 --> 00:39:53,160
that in.
So psychosis, in all its forms,

793
00:39:53,200 --> 00:39:56,120
demands curiosity.
The mind is not an island.

794
00:39:56,160 --> 00:39:58,920
It's tethered to the immune
system, the brain, the body and

795
00:39:58,920 --> 00:40:01,080
the environment.
When any part misfires, the

796
00:40:01,080 --> 00:40:03,960
symptoms can look the same.
Callahan's recovery shows that

797
00:40:03,960 --> 00:40:06,720
being wrong isn't the end.
It's the chance to get it right.

798
00:40:06,840 --> 00:40:10,120
For every Susanna Callahan who
finds her answer, others remain

799
00:40:10,120 --> 00:40:13,400
lost in psychiatric limbo.
The responsibility falls to

800
00:40:13,400 --> 00:40:17,280
clinicians, families and society
alike to look deeper, question

801
00:40:17,600 --> 00:40:19,640
assumptions, and never forget
that behind.

802
00:40:19,800 --> 00:40:22,880
Every diagnosis lies a human
being who wants their story

803
00:40:22,880 --> 00:40:25,440
understood.
Wow, that was excellent and

804
00:40:25,440 --> 00:40:29,280
definitely something to consider
for so many reasons.

805
00:40:30,160 --> 00:40:34,640
Also remembering, I think that
even though we have been trained

806
00:40:34,640 --> 00:40:39,080
for a long time in our world to
look at psychiatric disorders

807
00:40:39,080 --> 00:40:43,560
and diagnosis to be a
disability, it really is a

808
00:40:43,560 --> 00:40:47,000
disease.
And I've heard people say, well,

809
00:40:47,000 --> 00:40:49,720
if you had a broken leg, you
would treat it right.

810
00:40:50,000 --> 00:40:52,480
And nobody looked at somebody
with a broken leg and go, oh,

811
00:40:52,480 --> 00:40:55,920
wow, they're just messed up.
Well, and sometimes we break our

812
00:40:55,920 --> 00:40:59,880
legs because we're being dumb,
but we still nobody said, oh

813
00:40:59,880 --> 00:41:02,120
gosh, they should be
hospitalized forever for that.

814
00:41:02,440 --> 00:41:05,560
But when we hear about
psychiatric disorders, a lot of

815
00:41:05,560 --> 00:41:08,840
times people will just say,
well, they're too damaged or

816
00:41:08,840 --> 00:41:11,600
messed up or I don't want to be
involved because blah, blah,

817
00:41:11,600 --> 00:41:15,480
blah.
And many times they are having

818
00:41:15,480 --> 00:41:17,960
those diagnosis and we don't
even know anyway, which is

819
00:41:18,200 --> 00:41:22,560
probably good because when we
have our biases which show up in

820
00:41:22,560 --> 00:41:24,200
that moment for a lot of people,
I think.

821
00:41:24,480 --> 00:41:28,240
But when we do hear that there's
a psychiatric disorder or a

822
00:41:28,240 --> 00:41:32,120
diagnosis, it's important to
remember that it is an illness,

823
00:41:32,440 --> 00:41:36,440
same as anything else.
And if anything, we should be

824
00:41:36,440 --> 00:41:40,960
more compassionate and concerned
to make sure that we are some of

825
00:41:40,960 --> 00:41:43,320
the people going, You know, I
noticed this.

826
00:41:43,360 --> 00:41:45,280
Did you know you were doing
this?

827
00:41:45,280 --> 00:41:48,240
Is that a concern to you?
You know, and and that kind of

828
00:41:48,240 --> 00:41:50,320
thing, obviously you don't walk
up to so told a stranger, I

829
00:41:50,320 --> 00:41:53,120
wouldn't think and say it, but
but like, if I noticed with you

830
00:41:53,120 --> 00:41:55,680
that you were doing something
different, I'd say, hey, did you

831
00:41:55,680 --> 00:41:57,520
notice that?
And that would be appropriate,

832
00:41:57,520 --> 00:41:59,800
that part of the friends and
family as reporters.

833
00:42:00,240 --> 00:42:01,040
Yeah.
Yeah, exactly.

834
00:42:01,560 --> 00:42:04,480
Friends and family will notice
stuff sooner a lot of times

835
00:42:04,480 --> 00:42:06,600
about us than we noticed for
ourselves.

836
00:42:06,840 --> 00:42:10,680
Yes, and when it's off baseline.
So I think with everything, I

837
00:42:10,680 --> 00:42:13,880
feel like we just get to have
compassion for the people in our

838
00:42:13,880 --> 00:42:18,480
lives to to assist them to
thrive instead of blaming them

839
00:42:18,480 --> 00:42:21,000
for something, especially that
has nothing to do with anything

840
00:42:21,000 --> 00:42:21,960
they chose.
Yeah.

841
00:42:22,120 --> 00:42:25,880
Well, and you look at the really
good example of this is the

842
00:42:25,880 --> 00:42:30,600
unhoused population in that the
majority of unhoused people are

843
00:42:30,600 --> 00:42:34,680
either mentally ill or drug
dependent or both.

844
00:42:35,200 --> 00:42:39,560
And a lot of times it can become
a self perpetuating cycle of

845
00:42:39,560 --> 00:42:44,480
descent, right?
That's DESCENT, not DISSENT.

846
00:42:45,640 --> 00:42:48,640
There is such a thing as drug
induced psychosis.

847
00:42:48,640 --> 00:42:51,760
We'll take somebody with actual
psychosis that actually, let's

848
00:42:51,760 --> 00:42:55,920
say, does have schizophrenia,
add to that drugs and that cause

849
00:42:55,920 --> 00:42:59,400
psychosis and just look at the
powder keg that's been built.

850
00:43:00,000 --> 00:43:02,920
And I, you know, I know a lot of
people have their opinions about

851
00:43:03,040 --> 00:43:05,160
unhoused people.
And I'm going to tell you right

852
00:43:05,160 --> 00:43:09,160
now, we could solve the unhoused
problem if we bothered to even

853
00:43:09,160 --> 00:43:10,680
try.
But that's all I'm going to say

854
00:43:10,680 --> 00:43:13,400
about it right now.
It just it's a good it's a good

855
00:43:13,520 --> 00:43:18,040
example of how much mental
health matters and people all

856
00:43:18,040 --> 00:43:19,440
the time.
It's funny, there's one of my

857
00:43:19,440 --> 00:43:21,360
pet peeves is people like mental
illness matters.

858
00:43:21,680 --> 00:43:23,920
Well, it's their health that
matters, right?

859
00:43:23,920 --> 00:43:26,880
Like, let's not, let's not keep
calling it mental illness.

860
00:43:26,880 --> 00:43:30,240
Yes, they may have a mental
illness, but we need to be

861
00:43:30,240 --> 00:43:32,720
focused on their mental health.
That's right.

862
00:43:32,800 --> 00:43:36,400
That's my perspective.
Well, not just theirs, ours, all

863
00:43:36,400 --> 00:43:38,400
of ours.
Yeah, all of us have mental

864
00:43:38,400 --> 00:43:40,680
health.
Yeah, that's that's what's

865
00:43:40,680 --> 00:43:42,360
funny.
People talk about the, what's

866
00:43:42,400 --> 00:43:46,680
the word talk about the the
stigma of talking about mental

867
00:43:46,680 --> 00:43:47,880
health.
And it's like, that would be

868
00:43:47,880 --> 00:43:50,480
like the stigma of talking about
the knee, right?

869
00:43:50,480 --> 00:43:53,240
Or the stigma of talking about
sweat.

870
00:43:53,440 --> 00:43:56,680
Like we all have it.
We it's just a part of being a

871
00:43:56,680 --> 00:43:57,600
human.
Yeah.

872
00:43:57,600 --> 00:44:01,720
I mean, definitely.
I encourage people to to speak

873
00:44:01,720 --> 00:44:04,480
about mental health with the
people they love and to consider

874
00:44:04,480 --> 00:44:07,280
their own mental health and to
not let it be taboo, not let it

875
00:44:07,280 --> 00:44:11,880
be something that is like scary.
Yeah.

876
00:44:11,880 --> 00:44:15,280
And I know for me, when someone
asked me how I'm doing, if it's

877
00:44:15,280 --> 00:44:18,400
someone I'm close to, I will
actually tell them I want to say

878
00:44:18,400 --> 00:44:21,760
fine.
And I think that's important for

879
00:44:21,760 --> 00:44:24,840
us to be real and honest with
each other because then we can

880
00:44:24,840 --> 00:44:27,760
be watching out for each other.
We can assist.

881
00:44:27,800 --> 00:44:32,240
And back to the unhomed people,
they often start drugs to self

882
00:44:32,240 --> 00:44:36,120
medicate for mental health
issues that either they don't

883
00:44:36,120 --> 00:44:40,960
understand or just know that if
they take this or do that, they

884
00:44:40,960 --> 00:44:43,120
feel better because they've
disconnected.

885
00:44:43,200 --> 00:44:47,920
That is typically unhealthy.
It doesn't take them down a path

886
00:44:47,920 --> 00:44:50,800
that really works, but it can
probably feel like it at the

887
00:44:50,800 --> 00:44:53,480
beginning, especially if they
feel like they have no options.

888
00:44:53,640 --> 00:44:54,640
Right?
All right, well, excellent.

889
00:44:54,640 --> 00:44:56,480
Thank you very much.
You're very welcome.

890
00:44:56,840 --> 00:44:59,480
All right, if you've made it
this far, clearly you like a

891
00:44:59,480 --> 00:45:01,120
little mayhem with your
medicine.

892
00:45:01,440 --> 00:45:03,960
Or you just enjoy hearing us
ramble about weird medical

893
00:45:03,960 --> 00:45:06,160
mysteries.
Either way, we'd love you for

894
00:45:06,160 --> 00:45:08,360
it.
So hit that follow or subscribe

895
00:45:08,360 --> 00:45:09,760
button wherever you're
listening.

896
00:45:09,880 --> 00:45:11,880
And toss us a rating or review
while you're at it.

897
00:45:12,160 --> 00:45:14,760
Helps other curious weirdos find
the show.

898
00:45:15,440 --> 00:45:17,520
And we know there are a lot of
you out there.

899
00:45:17,840 --> 00:45:20,360
Oh so many.
Come join the chaos.

900
00:45:20,400 --> 00:45:23,560
Thanks for listening to
Medicine, Mystery, mayhem, and

901
00:45:23,560 --> 00:45:26,200
sometimes Murder.
Do you have an idea for an

902
00:45:26,200 --> 00:45:29,160
episode of this podcast?
Just want to say hi?

903
00:45:29,480 --> 00:45:32,520
You can get in touch with us at
our M4 pod.

904
00:45:33,000 --> 00:45:42,240
That's OURM the #4pod@gmail.com.
We read every e-mail, and

905
00:45:42,240 --> 00:45:45,560
sometimes we even respond just
like real professionals.

906
00:45:45,720 --> 00:45:50,680
Because we are old.
Friends with new twists and lots

907
00:45:50,720 --> 00:45:51,680
of body bags.