Ep. 12: Got Me Feeling So Crazy Right Now

0:06 Welcome to M4 Medicine, mystery, mayhem, and sometimes murder. I'm Andrea Marciano and RN with 35 years of experience across various fields. From direct patient care in hospitals to home health, geriatrics, and injury medicine, I face life, death, and everything in between. And I'm Crystal Miller and RN with 13 1/2 years of experience. My work spans home health, Hospice, emergency care, geriatrics, and occupational health. From the chaos of trauma based quiet moments with patients, I've seen stories that defy explanations. We've been friends for over 25 years and as nurses we've shared countless stories that have left us and our families speechless. Now we're bringing those stories and many more to you in medicine, mystery, mayhem, and sometimes murder.

0:53 Each week, we'll uncover cases that challenge the boundaries of medicine, sharing the human stories behind the science. From puzzling medical mysteries to shocking real life crimes, we'll bring you stories that'll leave you questioning everything you thought you knew while. We're both experiencing these nurses. We want to make it clear we're not here to give medical advice. This podcast is about storytelling, education and exploration, not diagnosing or treating medical conditions. This is medicine, mystery, mayhem and sometimes murder. Let's dive in. Hey Crystal, how are you doing? I'm doing well. How are you? I'm well, thank you. Anything exciting going on? News of the day something. I wouldn't call it exciting, but I won the rock, paper, scissors to not have to go grocery shopping today.

1:38 Who was in contest? Who was the? Other person Holly's now grocery shopping. Yay for Holly on a Sunday. Yep. Oh dear. For our listeners, we usually record on Sundays, so this Sunday to me is one of the busiest grocery shopping days and I almost never go. Not in Utah. Well, that's true. At least it didn't used to be. In Utah, because it was much less busy. This is true. I you don't like grocery? Shopping I hate grocery shopping and part of what I hate about it is not just the shopping itself, but it's the fact that every time I bring groceries home, my kids just eat them and then I have to do it again those.

2:18 People. So I wish I had AI, wish I had a grocery conveyor belt that I could just have push a button. Jetson's right where? Where are our Jetson times, man? Well, I feel, I feel that's called Instacart. I know that's usually I usually use Instacart or or sorry everybody, Walmart delivery because I don't I actually don't have time for it. You know what I mean? I got a lot of stuff going on and it's nice to get steps in, but it usually wears me out so. Yeah, I get that. Dude. I went to get a new provider lately talking about steps in around our property, which for those who haven't been here, it's about 11 acres.

3:00 And we don't walk all of it, but I walk between 4:00 and 5:00 miles a day. You know. And I don't lose weight and I said what not? Fair. With that, and she said, well, unfortunately now four or five miles of walking a day is your baseline. That's not fair. It is not. And I told her that. I said that's just rude. And she said, I know. And I said, well, I, I didn't say this, but I was thinking, well, so maybe I should sit around like a slug for about a month and then maybe I'll lose weight. I just thought. And then we talked about menopause, which we've talked about a few times. And I said, well, this is bogus. She said, Yep, and this is not right. Yep, Yep.

3:40 Like this is not good. You're not helping me. This isn't fair. It's not fair and I said that several times during our appointments anyway. So when you go when back to the grocery shopping thing, when Holly is grocery shopping, do you guys make a list when you go shopping? We have a running list that the kids can all add things to in a notebook. Actually just sits on our dining room table. A physical notebook. What kind of people are you? Gen. X, yeah. I've got I've got a notebook but it's called Alexa. Well, yeah, we don't have Alexa or anything. So, and we're always adding stuff to the list. And when our granddaughter was here, she added, what was it? She added? She added it about four times every time. I can't remember what it was that she always oh, bagels she wanted bake.

4:25 She'd say add bagels to the Costco list, which it might be doing right now, but. We get bagels every time. Bagels are a big thing in my household. I started cooking my own. They're actually pretty easy to do and they're delicious. I. Should try that. I'm coming to I'm in a cooking and baking mood right now. I tried to make Amish friendship of an Amish friendship bread starter but I think I killed it so I threw away. Remember back in the day when we kept getting those and I Oh my gosh, I had it. It seemed like for about 3 years I was getting it every week from somebody. I got the recipe online from somebody who has their starter from 1987 still and I'm like.

5:07 I my my sourdough start is almost that old but I use sourdough all the time. That Amish friendship bread is really good, but it is in no way healthy so. Yeah, yeah, no kidding. Well, 5:00. Cups of sugar. We named it Freddy Krueger, so it was a lot of fun. So we'd be like, I massage Freddy Krueger today. And then I had to announce on the last day I said Freddy Krueger died today. Sad. Sad day. Oh my golly, that's hilarious. Oh my gosh. Well, anyway, what do you have for us today? Today I have an interesting topic. I think this one's going to get a little more technical than some of the ones we've done. Hopefully it's not too technical that it's still interesting for our non-technical, non clinical listeners, but it is misdiagnosis of psychiatric conditions. My main sources are all from or based on Susanna Callahan. So she has a book called Brain on Fire, My Month of Madness 1, called The Great Pretender, the undercover mission that changed our understanding of madness.

6:08 And then she was interviewed for an interview in the Guardian called Susanna Callahan. What I remember most vividly are the fear and anger. And then I'll put the rest of the, I'll put the rest of the sources in the show notes. There's actually quite a few more. I'm not going to list them all off SO. Wow. OK, great. Yeah, this story is really interesting to me. And like I said, I hope I can keep it interesting for for our listeners. So psychosis often sits at the uneasy border between psychiatry and neurology, between medicine and mystery. It's a condition where perception, belief and behavior can break from reality itself. But what happens when the diagnosis is what's disconnected from reality? In hospitals around the world, homeless patients are diagnosed every year with schizophrenia, bipolar disorder or substance induced psychosis.

6:56 Many of those diagnosis are accurate, but some are tragically wrong. The consequences of these errors ripple across lives, unnecessary medications, stigma, lost years, and in some cases, near death experiences. Perhaps no modern story illustrates this better than that of Susanna Callahan, a young journalist whose Month of Madness air quotes revealed not a psychiatric disorder but a misfiring immune system. Her journey from respected reporter to psychiatric patient to medical mystery exposed how easily psychosis could be mistaken for mental illness when the true culprit lies in the brain itself. Psychosis is not a single disease. It's a syndrome. Sorry, it's a syndrome, a cluster of symptoms that can appear in many disorders.

7:42 Some of these symptoms are hallucination, delusions, disorganized thoughts, bizarre behaviors. Lot of those can stem from schizophrenia or bipolar disorder or depression or substance use or brain injury or autoimmune illness or the metabolic dysfunction. And you can see already all of these, all of these things that are overlapping like this is the Venn diagram from hell, right? So diagnosis does not rely on lab tests or brain scans, but on the interpretation of what the clinician sees, hears, and believes. So without clear biological markers, psychiatry often works by exclusion. That lack of objectivity leaves enormous room for error. A2024 review found that psychiatric misdiagnosis remains among the most common and consequential forms of medical error. So that was a statistic that really surprised me. That's wild, and it's so difficult too, because moment to moment it can look different, even each person. Exactly, exactly.

8:41 Psychosis then, becomes both the medical and philosophical problem. It tests not only the limits of our diagnostic tools, but also the boundary between mind and body. So in 2924, year old journalist Susanna Callahan was thriving at the New York Post when strange symptoms began to creep into her life. At first it felt like the flu. Fatigue, irritability, headaches. Then came paranoia. She was convinced her boyfriend was cheating, that her father had harmed her stepmother, and she soon begin having hallucinations, seizures and losing track of time. Doctors searched for explanations. One thought it was bipolar disorder. Another alcohol withdrawal. Still others labeled it a psychotic break. Callahan's condition deteriorated rapidly. She became violent, incoherent and catatonic. EE, GS and MRI's appeared normal. Psychiatric words loomed to everyone, including her family. It looked like she was losing her mind. But beneath the psychosis, something else was happening. Her immune system had begun attacking the NMDA receptors in her brain, the receptors that are vital for memory, emotion and reasoning.

9:46 Neurologist Dr. Sohail Najar changed everything during an evaluation. He handed Callahan a blank sheet of paper and asked her to draw a clock. She clustered all the numbers on the right side, an unmistakable sign of right hemisphere brain dysfunction. Are you familiar with the clock test? Absolutely. And it's, it's most often that I've seen used for things like Alzheimer's and stroke and yeah, stroke and also other dementia. A Spinal Tap revealed inflammation test confirmed anti NMDA and cephalus colitis, a rare autoimmune brain disease only recently identified. Treatment with steroids, IV immunoglobulin and plasma exchange saved her life. Within months the quote UN quote madness vanished. She would She later learned she was the 217th person in the world to receive this diagnosis.

10:35 Oh my gosh. Yeah, so like I said when I was mentioning my my sources. Her story told him brain on fire. My month of madness became a best seller and a warning to the medical world. Callahan's experience, though extraordinary, is not unique in principle. Studies reveal consistent reasons why psychosis is misdiagnosed. Moose, Moose. Moose. Moose have a real problem with it. Moose have a real psychotic problem. I understand that they are kind of weird. Mood disorders and schizophrenia can both feature hallucinations or delusions. In early phases, they may look identical. In one study, nearly 60% of bipolar patients were initially misdiagnosed with schizophrenia.

11:17 This also stunned me because those are as far as the difference in the gravity of those two diagnosis, right? A patient with bipolar, although they may have hallucinations and delusions, is not not going to have the same problems that a person with schizophrenia, untreated, I should say schizophrenia, is going to have. I'm sorry, it was just going to ask. The one thing that I remember schizophrenia having a really big aspect in is the voices telling a person to do XY or Z, right? Is that schizophrenia? Yeah, that's schizophrenia. That's one, one form of schizophrenia. Yeah. First of all, I wanted to say I've been diagnosed with bipolar. I don't have hallucinations, or at least I don't think I do. Or delusions, maybe. Maybe I do. I don't know. I've been meaning to talk to you. But I can't imagine initially being diagnosed with schizophrenia that would that would scare me. You know, just like that just seems so much more serious, for lack of a better word.

12:11 Well, do you feel like you it's an accurate diagnosis for you? I didn't until it was my sleep doctor that suggested it as we were talking about my sleep habits. Then I went to my psychiatrist and she said that I'm going to misquote her probably. So if you interview our psychiatrist that I'm saying this wrong, this is my remembrance and I'll admit it probably not perfect. But I believe she said what because your sleep doctor suggested it. One of the best ways to figure it figure it out is to actually medicate you by bipolar and see if it makes a difference. And it did. So, well, and I think that for me, when I think of bipolar, I think of it being much more extreme than I've ever experienced you being. And you know, we've known each other a long time. It's actually not.

12:54 That's a huge misconception. Misconception. Misconception that it is always extreme it's actually much more common for it to be not so extreme like we what we see in the news and what we see in the movies and stuff that's the extreme end of it. But for me, so so my biggest like what did being treated with medication due for me, it made me sleep better. So now I'm not staying up for 12 days in a row or, you know, RIP Van Winkling for three days in a row. Oh yeah, because that would have been manic and then depressive. Episodes. Yeah, exactly. Exactly. I didn't put it together. I think you've seen me Rip Van Winkle for sure. So for those who don't don't understand what I'm saying, my sister calls it RIP bandwinkling. When I sleep for like 17 hours straight or 26 hours straight, It's just like, but I haven't done it since I once I started being medicated and I also like can get to sleep at a normal time and I wake up at a normal time and I hate it. Nobody's day should start at 8:00 AM. That's just.

13:52 I know I've been noticing that you've been sending me texts at morning time that I thought why are you awake? I figured medication. I know I figured you must have meetings and last night when and I was messing to you and I knew it was late for you. I'm like, well she's awake anyway so it didn't occur to me that you could actually be asleep. That's great though, if that's helping your sleep. Yeah, totally. Anyway, thank you for that. You're very welcome. So drugs, infections, autoimmune conditions, metabolic disorders, or even sleep deprivation can induce psychosis like symptoms. Substance induced psychosis are especially common in emergency settings. That's one of the things. OK, so I tell the story a lot. I don't know. It doesn't matter to me, but I like to tell it because I think it's funny. When I was working at a nursing home and I was the ADON assistant director of nursing, there was a time I came into our stand up meeting and I had been awake for 12 days straight. And the reason I think it's funny is because the Guinness Book of World Records, at least last time I checked, it was 11 days.

14:52 So I'm like I said, I we need to get a spec of world records that didn't even know it because I didn't find out about it until years later. But anyway, I remember I was in the stand up meeting and and that's just the beginning meeting of the day, kind of get the day sorted and what are we going to do today and etcetera, right? What do we need to focus on? Whatever. And I remember my boss asked me something and I just responded with absolute gibberish. I mean, not English at all. And he was like, are you OK? And I was like, I haven't slept for 12 days. And he was like, I'm taking you home, not not to his house, back to my house right now. And you need to go to sleep it. When he took me home, I, I was actually able to sleep. Yeah, it's just like. And so I have personally experienced sleep.

15:33 I'm being dyslexic today too. Sleep deprivation psychosis or or the very least sleep deprivation hallucinations, right. Just it was very strange. When there's been a lot of studies on people that have been put into sleep deprivation situations and how they respond and a lack of sleep actually seems to have a greater impact on reflexes and things like that than being drunk. Not that, not that you know you can. You can actually receive a parking or excuse me, a moving violation for being overly tired because you're still in a reckless way. You just aren't drunk. Yeah, I think that's why some states have DUI driving under the influence instead of DWI driving while intoxicated, because it does open the door for things other than just drugs and alcohol. Yeah, could be, but it's still, it would fall into the impaired driving at least.

16:27 Yeah, which is, I know that I saw something once where there was a group of people who wore those drunk glasses when they were tired and they had the same vision with and without the glasses when they were that tired. Like with 12 days, most people would have fallen over. Yeah, I don't even know. I didn't live far from work, but I don't even know how I drove into work that day, honestly. Yeah. So I want to talk, or I want to point out a little. The effect of clinician bias and systemic shortcuts, time pressures, anchoring bias, and and lack of interdisciplinary collaboration lead to premature labeling of of psychosis or schizophrenia or other mental illnesses. Racial disparities compound the issue. Black patients are over diagnosed with schizophrenia even when mood symptoms dominate. When you said the first thing about lack of collaboration, I mean, we do know that people of color tend to have worse outcomes in so many different ways in the medical field. But what do you mean with a lack of collaboration at what does that mean?

17:26 Are you going to go into detail on that? Lack of collaboration, like with a psychiatrist, speaking to a neurologist or psychiatrist, speaking to a family care provider, even even Speaking of interdisciplinary collaboration, but even maybe speaking to the person's family additionally, like psychiatry. I think this comes up later in a minute since I read this, but over but psychiatry is all opinion because every all the information you're getting is subjective. There is really not a lot of objective data for psychiatric diagnosis. Yeah, I was listening to podcast recently where a psychiatrist had diagnosed the the accused of a certain disorder and it turned out that he a had only spent a couple of hours with him and some of the tests he used are known to be inconsistent or inconclusive, especially when they stand alone.

18:21 So that's interesting. And also, I would think that some of that collaboration goes back to where you were talking where if it was just a psychiatrist, they might have not have done a Spinal Tap. It was just a position, may not have done any of the psychiatric evaluations. So I get that. That makes sense. And The thing is too is that early air quote psychosis may change form. What begins as psychotic depression may evolve into bipolar disorder or like in Susanna Callahan's case, reveal A neurological disease. So antipsychotic drugs, while life saving for true psychotic disorders, can cause serious side effects, metabolic syndrome, tremors, tardive dyskinesia. Do you want to describe what tardive dyskinesia is?

19:03 Yeah, that's something that when I was working for a long term care facility, we had a lot of people on antipsychotic medications. So we had to watch for tardive dyskinesia, which is involuntary tremors. And often what's interesting is that the gate that they have can look like Parkinson's. That's sort of a shuffling gate. But the rest of them, they'll have movements in their hands or their faces, especially their faces. They'll have twitches and tremors in their faces. And then they have, it reminds me when I see someone who's heavily involved in drugs does some of the same sort of weird hand movements where it's uncontrolled and doesn't make sense to what's going on. And that's one of the there's times that people get to work together to figure out what, what is it. And unfortunately, tardive dyskinesia is usually not curable.

19:51 Once a person gets it, they're usually in it. But taking away the medications doesn't make it go away. Correct. And it was very well known when people were taking a lot of lithium. That was one of the very common side effects with lithium, Yeah, which was used for antidepressant experiences. There's a lot of psychiatric medicine going into old people in nursing homes. There really is. Yeah, that's a whole other tangent. So obviously when prescribed to someone who doesn't need them. So antipsychotic drugs can worsen suffering without benefit, right? Another thing is that a lack of collaboration with other disciplines can delay proper treatment. So, for example, in autoimmune encephalitis, time is brain. And so the longer the inflammation continues, the higher the risk of permanent damage. Early immunotherapy is crucial and Susanna Callahan spent a month under the wrong diagnosis before being treated and. She's like, it was only a month, really. Right.

20:48 She really is. She's very lucky. And she's very lucky that she did not have more serious side effects. She's lucky that she can still write, write and read and all of those things. You know, I'm, I'm very happy for her that it was not worse. And remind me how old she was. I believe she was 23, but let me. Yeah, I thought she was young and. And that makes me feel like they're. 24 She was 24 years old. 24 And I feel like the fact that she was young probably and was involved in her good recovery where if you were older and had other search of brain lesions and things like that, it might not have been as good. And that is theory by Andrea. I have no basis on that other than just knowing that there's already potential essentially brain damage with an older person. And so when asked what was the scariest part, Callahan said that the scariest part was not losing control.

21:33 It was losing herself and gaining labels that she knew could potentially alter relationships, employment, and even her own self self worth. Right. Like I had just recently said, being told one has schizophrenia can be scary. And it's not just scary for the person receiving the diagnosis, it can be scary for those that are around that person, right? I mean, I, I think that most people, if you were to ask them, when you think of schizophrenia, what do you think of? They're probably going to say serial killers or harm people who harm other people or crazy people. And it's just there. We have a stigma. We have a stigma based on the label of schizophrenia, schizophrenia and whether we like it or not, the labels that we create and that we pass around other people state their self concept.

22:22 So. Yeah, No, it's true. And and when we hear about the big bad guys, they have one of these disorders often and that doesn't help. And you know, we so often talk about a spectrum. And I think this is like anything where there are stages and grades of whatever the disorder is. So some people will have it in association with other things. Some people will have it in a mild degree. Now with this Suzanne, right? Susanna. Susanna. Oh, yeah. Was she aware of what was happening? I mean, did she have knowledge of kind of losing her grasp or did she know this was happening to herself? I didn't mention it. Yeah, she did.

23:03 But I mean to a point, like like I said, she basically lost herself. And so she could feel as she experienced the losing of herself. And, and it's funny, I've, I've gotten ahead of myself a little bit in this podcast, but I wanted to just say that not only does misdiagnosis threaten people's health and well-being emotionally, medically, culturally, etcetera, it wastes medical resources. We have unnecessary admissions, inappropriate drugs, long term care and it diverts attention from real underlying diseases. Well, and also many of these antipsychotic or antidepressants or all of those drugs take a period of time to get to a therapeutic level.

23:47 So even if a person is diagnosed with a psychiatric disorder and giving a medication, it can take weeks to months to even know if the dosage is therapeutic, which is high enough. And then if it doesn't work, then you're back to square 1 going OK, so is the diagnosis incorrect? And you usually have to wean off of those drugs. Most psychiatric drugs you can't just stop taking. And so you have to wean back off of those drugs as you wean back onto another drug. And then you're taking both of those drugs at the same time. I mean, it's, it's scary business. Yeah, it certainly is, especially because as you say, it can be so subjective with a what I'm reporting. So if I come in as the patient and I report this and that, my family might have noticed something different, the the psychiatrist might be hearing something different based on any personal internal bias or whatever. And so we can go off track in so many different ways, which is true really at any kind of diagnosis. However, I think there are more immediate tests that can happen because there aren't a lot of tests. I mean, I can't in most cases do a blood draw and say, Oh yeah, psychotic, right?

24:56 I mean, it does. It doesn't work that way as far as I know. So what the suggestions are, there are a few lessons we can learn from Susanna's case, and one is never stop at psychiatric when neurological signs such as seizures, abnormal movements, autonomic instability are present. If I'm having seizures, if I'm having, you know, tardive dyskinesia, then let's check out the neurological side of it as well. Psychosis can have a physical cause. Autoimmune encephalitis like Susanna had thyroid disease, lupus infections, just sepsis can make you have psychotic symptoms, right? Metabolic imbalance. Like I was saying before, families are data.

25:39 Her parents insistence on further testing saved her life. If it hadn't been for them, she would have been probably institutionalized and that would be that. Essentially for forever. Exactly. A diagnosis is a process, not a verdict, and I loved that one. In her second book, The Great Pretender, she broadens the inquiry. If she was my excuse me? If she was misdiagnosed, how many others are? In it, she re examines the 1973 Rosenhan Experiment, where healthy volunteers feigned psychosis and were all admitted to psychiatric hospitals. I remember that. Decades later, her investigation suggests that psychiatry still struggles to separate sanity from sickness, so misdiagnosis happens everywhere from New York to Nairobi to the Taj Mahal.

26:20 Although they're probably not being being diagnosed in the Taj Mahal. I have a vision of that people wandering through. Anyway, I'm not going there. And it often mirrors system systemic inequalities, racial bias, lack of mental health resources, stigma that discourages second opinions. A systematic review found that only 28% of initial psychosis diagnosis diagnosis made by non psychiatric physicians were accurate after psychiatric evaluation. 20 Only 28% of psychosis diagnosis made by doctors who were not psychiatrists were accurate after a psychiatrist evaluated the patient.

27:05 So let me put that the other way. 62% were inaccurate. Oh my gosh. And therefore medicated and potentially high hospitalized and potentially blah blah blah. Oh my goodness, that's wild. It is so so. The data suggests the universal truth. Psychosis is easy to label but hard to understand, right? How could we prevent misdiagnosis? We can start with a comprehensive evaluation, a full medical and neurological workup including blood tests, imaging and cerebral spinal analysis to accompany any first episode psychosis. This hit me really hard and I, I will be the first to say that our healthcare system in the US sucks and that actually even being able to have all of these to use, utilize all of these steps may not even be possible in our system. And don't edit this out Andrea.

27:53 Healthcare for profit is a crime against humanity anyway. Like I but you know, in an ideal world where we could be treated the best possible. I don't know how to say it, but so we would want, I'm going to say it again because it hit me so hard. A full medical and neurological work up, including blood tests, imaging and cerebrospinal analysis should accompany any first episode psychosis. Well, that makes sense, because then it does. You're ruling out other stuff right up the front, and it gives the person a chance to have a much better option to have the correct diagnosis, then go again for months and months or even years in the incorrect diagnosis, having other types of physiological problems. But then they'd probably have died by then too if that was the case.

28:38 So next step is specialist collaboration. A study in the Journal of Adolescent Health in 2021 indicated that early referral to first episode psychosis clinics or multidisciplinary teams improves accuracy and outcomes. Same sort of thing, right? Don't just see the psychiatrist, see the psychiatrist and the neurologist. See the psychiatrist and the orthopedist. I don't know that I made that up. Endocrinologist. That's a better one, right? But like, let's have the. Let's have the psychotic, unless of course it's a behavioral issue and that makes and that makes sense. And one of the things that I was thinking about is how many people who have these sorts of thoughts or symptoms are the first reporters?

29:22 Because I think because of the stigma of mental health, which is getting better because more and more people are talking about it and saying it's just, it's the same as any other disease. It just effects a different body part. However, it's been such a strong stigma that many people don't say anything and then they go longer and longer being not treated. So if they have a metabolic thing versus a psychiatric thing, they may have more permanent outcome problems than if they had been treated right away. Self reporting may or may not be common. Yeah, that's definitely true. The next step is bias awareness. And we talked about this a little bit, but clinicians must be trained to recognize how race, culture and gender bias affect diagnosis. And I would even say beyond that, there are, there are so many other things that could affect diagnosis, you know, gender identity, sexuality, sexual preferences, even obesity can be something that creates A bias. And I think the important thing here is that we have to focus on the word trained.

30:28 They have to be trained to recognize it, to just say to a clinician now make sure you're not biased against people of color and you know this and that and that there has they, we have to give them the tools that they need so they can use them to reduce their their biases, right? Right, because most people who are biased aren't going to say, Oh yeah, totally, I'm biased because they don't want to admit it to themselves. And if it's an inherent bias where maybe it's because I was raised just for example, in the South, I may have some biases that I don't have if I was raised somewhere on the West Coast, which tends to be more open minded. And I mean, that's a blanket statement. And no, no, it's not true for everyone in any of those places, but it is more likely to have something based on your cultural upbringing that you may or may not even and recognize, like you said.

31:19 So they get to be trained to look at it. I know that I had, I can't remember where it was, but a test about bias, implied or implicit bias that made me think about some stuff. Was I looking at this, that or another sort of thing in a way that I might make a decision differently than I would for someone of another group? Right. Yeah. So I was confirming my suspicion. Susanna Callahan is a, an attractive young white woman. I mean, I can tell you based on scientific results and studies, she probably got better treatment than somebody who was not a pretty white young woman, right? That's just and, and good for her. Don't get me wrong. When we talk about privilege, I we have to remember that just because we have privilege doesn't mean we have to. We should use our privilege to make things better for the people who don't have privilege because we're going to have the privilege whether we like it or not. So that's my soapbox on that one. And then next step is follow up and, and reassessment. Psychiatric diagnosis should be provisional and revisited over time as symptoms evolve.

32:21 And I know I know of a lot of people, a lot of people. Well, first of all, let's talk about the fact that family doctors are managing their psychiatric symptoms. I was never against that until I got a psych psychiatrist. Well, there were a few things, but one of them was getting a psychiatrist to manage my medications rather than a family doctor and all of like how how much different that was and just somebody being like, oh, you have depression. Here's this common antidepressant. And so that's one of the things like, and then what I was going to say is how many people just get, you know, their antidepressant from their family doctor and then it never comes up again. And their doctor does the three month assessment with the questionnaire. They don't really look at it right. They just continue with that dose for who knows how long.

33:03 What point is a patient supposed to be able to say, Hey, wait, I don't feel as good as I used to. I should go back to my doctor. They shouldn't, they shouldn't be held responsible for that now. They should be held responsible for their own health in the sense of like, if you're not feeling as good as you were, you should go to the doctor. But it should. We should always be following up. I mean, really, you should be following up with a doctor for anything you're prescribed. That's my opinion. Yeah. Well and and our symptoms can change the efficiency and efficacy of the medication can change our. Metabolism can change. Right. Exactly. There's so many, so many things. If a provider is not necessarily trained on all of the things to watch for, they may not have even told the patient. Watch for this, that, or the other thing.

33:44 If you notice any sort of tremors, if you notice anything like that, let me know immediately so that medications can be changed. Because they may not, they may not even be as aware of it as they should be. And when you've got somebody who specializes in everything that it's hard to remember everything. Right. Yeah, exactly. And no shade to family doctors, by the way. They're they're. Certainly a wonderful starting point for anything that does need further specialization especially. I was, it's funny, I was talking to Holly yesterday about going to my primary care provider, family doctor, same difference. And I was like, I realized I I realized how old I'm getting when I said to her, not in these words, but through the course of conversation, it came out that I have a sleep doctor, a breast doctor, doctor, colon doctor, orthopedic doctor, an eye doctor.

34:38 Let's see, I got to do a body scan here real quick. And I think, yeah. And then her and then her. I don't know. OBGY well, 9, I don't do OB anywhere. And a gynecologist, 7 doctors. I'm old. Right. Yeah. And, and also though it's not just because you are as old as the hills, it's being, I can say that I'm 10 years older, but also because physicians are specializing so, so tightly that we have to, we can't see our orthopod in our rheumatologist, which you may have as well as at the same time because. Oh, I have an endocrinologist also. Dang it, there's another. And a weight doctor. Oh my gosh. Oh my gosh, yeah. You don't even have time for doing anything. How can you be sleeping?

35:19 With all these providers. Pretty funny it is. Oh, it didn't even include my psychiatrist. Dang, that's 10. Man, you've got more than I do. That's why I'm going to have to start collecting a few more. Yeah, you need to collect a few more. I guess. So the last step is patient empowerment. Patients and families should keep records, ask for explanations, and request reevaluation and 2nd opinions when things don't add up. And that was probably another thing that really benefited Susanna, Susanna Mohan, is that her parents stood up for her when she could no longer stand up for herself. By the way, I didn't say it, but she didn't just think, believe that her dad had harmed her stepmom. She was convinced that her dad had killed her stepmom.

35:59 So imagine believing that for however long it took. Oh my gosh. Well wait, was her stepmom unavailable? I mean. I have no idea. It seems like one would notice if she was standing in the kitchen that she was not dead. I have no idea. I didn't get, I didn't get that deep, but isn't that wild? It is. That would be disturbing on so many levels. So I have a friend who when I first met her she was on some psychiatric medications. It was like it seemed pretty similar to like what I was on mostly just an antidepressant I think. And she had an episode where she threatened to harm herself and me and her, her boyfriend took her to, well, mostly her boyfriend.

36:41 I met them there, but took her to an institution and had her checked in. And anyway, she started getting prescribed more and more drugs, more and more drugs, more and more drugs. And just, I mean, she just was, according to all of her diagnosis, she was crazy as hell, right? Just like, holy wow. Holy, holy smokes. And one of the drugs she ended up taking long into this process, years into this process. We, you know, we all read about her mental stability and this sort of thing because she was so brittle with her mental health. One of the drugs she started taking, like I said, years into the process, actually made her lactate even though she'd never been pregnant, pregnant, pregnant in her life now. Yeah.

37:22 So now she's feeling crazy and now and lactating and, like, what do you do with that? Anyway, to make this Long story short, she eventually told her her, her doctor, and her therapist that she wanted to wean off the medications and start from scratch. That makes sense. And so they agreed to let her do that. And lo and behold, once she was weaned off all of the medications, she felt great. And it turned out all she had was ankylosing Spondylosis. And like, I don't know if that was giving her psychiatric symptoms, but it's the only thing she currently has a diagnosis for. Hasn't been on any psychiatric medicines in a decade. Probably. Doing great great life great as a kid now. Well, I'm glad she is.

38:03 And that speaks to the fact that there is no medication that has zero side effect. Every single thing has a side effect. So we take one medication, have to take another one just to combat that side effect, then another one, another one, another one, which this speaks really strongly to. Yeah. I the first bipolar medication that I tried increased my appetite and I gained like 30 lbs and I was like I am not doing this man. I'm I literally have a weight loss drug. I'm not taking this medication. And it was weird. Because I, I, I could see, I could recognize that my appetite was so much bigger. And I was like, this is really weird to be hungry like this. Yeah, I do not like it. And so when I I just happened, I didn't realize it was a side effect of this drug.

38:43 And I happened to mention it to my psychiatrist. And she was like, oh, yeah, that'll do that. We could try something different that doesn't do that. I'm like yes please. Well, and that is a common side effect for for psychiatric drugs is an increase in appetite. And I don't know why it is. I've never looked into it because I haven't had to take any of them, but it I know that has been a common side effect. Yeah, how does this, how does this topic fit into medicine, mystery and mayhem, you may ask? I may how does it? Well, Callahan's Urbil embodies all three themes of this podcast. It it includes medicine, the science of neurology and immunology ultimately solved the Riddle.

39:24 Mystery. For weeks, doctors couldn't explain her descent into psychosis and mayhem. The chaos that misdiagnosis wrought in her life lost identity, Fear. Hospitalization was nearly fatal. Fortunately, there was no murder. She's alive. Her story reminds politicians to balance humility with vigilance. And it tells listeners that madness isn't always mental. Sometimes it's medical. Wow, I like the way you tied that in. So psychosis, in all its forms, demands curiosity. The mind is not an island. It's tethered to the immune system, the brain, the body and the environment. When any part misfires, the symptoms can look the same. Callahan's recovery shows that being wrong isn't the end. It's the chance to get it right.

40:06 For every Susanna Callahan who finds her answer, others remain lost in psychiatric limbo. The responsibility falls to clinicians, families and society alike to look deeper, question assumptions, and never forget that behind. Every diagnosis lies a human being who wants their story understood. Wow, that was excellent and definitely something to consider for so many reasons. Also remembering, I think that even though we have been trained for a long time in our world to look at psychiatric disorders and diagnosis to be a disability, it really is a disease. And I've heard people say, well, if you had a broken leg, you would treat it right.

40:50 And nobody looked at somebody with a broken leg and go, oh, wow, they're just messed up. Well, and sometimes we break our legs because we're being dumb, but we still nobody said, oh gosh, they should be hospitalized forever for that. But when we hear about psychiatric disorders, a lot of times people will just say, well, they're too damaged or messed up or I don't want to be involved because blah, blah, blah. And many times they are having those diagnosis and we don't even know anyway, which is probably good because when we have our biases which show up in that moment for a lot of people, I think. But when we do hear that there's a psychiatric disorder or a diagnosis, it's important to remember that it is an illness, same as anything else. And if anything, we should be more compassionate and concerned to make sure that we are some of the people going, You know, I noticed this.

41:43 Did you know you were doing this? Is that a concern to you? You know, and and that kind of thing, obviously you don't walk up to so told a stranger, I wouldn't think and say it, but but like, if I noticed with you that you were doing something different, I'd say, hey, did you notice that? And that would be appropriate, that part of the friends and family as reporters. Yeah. Yeah, exactly. Friends and family will notice stuff sooner a lot of times about us than we noticed for ourselves. Yes, and when it's off baseline. So I think with everything, I feel like we just get to have compassion for the people in our lives to to assist them to thrive instead of blaming them for something, especially that has nothing to do with anything they chose. Yeah. Well, and you look at the really good example of this is the unhoused population in that the majority of unhoused people are either mentally ill or drug dependent or both.

42:35 And a lot of times it can become a self perpetuating cycle of descent, right? That's DESCENT, not DISSENT. There is such a thing as drug induced psychosis. We'll take somebody with actual psychosis that actually, let's say, does have schizophrenia, add to that drugs and that cause psychosis and just look at the powder keg that's been built. And I, you know, I know a lot of people have their opinions about unhoused people. And I'm going to tell you right now, we could solve the unhoused problem if we bothered to even try. But that's all I'm going to say about it right now. It just it's a good it's a good example of how much mental health matters and people all the time. It's funny, there's one of my pet peeves is people like mental illness matters.

43:21 Well, it's their health that matters, right? Like, let's not, let's not keep calling it mental illness. Yes, they may have a mental illness, but we need to be focused on their mental health. That's right. That's my perspective. Well, not just theirs, ours, all of ours. Yeah, all of us have mental health. Yeah, that's that's what's funny. People talk about the, what's the word talk about the the stigma of talking about mental health. And it's like, that would be like the stigma of talking about the knee, right? Or the stigma of talking about sweat. Like we all have it. We it's just a part of being a human. Yeah. I mean, definitely. I encourage people to to speak about mental health with the people they love and to consider their own mental health and to not let it be taboo, not let it be something that is like scary. Yeah.

44:11 And I know for me, when someone asked me how I'm doing, if it's someone I'm close to, I will actually tell them I want to say fine. And I think that's important for us to be real and honest with each other because then we can be watching out for each other. We can assist. And back to the unhomed people, they often start drugs to self medicate for mental health issues that either they don't understand or just know that if they take this or do that, they feel better because they've disconnected. That is typically unhealthy. It doesn't take them down a path that really works, but it can probably feel like it at the beginning, especially if they feel like they have no options.

44:53 Right? All right, well, excellent. Thank you very much. You're very welcome. All right, if you've made it this far, clearly you like a little mayhem with your medicine. Or you just enjoy hearing us ramble about weird medical mysteries. Either way, we'd love you for it. So hit that follow or subscribe button wherever you're listening. And toss us a rating or review while you're at it. Helps other curious weirdos find the show. And we know there are a lot of you out there. Oh so many. Come join the chaos. Thanks for listening to Medicine, Mystery, mayhem, and sometimes Murder. Do you have an idea for an episode of this podcast? Just want to say hi? You can get in touch with us at our M4 pod. That's OURM the #4pod@gmail.com. We read every e-mail, and sometimes we even respond just like real professionals.

45:45 Because we are old. Friends with new twists and lots of body bags.