A Mental Disorder That Should Be DSM Approved

NERVOUS BREAKDOWNS.  Classic “I know it when I see it” stuff.  Here’s two stories from attendings I work with, and two from me:

  • A 3rd year resident who “just snapped” one day.  In the middle of a busy work day, she took out every single patient chart and simply wrote an order to “D/C home”.  3 hours s/p CABG?  D/C home.  Hematocrit of 4?  D/C home.  Still on a ventilator?  D/C home, damnit.
  • A surgical intern who left a case, started yelling nonsensically in a hallway and then locked himself in the team room.  They had to call security to make sure he was still alive, but when they unlocked the door, he was just sitting there, chilling.  (He allegedly was leaning back in a chair and drinking a soda, but I don’t know if I can buy that part – no matter how awesome the mental image is.)
  • A patient who sent her kids off to school, packed her husband a lunch for work, kissed him goodbye, and got in a car and drove to a totally random city 5 hours away with no plan.  Found lying on a park bench, memory totally intact, tox screen negative.
  • One of my classmates, before our first anatomy exam.  (I don’t feel like I even need to supply details because it’s surprisingly easy for most medical people to imagine the kind of crazy things someone might do in this situation.)

The point is, nervous breakdowns are a thing.  People who are under a lot of stress occasionally “just lose it” and act like a crazy person, and can never properly pinpiont why afterwards.  And these are people without histories of psychosis – and they usually never have another episode.

And it would be sincerely, 100% helpful to me and probably the medical profession at large if I could use it as a diagnosis.

6 thoughts on “A Mental Disorder That Should Be DSM Approved

  1. Good one!
    So convenient to have an explanation the general public understands, that we don’t.
    When I did my psyche rotation, my inpatients were a catatonic med student six weeks from starting OB residency, a physics PhD candidate smearing his feces on the wall, and a dermatologist who’d discovered a common disease the board of dermatology denied existed.
    On rounds, I imagined how my own nervous breakdown would manifest.

  2. I’m a nurse, currently off work because I relapsed into an eating disorder. Stopped eating & became the patient. That’s a tough one to explain. “So what do you do with yourself?”
    “I’m a nurse”
    “& you don’t know that starving yourself could kill you?”
    “Oh it could kill people, it won’t kill me.”
    “Then why are you here in resus with severe hypoglycaemia, hypokalaemia & paralysis from low magnesium?”
    “I’m really ok”
    “we’ll just get you that psych review…”

    Even more awkward when the treating reg. was a former colleague.

  3. Toward the end of my first semester of med school one guy in my class snapped. While studying for finals he threw all his textbooks threw a closed window into the snow, then got in his car and drove back to his hometown 10 hours away. He left all his stuff in his apartment, and never came back. I have no idea what happened to him.

  4. When I did my mental health rotation (in Europe) we had patients who were diagnosed with acute and transient psychotic disorders including bouffee delirante (“a puff of madness”). Several of them were students at my university and listening to them it used to really scare me how easily the roles could have been reversed.

  5. Aren’t “nervous breakdowns” now called “Major Depressive Episodes”. Try using that term as a diagnosis, it sounds a bit more technical so it might work ;D

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