... and the first thing I did, after the barn work, was email M's pdoc.
I almost NEVER email M's pdoc... He's ok, but we've never "clicked" and honestly... unlike M's old pdoc, he seems not to give a d*** in terms of M's day to day ups and downs, so there is seldom any reason to contact him. M's sees him every few months, he writes a bunch of prescriptions, and that's about the extent of it.
M's pdoc is great when it's life and death though... There have been a couple of times since he took over M's care that the situation was literally life and death and he jumped right in and was available, helpful, and kept with it until the crisis had passed.
But if it's not life and death he really doesn't have time for it.
This is the third time I've emailed the pdoc in the past month... letting him know that M's hallucinations had significantly increased and his insight* had decreased. The pdoc called me after the first email, but didn't offer any suggestions or advice. He never responded to the second email.
M had another serious "disconnect" on Friday and I decided I needed to do something... (lots of hallucinations with poor insight is a poor and risky combination)... so I increased his haldol. I let the pdoc know about the change in this morning's email and asked (again) for direction.
I know I'm very lucky to have a pdoc for M... especially one specially trained in child/adolescent psychiatry and with the knowledge and experience M's pdoc has.
And I know this pdoc (who also works at one of the state hospitals) probably has, at any given time, MANY patients with schizophrenia who are hallucinating and have poor insight.
But I have only ONE child with schizophrenia who is hallucinating and struggling with insight and I would really appreciate the pdoc taking the situation somewhat seriously!
Ok.... end of rant.
*Insight, from Wikipedia:
In psychology and psychiatry, insight can mean the ability to recognize one's own mental illness. This form of insight has multiple dimensions, such as recognizing the need for treatment, and recognizing consequences of one's behavior as stemming from an illness. A person with very poor recognition or acknowledgment is referred to as having "poor insight" or "lack of insight." The most extreme form is Anosognosia, which is the total absence of insight into one's own mental illness. Many mental illnesses are associated with varying levels of insight. For example, people with obsessive compulsive disorder and various phobias tend to have relatively good insight that they have a problem and that their thoughts and/or actions are unreasonable, yet are compelled to carry out the thoughts and actions regardless. Patients with Alzheimer's disease, schizophrenia and various psychotic conditions tend to have very poor awareness that anything is wrong with them.