Had a new patient today. She's starving herself to death, and her family is frantic.

[Aristus]

I referred her to Behavioral Health. We'll see what happens. She thinks God commanded her to fast so she can "preach to the nations."

Her urine specimen is almost pure ketones, meaning her body is breaking down muscle mass for nutrients in a desperate bid to save itself.

I am so over the God delusion...

[paleotn]

1. Ugh...you and me both.

[femmedem]

2. I hope she can be saved.

I can't imagine what it's like to treat people who are in such grave danger of dying over their delusions.

She does sound like she has something going on that goes beyond anorexia. Not that anorexia isn't deadly on its own. I knew three kind, sweet women who died from it.

[Aristus]

3. She has a history of schizoaffective disorder.

This might be a manifestation of that. I hope Behavioral Health can sort it out.

[femmedem]

4. I'm no doctor but that was my first thought.

I hope they can say she's a danger to herself and hospitalize her. And that it's not too late.

I was an exotic dancer for many years; I had too many coworkers who suffered something similar. I wish I could travel back in time and do more for them.

[Aristus]

5. Well, it was my job to look for physical causes for her weight loss.

Found a pulsatile mass in her abdomen. Probably just a prominent aortic pulse due to lack of abdominal fat. But I referred her for an ultrasound to rule out abdominal aortic aneurysm or cancerous mass.

[femmedem]

8. I apologize, Aristus.

I know you came to vent about seeing people die for their misguided beliefs, not to get even a whiff of advice from people like me who aren't physicians and haven't even seen the patient.

I look forward to your posts, and I hope that sharing here makes the difficult parts of your job more bearable.

[soldierant]

10. Well said.

I hope it's acceptred. I've been known to say things I've regretted.

[Aristus]

12. You have nothing to apologize for.

I didn’t find your post the least bit offensive.

I thought it was friendly and kind.

[littlemissmartypants]

13. I was going to say that she sounds psychotic. If not metabolic then

An exacerbation of an underlying mental health diagnosis. Maybe both. I hope she can get help. Anosognosia is such a handicap to recovery in many of these cases. You might have just saved her life.

Stay encouraged, Aristus. You're a good egg.

❤

[Aristus]

15. Thank you.

Right now, I’m a little fried…

[littlemissmartypants]

16. Hahaha. Don't be so hard on yourself. Try over easy....

[Aristus]

17. You don't want to see me when I'm scrambled...

[littlemissmartypants]

18. Hahaha..I dunno, might be good for a laugh on a rainy day.

Clearly, I'm fresh out of egg jokes. ❤

[Aristus]

19. Me too.

I’m too drunk to think of more…

[GoneOffShore]

26. So now you're poached?

[Aristus]

28. Nope. Deviled.

[GoneOffShore]

29. Better than being pickled.

[LastLiberal in PalmSprings]

14. She thinks she already HAS been Saved. That's the problem.

She sees it as a no-lose proposition. If she dies from starvation she goes to Heaven because she's Saved. If she lives due to the medical staff's extraordinary efforts, God wanted her to live to spread His message. The fact she's alive only because of science and the work of others doesn't matter to her; obviously God was motivating them to take care of His special messenger.

[Skittles]

6. sounds like she needs a mental health evaluation

poor thing

[Aristus]

7. I referred her for one.

[Skittles]

9. ahhh

"behavioral health" I like that - hopefully not as much stigma attached

[PoindexterOglethorpe]

11. Oh, dear.

I want to ask, Why is she starving herself to death, but I think you may already have answered that.

I can't begin to imagine. I do hope there is a good outcome, although I suspect there won't be a good outcome here. So sorry.

[totodeinhere]

20. Maybe the family should try to get a court order to have her force fed. n/t

[Wolf Frankula]

21. I contacted my friend Thor.

He will tell God to lay off, or else.

Wolf

[Irish_Dem]

22. Command hallucinations means psychosis. The most dangerous kind of psychotic ideation.

Entities commanding a person to do bad things.

Referral to inpatient psych is appropriate.

She will probably be placed on antipsychotic meds and also placed on an acute anorexia protocol.
She is a danger to self and should be on an involuntary hold in a psych unit, locked ward.

This gal can die, so the family needs to address this and in a timely manner.

[Aristus]

23. They waited a year to bring her in.

There’s still hope, but she should have been evaluated months ago.

[Irish_Dem]

24. Omg unbelievable. They may lose her.

I don't know what percentage of body weight she has lost. Obviously, the higher the percentage, the higher the risk.

This kind of case is very hard to stabilize.

Anorexic cases are very high risk, most outpatient mental health professionals won't even treat them any more.
It is all done inpatient, residential or day care. Too much liability outpatient.

Command hallucinations are also high risk.

If they have her inpatient, they can load her up with a high dose antipsychotic, and antidepressant cocktail and hopefully the psychosis will diminish and then hopefully then she may start eating. If not, then the anorexic protocol kicks in.

This is a very sick gal, and the family needs to understand that. There is going to need to be some family therapy as well.

[Aristus]

27. That's probably less charitable than I would like for this patient.

She’s not some demented right-wing evangelical. She’s a sweet, quiet devout Catholic with daughters who love her and are worried about her.

She’s not harming anyone outside her family or calling for the annihilation of everyone she doesn’t like.

She’s just getting her messages screwed up inside her head. I’m trying to get her the right treatment.

Oh, and I’m trying to rule out the possibility that her radical weight loss may be due to a cancerous mass.

[Ocelot II]

30. That's pretty harsh. The woman is almost certainly mentally ill

and in need of psychiatric help. She's not a moron.

[Paladin]

31. If you and your family members have avoided eating disorders, you ought to be very thankful.

I speak from personal experience.

[hunter]

32. If it wasn't a god delusion it would be something else.

Space aliens, the telepathic voice of Donald Trump, long dead ancestors, voices on the blue television screen...