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Sunday, July 22, 2012

Paranoid Schizophrenia in Aurora, Colorado


I am sad thinking about the Colorado shootings. Victims and survivors. It makes me think about my college days. I can't imagine dying in my 20's. When I was in school, the only time I really went out was to see a movie. I couldn't afford much else. When I was in med school, 2 of my classmates 1 in my first year and 1 in my third year had psychotic breaks. Both were struggling during exams and both became very isolated. One of these classmates I knew well. I even escorted him to the dean's office when he had come to my apartment obviously acting odd. As a psychiatrist I now know both of these men suffered from paranoid schizophrenia. Thinking back I remember how two bright young men seemed isolated at first, then talking very little, then what appeared as an odd way of listening to things that weren't there. We call this in psychiatry responding to internal stimuli, another way of saying "listening to auditory hallucinations". Both men were in their early 20's. Both men had no prior psychiatric history. I don't know their family histories except to say they were from families who were very proud that their sons were going to be doctors. There was probably no legal history. You really can't get into med school if you have one.

Paranoid Schizophrenia is a disease that strikes young people and usually becomes apparent after some initial stressor. It is characterized by delusions, particularly paranoid delusions which are fixed false beliefs that would not make sense to you or me. This is a thought disorder that then includes changes in emotions and behaviors. The affect or emotional expression becomes blunt, flat or inappropriate. For James Holmes the Colorado shooter, the affect was blunted and is now described as inappropriate (his grin).

Mr Holmes does appear to have symptoms consistent with Schizophrenia. I don't know the particulars, I have made no examination. Drug abuse although a possible issue and co-occurance, does not present in this fashion. There are no strange behaviors after intoxication wears off. In fact, Mr. Holmes seemed alert with a clear sensorium during the shootings. Having seen many such patients, the description of events can be interpreted as a psychotic episode. The treatment is actually fairly simple. Depending on the severity, the prognosis is good with medication and psychotherapy that emphasizes treatment compliance.

I am angry thinking about the Colorado shootings. 1 in 4 Americans, right now suffers from mental illness. Yet people continue to minimize mental health issues. I hear statements like, "oh, he'll grow out of it, it's just a phase" or "it's normal to feel like this, it's a part of life". I am tired of psychiatrists and mental health professionals being vilified and scapegoated because of people's refusal to understand their own suffering. Insurance companies don't want to pay for treatment, stereotypes about medications and treatment abound, etc., etc., etc. Even other physicians I know don't understand the value of treatment. Once I see their kids for management and they thrive; all of the sudden I'll get a ton of patient referrals from them. WAKE UP ONE AND ALL. IF THERE HAS BEEN A CHANGE IN HOW YOU OR SOMEONE ELSE IS BEHAVING, THINKING OR FEELING FOR MORE THAN 1 MONTH, GET HELP. PLEASE. PLEASE. PLEASE. JUST ASKING A PROFESSIONAL "IS EVERYTHING OK?" CAN SAVE A LIFE. MAYBE YOURS.

I can't imagine dying in my 20's.





5 comments:

  1. I agree with Soroya Bacchus' diagnosis; I believe that it is highly probable that Mr. Holmes suffers from paranoid schizophrenia. This would be consistent with his described as well as apparent behavior thus far, his actions, and reported exceptionally high level of intelligence. His intelligence would have enabled him to live an apparent "normal" life and go undiagnosed. If this diagnosis is correct (experts would need to confirm it) I understand that there is a high probability that Mr. Holmes will respond positively to medical treatment for his condition and in that case, I cannot begin to imagine how this young man will feel, if this is the case, once treated and able to think clearly about what happened. This would be extremely difficult to live with.

    How could a tragedy such as what happened in Aurora be prevented? There are no guarantees. However we might begin with requiring psychological evaluations before anyone is permitted to carry weapons or order ammunition or components/chemicals that could be used as weapons or parts of weapons. Weapons, ammunition and chemicals that could be used to build them should be very tightly regulated; internet trade should be part of these controls and this is something we haven't yet figured out in today's world. Largely unregulated internet trade is probably one of the greater hazards we face as a society today and we need to pay more attention to it.

    I feel extremely sad for the victims and their families, and grieve with them. I hope that qualified experts will have an opportunity to make a psychological evaluation of Mr. Holmes' mental health very soon. The answers will not bring anyone back, but it might help us understand what happened, and it may lead to positive societal/regulatory action towards prevention.

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  2. AnonymousJuly 24, 2012

    Thank you for sharing this, it is so sad that still in 2012 people do minimize mental health issues. I want to thank you for reminding us to help the ones we love and the people we are around, and ourselves by just asking for help. It is OK to ask for and get help people.

    Thank you Dr. Bacchus!

    Dianna McCullough

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  3. the unfortunate grim avoidable loss of lives must become an eye-opener for those involved in healthcare to remain vigilant,almost on guard,to detect timely and ensure their religiously regular treatment,counseling,psychotherapy,follow-ups military-like rigidly:
    paranoid schizophrenia once diagnosed must be very properly monitored/medicine-dosage titrations/
    keeping these patients drugs-free,weapon-proof
    standard operational procedures must be laid down without the least deviation
    it seems psychiatrists would have to sound a kind of alarms to the parents,primary care physicians,institutions/offices where the prospective patient inhabits/works etc..
    the gun culture,gun rights,gun availability must be curbed
    pepper-guns for self-defence should be aimed at possession by vulnerable public
    rather than my weapon is more sophisticated than yours basis,as if possessions are promoted comparable to myth of
    like my car is of greater horse-power etc.
    may this major disaster leading to loss of precious young lives become an eye-opener for people who matter in decision-making in USA and other countries.

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  4. My father has Paranoid Schizophrenia. I'm going to the psychiatrist soon to make sure he's going to get the care he needs. I am bringing the pill bottle (pills flushed away) he threatened to commit suicide with in my bum bag/fanny pack and his paranoia-filled writings to my mother in a purse I am bringing with me for my time of the month as an extra reassurance against waiting in a lobby for a long time.
    He is a liar who believes his neighbors out to get him for some reason and would not tell the psychologist anything to make himself sound insane. I am not as smooth a talker as he is nor as good an actor/actress so I hope that my physical proofs of what he is doing to himself and to us will be enough.

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    Replies
    1. I think taking in the pills and writings would be a great idea. When families have brought me this information I ALWAYS pay attention. Be clear this is also not a HIPAA violation. There is no confidentiality issues if there is an emergency. I often let families tell me everything. I don't reply or provide corroboration and no HIPPA laws or broken. Just common sense really.

      Think of your father's brain as functioning abnormally, like a heart that skips a beat. He is not a liar. Arrhythmias can be treated. Abnormal thoughts like delusions can be treated too. Know that he will get better. A good psychiatrist will help you do this.

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