Folie à deux

In the course of a clinical day you often meet some stealth DSM IVrs that take a bit of time to figure out. When I was a resident, we used to put a little Rho sign in the upper right corner of their chart to let everyone know that this person might be a bit on the prolixin deficient side of the reality finish line. Somehow, this little sign came up in a chart review in some lawsuit and their was a big stink so now all we can do is make sure that the patients antipsychotics are highlighted in light yellow. (Doesn't show up when photocopied!) Anyway, these are at least patients that have been identified as crazy. Its the de novo ones that are hard that just show up in the office. I dont know why, but it seems to only take one to be nuts, but it takes two to be really off the deep end. The realy psychotic ones always seem to come to the office with someone else who is at least if not more crazy than they are. Quite often, this person is the friend or the spouse who is the driver. (think about that as you drive home) When the patient explains that everyday at 9:30 a choo choo train comes out of their navel, the other will tell you that he they have seen it and that is why the pateint needs disability. Almost as if they are the enabler of the psychosis. The mental sock puppet master, if you will. The friend will then be the one who goes off at you when can find no evidence of railroad tracks on the abdomen and tell you that you are part of the conspiracy and in on it with "the man". It is almost that the degree of psychosis increases exponentially when you get codependent supratentorials together. (Boy, I would hate to be in a room with Nancy Pelosi and Harry Reid!)