Psyche

The word psyche comes from Greek meaning soul or butterfly. In fact, the insect appears on the coat of arms of Britain's Royal College of Psychiatrists.

It has been a long time since I've seen a patient admitted for a primary psychiatric diagnosis. We were consulted on a patient in a locked unit on a 5150 for a suicide attempt. She was a young type I diabetic with chronic fatigue who threatened to kill herself. She was involuntarily held for danger to self, and as the psychiatrists made their assessment, we were asked to help with insulin management. We kept her on her home dose, and she did well for a while. Then one day, she was about to eat lunch, got her prescribed insulin, and then purposefully refused to eat anything. Furthermore, she then barricaded the door so that none of the doctors or nurses could get in. They called a code on her and when they finally got to her, her fingerstick glucose was 30 and she had passed out.

We were caught off guard with this in-hospital suicide attempt. I'd seen one successful hospital suicide attempt as a student and it was awful. We then recommended that insulin be given after she ate her meal (routinely, it is given before a meal because the kinetics make more sense). But this reminded me how a very common hospital drug - insulin - can have deadly potential whether intentional or unintentional. It also reminded me of the precautions that we must take when working with someone with serious psychiatric illnesses.

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