an old lady with psychotic breakdown

When I went to the Behavioral Institution for a night shift to see my new patient, I expected to see a person in a relatively stable situation as the two previous patients I had before in this mental hospital. However, this time the circumstances were totally different.

In her 60’s - 70’s, the patient is short-statured and plump and originally from Taiwan, which I found out from the medical staff later. I noticed although she has hair in the middle of her head, it was missing in a large area in the back of her skull, which was not natural and made her appearance old.  

When I first saw the patient, she was eating her dinner by herself in a room. She ate slowly and only ate a little, and kept murmuring to herself. I tried to talk to her in Chinese, and found it was very difficult to make a conversation with her. She only responded well to the simplest question, such as  “do you want some water”; when I asked her something like “when you came to this hospital”, her reply made non-sense.

Later, her medical staff told me that she was admitted to the hospital the day before. Since she came to the hospital, she kept talking and walking and did not sleep, and refused help from the staff. She can speak English very well, but she would suddenly switch to Chinese, and that was the reason they required an interpreter for her.

 However, I did not think I could help with the situation too much. The patient’s English has no problem. She comprehends and speaks English very well, but could not think or act rationally. She could not stay quietly or still, and kept walking around talking nonsense alternatively in English and in Chinese, and sometimes sang in English or Chinese. I found that her hands shaked from time to time and she sweated a lot. Not following instructions at all, she sang and talked loudly in the common room when a nurse spoke to all the patients in the unit even after she was asked to leave, which was very exasperating.  

I tried to follow her and see if she needed any help as I had done with other mental patients and required by the institute. Very soon, I found that it was a very bad idea. The patient became angry, irritated and even began to chase me. Frightened by her behavior, I stayed away from her for the rest of my assignment.

This patient was clearly in a psychic breakdown. I believed that she should not interact with other patients, who could be disturbed or even assaulted by her in current situations. In the consideration of safety, she should be put into solitary confinement with supervision, and be released only after her mental status was stabilized.