Many years ago when I started working as a psychiatric nurse, I was assigned to teach a class about healthy eating. It was back in the days when patients spent weeks in the hospital and we had the luxury of thoroughly teaching our patients everything they needed to know before they went home. It was also during a time when MAO inhibitors were frequently used to treat depression.
The dietary department sent up a fruit, vegetable, and cheese platter every week for my group. They would also send up a variety of snack crackers and a few bottles of carbonated grape juice. I served the juice in plastic champagne glasses as I talked about the dangers of drinking alcohol while taking MAO inhibitors, and other psychotropic medications. The bubbly juice taught patients about the alternatives to drinking alcohol. I used the cheese on the platter as a prop when I talked about foods to avoid when taking MAO inhibitors. Patients not on MAO inhibitors would nibble on the cheese during group while those on MAO inhibitors were invited to snack on the fruits, vegetables, and crackers. The food was good—a welcome change from regular hospital food—and my group was well attended.
One day a patient with a huge chip on her shoulder came to my group. She was prescribed a MAO inhibitor, and she started complaining bitterly about the dietary restrictions associated with her medications. One of the other patients teased her by asking if she wanted “a little WHINE with her cheese.” She said she’d skip the wine but would take the cheese. Then she grabbed a handful of cheese cubes off the food platter and stuffed them into her mouth. After she swallowed, she looked at me, smiled, and said she wanted to die if she couldn’t eat what she wanted. I called the doctor and my patient was treated for a sharp rise in her blood pressure.
The patient later told me that she was sorry for her impulsive behavior during group. She said, “I don’t know why I ate that stuff. I don’t even like cheese.” She later came to realize that she acted out as a way of rebelling against her mental illness. I also believe my patient had a personality disorder.
Here’s what I learned from the incident:
1) Self destructive patients are angry people. They need our support, but they must face the consequences of their actions. My patient had a killer headache after her blood pressure hit the ceiling. She wanted narcotics for the pain. We gave her Tylenol.