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    The American Psychiatric Association (APA) has updated its Privacy Policy and Terms of Use, including with new information specifically addressed to individuals in the European Economic Area. As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies. Since I worked in an ER for 25 years, I thought I had pretty much seen everything in medicine there was to see. But when I started working in jails, I was quickly confronted with clinical scenarios that I had no experience with from my ER days. Here is one such case: A 46-year-old man came into my jail medical clinic complaining of muscle aches and twitching, which he first noticed 2 days before. He had been booked into the jail 2 weeks previously. This patient's currently prescribed medications prior to coming to jail were continued (as is our general policy): sertraline 200 mg a day, buspirone 15 mg PO BID, and trazodone 200 mg at bedtime. He also took lisinopril/hydrochlorothiazide and atorvastatin. The patient walked into clinic with an odd stiff-legged gait and a noticeable hand tremor. His patellar reflex was exaggerated, but without clonus. I considered the "usual suspects," such as infection, metabolic abnormalities (like hyperthyroidism), and methamphetamine intoxication (inmates can, indeed, sometimes get meth and other drugs despite being in jail). He had a heart rate of 124, a blood pressure of 156/100, and a temperature of 99.4° F. But I was most suspicious of serotonin syndrome -- and this turned out to be the right diagnosis.

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