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My secretary said: “There is a very unusual patient…” (being a psychiatrist, however, I don't find “unusual patients” really come as a surprise to me) “a gorilla, an agitated gorilla.”
“Is it in A&E?” I blurted out.
“No, no, it's in the zoo. The vet wants your advice.”
The whole unit soon knew the story: the consultant in whose catchment area the zoo fell claimed it should be his patient, one colleague asked in an irritated manner if we were now supposed to cover the zoo as well, and many, including my room-mates, wanted to join me at the initial assessment.
So far so good, but when I got there the story was not funny at all. The gorilla, who had been the alpha male for years and was a very easy going guy, had suddenly lost interest in the leadership position and become withdrawn, which had led to fights between the other males for the leadership. The worst part was that he was constantly chewing his feet. He had already lost the proximal phalanx of one of his big toes and had a few big holes in his soles.
The vet couldn't find any medical reason for the gorilla's condition and so had resorted to a psychiatrist.
After two hours of discussion with the zookeeper and the vet and observing the dynamics of the gorillas, I came to the conclusion that my patient was depressed and decided to give him a gradually increasing dose of escitalopram. We increased this up to 50 mg as his weight was around 200 kg. At first, this seemed to have a good effect: he became less irritable and let the zookeepers care for his wounds. Everyone was enthusiastic about his progress apart from me, as I knew that the course of psychiatric illness is unpredictable and that I should not get too excited if a patient gets better or too disappointed if he gets worse.
I was right, as his improvement was not maintained. I suggested antipsychotics, as indicated in humans for automutilation, but his carers declined. Their backup plan was to send him to a zoo in Spain, and, as far as I know, he is still waiting to go to a sunnier place.