bipolar

Day 469

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This afternoon one of my junior colleagues mentioned that his wife had just finished her 3 years of GP training. During those 3 years she has not spent any time in psychiatry.
It takes 7 years of training to specialise in any particular medical discipline. But it is expected that GPs should know a little bit about everything in 3 years. That seems rather disproportionate. Without any training, how can they be well equipped to look after 1 in 4 of their patients who will present with a mental illness?

It is not uncommon to hear GPs say that when they call specialist services, they can sometimes be left holding the phone for hours. They often don’t get the support and advice they need. Some general practices have doctors with special interests, such as gynaecology, dermatology, psychiatry etc. Others don’t. Some GPs work in isolation. Others have no interest in psychiatry.

Of late the news has been resplendent with the issue of ‘hospital deaths’ being more over the weekends. It is almost illegal to die in a hospital as it brings a bad name to the organisation. However anyone can die unnoticed in the community and it seems to be nobody’s problem.

No health without mental health : a cross-government mental health outcomes strategy for people of all ages’ sets out six shared objectives to improve the mental health and well-being of the nation, and to improve outcomes for people with mental health problems through high quality services. The strategy was produced in collaboration with many of the Department’s partner organisations. It will enable more decisions about people’s mental health to be taken locally, and stresses the interconnections between mental health, housing, employment, and the criminal justice system.

For those who only understand the language of money, Knapp et al at London School of Economics studied the economic benefit of GP training and concluded that investment in GP suicide prevention training is cost ­saving overall from year 1. The intervention appears highly cost­ effective from a health system perspective alone.

Hence there is a strong case for suicide prevention training for GPs.

 

 

 

 

 

 

Day 461

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‘Parity of Esteem’ is best described by The Royal College of Psychiatrists as: ‘Valuing mental health equally with physical health’.
More fully, parity of esteem means that, when compared with physical healthcare, mental healthcare is characterised by:

  • equal access to the most effective and safest care and treatment
  • equal efforts to improve the quality of care
  • the allocation of time, effort and resources on a basis commensurate with need
  • equal status within healthcare education and practice
  • equally high aspirations for service users
  • equal status in the measurement of health outcomes.

At the Coroner’s court, when the (Honorary) Consultant Psychiatrist was asked why he did not have a conversation with me, the patient’s mother, about his diagnosis of Bipolar Disorder when he made that diagnosis , he said that was because the patient ie. Saagar was very averse to me (his mother) at the time. It is eminently possible that his hostile attitude was a symptom of the illness.

However, the doctor felt comfortable sending him home to live with me.

If Saagar would have presented with a Hb (Haemoglobin) count of 5 (normal being 14-16) due to blood cancer, would he have been told his diagnosis, put on medication and sent home? No. The family would have been informed and educated about the illness and given clear instructions on a possible hospital admission and where to go if things got worse. The patient would have been offered counseling services to deal with this potentially life threatening disorder. They would have informed them about the 5 year or 10 year mortality associated with the condition and the expected desirable and undesirable effects of the medications.

With all due respect to the Psychiatrists who work under tremendous constraints and do a lot of good work everyday : if they, as custodians of the mentally ill, are unable to give mental illness the parity of esteem it deserves, how can we expect anyone else to?

Day 450

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In the year 2000, John O’Callaghan, a 29-year-old Australian who became mentally ill after taking Lariam during a surfing trip to Indonesia, wrote in his suicide note: “Since [Lariam] first blew my brains apart… I have never been the same, always dazed and confused, always physically sick. I never thought this could happen to me. Sorry mum, dad.”

In 2001, 27 years old Malcolm Edge, an irish student was found hanging in a hotel room in Vietnam after suffering a paranoia attack apparently brought on by a combination of Lariam and alcohol.

In 2002 four US soldiers from Ft. Bragg were accused of killing their wives. Two of the men died by suicide. So many brutal crimes, so similar, so close in time – raised questions, and the army sent a team to investigate. One possible suspect was mefloquine (Lariam), an anti-malarial drug, routinely given to soldiers deployed overseas.

“It was confusion, it was disorientation, it was anxiety and panic attacks,” says Dr Paul Clarke, an infectious Disease specialist. “There were episodes in which people were clearly divorced from reality and indeed had unusual symptoms that could be described as psychotic.”

Lariam (generic name: Mefloquin) was invented by the US army. It is manufactured by Roche which constantly manipulates numbers and words to misinform doctors and public. It claimed that the incidence of psychiatric side effects was as small as 1:10,000. However Dr Clarke’s research showed that it was as high as 1:140.

Beware: Lariam can make you lose your mind.

 

 

 

 

 

Day 448

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Just before concluding Saagar’s inquest the coroner asked me, “Do you think your son was treated differently because you are a doctor?” At the time I could only think of the Daksha Emson Inquiry which concluded that “doctors may end up being treated less effectively than if they were ‘ordinary’ patients.”

In my experience as an anaesthetist when a colleague or their family members come into hospital to have a baby or an operation, however minor, they are approached as ‘high risk’ patients. They somehow seem to bring trouble with them. Red flags go up automatically. As far as possible they have a consultant anaesthetist and surgeon looking after them as a matter of professional courtesy. It doesn’t incur any extra cost. Courtesy often doesn’t.

Saagar was scheduled for a minor surgery at my hospital in February 2011. One of the most senior and highly respected surgeons in the country put him first on his list and a brilliant consultant colleague anaesthetised him. I did not ask for or expect any of this but was very grateful for it.

So, I am not sure how to answer that question. Was Saagar treated differently because I am a doctor?

Maybe the Honorary Consultant psychiatrist who made the diagnosis of Bipolar disorder assumed that I would know all about it. Maybe that is why he did not speak with me or Saagar’s father even once. Maybe the GP assumed the same. I knew as much about mental illness as an average psychiatrist would know about anaesthesia. Those assumptions are baseless.

Maybe Saagar would have received better care in a smaller town. Years ago, when I had decided to move from Belfast to London, one of my colleagues had commented, “You are going from being ‘a rich somebody’ to ‘a poor nobody’”. He was right.

Well. I wish he could have received the treatment that every single person deserves. If that would be the case I would not be the author of this article in the Huffington Post : Suicide – The Silent Epidemic.

Day 436

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Compassion is defined as ‘a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate their suffering.’

NHS administrators now see the value in ‘teaching’ compassion to nursing and medical staff. Obama emphasizes the need for compassion amongst people in his Christmas message.

Research has shown that when we feel compassion, our heart rate slows down, we secrete the “bonding hormone” oxytocin and regions of the brain linked to feelings of pleasure light up which often results in us wanting to approach and care for other people.

Compassion makes people more resilient to stress. It lowers stress hormones in the blood and saliva and strengthens the immune response. Compassionate people are generally happier as their mind does not focus too much on what has gone wrong in their lives or might go wrong in the future. They make better parents, friends and spouses as a they tend to be more optimistic and supportive when communicating with others. They are more socially adept, making them less vulnerable to loneliness. Employees who receive more compassion in their workplace see themselves, their co-workers and their organization in a more positive light, report feeling more joy and contentment, and are more committed to their jobs.

Stanford University’s Compassion Training Programme’s top tips are:

  • Look for commonalities: Seeing yourself as similar to others increases feelings of compassion. A recent study shows that something as simple as tapping your fingers to the same rhythm with a stranger increases compassionate behavior.
  • Calm your inner worrier: When we let our mind run wild with fear in response to someone else’s pain (e.g., What if that happens to me?), we inhibit the biological systems that enable compassion. The practice of mindfulness can help us feel safer in these situations, facilitating compassion.
  • Encourage cooperation, not competition, even through subtle cues: A seminal studyshowed that describing a game as a “Community Game” led players to cooperate and share a reward evenly; describing the same game as a “Wall Street Game” made the players more cutthroat and less honest. This is a valuable lesson for teachers, who can promote cooperative learning in the classroom.
  • See people as individuals (not abstractions): When presented with an appeal from an anti-hunger charity, people were more likely to give money after reading about a starving girl than after reading statistics on starvation—even when those statistics were combined with the girl’s story.
  • Don’t play the blame game: When we blame others for their misfortune, we feel less tenderness and concern toward them.
  • Respect your inner hero: When we think we’re capable of making a difference, we’re less likely to curb our compassion.
  • Notice and savor how good it feels to be compassionate. Studies have shown that practicing compassion and engaging in compassionate action bolsters brain activity in areas that signal reward.
  • To cultivate compassion in kids, start by modeling kindness: Research suggests compassion is contagious, so if you want to help compassion spread in the next generation, lead by example.
  • Curb inequality: Research suggests that as people feel a greater sense of status over others, they feel less compassion.