Monthly Archives: February 2015

Mental Health: Truth-Telling VS Information Withholding

Basic & General, Issues & Debates

Should patients with mental health issues and their family members be noticed and explained about everything on their mental illness, diagnosis, treatments etc?

For Truth-Telling:

  • Most patients want to know. Studies found that most patients would want to know everything about their illness. Though not so sure what happens when they really discover “everything”.
  • Make informed decision and consent possible. Only when the patients know the full story that they can make a personally meaningful decision.
  • Building trust. If the doctor intendedly hides some information or lie to the patient and the patient finds out later, the patient will less likely to trust the doctor.
  • Lying is impractical. Chances are at some points patients are going to find out more through other people or means.
  • Avoid incorrect information found. When patients aren’t told enough about their illness or treatment, they may search for it themselves (e.g. google it) and find some information that may not be irrelevant or applicable to them.
  • Patients feel respected. Clinicians can always explicitly ask for patients’ preference.

 

For Information Withholding:

  • When everything was explained to patients/family, they may not accept the truth, lose hopes or become demoralised (e.g.” Chances are you may need to depend on medicine for the rest of your life”).
  • Some patients may deliberately state that they do not want to know more.
  • Patients become too mentally disturbed after knowing the truth that they harm themselves.
  • Patients/family feel stigmatized, being labelled as e.g. “schizophrenic”, “manic”, “mentally ill”
  • Family giving up their support to the patient knowing that it’s a long journey.

Brief Psychotic Disorder

Clinical Case Studies, Schizophrenia & Psychotic Disorder

It’s approaching Chinese New Year and it’s this time of the year where Chinese Restaurants are at their busiest period, whether it’s for reunion dinners, company year-end party, annual dinner or casual friends and relatives gathering dinners.

She’s in her 30s, a manager in one of a big Chinese Restaurants. Past few nights she hasn’t been sleeping well, under great stress and worrying about the bookings, menus, dishes, prices, ingredients, staff, part time staff etc. After few nights of poor sleep and poor performance at work in the day, one afternoon her family found her not gone to work but crying and laughing at the same time in her room, at times screaming, and at times talking about things that they can’t understand.

Her husband and mother admitted her into the general hospital, where she was put under anti-psychotic medication and injection. Though a lot more stable and spending more time in bed, she’s still screaming and at times talking nonsense. She then started to experience some side effects from the medication and injection, drooling, tremor, stiffness.

Upon discharge from the GH, the husband decided to bring her to see us. She has to come in in a wheelchair, still drooling and having stiffness, still screaming and non-responding.

She’s believed to have Brief Psychotic Disorder, triggered by great stress from work. There’s no history of mental illness running in her family. More about the illness on wikipedia here. It’s kind of difficult to believe that people actually get psychotic disorder just merely due to stress (oh well, what can stress not do!), it’s more usual depression or anxiety disorder.

So, well, guys and girls, do make sure you are aware of how much your body and mentality can take, not to put yourself under too great stress (hard!), and more importantly, always find healthy ways to de-stress yourself (e.g. exercise, hobbies, movies, outings with friends etc)!

A doctor who can’t doctor

Anxiety Disorder, Clinical Case Studies, Obsession & Compulsion

A doctor (noun, a person), who can’t doctor (verb, to treat).

She’s on her 4th year of medical degree when she first came to the clinic with her parents. Once treated for OCD many years ago, she had recovered from it with some medication and never had any problem causing much distress since then.

She is brilliant academically since young, doing so well on most of the papers in the uni now. Now it’s towards the end of her medical degree, the problem rises.

The parents found that she’s always studying, doing revisions – but she’s already done so well and that’s not even the most important things to do now, as they should start with practices, attending to patients on the wards. She slowly disclosed that she is very afraid of meeting people, especially seeing patients. Her mind is occupied with herself misdiagnosing patients and failing to treat patients. So she wants to revise more, learn more about the theories (a good example of safety seeking behaviours – doing something to relieve her fear in the short-term, but in long-term what she does further reinforce what she couldn’t do – seeing patients).

The parents aren’t quite sure what to do. They don’t care if their daughter can never become a doctor, it’s not important, as long as she’s happy. But now her fear is killing her confidence, and they’re still hoping that she can at least complete the degree (and plan what to do subsequently, e.g. teaching, doing research etc). She doesn’t seem to be able to cope to complete her degree.

The parents can give her a gap year, “but the more she rests, does it mean the harder she can ever practice again?”.

“We can push her. But we don’t want her to think we’re forcing her then start to avoid us or lose trust in us.”

The parents were advised that what’s most important now is not whether or not she can become a doctor, whether she can graduate, but whether she can conquer the fear, have the courage and go for her practices despite the obsessional thoughts that she may fail. (Something that Acceptance and Commitment therapy could do, I’m kind of interested to know whether ACT can do better than CBT in this case.)

It is definitely not going to be easy, in fact it could be a long journey till she can manage that, but everything that can make that possible should be done.