Monthly Archives: December 2013

Leading a Normal Life after Recovery?

Clinical Case Studies, Issues & Debates, Schizophrenia & Psychotic Disorder, Treatment Approaches

Part I:  Teenage Schizophrenia (the same topic person as below)

Few days ago the father rang us. The patient is now in ICU in a general hospital. She attempted suicide taking over 200 tablets of medicine. As she usually wakes up late in the day, so the father wasn’t concerned that she’d been in her room all day. Till that evening when the father was thinking to bring her some food, and found out that she was covered in urine on her bed, and was unconscious.

Over the past few months, she had got so much better with medication, no longer spending all her time pacing in her house, talking to herself or swearing at her younger siblings. Her father was even able to get a tuition teacher for her, and later the patient even requested to go back to schooling. They were looking forward to seeing patient going back to lead some “normal life” just like any other teenagers. The only thing is probably that she’s spending a lot of time looking at her phone (don’t you think this is also a common feature of a “normal” teenager nowadays?!)

Then this happened. She tried to kill herself and is still unconscious. The father could only guess that as the new academic year is starting soon, patient couldn’t manage the stress and intended to avoid it by ending her life. She went to school to collect the text books the day before. The younger sister said the patient asked for a cut blade from her, but she didn’t give it to her.

Quite often we may think that the patient is ready for a normal life once the active symptoms of mental illness is not presented, yet it is very difficult to judge whether or not the patient is ready psychologically, to go back to the society, to face other so-called normal people and function normally just like others.

What can we do about this? What can we do for them? What can family do to get them prepared to go back to the society, if they can ever achieve it?

Caring for family who is mentally ill

Basic & General, Clinical Case Studies

This is a woman with PhD and was working in the UK when her mother was getting depressed, with insomnia and palpitation. Without much considerations she decided to quit her job and come back to Malaysia to look after her mother.

She has a younger sister who can’t manage stress and see us for some medications; another sister’s husband (brother in law) who is having fits and seizures. She also has a brother who abuses substance. So when she gets home being unemployed, she became the person to look after all these family members, like a … maid, but with a PhD and a highly paid job in UK which she left. Every day she wakes up around 5:30am, preparing meals, cleaning the house, preparing medicine for all ill family members, bringing them out for hospital appointments, collecting medicine for them from different clinics and hospitals.

Sometimes the brother in-law refuses to take medicine. Sometimes the mother refuses to exercise (or even move at all) despite advice from specialist doctors. Every day the mother moans about her problems and illness, winding her up. Her day usually ends at about 10.30pm when most of the family are settled down or sleeping.

When we spoke to her, she said she would probably, at some points, have to make an appointment and come to see a psychiatrist doctor and take medicine, as she really couldn’t take it anymore. All these caring work is draining her out.

It really isn’t easy to look after family who are mentally ill after all, what say a few members that’re unwell. These family members should win more respects, and should really get some proper support groups, perhaps just from each other, some time off, just to do something they like and to lead their own lives, yet it really isn’t that simple as said once the “job” commences…

Antidepressant & Anti-anxiety Medicine

Basic & General, Issues & Debates

Well first of all, I’ve to emphasize that I’m a Clinical Psychologist, I wasn’t trained in any medical background, what I’m writing and sharing in this post, regarding medicine, is from my working experience with a lot of patients every day.

Quite often people come to a psychiatric clinic with more than one problem, so things like “depression with insomnia”, “anxiety depression disorder”, “OCD with negative ruminations” are not uncommon. So they are of course, often prescribed with a number of different types of medications, which may fall under categories of anti-depressants, anti-anxiety or anti-psychotic (there are other types, but not my focus today).

Over the months or years patients or family will then start to tail off some medications themselves, whether because they think they’ve recovered, or they no longer need certain med, or certain med isn’t helping, or certain medicine is simply too expensive to afford taking long-term… And what’s left in their prescription, is often anti-anxiety medicine (and their names are often ended with -pam, such as lorazepam, xanapam, diazepam, tranpam, or their family lorans, xanax…).

Anti-anxiety is also commonly known as tranquilizers. They usually act fast, so within 10 to 15 minutes the patient will probably see the effects, whether when they feel restless, unable to sleep, too much worries, having obsessional thoughts… And this is what people like about these –pams. The effects are obvious, immediate, straightaway, you feel better right after it.

As compared to many anti-depressant drugs, it makes you drowsy, sleepy, tired, lose of sex drives, increase or lose of appetite etc, but you may take it for 2 weeks or even longer and still don’t see any changes in your mood. People’re definitely losing confidence in them, especially because many of those anti-depressants are also expensive (one tablet of it could be 6 to 7 times the price of a tablet of a tranquilizer).

So well, why not the all of us take anti-anxiety drugs? If you can’t sleep, take it. If you’re an OCD patient, take it. If you’re thinking or worrying too much, take it. If you can’t go on planes (phobia on board), take it. It’s probably going to solve most problems one may have, why pay more for something that you don’t see effect?

What’s the problem with it? Well no problem, other than the problem that you will probably have to take this anti-anxiety medicine for your problem, FOR THE REST OF YOUR LIFE. This is because it solves your problem on the surface, not on the root, it doesn’t in fact cure anything, although you see the effect right away. Unlike anti-depressant drugs, it takes time but eventually when the right dosage is on, you don’t just feel better, you get better too! (A bit like taking antibiotic…) One important to note here, is that taking the right dosage is also very important, some people like to reduce the medicine dosage themselves (especially if they find out that the tablets are expensive), however, taking too mild a dosage will not help with your problem!

So now I’m offering a solution, take both, take all that’s prescribed and the recommended dosage, some will release your problems right now, ease your suffers, but some will act for the long-term, and get you recovered.

Paranoid Schizophrenia

Clinical Case Studies, Schizophrenia & Psychotic Disorder

It was a very busy day and one staff was on emergency leave.

As all was in the waiting area for their turn, suddenly a woman in blue top rushed through the staff door that wasn’t closed properly, and ran all the way, through the treatment room, to doctor’s consultation room. The doctor was seeing other patients there.

We don’t know what she was going to do to the doctor, as we, including the doctor who was in shock, had already grabbed her hands before she did anything. We pulled her back to the treatment room. She was undeniably strong, despite all four of us were grabbing her, and one was preparing the injection. She scratched our hands, kicked our legs, screaming, resisting.

She has defaulted with medicine since 2010. Recent few weeks she has become unwell again, but the husband was too busy with work so he didn’t bring her here immediately and let her deteriorate. She started to see a psychiatrist from the year of 2005, being diagnosed as paranoid schizophrenia. With very regular injections and medication she’d got much better. Then a second breakdown in 2010, when she moved to a low-cost flat with Malay and foreign neighbours, whom she was so paranoid with. Later in the year she stopped taking medications, telling our staff that she feels much better without medication.

When we pressed her on the bed, she was shouting, saying her Malay neighbours were spreading her personal details and photos on youtube and other social medias. We could hear her saying 8TV, radios, youtube… the Malay neighbours were spying on her, peeping her, going through her rubbish, taking her pictures and videos then spreading them online.

The husband said she cannot get along with her Malay neighbours, she actually went to argue with her neighbours due to her delusions.

She came from a big family, being the youngest of her 10 siblings. She has two girls and one boy with her husband.

With medication and injection she has got much better now. Though relapses are likely to happen if she is not going to come back for follow ups and maintain with her medications.