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.

Illness Phobia

Anxiety Disorder, Clinical Case Studies

She has consulted many specialists, cardiologist, gastroenterologist, orthopedist… It all started with some pain in the arms, then the shoulders and later her back.

Other than the aching in her body, she also feels something stuck in her throat, chest discomfort, her stomach twitching, sometimes having light-headed, sometimes having red rashes on her skins… She even imagines that she’s got cancer and is suffering from it badly. She is worried so much about all these somatic symptoms and about getting more and more ill, she can’t eat properly, she doesn’t have any appetite.

In addition to those complaints, she’s also paranoid and may be hallucinating. She feels that the DJs on the radios are all talking about her (“Why do they know so much about me?” “Why do they talk about me non-stop?!”), she feels everyone on the train knows that she’s sick and is taking medicine for her sickness…

The problems were aggravated by a big row with her boyfriend, whom she found out to be getting back in touch with his ex-girlfriend. She’s becoming really sensitive and paranoid. She thinks the boyfriend is not being faithful, for contacting the ex. At the same time she was also having some massive pressure preparing for her professional paper.

She slowly moved away from her relationship and study problems (she passed the paper). But then she developed all those psychosomatic pains and problems. What’s worse is not the problems themselves, but the fact that she’s so overly worried about them – even the slightest rashes on her skin makes her think that she’s got skin cancer and is dying… When she started to take the medication, she did a table diary, noted down every small changes and symptoms in her body, whether she felt sleepy, had rashes, felt dizzy, could breath properly… She tried so hard to notice every little things in her body (perhaps it’s also an obsession?).

Illness phobia is not uncommon nowadays (see here for another case study on illness phobia), it’s under the anxiety categories, yet this appears to be some modern mental illnesses, as people nowadays know more and learn more as the technology gets advanced, at the same time people are also creating more problems for themselves as the world develops further (unhealthy processed food, overly urbanised cities, pollution…). But why, why get so worried when you’re not ill? Why are people losing the abilities to enjoy lives? Why worry before even knowing if the problem exists? It’s like people being worried about getting worried, now these people with illness phobia are getting ill mentally because of being worried about getting ill physically…

Underlying Perfectionism?

Clinical Case Studies, Unclassified Disorders

The mother made an appointment being not so sure about what her daughter’s problem is. She said the daughter is lacking confidence, or something is wrong with her, but the mother isn’t sure what it is.

This patient was doing A-Level at College A. She later said the course wasn’t so good and so she wanted to transfer to College B. So the parents went through a lot and completed the application and helped her to do the transfer. Everything went well for the following months. Till about one month ago, the patient told her mother that she wants to transfer back to College A again. The mother wasn’t happy about it but still she asked for the reason. The patient said she isn’t making any friends in College B, all her friends are in College A, she wants to go back there. The parents think it’s not a good decision so they continued to persuade her to stay on, and encouraged her to take part in some societies/organisations in order to make new friends.

The patient then stopped attending classes, when her request wasn’t fulfilled. She stayed home all the time, keeping to herself, not responding to mother when the latter speak to her. She isn’t even answering her friends’ phone calls (well, we thought she wanted more friends?). It does appear that she’s rebelling. But other than that she’s also losing the ability to make decision, to be assertive about what she wants and doesn’t want. When the mother asked whether she wanted to go back to College B, as the college has been calling the mother, she just stayed quiet.

This was continued with another two weeks till the mother came to us. The mother doesn’t know what to do. The mother consulted doctor on behalf and brought the medicine back to the daughter. She was very eager for the daughter to get better, to return to college and sit for her exam in two weeks.

So the mother gave us a call every two days, asking us what to do with her daughter, asking why her daughter still couldn’t make any decision, keep to herself, not going back to college, asking when she would get better…… She tried to push the daughter further and further, and of course, in such short period, she gets no results, but probably have made things worse.

What do you this girl’s problem is? Perhaps some underlying psychological worries? Depression? Social phobia? Agoraphobia? Laziness?! Avoidance, avoiding what? Some obsessions, obsessed with what she wants? Or is she a perfectionist? Someone who tolerates no imperfection? So when a bit of problem shows up she just avoids it?

What do you think?

Do I have a psychological problem? Am I mentally ill?

Basic & General

This is one common question I get as a psychologist, sometimes the question may not be as direct or obvious, but the root of the problem is always “Do I have a problem if I’m…”

Some people feel anxious. Some depressed. Some feel mood fluctuates. Some have sleeping difficulties. Some repeat things.

Then at some point they wonder, do I have a mental illness? Is it a problem? Should I get treated? Should I take medicine or see a doctor? How do you judge whether it’s a problem?

For the person asking: I always ask, do you think it’s a problem? Is it causing distress to you? Is it causing distress to people around you? Does it affect your life massively (e.g. so disabling that you can’t function properly in at least one aspect of your life, work, relationship with family or partner, …)?

For one’s family: Can this person still function properly in life? Is it causing distress to himself and/or to people around him? (Quite often I’d say the people surrounding know it better!)

You may be checking the locks 10 times before you go to bed every night, but if neither you nor your family find it a problem, then it’s really no big deal! Similarly, you may have a family member who’s very bad-tempered, getting angry very easily, but this person is like this all his life, he can form proper relationships, then maybe this is not a big problem. One may sleep 4 hours a day and is suffering from it whereas another is feeling happy with his life.

So don’t be so sensitive and get worried so much about it. Ask yourself the questions above. Here I’d also like to emphasize, life is never perfect, there’re always ups and downs, so it’s completely normal to sometimes feel sad, low in mood, worried, anxious… as long as it doesn’t get chronic and/or acute.

For further and more in-depth screening tools and scales, check here.