Tag Archives: Suicidal

What a patient learnt from Robin Williams’ death

Depression, Issues & Debates

Got a phone call from a long-standing depressed patient who is now maintaining well with medication, the first thing she asked me,

“Do you know the American actor who committed suicide?” (I personally dislike the phrase “committed suicide”, it sounds like they deliberately chose to do it, like “committed a crime” which I don’t quite agree – they didn’t willfully choose to do it, although it may appear so)

“He’s also suffering from depression [like me], right? Why would he commit suicide?” Back in year of 2004, this patient had had ECT done due to her depressive mood with suicidal ideation. I think she understands how that feels, very well.

“Perhaps nobody has paid enough attention or has realized someone like him, a comedian who brought so much laughter to the world, can be so severely depressed.” I also told her that I didn’t know much about his biography (his personal life, history with addictions etc), that was just my guess, but I kind of think that his death must have triggered a lot of thoughts in the field of mental health.

“Imagine a celebrity like him, with that much of fame, popularity, wealth, well-liked by the world. He, too, suffered from depression [or bipolar?] just like you, and many on the streets. Just that they may not show it, but they may cry alone in the corner in their room, or their symptoms are at residual at this point”

“For mental illness, it’s so much harder [for people to understand and sympathize], unlike high blood pressure, gastric, cancer etc. You get a report, a figure telling you and everyone else that something is not right. It’s like boarding a bus with a plaster bandage after a fractured ankle, people would offer you a seat. If you take away the plaster but still suffer the fracture and pain internally, would people still offer their seat? And if you ask they may even think that you fake it! Being depressed is sort of like this, only you know it best.”

“So I should really not care about what my relatives said [of me taking those medicines] and be so grateful. My depression is all under control now. Occasionally when it hits me I’ll just meditate or do some exercise. My son bought the family this house. All 3 of my children are finishing their studies and doing good…

People may think you own the world and should be so delighted, but deep inside you want to just end your life! So let’s just be grateful, show more love, understanding and respects!”

15/8: A comic of what somebody else learnt from Robin: I want to live.

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?

Depression Following Stroke

Clinical Case Studies, Depression

His wife came to us after the husband had a stroke. She is very concerned as the patient has had an elder brother who committed suicide after being depressed for years.

She is worried that her husband will do the same as he is currently staying in a hospital doing physiotherapy, being emotionally unstable, agitated, and very bad-tempered. He keeps to himself most of the time, makes no social contact with others, and cannot tolerate the least of any physical discomfort (e.g. sore throat, skin itchiness).

The wife is very keen to bring patient to consult a psychiatrist, yet he is not ready for it at all. If he ever knew that he’s taking any of the psychiatric related medicine he will get so mad. So the wife has been putting medicine in his food and drink. What’s difficult is his poor physical condition, due to the stroke he needs to do a lot of physio, but the medicine is making him drowsy and sleepy. In addition he’s having high blood sugar, high blood pressure and high cholestrol, so whatever kind of medicine that may raise any of these he can’t take it, especially his blood sugar is always sky high.

The wife spends almost 24/7 by his side to look after him. One day their only 15-year-old son made a call to her, saying he missed her and was very anxious about sitting for PMR (exam), he wanted her to pray with him over the phone. The wife decided to discuss with patient, told him to let her to go home and see the son, the patient agreed. However, when the wife wasn’t around, patient went up to the 13th floor of the hospital and attempted to jump down.

When he is okay, he is okay (what kind of sentence is this?). When he’s having a slight of bodily discomfort, he wants to end his life. Nobody really knows what he’s thinking, not even his wife. But he’s very upset and irritated being hospitalized, not being able to earn money and function like normal. What’s worse is his only sister and her family, who lives just next to him but have never come to visit him at all. So the wife seems to be the only connection he has, and when the wife isn’t around, all kind of negative thinkings float in his mind…

“She no longer wants me” “She doesn’t want to care for a sick person” “I’m useless” “Nobody cares about me”

Having a strong supportive family connection is something very essential in the recovery of mental illness. Yet unfortunately he has a brother who left him due to depression, and a sister who lives next to him but built a wall in the middle of two houses.

Depression & ECT

Clinical Case Studies, Depression, Treatment Approaches

“I’m single. I don’t want to trouble my family. Let me end my life.”

She repeatedly stressed that she’s single (I’m quite sure when she was well she never minded it). She seeks for all different kinds of methods to end her life. But because of how caring and loving her family is, she is still living, and maybe to her, suffering. She has had at least one attempt of suicide in the past in which she cut her wrist.

This is a woman in her 60s, not married, currently staying with her nephew and nephew’s family. Her sister used to look after her, and live with her, but over months, sister was upset by her, affected by her negative energy and mood, and has temporarily withdrawn from her role of looking after her. She has a lot of very negative thoughts, lacking drives and interests, just feeling lazy and not wanting to go out, see anyone, do anything. She has lost interests to those that she used to find pleasurable (Remember I said in “Depression & Suicidal Risk”? Lacking interests & drives!)

I spoke to her nephew and nephew’s wife quite a number of times. They are both very empathising. They are feeling pretty helpless, not knowing how to look after a severely depressed auntie. Sometimes they have to lock her in the house or bring her everywhere with them, being worried she will commit suicide if she’s left unattended.

She’s still on quite a high dose of anti-depressant medication, she’s very regular with it, after all these years. Sometimes even the family is a bit doubtful whether the medicine is helping, the patient is the one that knows clearly things are going to be so messed up and so wrong if she stops it. But it seems that the medication has stopped working for her, as she grows more and more depressed and negative.

Consultant psychiatrist suggested Electroconvulsive Therapy (ECT) for her. On the day before her ECT, she jumped off the sea, and perhaps she’s meant to live a lot longer, a passerby saw her and dragged her back. She has had two sets of ECT done about 4 years ago. This does appear to be the fastest and perhaps the last resort for her current condition. It’s a controversial treatment, yet I’ve seen people benefited from it. Memory loss is one common side effect reported, yet perhaps it’s best for the patient to temporarily forget certain things?!

I’d say if ECT is likely to do more good than harm then people should really go for it, but it should always remain as the last resort, after patients have tried all other therapies.

 

Subsequent follow up of this patient: Can we allow a severely depressed patient to make the decision?

Depression & Suicidal Risk

Clinical Case Studies, Depression

She has a long history of depression, but due to financial constraint, has stopped following up in private clinic and gone to the general hospital. After few months she came back to us, not being well, but still not that bad, able to smile and chat with others a little bit.

Few days later she made a call to us, saying she’s feeling really low in mood, not having any interest, she didn’t know what to do with herself, still regular with med, but didn’t think it was helping with her problems. Nothing happened in particular that led to her mood being that way, she said. Her medication was adjusted. Couple days later I rang her again, she took the extra dosage, but remained the same, not happy, lacking drives and interest. She did try, she went out for group exercise with friends, but she kept feeling her mind was somewhere else. She was told to come back so that she could get a better review and a medicine regime that helps with her current condition better.

She didn’t come back for review. She never called us again. About 3 or 4 days later I called her house numbers again (which I usually did), somebody else picked up, saying she is no longer here. At first I didn’t get it, I thought she was just away. Then this lady said the patient committed suicide yesterday. I sent my condolences and ended the call.

Lacking interests and drives is one very important suicidal risk factor. They try to get engaged in something, but they don’t find their mind with them. It isn’t them, it’s their illness.

I used to think as long as they find some pleasurable things to do they will get better. Sometimes it just isn’t that simple, maybe it isn’t just the behavioural intervention or medicine alone, they need cognitive, behavioural and pharmacological interventions all together.

Genuine Suicidal Attempt or Attention Seeking?

Clinical Case Studies, Depression

She was told by the doctor to come to the clinic to collect her medication and for an injection, after seeing the doctor in the hospital.

When she got here she looked like she was on the phone, but nobody heard her talking at all. Staff told her to come in to the treatment room. She gave no response, made no eye contact – as if she was so concentrate on a spot in the air. Then she walked towards the door, went out, and stood by the stairs. She looked down to the lower floors. A colleague said, “she isn’t going to jump down is she?” I was going to say “Is she looking for someone downstairs?” but before I even completed the sentence, her feet were already in the air, hanging her body on the rail. we all ran out. She didn’t do it fast as her left hand was still holding the stairs handle/rail. So one of the colleagues managed to grab her legs, another her arm.

She was brought in. She continued to say that she wanted to leave, and of course she wasn’t allowed. It took some time till she was injected and given stat dose. The doctor came from the hospital to see her.

It appeared to be something related to drugs, she seemed to be taking illicit drugs, and according to her, she will be charged for distributing drugs (or bringing drugs in from another country). She said she was innocent.

She calmed down later as the stat dose kicked in. Family member was contacted to bring her home. I’m not sure how she is right now, I hope people will all stay away from illicit drugs.

If it was one of our busy days we wouldn’t have noticed and managed to stop this. Though we doubt if she really wanted to commit suicide, or she really just needed some attention and help maybe. Because of how the stair is designed, it wouldn’t be possible for anyone to jump down straight from 4th to ground floor (other than a small baby).  She could only fall to the third floor, though her head would have landed on the stair case below. I’m sure she was aware. So attention seeking through a suicidal behaviour?

Sometimes when it comes to mental illness (and I guess many chronic physical illnesses), family members get fed up and lose their patience after a period of time, due to the time, money and attention needed to care about the patient, but also the stigma that come with it. But without any support from close family and friends, it’s almost impossible for someone to completely recover from mental illness…

N.B. This was first posted at huibee.blogspot.com by the same author