Addiction

Hi,

This week is very laid back, but the three patients I do manage to meet are poles apart, one being an alcohol and heroin addict, one being depressed and anxious and one being the 'stereotypical' mentally ill patient that the public seem to imagine. Rapid mood swings, shouting and delusions, this sort of patient is a rarity nowadays due to all of the medication passed around.

This week was very quiet due to having our consultant and his PA both on holiday (not sure if they were off together, but that could be the ingredients for a soap...) Unfortunatly this meant that we only saw 3 patients over the entire week. We had times we went to the hospital for ward rounds which we couldn't participate in, and we have had teaching as well - so the week was not empty, but it was by no means as busy as the elderly weeks. So far I think psych is a lot more laid back compared to everything else I have seen. We got refused consent to sit in on consultations as well, but I can only assume that this will be a lot more common in psych than in other specialities due to the stigma some people still associate with mental illness.

Anyway - On the first day myself and my partner spent some time talking with a 28 year old lady who had admitted herself to the hospital to help her detox from her addicts life. Talking to her, it sounds like she has had a very hard life. Currently addicted to alcohol (drinking 8 litres of 7% cider) and heroin (still using despite being on methadone) she wants to come off of alcohol completely and move back to just being on methadone. She started off with cannabis at 12, moved onto cocaine when 14 because she was a model and it was part of the job and then she has been on heroin since 15 and an alcoholic since 16. Because she has been using heroin for so long, the normal injection sites have become unusable and she has had to start using other access points such as her breast or neck. Despite being on methadone for 10 years she has never really come off of heroin. She first got into heroin in quite a forced way, being invited back to a strangers flat after drinks (age 15 remember) and being persuaded to shoot up there because it was 'fun'. She was then kept there for 2 1/2 weeks against her will, her parents didn't really seem to mind as she was often away from the house, and she was raped by the men living in the house and their friends. They shot her up with heroin every day and she developed an addiction. She was 'sold' by her then boyfriend when she was 21 to some drug dealers to pay for some drugs, who raped her and lead to her having a daughter, who is now 7, but has been taken away from her. She has had to work as a prostitute since she was 15 until now to pay for the drugs, but now wants this life to stop so she can get her daughter back. She has to get up at 7 every day to walk the miles to the clinic to get her daily methadone, and she cannot drink before getting in, as they breathalyse and will not give the drug unless people are sober. She suffers terrible alcohol withdrawal symptoms before taking her first drink, such as shaking, hallucinations and sickness, and then she spends the rest of the day drinking and vomiting after walking home This sounded like a terrible story, and reminds you that it isn't only in 3rd world countries that people face tragedy and life events that many of us cannot even imagine. Talking with the doctor afterwards about the patient, it turns out that the only thing she lied to us about was when she told us the last time she tried to detox was 5 years ago at another centre. It turns out she attempted to come off the drugs a few months ago at this centre but quit the programme after a few days. I hope she can pull through it this time, but I know the statistics say she is likely to end up back on the street. Patients can be at rock bottom.

The other 2 patients we saw this week were in a secure unit, which we had to be let into and then locked in with the staff after we had entered. A bit of a scary prospect, seeing as we wouldn't be able to let ourselves out if something started kicking off! Anyway - this was with a different partner, as we tend to be with different people on different days and different rotations - it is not just one person who has to put up with me all this time. The first patient we talked to was very depressed and had been sectioned by the police under a Section 136 which involves him being taken to somewhere like a hospital and being assessed by psychiatrists. These doctors then further sectioned him as they thought him a risk to himself. He was bought in because his family phoned the police telling them that he was trying to jump out of a 4th floor window. The patient had had suicidal thoughts and had sought CBT to try and turn his life around, but kept telling us that he was definitely not trying to jump that time, and was just trying to climb out to get out of the house. I suppose he was a danger to himself either way, and it is best to try and help him. He was currently on several drugs to try and bring his mood up, but hated being in the secure unit. He did not feel it was the place for him, and wanted to be transferred. A very anxious man, he said whenever it 'kicked off' between a patient, or patients, and the staff he would hide in his room until it all went away. Indeed, when we were talking with him, there was a lot of shouting and crashing from outside and he looked very anxious and was flinching away. I am not sure why he was in such a place, but perhaps it was the only slot available. He had only been in for a few days, so hopefully he was going to be transferred soon. An easy to talk to and polite gentleman, he was setting us up for a stark contrast with the next person we talked with.

The next patient found us, rather than the other way around, and asked us if we could come and talk with him.  I was on my way to the toilet when he collared me, shambling over dressed in about 4 coats and many jumpers, but I was not going to refuse just because of my bladder. After calling my partner over the patient lead us to a little room at the end, we were a little suspicious of this, but we followed after him, slowly, with his shuffling walk. The man looked in his late 60s and, along with his very strange dress sense with many layers, looked pretty crazy. Large, bushy eyebrows and alternating staring and flitting eyes, he looked as though he was meant to be here. Once in the room, we made the rookie mistake of sitting down in chairs that were not closest to the door. It was quite a small room, and the patient sat next to us, between us and the door. We were then subjected to a very confusing talk for about half an hour, out of which we got very little information from the patient. He started off telling us how he killed someone when he was 6 and then continued to tell us how he used to own a mental hospital and was trained as a psychiatrist (possible but unlikely). The only reason he gave for being admitted, though we asked numerous times, was that he kept talking to himself. This is different from hearing voices, which steers us away from schizophrenia. We weren't sure about his diagnosis at all. He kept alternating between shouting, standing at some points and becoming threatening, then apologising, telling us he knows it is his fault and he works himself up into it, and trying to be calm, stroking the material of my trousers at one point and telling me I am very finely dressed (£10 trousers from peacocks. Nice!) We were not really sure what to say through much of this, but he then invited us to his room to see a talking car. Assuming it to be some kind of delusion, we accepted (unsure about the ethics, but sure to remain next to the door at all times this time.) It turned out to be a talking toy car - I suppose you have to accept that patients may be talking sense sometimes. Anyway, the patient was convinced that my partner and I had some form of romantic attachment (we do not) but would not take no for an answer. In the end, he told us we had to leave NOW before he started becoming violent. I don't need to tell you we left very rapidly! Patients can be intimidating.

Despite only seeing 3 patients this week, we heard about many more. Looking at some of the notes for the secure unit we read about a patient who kept trying to sneak knives in, or take them off of staff if he ever saw a staff member carrying one for a task. Scary! I also heard about a patient, (this was in a clinic I went to but saw no patients due to no-one consenting) who was highly manic and decided that the problems in the middle east were starting to get silly. He spent all his money on a plane ticket and flew over to try and sort out the dispute over the Gaza strip - they wouldn't let him into Israel or the Gaza strip, but deported him back saying he was mentally ill. He started getting psychiatric help and then flew out again to try and sort things out, escaping into the river Jordan where he had to be fished out. What a wonderful person, trying to sort out all those problems on his own! I often wonder if I am (at least in part) perpetually hypomanic. I am usually full of energy and feel great most of the time. Perhaps I am just a cheery person. That is the problem with psychiatry I suppose - the blurriness between mental illness and normal variation in people. When do you start treating! A lecturer once said to us that psychiatry is about 100 years behind most of the rest of medicine in its crude diagnosis and treatment. It seems like they could be right

Anyway, apologies for the strange text changes in the last posting - I think they came about because of pasting in images and the such, and I couldn't seem to get them out. Have a good week!