Suicide

Introduction. Talking about suicide is not easy. There are still taboos and lack of information around this topic.

Numerous people have had negative thoughts at some point in their lives. There is no need to feel ashamed when saying that there have been times when we may have found it hard to cope and we have thought about the possibility of ending our life as a way out. Suicidal thoughts are not uncommon. They are usually fleeting and go away by theirselves or as soon as social circumstances change.

There are some other cases in which people experience fixed negative thoughts and they start thinking about possible plans of ending their life and how to act them. This usually happens in the context of major mental disorders, such as Depression, Bipolar Disorder, Schizoaffective Disorder, Schizophrenia and other Psychotic Disorders. It can also happen when life stressors, such as financial worries, social isolation, divorce, and homelessness, become too much and bring to a point where it is difficult to see a way to overcome them. In the vast majority of cases a combination of mental illness and life events is usually responsible for suicidal thoughts, plans and intent. Furthermore, in some cases people try to self-medicate by using alcohol and/or substances. This increases the likelihood of impulsive acts and causes further deterioration in mental state, which are both related to an increase suicide risk.

 

Definition. Suicide is defined as the act of taking one’s own life voluntarily and intentionally. There is not much more information on a dictionary. It is difficult to explain and describe how someone who attempts/commits suicide feels.

Suicide is an act of extreme despair that is carried out when people feel helpless, worthless and hopeless. The first image that comes into my mind is the one of a black blanket that surrounds us and does not let us breathe properly. We cannot see much behind the blanket because it covers everything. The blanket becomes everything. It prevents us from moving forward and makes us feel stuck. It is also the reason why we cannot see a way out. The same reason there is only an ending and no beginning. It is at this stage that it is fundamentally important to share how we feel with family members, carers and professionals. We would all agree that death is death, and there is no coming back. Making the decision of not ending our life give us a second chance. A change of getting help even though we are not really sure anything will change the way things are. It’s okay and worth to ask for help.

 

What do I do if I feel suicidal? Feeling suicidal and dealing with mental health problems can be difficult, but there are places to access professional support and get help.

If you are feeling like attempting suicide in the immediate future, it is utterly important to dial 999 or go to A&E where you can get prompt professional help. Suicidal thoughts and plans are a medical emergency that can be successfully treated by professionals.

If the thoughts are not persistent and you feel you can cope, the most important step is to urgently discuss how you feel with your GP and if possible with family members, friends and carers. Your GP may wish to refer you to Mental Health Services in order for you to get specialised support and treatment.

Remember that even if everything looks dark and you cannot see any way your current situation can improve, it will go away if you ask for help. The way you feel is driven by an illness, which can and needs treatment. When you think about killing yourself just reflect on the fact that there is no turning back from death and it is worth to give life a second chance.

Below that are some emergency numbers:

Ambulance: 999 (UK)

                       911 (United States of America and Canada)

                       000 (Australia)

                       112 only from mobile phone (Australia)

                       106 for people that have hearing or speech impairment (Australia)

Helplines:

Samaritans: 116 123 for everyone 24 hours 7 days a week (UK and Republic of Ireland)

Campaign against living miserably: 0800 58 58 58 for men from 5pm to midnight everyday (UK)

Papyrus: 0800 068 41 41 for people under 35 Monday to Friday from 10am to 10pm, weekends from 2pm to 10pm, Bank Holidays from 2pm to 5 pm. (UK)

Childline: 0800 1111 for children and young people under 19 (UK)

The Silver Line: 0800 470 80 90 for older people (UK)

Suicide Prevention and Crisis Hotline: 1 (800) 273 – 8255 (United States of America)

National Suicide Prevention Lifeline: 1 (800) 273 – 8255 (United States of America)

Suicide Hotline: 1 (800) 784 – 2433 (United States of America)

Lifeline Australia: 13 11 14 for everyone 24 hours 7 days a week (Australia)

The Samaritans: free Countryline 1800 198 313, Hotline 08 93 82 8822 for everyone 24 hours 7 days a week (Australia)

 

Suicide throughout history. Throughout history, suicide has been both condemned and accepted by various societies. It has been condemned by Islam, Judaism, and Christianity.

In Ancient Greece, suicide was generally regarded as not wrong in itself. However, a clear justification needed to be identified.

In Ancient Rome, there was no prohibition of suicide for citizens. On the other side, especially towards the end of the Empire, suicide became forbidden for slaves. This was due to the high incidence of suicide among slaves that deprived their owners of a valuable property. Because life was not considered as a gift of the gods, most Romans supported the idea of suicide in certain specific situations, such as individuals preferring death to dishonour or people wishing to avoid the decrepitude of old age.

In the Middle Ages, suicide was often considered the result of diabolical temptation induced by despair or madness. Penalties used to be inflicted on the dead body – such as dragging it through the streets where the deceased had lived and hanging it. The estates of these people were confiscated, and Christian burial was forbidden.

Attitudes towards suicide began to change slowly during the Renaissance, although for many religious people suicide was still regarded as diabolical.

In the 19th Century, in England, coroners’ juries began indicating that an individual was only insane at the actual moment of suicide. And, among the aristocracy, some suicides started being attributed to accidents. In this century, the religious penalties for suicide were finally abandoned.

Across Europe, suicide was slowly decriminalised, although it was not until 1961 that the Suicide Act was finally adopted in England and Wales with the removal of penalties.

 

Risk factors. Since the 1930s, there have been several research studies, books and conferences about suicide. The aim is to increase the awareness on this topic for patients, carers, and professionals. There is not a single approach that can be expected to succeed in reducing the incidence of suicide. However, early recognition and treatment of mental disorders is an important deterrent.

It is fundamental to highlight and describe the following factors that increase the risk of suicide:

  • Male gender;
  • Older age. Even though it is documented that men in the UK aged between 20 and 49 are more likely to die from suicide than any other cause of death;
  • Loss of family support and deterioration in personal relationships;
  • Separated/widowed/divorced;
  • Loss of accommodation or unstable living arrangements;
  • Unemployed/retired;
  • Previous history of suicidal attempts;
  • Previous use of violent methods;
  • Misuse of drugs and/or alcohol;
  • Major psychiatric diagnosis such as Severe Depressive Illness, Bipolar Disorder, Schizophrenia, Schizoaffective Disorder, Chronic Sleep Disorders;
  • Symptoms such as: pessimism, inability to feel pleasure in normally pleasurable activities, despair, morbid guilt, insomnia, self neglect, memory impairment, agitation, and panic attacks;
  • Expressing suicidal ideas;
  • Expressing intent to harm to self;
  • Plans of self harm;
  • Belief to have no control over their life;
  • Expressing high levels of distress;
  • Family history of suicide;
  • Helplessness or hopelessness;
  • Recent significant life events;
  • Major physical illness and/or disability.

 

How do I know if my loved one is suicidal? There are some key suicide warning signs that people in distress can display.  Someone who is thinking about suicide will usually give some clues to those around them that show they are troubled. Suicide prevention starts with recognising these warning signs and treating them seriously.

People often present with clinical signs of Depression. They may look sad, dishevelled and tired. They may talk about the fact that they have not been sleeping or eating well or on the contrary they have been eating and sleeping too much. They may say they have lost interest in activities they were previously interested in and they have lost interest in sex. They may express feelings of hopelessness, worthlessness and powerlessness. They may feel lonely and/or tend to isolate theirselves. We could also notice that they have an increase in minor illnesses such as dermatological illnesses (eczema, herpes simplex, psoriasis), gastroenterological symptoms or chronic pain.

An alarm bell needs to ring in our mind when we hear phrases such as “What’s the point? Things are never going to get any better”; “It’s all my fault. I’m to blame”; “I can’t take this anymore”; “I’m on my own. No one cares about me”; “I’ve been irreparably damaged. I’ll never be the same again”; “Nothing I do makes a bit of difference. It’s beyond my control”.

From a behavioural point of you, what we notice is that people withdraw from family and friends, they look anxious and agitated, they cry inexplicably, they quit activities that they used to enjoy, they put affairs in order, and they write unusual good-bye messages or letters.

For some reasons, there are people that believe that if a person says they want to commit suicide it means it is not the case. Wrong. Declared intent to kill themselves is the strongest indicator of risk and should never be dismissed.

 

How can I help someone who is suicidal? Talking to a friend or family member about their suicidal thoughts can be extremely difficult. But if you are unsure whether someone is suicidal, the best way to find out is to ask.

You might be worried that you could put the idea of suicide into the person’s head if you ask about suicide. However, it is good to know that you cannot make a person suicidal by showing your concern. In fact, giving a suicidal person the opportunity to express their feelings can give relief from isolation and may reduce the risk of a suicide attempt.

If someone you know tells you that he or she is thinking about suicide, it is vital to evaluate the risk. People who are at the highest risk in the immediate future have the intention to end their life, a specific plan, the means to carry out the plan and a time frame. It may appear obvious but is important for both professionals and non to explore if the person sees suicide as a solution to his or her problems. Questions like these could help in estimating the risk:

  • Does the person think or fantasise about suicide?
  • How frequently does the person think about suicide and how does he or she respond to these thoughts?

The greater the prominence and rigidity of these thoughts in the person’s life, the higher the risk of suicide. Fleeting thoughts quickly rejected represent low risk, while persistent, intrusive and painful thoughts indicate high risk even in the absence of planning. Protective factors from suicide can be religious beliefs or family obligations. If the person admits suicidal ideas, we need to explore if he or she has taken it a stage further to commence planning how to do it and how likely is the plan to succeed. Preparation, including hoarding of tablets, settling financial affairs or leaving a note, or both are indicators of a high risk.

If we find out that an individual is presenting with high suicide risk, it is advisable to encourage the person to attend A&E or we may want to call an ambulance. If the risk is not imminent we may suggest that the person attends the GP Surgery and if possible, we accompany them.  People that are suicidal need help and support. It is important to make sure we are there for them.

Image by Nicoletta Ceccoli

Depression

Depression is a mental disorder characterised by some very specific core symptoms. Unfortunately, nowadays, there are still people that think Depression is not a real illness but a sign of weakness or something that can be sorted out by the individual if she/he really wants. They are terribly wrong. Depression is a psychiatric illness with defined and well-known symptoms.

Depression affects people of every age and can happen to anyone. Many successful and famous people battle with this problem every day. Living with Depression is difficult for those who suffer from it as well as for their family, friends and colleagues.

 

What does depression feel like?

Depression affects people in different ways and causes a wide range of symptoms. In a Depressive Episode people may experience: persistent low mood; diminished interest or pleasure in activities; low energy; feeling of worthless or guilt; low self confidence; diminished ability to think or concentrate; agitation or slowing of movement; poor or increased appetite; poor or increased sleep; suicidal thoughts or acts. Symptoms of depression range from mild to severe, depending on the number of symptoms present and on their intensity.

 

When should I seek help for depression?  Suffering from clinical depression is different from feeling low in mood or sad. In fact, feeling sad from time to time is a common experience for human beings and does not require specialist input. When your mood is persistently low, you think that life is not worth or there are other symptoms that make it difficult to cope with your daily activities, it is important to discuss it with your family members, GP, and Psychiatrist. There are people that usually wait before seeking help for Depression, however it is best not to delay. Asking for help and support if the first step to recovery.

 

Why did I get depressed? There is not a single cause of Depression. Many factors are deemed to be responsible. Depression has been linked to an imbalance of neurotransmitters in the brain, such as Serotonin, Norepinephrine, and Dopamine. The use of neuroimaging has shown which brain regions regulate mood and how other functions, such as memory, may be affected by Depression. Areas in our brain that play a significant role in Depression are Amygdala, Thalamus, and Hippocampus. Researches showed that the Hippocampus is smaller in some depressed people.

Stressful life events, such as bereavement, divorce, illness, financial worries, unemployment, can have an important role in the emerge of Depression. At the same time some personality traits, such as being overly self-critical or having low self-esteem, can make people more vulnerable to develop Depression.

Having family members that have suffered from Depression increases the risk of developing the same illness. However, due to the fact that Depression is a result of several concomitant factors, genetic predisposition cannot be considered the only cause. Also social isolation plays an important role in the genesis of Depression, which shows the importance of having support from family and/or friends. Some women are particularly vulnerable to Depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to what is called Post-natal Depression.

When life is getting people down, some individuals try to cope by drinking alcohol or taking drugs. This can result in a spiral of depression.

A higher risk of Depression has been seen in longstanding or life threatening illnesses, such as cancer, coronary heart disease, head injury and chronic pain.

 

Treatment. Treatment for Depression can involve a combination of lifestyle changes, psychological therapies and medical treatment.

Medication is not the first choice if Depression is mild. In this case, it may be worth considering life style changes and psychological sessions.

Medical treatment is used for moderate and severe Clinical Depression. Antidepressants are a type of medication used to treat Depression. They work by increasing the levels of neurotransmitters, such as Serotonin and Noradrenaline, in the brain.

Antidepressant medications are a first line treatment for Major Depressive Disorder and for sub-threshold Depression that has persisted for 2 years or more. Antidepressants are an option for short duration Major Depressive Disorder if there is a history of moderate to severe depressive episodes or if Depression has persisted for more than 2-3 months.

Antidepressants usually exist in tablet form. When prescribed, the medication is started at the lowest dose possible and it takes about 2-3 weeks before the benefits are felt. It is very important to take the medication consistently, every day, and not to stop it if you experience mild side effects. These can be easily discussed with your specialist and are mostly temporary. A course of treatment lasts at least six months.

 

Caring for someone with Depression.  The support of friends and family can play a very important role in someone who is suffering from Depression. The best thing that relatives and family members can do is to simply listen, which makes people feel less lonely and isolated.

It is important to support the people we love to get medical help and be open about Depression. It might be hard for the people we love to have the energy to keep up contact, so carers may want to try to maintain in touch.

Caring for someone suffering from Depression is not an easy task and can be overwhelming at times. Therefore, it is always important that carers keep a balance in their life and maintain some spare time in order to look after theirselves. Carers that feel burnt out are encouraged to talk to their GP and find out if there is support they can access, such as counselling, family therapy or carers’ support network.

 

 

 

illustration by Benjamin Lacombe

Psychiatry throughout history

Throughout history, there have been several changes in how people suffering from mental illness have been seen and treated.

In ancient cultures, such as Persian, Egyptian, Indian, Greek and Roman, mental disorders were believed to be caused either by demons or by deities. There is evidence that in the 5000 B.C. one of the treatments for mental illness was drilling holes in the skull in order to release the evil spirits.

It was only after the 5th century B.C. that in Greece a different approach to mental illness was adopted. A greek philosopher named Hippocrates started talking about mental illness as a problem of the body rather than a punishment sent by the god. Hippocrates’ treatment focused on changing the patient’s environment or occupation, administering certain substances as medications, and using different other techniques, such as phlebotomies, bloodletting, purging, and diets. The principle that the body was affected by the mind or, more commonly called “soul”, became common by the time Galen was writing in the second Century A.C.

Unfortunately, the vast majority of cultures still believed in supernatural causes of mental illnessness and used treatments such as amulets, talismans, and sedatives to “ease the torment” of the afflicted. In countries that had strong ties to family honour, such as China, people suffering from mental illness were hidden by their families so that the society would have not thought that the condition was the result of an immoral behaviour displayed by the individual or the family.

During the Middle Ages, people suffering from mental disorders were believed to be possessed or in need of religion. Negative attitudes towards mental illness persisted throughout the 18th Century, which led to stigmatisation and confinement of patients. As a result of the social stigma, many people were forced to either live in confinement or on the street. Any of those that were abandoned to live on the street, were also considered dangerous, and were often put in jail or dungeons, “out of the public eye”.

The arrival in the Western world of institutionalisation as a solution to the problem of mental disorders was very much an event of the 19th Century. The first public mental asylums were established in Britain. The passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house the “pauper lunatics”. The first public asylum opened in 1812 in Nottinghamshire. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every country compulsory with regular inspections on behalf of the Home Secretary. The Act required asylums to have written regulations and to have a resident physician. The treatment of people in the early “lunatic asylums” was sometimes very brutal and focused on containment and restraint.

Late in the 19th Century views were influenced by the evolutionary theories of Charles Darwin and Herbert Spencer. Francis Galton, who coined the term “nature versus nurture”, developed theories of inherited disease which held that mental and physical conditions were caused by organic abnormalities that might be transmitted across generations. Collectively, these ideas had in turn been influenced by the apparent failure of asylums and “moral therapy”.

The influence of gender on the presentation and understanding of mental illness is longstanding. In the late 19th Century, the views of Darwin and Spencer emphasised core differences between men and women. Men were considered to be rational while women were, in contrast, considered biologically inferior to men, dominated by their reproductive system and prone to irrationality.

The new term Hysteria was coniated to indicate various symptoms, often associated to women. Women who spoke out were seen as the “shrieking sisterhood”, and were advised to withdraw and rest. Symptoms of hysteria included: convulsions, paralysis, sensation of respiratory obstruction, speech and mood disorders. By the late 19th Century, the influential French neurologist Jean Martin Charcot proposed that hysteria was an inherited disease of the nervous system triggered by trauma in vulnerable people. Although he promoted a neurological cause, he still focused largely on women and especially their ovaries.

Early psychological theories of hysteria came from Pierre Janet who worked under Charcot. He believed that emotional trauma weakened or injured an individual’s psyche. However, it was Sigmund Freud’s psychoanalytical theories that became most influential. Freud proposed that hysteria was a psychological illness caused by the repression of traumatic memories and that traumatic memories were often sexual in nature, and the trauma would be converted into somatic manifestations, such as hysteria. Freud also proposed psychotherapeutic intervention as main treatment.

Before the First World War, Psychiatry did not have its own clinical/medical recognition to the point that symptoms of mental illness were frequently confused and associated to a broad range of problems like crime, alcoholism and homelessness. Psychiatric patients were being managed in the asylums together with people presenting with other conditions or circumstances. Some of the reasons for admission to an asylum included: alcohol dependence; frigidity, homosexuality and masturbation; late stages of syphilis; unmarried pregnant women; epilepsy; and disables.

Soon after the onset of the First World War (1914–18), soldiers started exhibiting unspecified somatic and psychological symptoms, which were initially explained as a result of damage to the central nervous system from heavy artillery explosions. Symptoms included blindness, deafness, palpitations, paralysis, muscle tremor and anxiety, and were gathered together in the term “Shell shock”. This condition seriously challenged previously accepted views about the causes of mental illness and talking therapies. There was also considerable official and public concern about the number of executions for cowardice. The Report of the War Office Committee of Enquiry into shell shock in 1922 aimed to examine the nature and treatment of the condition. The committee consisted of doctors, military men and parliamentarians. The outcome of the report reflected in shifting ideas about mental illness as it was accepted that the origin of the condition was “a war trauma” and psychological therapies would have been beneficial.

During World War II, the term shell shock was replaced with “battle fatigue” or “combat exhaustion”. Approximately one million men suffering from battle fatigue were admitted to hospitals and a large number of them were returned to battle afterwards. Their military leaders consequently received accolades for this success. The somatic features of battle fatigue shifted to gastrointestinal symptoms. Mirroring a rise in ulcers in the general public, and concerns about the risks of gastrectomy (the only cure at the time), historians suggest that conversion disorders were influenced by popular health fears and the limits of medical science.

During the 1950s and ‘60s, asylum care was gradually replaced by mental healthcare in the community. Prior to the 1960s, it was difficult to accurately gauge the number of people suffering from depression and anxiety, and any cases remained undiagnosed in the community. The gender distribution of mental disorders continued to be more common in women, being approximately 2:1 female to male.

During the Post-war period, a strong cultural association developed between neurotic and depressive illnesses and middle-class married women. Feminist authors and commentators in Britain and the United States began to suggest that, for women, new suburban housing estates built following the Second World War were causing a range of psychological and psychosomatic disorders. The image of the “desperate housewife” began to resonate in our culture where the isolation, boredom and banality of domestic life was increasingly portrayed as pathogenic.

Suicide statistics from the mid-20th Century onwards have repeatedly showed that men are more likely to end their own lives and they are more likely to fail seeking help. Historically, ideas about masculinity and the association between weakness and psychological disorders have been suggested as an underlying explanation for men’s reluctance to visit their doctor. Men were more likely to present with physical or psychosomatic symptoms affecting, for example, the stomach, digestion, musculoskeletal system, sleep and general wellbeing compared to a more typical presentation seen in women, i.e. lack of motivation, sadness etc. Physicians writing in the medical literature during the 1960s and 1970s reported that many male patients maintained a defensive denial of mood disturbances. GPs noted that somatic symptoms were a mask and an “excuse with which to come to the doctor”, because they were viewed as more acceptable to the patient, his family and employer. Alcohol abuse appeared to be more prevalent in men than women: one explanation was that men “self-medicated” when suffering from mental illness. Alcohol problems were under-diagnosed and often presented in the late stages of liver disease. Stigma about alcoholism prevented official diagnosis and accurate recording of the illness on sickness certification.

During the Post-war period, General Practitioners were usually male physicians who were themselves influenced by prevailing attitudes towards masculinity and inclined to identify psychosocial problems more readily in women. Physicians were also socialised into a culture of heavy social drinking at medical school and a significant problem with alcohol, drugs and mental illness existed in the profession. By 1982, the standardised mortality ratio for cirrhosis in doctors was three times that of the general population.

From the 1950s onwards, the field of psychopharmacology developed rapidly as new antidepressants and tranquillisers were discovered, developed and introduced into clinical practice. These developments are often referred to as the pharmacological revolution in psychiatry. Echoing earlier associations between femininity and mental disorders, tranquilliser use became strongly identified with women, particularly housewives, who, it was argued, were prescribed drugs in order to adjust them to a role with which they were dissatisfied.

Unfortunately, in our society mental illness is still stigmatised. People often feel ashamed of talking about how they feel and about psychiatric symptoms they may experience. Somehow, we still feel personally responsible and guilty if we suffer from mental disorders. We think they are less real than any other clinical condition and we (optimistically? fantastically?) believe we can control them and move on. The truth is that there is still a lot of disinformation around mental illness and its treatment. Psychiatric medications are often rejected by patients that are prone to think they may become “zombies”, addicted, or for some magical reason, their personality may change. One of the reasons for it is that old fashioned psychotropic drugs used to cause unwanted side effects and some of them still do. Generally speaking, psychiatric medications are not any different from other medications used in clinical practice. The vast majority of drugs in medicine cause side effects. However, these can be controlled and minimised, and different medical options can be considered. A good compromise between clinical effectiveness and reduced side effects can and needs to be found. It is important to maintain a scientific and biological approach.

Mental disorders likewise other disorders need treatment and the goal is always to get better. If there are doubts in regards to what the best approach to treat an illness is, the optimal attitude is to discuss it with a doctor. Google, Yahoo are not good sources of information as there are far too many articles, people express opinions rather than facts and it is difficult to know what we can trust. Psychiatric symptoms and conditions can be treated. People do get better and they take their life back.

#nohealthwithoutmentalhealth #it’soknottobeok

 

 

Image by Nicoletta Ceccoli

What is a Psychiatrist and what to expect from a psychiatric assessment

What is a Psychiatrist?

A Psychiatrist is a physician who took a degree in Medicine and Surgery, which usually lasts 6 years, and then did training in Psychiatry, which usually lasts for another 5-6 years. Psychiatry is a branch of medicine dedicated to the diagnosis, prevention, study, and treatment of mental disorders.

 

What is the difference between Psychiatrists and Psychologists?

I am aware that many people get Psychiatrists and Psychologists confused with each other. It is important to highlight that both Psychiatrists and Psychologists have knowledge of how the brain works, and have an understanding of our emotions, feelings and thoughts.

To summarise:

  • Psychiatrists attend medical school and become medical doctors before doing specialist training in mental health. They have a good understanding of the links between mental and physical health and, as doctors, can prescribe medications. Psychiatristscan provide a wide range of treatments, including psychotropic medications, general medical care, and brain stimulation therapies such as electroconvulsive therapy (ECT).
  • Psychologistsattend University where they study Psychology, which lasts for at least 5 years. During those years they also do some training and get supervised experience. They may also hold a Masters or Doctorate level qualification in Psychology. If they have a Doctorate (PhD), Psychologists can call themselves ‘Dr’, but they are not medical doctors.  Psychologists focus on providing psychological treatments, commonly called “talking therapy”, which can be of different types, such as counselling, CBT, CAT, psychodynamic therapy, etc.

 

What should I expect from my Psychiatric assessment?

A first psychiatric interview can probably generate some anxiety, especially if we do not know what it is all about. We probably imagine weird things happening in a psychiatric setting and this post has the aim of clarifying and explaining how a psychiatric assessment works.

Prior to attend the appointment, a discussion with the General Practitioner may be useful. GPs need to be involved in the treatment plan. If asked, they are usually willing to write a referral letter where they summarise the main symptoms that a person is experiencing. Having a referral would allow me to get a better and immediate understanding of the problems we want to deal with and would also facilitate regular correspondence between the General Practitioner and myself.

I commence the meeting by introducing myself, my role and explaining the nature of the interview. During the interview, I usually take some notes so that I can keep track of the topics discussed in the most faithful way possible.

It is utterly important to start building a therapeutic relationship since the very first beginning of the consultation. The person who takes part in the assessment needs to feel understood, valued and supported. At the same time, he/she needs to be able to understand each part of the meeting and to feel comfortable with participating fully in the process of the consultation.

I usually proceed by asking information about social circumstances, such as family, accommodation arrangements, personal relationships, work, hobbies and plans for the future.

We then discuss the concerns or the issues that brought the person to my attention. The symptoms that are most commonly discussed are related to anxiety, mood, thinking and behaviour, eating, sleeping, and drug and alcohol use. It is important to discuss if these symptoms have an impact on daily activities and if they affect the ability to function.

In many cases relatives, friends, and partners are able to help describing some symptoms from an external point of view. In other cases, they bring up symptoms that had not been previously identified. For these reasons, I strongly encourage inviting them to the interview whenever possible.

Once we have gone through the symptoms, we then discuss a bit of the personal history, such as childhood, education, previous jobs, and previous relationships. Often, more than one member of the family experiences psychiatric symptoms. Therefore, investigating on family history for mental disorders plays a crucial role in the assessment. I will be also asking about physical issues and concomitant medical treatments.

The following step will be to agree the appropriate diagnosis and make a treatment plan. Throughout the consultation I will be aiming to enable the person to understand the decision making process, and to get him/her involved in the decisions to the level they wish. I will explain my professional opinion in a simple and clear way and I will address doubts and concerns when expressed.

We will be exploring management options. If medical treatment is suggested, we will go through options available, we will discuss how medications work and possible side effects. I will be offering suggestions and choices, encouraging people to contribute with their own ideas so that a joint decision can be reached.

In light of the fact that physical health has a crucial role in the person’s wellbeing, it is likely I will suggest performing blood tests, and other investigations such as ECG and, occasionally, brain scans.

We will be finishing our meeting by agreeing whether and when we should meet up again.

After the appointment, I will write a letter that I will send to the person’s GP and I will send a copy of the letter to the person so that things can always be open and transparent and people are able to keep records of our meetings.

 

 

Image by Nicoletta Ceccoli

Brief Introduction to Mental Health

It is very common for people to have mental health concerns from time to time. A mental health concern becomes mental illness when the intensity of the symptoms causes significant distress and/or it has an impact on daily activities and social interactions.

Good mental health means being generally able to think, feel and react, while poor mental health is characterised by a certain level of difficulty in those areas.

 

Mental illness is a broad term that refers to a wide range of medical conditions involving changes in thinking, emotion and/or behaviour.

The ICD 10 and the DSM V are the two manuals that are used by professionals to define and classify mental disorders in a territory such as Psychiatry where there are no blood tests, no imaging investigations or anatomical pathology results to support diagnoses.

The main mental health conditions are: Neurodevelopmental Disorders; Anxiety Disorders, including Obsessive Compulsive Disorder; Mood Disorders; Psychotic Disorders; Trauma related Disorders; Eating Disorders; Personality Disorders; Substance related Disorders; and Neurocognitive Disorders.

 

The distinction between mental health and physical health sometimes leads to an erroneous belief that mental health is not “a real illness” and can be controlled with “the power of the mind”. In all honesty, I don’t think we would ever ask someone who suffers from Hypertension (high blood pressure) to stop taking Antihypertensive medications but instead to “think positive and try to get better”. We would not encourage someone who suffers from Diabetes to not take Insulin but to “be strong and cope with it”. We would not blame a person who broke his/her leg for not using that leg to walk. Wisely, I’m pretty certain we would not tell any of those people phrases such as “it is all in your mind. It depends on you and what you want to do with your life. Get over it”.

On the other side, when a person is depressed or experiences other types of psychiatric conditions, sometimes we are erroneously brought to think that the person can resolve the condition if he/she wants to. Experiencing psychiatric symptoms is often scary, confusing and frightening. People may feel anxious and preoccupied most of the time, or they may experience sudden and intense attacks of fear. They may find themself ruminating about things, not being able to stop thinking, and having to perform specific actions in order to feel in control. They may experience mood swings, low mood, poor energy or an inexplicable feeling of wellbeing, strength, and elevated mood. They may have unusual thoughts or experiences. Also sleep and appetite may be affected.

 

Being mentally unwell may be considered a sign of weakness or shame. It may be considered a decision rather than a condition. Unfortunately, social media and the Internet often reinforce these negative messages. This can easily lead to a delay in seeking help, which is likely to increase the level of distress and sense of isolation that a person is already experiencing. People cannot recover from anxiety by just staying calm. They cannot recover from depression by being positive. They cannot recover from psychosis by deciding to stop hearing voices and being paranoid. They cannot recover from anorexia nervosa by just eating more. If mental illnesses were that simple no one would ever struggle in the first place.

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Probably the most poisoning and dangerous elements in our society are ignorance and people that talk about things that they don’t really know. Prejudice, stigma, and erroneous judgments are possible consequences of such a dysfunctional attitude.

I don’t want to diverge from the main topic of this post. I don’t even believe that in this context it is useful to speculate on the reasons why human beings think they can control their brain.

I would rather like to point out that from an anatomical and physiological point of view, our brain is probably the most complicated organ of the entire human body. Pathological alterations of the brain are the cause of mental illnesses. Therefore, in order to treat psychiatric conditions a medical approach is an essential requirement and psychotropic medications are often necessary.

In reality, mental health problems are very common and can be treated. The most important step to take is to recognise we need help and/or to trust people that encourage us to seek support from a specialist.

 

 

Image by Nicoletta Ceccoli