Honestly, you lot. Bunch of fusspots. Fuss fuss fuss.
So anyway, on with This Week in Mentalists, which coincidentally is six months old today. Time flies, eh?
To nominate a blog for future editions e-mail zarathustra at mentalnurse dot org dot uk
Experimental Chimp reports on an innovative treatment for depression.
Let me introduce you to Nikolai Shevchuk. He’s worked at the Department of Radiation Oncology at Virginia Commonwealth University School of Medicine. One day Nikolai gets an idea. What if cold showers could treat depression? After all, cold showers get the adrenaline pumping, doesn’t it? So Nikolai gets a few friends together and asks them to try taking a cold shower and seeing if it improves their moods. Nikolai probably likes to take cold showers himself and he feels just fine!
So Nikolai writes down his ideas. There’s not what you’d call a huge amount of evidence for them. Nikolai tries his hardest to think up a mechanism by which cold showers can make you feel good. The adrenaline thing was good, but what if he can invoke some kind of evolutionary mechanism. Hey! Yeah! That’s it! Back when man was a hunter-gatherer chasing after prey, he’d have to swim after it in cold water. So modern man, lacking these environmental stressors must be getting depressed as a result!
Returning to more conventional treatments for depression, Aethelred the Unread answers some questions about his own treatment.
R: Have you tried combining drugs? I think it’s called augmentation or something e.g. mirtazapine + another etc.
That’s never been suggested to me, although it is something I’ve wondered about. I’ve come across quite a few people on the web who’ve said that combining drugs is the only thing that’s really helped them, but most of them seemed to live in America. I don’t know if it’s common practice to do that sort of thing over here. I’m also not sure how I’d cope with two sets of side-effects at the same time.
The Shrink talks about nurse prescribing. Yeah, quacktitioners! Quacky quack quack. Though personally I think his approach seems quite sensible.
At the moment, legally, the nurses can be independent prescribers. I’m not comfortable with tossing them the BNF and sending them on their way, so we’ve quite constrained formularies they can use and they can only undertake supplementary prescribing. This means that I see a patient (usually with them), if a nurse wants to be involved in prescribing she suggests this then we all agree a clinical management plan (CMP), I type this up, the nurse actions it.
Benefits of this are :
- I still see every patient for diagnosis
- The nurse and patient and I agree a range of drug treatment options together, so I get to say what options are on the table and the patient gets to select from those what they want in the CMP
- It’s typed up on a proforma so the CMP can be printed out and easily shared with one and all, making it clear to one and all what’s being proposed
- The patient never then needs to see me just for a prescription
- When things change, the nurse has latitude to effect change with the patient (e.g. titrating dose as we’ve agreed) so things can be done quickly
- The nurses say they’ve become much more familiar with medications’ benefits and consequences
- They’re so cautious in prescribing that they collect massive amounts of information about what they do, so we’ve rich audit/clinical effectiveness data
Mandy Lifeboats Ahoy is pondering her psychosomatic symptoms.
If anyone (hypethetically) looked at my medical records they would see a list of referalls to a variety of specialist doctors and clinics. The outcomes of most being the all clear on physical front, although most reminded me that smoking is doing me no good. Which is fair enough. Is their job to save lives.
And another example of me having to suss the difference between mental illness manifesting in physical symptoms was last night. I kept getting so dizzy and fell a couple of times. It was very frightening.
My mind then tries to work out if that is a physical probby or stress or withdrawal from lorazepam and then it goes round in circles. Doing a for and against list, of sorts.
In the end, I couldn’t hack it anymore. Whatever it was/is. I took another quarter of a lorazepam and listened to Franz and his calming German accent, as he talked me through a tense and relaxation session. I have to say it is good stuff on a CD. I normally try these things and my mind wanders about all over the place, or I get too panicky, but I can stick with this. I think it is paced right and also it is not one of those “You must do this and properly”. It is a laid back kind of session.
After that, the dizziness eased. Whether that was the extra bit of loz or the CD is hard to tell. Most likely a combo of the both together. And I slept soundly.
Seaneen has discovered, rather disconcertingly, that she’s not real. Or at least, that’s the opinion of some blogger who decided to parody her and claim she was faking her mental illness.
It’s inaccurate for many reasons; first of all, the whole (three entries) of the blog paint me as some keeerrrazy London hipster when I am in fact a skint semi-recluse that only cares about comedy from the 60s and music from the 90s. There has also been a tendency in my lovely internet detractors to make assumptions about my lifestyle based upon who my (far more outgoing, far more successful) friends are. That I go clubbing all the time and stuff. If I did, it’s no-one’s business but I rarely go out now and when I did it was for quiet pints with friends or to the one club in London I get into free because I used to flyer for them.
I’ve met Seaneen in the flesh on more than one occasion, and I can confirm that she is who she says she is in her blog, and that she is indeed, to use her own expression, “mentally interesting”. As for being a hipster, I’ve seen her singing 5ive songs before today, which pretty much destroys any hipster credentials on the spot.
And on that note…
Let’s dance
Like you mean it, can’t you feel it, don’t you know
Let’s dance
‘Cos you need it, better believe it, here we go
Let’s dance
Give your all when we’re coming together on the floor
Let’s dance
You know that you’ve got what I like
Tags: this week in mentalists
