Articles by Mr Ian

This last two weeks is far less entertaining. But there’s a few tid-bits to ridicule review.

Starting off with the reliable Tehran Times is the report of a story from Beijing of an Italian research study into the benefits of Dark Chocolate. Read the rest of this entry »

You know the one’s I mean - neurotic depression; ADHD - the one’s that take situations that substantially and genuinely disaffect less than 3% of a population - and they contort it to make it affect 30% or more people, then medicalise it; all about the same time as they declare - “Oh, wow. We just happen to have a pill/treatment here that will help you with that. Aren’t you lucky!”

It’s impossible to tell now - are the diseases and disorders we ‘discover’ ever real anymore? Are they simply new ways for psychobabblists and Big Pharma to create personal wealth? Are they reflections of our socially demoralised, desicrated disparate or disposable society in which we still live? Or do they represent some real underlying and problematic issue that needs to be addressed in a medicalised or psychotherapeutic way?

I have no idea anymore. [Life is a disease which generally cures itself eventually]

NY Times brings us news on the latest one - How to treat Money Disorder. Read the rest of this entry »

There are two main classifications of MH issues. ICD-10 and DSM-IV. ICD is a taxonomy of all health related conditions and diagnostic criteria and is varied from country to country (which kinda makes the ‘International’ nomenclature redundant). DSM is MH specific and has developed into a multi-axial tool to aide in a brief summary of clinical presentation. It is praised and criticised in equal measures.

This post is about exploring the DSM and how the axes are currently used with a proposal for a new way of using the DSM in determining need for health care interventions. I may be out of sync with other places internationally that have already taken this pathway - or similar - but I’ve not seen anything thus far to lead me to think so. Let me know. Read the rest of this entry »

NICE has produced guidelines on diagnosis and management options for ADHD.

Pulse reviews the guidelines which saves me reading anything.

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Don’t ask me why I’m doing this. An absence of anything to bash on about I guess. So I thought I’d peruse the global news stands and link the interesting stuff back here. I’m such a martyr for the cause, I know.

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Behaviour. Is it choice or is it pre-determined?

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I like dropping in the odd buzz word.

Joe has consented to trial Clozapine. He has undergone all the tests, titration and monitoring is progressing without incident and is now at day 12. He’s receiving 50mg in the morning and 200mg a night and progress seems to be looking good.

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Everyone employs moral reasoning in various situations, almost daily. To pay taxes, to not speed, to honour promises - all require a sense of moral reasoning. Some things we know intrinsically as being good simple choices - to kill is bad - to give to charity is good.

But when it comes to making more complex moral decisions, such as enforced medication, declining leave or involuntary treatment - how trained are nurses in the process of moral reasoning?

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That’s not to say Risk Assessment can’t have a place. After all, we accept the use of parole boards and probation services for the rehabilitation of criminal offenders.

Here in my part of Oz, mentally ill offenders can only have leave approved by the MHRT. When a person breaks the law in the context of a mental illness, it’s no longer a clinical decision as to whether someone is suitable for leave and all leave conditions are determined (increased, decreased or remain the same) by the MHRT at 6 monthly meetings.

Recent news has us once again reacting for our Risk Assessment calculator (that should say ‘reaching ‘ but oddly it doesn’t). Darren Harkin, a 21 year old who was resident of a low secure unit has been charged with the rape of a 14 year old girl after absconding. Darren is reported to have Autistic Spectrum Disorder. Not specifically a ‘mental illness’ - more of a mental disorder - but “he’s not normal” so he must be a mentalist.

Before I continue, a word of sympathy to the victim of this event; an event that no one disputes should not have happened. Though this posting may be somewhat anti-reactionist, I do not wish to minimise the nature of the events that have taken place.

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Joe, having managed to stay for the weekend and not get “sectioned”, is reviewed again by the treating team on Monday. Following review the registrar tends to the consultants requests to run “routine admission blood tests”. He writes out the pathology lab request form and pops it in the pending tray.

When the phlebotomist arrives the next day, you collect up the forms and take them along to the clinic room. As you peruse them to see who needs what doing - you note the following tests have been ordered on Joe’s form:

FBC; U+Es; Hepatitis; serum HIV*

What should you do?

[*: FBC = Full blood count and U+E= urea and electrolytes - which are the normal routine bloods and show generally how the body is functioning; Hepatitis and serum HIV are tests for specific chronic contagious diseases]

kiwipsychnurse has been asking a few questions about Seclusion and Restraint reduction. It’s a whole element of mental health nursing that has become a focus of serious attention in certain countries.

I’ve got some experience of seeing seclusion used in some places at the slightest concern (”Her looks a bit odd”) and the dodgiest of reasons (”He refused to take his medication”) - and yet, also having seen it used only once in an 8 year period for one patient (until she kicked the door off and we all sat around laughing with her about it.. hmm.. surreal).

Anyhoos… lately I’ve seen it reduce from sometimes 3-4 patients a week to being not used in over 9 or 10 months now. I’ve put some of the reasons I believe are responsible (and there are a few more reasons also) over on the forum page if anyone’s interested. But at the last part I decided to write it up here because it’s one of my pet hates and I’ve seen it happen on more than a few occasions.

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Furthering the “good news” story that appeared on MN mid-August, and the notable absence of any significant media coverage in the UK of the apparent decline in mental health related homicide, I was listening to an ABC Radio presentation here in Oz which can be downloaded in podcast from here with one (maybe more?) of the authors, of the BMJ article, Matthew Large. I first thought it was odd that such a report should get better media coverage in Oz than the country of origin - but having looked - 3 of the 4 authors are Oz/NZ based.

Further resources can be found here here and the full BMJ in iPaper for - here.

Saturday at 2pm you arrive for your afternoon shift as nurse in charge of the acute mental health unit to be informed of a new admission. Joe (from previous vignette), was reviewed by the community consultant psychiatrist and admitted voluntarily on Friday afternoon (with some persuasion).

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Mental health care most often becomes ethically clouded when it interacts with the law.

Jodie is a 19 year old female who is voluntarily admitted to the acute mental health unit following a suicide attempt whilst under the influence of alcohol. This is her first presentation to the service and you spend some time to get to know her the following day.

During the course of conversation Jodie tells you what caused her to act as she did.

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Scientists are exploring the use of psychedelic drugs such as LSD to treat a range of ailments from depression to cluster headaches and obsessive compulsive disorder.

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