Gathering Nuts While in May

[usuakari]

My month in an acute psych unit is over. This one has proved to be more intellectually and emotionally draining than the last. I’m not ultimately surprised at that, because it’s minds and emotions that we’ve been dealing with so much more than bodies, but still a noticeable thing. This isn’t to say that problematic interfaces between minds and

Comments

[mimdancer]

Yes, my father has been told about the cigarette thing. The only trouble is that the cigs are a form of anxiety control and a form of self medicating.

He has tried unsuccessfully to get off them at least three times in the last three years. Although being in a co-dependant relationship with her children in the house doesn't help.

[usuakari]

You do know that I wasn't trying to preach at you or (remotely) your father, right Mim?

I was also thinking more of the side effects of anti-psychotics rather than mood stabilisers, although I have no idea what your dad may be on anyway. Most of the stuff I've been reading says litle about drugs such as sodium valproate or lithium, as the data isn't sufficient to make good calls at this stage. That being said, smoking is known to reduce the clinical effect of lamotrigine (which is like valproate in that it can either be used as a mood stabiliser or anti-epileptic), and probably does have similar effects on other drugs.

I wonder if another form of anxiety management would an option (either alongside or as a replacement) in the long run...? Regardless, quitting is tough at the best of times, and I can appreciate the difficulties in trying with another smoker in very close proximity.

[mimdancer]

I am not worried. I preach at my Dad all the time! :)

I know he is on lithium and cephaplex (?) He has tried a very large amount of different drugs, including experimental. Also had electro-therapy.

He has regular blood tests to check kidney function, because the higher doses can overwhelm his kidneys and they can give out.

[asakiyume]

What your preceptor told you about dealing with patients reminds me of what I read prior to starting to volunteer in the jail, about people being able to run rings around you. I was depressed by it; fortunately so far I haven't found it so much of an issue (but then, I only go in every two weeks and may not be a very worthwhile target).

[usuakari]

The preceptor in quo was a psych trained nurse (back when that was a direct entry course, rather than the post-grad specialty it is here currently) of considerable general and forensic experience and a robust approach to health care. An older Scottish immigrant who could believed mightily in the power of swear words. I enjoyed my shift with him quite a lot. :)

The patient who was giving me particular grief was young, smart (although not as smart as they thought they were), had a certain brash charm, and was a little shit while they were with us. I strongly suspect that they were also likely to be diagnosed as having a personality disorder (assuming you believe in the concept in the first place) of one sort or another with the infamous Cluster B traits. Along with very manic, charming and clever, went deceptive, intrusive, and manipulative. When I expressed my frustration and difficulties at dealing with them, the preceptor reminded me of a couple more things. One, being manic, they were probably only hearing half of what I was saying

[alecto23]

Interesting. When we did some training last year for dealing with difficult people who have mental issues (this wasn't what it was called, it's what I'm calling it) the trainer was also very clear about the need for setting limits with people. Yes, you try to be understanding and sympathetic, and understand that for people with a mental illness, even getting out of the house and into the library might be putting them under a lot of stress and testing their courage and/or limits. But that doesn't mean you have to tolerate inappropriate behaviour. Librarians are also pretty conditioned to want to help people (part of the job) so initially these seem like contradictory responses. Learning how to set firm boundaries with empathy and understanding is still an ongoing thing for me. That trainer was awesome, though. She'd worked in various roles involving "crazy people" and also had a schizophrenic son. The fact that she was able to maintain a sense of humour about the time her son came after her with an axe is pretty cool.

[usuakari]

The fact that she was able to maintain a sense of humour about the time her son came after her with an axe is pretty cool.

Impressive.

One of the things that I haven't really conveyed is the humour to be found working in mental health. There's a surprising number of laugh-out-loud moments. They range from bursting into laughter at the totally over the top paranoia of patients (that you know well and have a good working relationship) and asking them just how much a celebrity they really think they are, and shouldn't they be handing out autographs; to episodes like this one from uberjeep, back in the day.