Insight into Psychiatry

Dr Spurrell came in this Thursday to give The Medical Society a talk about what it is like to work as a psychiatrist, and in particular what it is like to work with a particular form of psychosis- schizophrenia.

So first of all, what exactly does a psychiatrist do? As some of you asked during the meeting, the perceptions of a psychiatrist and a psychologist are often blurred. Dr Spurrell explained it most clearly by likening the relationship between psychiatrists and psychologist to that between rheumatologists and physiotherapies. A psychiatrist is fundamentally a doctor who treats illness related to the brain, administering drugs and considering aspects of the whole case in order to cure the patient. It is the psychiatrist who decides which course of action is best for the patient, whether be it referral to a clinical psychologist or a course of medication.

Psychiatry is a very broad term used to describe studies and treatments of mental and emotional disorders. It is further divided into areas such as psychosis, depression, anxiety, and personality disorders.

Psychosis is a condition in which a person isn't in contact with reality. There are usually four aspects, hallucination, delusions, thought disorder and lack of insight, all of which contribute to a unusual or bizarre nature of such behaviour, difficulties with social interaction and impairments in carrying out the activities of daily living. It should be noted that psychosis can occur in persons without chronic mental illness, as a result of an adverse drug reaction or extreme stress

About 1 in 100 of the population develop Schizophrenia, a disease that translates from Greek into “shattered mind”. This statistic is consistent in most populations, and surprisingly the disease usually presents in adolescence or early adulthood, with males tending to show symptoms earlier than females. Symptoms of schizophrenia may include; include delusions, auditory hallucinations and thought disorder, constricted affect and emotion, poverty of speech and lack of motivation, reduced or impaired psychological functions.

The causes of Schizophrenia are still unclear, although scientists believe that it is related to dopamine levels within the brain. There is definite evidence for the importance of genetic, neurobiological and environmental factors. If you have a close relative with schizophrenia, then your chances of developing the disease goes up to 1 in 10. The use of cannabis increases your chance of developing psychosis, which can lead into schizophrenia, and so does stressful or traumatic experiences in early childhood.

As Dr Spurrell outlined treatment for Schizophrenia is incredibly difficult, especially if the case is advanced or has been allowed to relapse. With milder cases it may be possible to treat a patient at home by examining and alter environmental factors such as stress and deciding on a course of medication. However for sever cases in which the hallucinations are acute, and perhaps dangerous to the individual, it is assumed that the best course of action is to admit them into hospital were they can be best cared for.

The pathology of a typical case is 18 months at least. And most of the time the disease is extremely damaging to the patient as it may cause the loss of family, friends and jobs.

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I found Dr Spurrell’s session both mentally and emotionally draining. My knowledge was certainly expanded, and in a way it my perception of the whole field has shifted slightly. I realise now the breadth of qualities required in a psychiatrist and how important they are to a healthy society.

Feel free to add your impressions in the comments below.

"Why Medical Students should keep Blogs"

If I ever mention the word blog to Lucy, she will sign exasperatedly at me and brace herself for some very animated gushing about people she will never meet, or events that are quite remote from our lives. Yes, I know I am slightly obsessed with weblogs and that I have been obsessed with them for a good many years, that is before they were well known and cool. But the below article found on medscape.com (members only, but registration is free) highlights some of the benefits of this occupation called blogging.

A word of warning- American English ahead

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All across the country this fall, thousands of students are starting medical school or new clerkships. Some are kids fresh out of college, while others are embarking on a second career they've always dreamed about. Still, this diverse group shares some common features:

They're going to be isolated from the life they knew before; maybe they've moved to a new city, or maybe they won't get to call or see family and loved ones as often as they used to.


They are going to experience some powerful things, such as cutting into flesh, delivering a baby, breaking devastating news, or staying awake for ungodly periods of time.


In short, this is a group that should be communicating a lot with others -- stories, perceptions, rants -- at precisely the time when such communication is most difficult.

The solution? I think they all ought to get a blog.

You know -- a Web-log, an online diary. Now, I'm not talking about those vapid MySpace pages full of classroom gossip and party pictures (although medical school provides its share of that, too). But I think the students who sit down for 20 minutes every now and then to record their impressions of the wondrous, challenging experiences they're grappling with will be doing themselves a favor. Frustrated friends and family who haven't heard from their beleaguered med school castaway will take a measure of relief in seeing an updated blog entry, even if it's a gripe about exams written at 3 AM.

But perhaps even more important is that medical student blogs are useful for students themselves. It's therapeutic to record your feelings, to vent frustrations, and to register difficult experiences. This is the kind of activity that makes for a sensitive and caring doctor -- probably the kind of doctor that most beginning students expect to be but forget about somewhere along the line. Blogging can help students remember. It's also instructive because it allows us to chart our progress through the years. On those bleak days of surgery clerkship, it may be encouraging to look back and see how far you've come since the first squeamish posts about anatomy lab.

Finally, blogging can create opportunities and open up frontiers. Beyond the simple scenarios that have helped me -- such as getting the inside scoop on hospitals during residency interview season -- getting involved with the nascent medical blogosphere can help you sift through the Web's educational resources (such as a collection of clinical cases and archived school lectures). It also can inspire student activism or show you what life is like in foreign med schools. Blogging might even open up doors into research.

To put it in med-school parlance, such an activity is "high-yield" and quite possibly "evidence-based,"[1,2] and thus worthy of a medical student's valuable time. Plus, you can't beat the price (blogs are free and easy to set up at sites such as www.blogger.com and www.wordpress.com).

Medical students can take their cues from some of the blogs already out there. Besides Medscape's own cadre of bloggers at The Differential, there are institutional blogs such as the University of Michigan's med school blog and StudentDoctor.net, where some editorial freedom is sacrificed for a potentially larger audience. Some students write mostly for family and friends, while others give updates on much more than medicine.

If there's one unique concern that weighs heavily on medical students, it's privacy -- for their patients, for their colleagues, and for themselves. This may explain in part why med student blogs are less common than, say, graduate or law student blogs. While students in other disciplines are expected to develop public communication skills, future doctors are instructed to keep it in the chart or at the bedside.

But there are plenty of medical bloggers who are HIPAA-compliant. They simply obscure details of patient encounters and keep their own names and affiliations offline (which is relatively easy to do, although there's no guarantee that a blogger still won't be discovered). Other bloggers maintain anonymity, not necessarily for their patients but to protect themselves (the blogger behind Ah Yes, Medical School wouldn't be nearly as funny if his classmates and teachers knew who he was).

Of course, getting your feet wet in medical blogging may seem a little overwhelming. Fortunately, there's Grand Rounds -- which in the hospital means stale bagels and esteemed, boring lecturers, but on the Web means a weekly collection of the best in medical blogging. Each week, a different blogger "hosts" Grand Rounds and displays links to other bloggers' best posts of the week. I have been fortunate to interview many of these bloggers for Medscape's Pre-Rounds series, and I can say that many initially had a skepticism of this new form of communication until the benefits won them over.

Andy Warhol said that, in the future, everyone will be famous for 15 minutes. While that's not yet proven, it's safe to say that most people will one day have some sort of online presence. I urge medical students to set up that territory now -- for themselves, their careers, their loved ones -- as they undergo some of their most transformative years.

Homless Families Health Visitor

This Thursday Ethna M Dillon, a Homeless Families Health Visitor gave The Medical Society an insightful presentation on the health issues that may be connected with homelessness.

The strongest impression which I took away from the talk was that how easy it was for the basic levels of Maslow’s pyramid to be undermined by homelessness. On first glance homelessness and medicine may appear to be unrelated however in reality a person's health is rooted so much in their immediate environment.

Feel free to discuss your feelings towards the talk in comments to this post.

"Legal Highs on the Rise"

I came across this article today on New Scientist. The article reminded me of the recent Smokers debate, where I got the impression that a lot of people would like to see a total ban on tobacco.

Whilst I think that restricting smoking in confined public places is a fundamentally good idea, reducing significantly the risk of non-smokers developing health problems through passive smoking, a total ban on smoking should be reviewed with more consideration. The issue is complicated because it would involve answers to hazy questions involving free will and explanations of the diverging perceptions society has of drug users in general.

The main problem, I feel is that there doesn’t seem to be one single universal opinion of what is or isn’t acceptable; the confusion classifications of legal and illegal drugs distort with each change in government. Not so many years ago, gentlemen carried snuffboxes and Coca-Cola actually contained coca a plant now used to make cocaine.

The confusion extends so that even the definition of a drug is disputed. Wikipedia defines a drug as “any substance that can be used to modify a chemical process or processes in the body, for example to treat an illness, relieve a symptom, enhance a performance or ability, or to alter states of mind.” It clearly recognises the existence of recreational drugs.

However the Labour government’s definition, which states that a drug “includes any substances or mixture of substances manufactured, sold, or represented for use in: the diagnosis, treatment, mitigation, or prevention of a disease, disorder, abnormal physical state, or the physical symptoms thereof, in man or animal,” makes no mention of drugs that aren’t medicinal.

It would be much simpler if the government were to legislate and restrict the use of all recreational drugs, this would include everyday stimulants and depressives such as caffeine, nicotine and alcohol. Could we see future legislation on herbal drugs such as Salvia divinorum, a hallucinogen, or benzylpiperazine, an ecstasy alternative? If that were to be the case shouldn’t the government also ban the addition of E- numbers to processed food as they have been proven to be detrimental to our health, or better still, why not ban processed foods altogether?

A State cannot hope to control so much of a person’s life, in fact, it shouldn’t unless it were striving to become a vision of Big Brother.

“Should Smokers and Drinker be denied treatment on the NHS?”

This Thursday the Medical Society debated the motion: “Should Smokers and Drinker be denied treatment on the NHS?”

Main arguments for the motion were:

The World Health Organisation estimates that “in developed countries of North America, Europe and the Asian Pacific, at least one-third of all disease burden is attributed to these five risk factors: Tobacco, alcohol, blood pressure cholesterol and obesity.”

The smoker’s health problems are self-inflicted and other non-smoking taxpayers should not be left with the bill.

There is already a substantial amount of money being spent on advertising and initiatives to stop smoking, so more shouldn’t be spent on treatment.

Smoking should be banned so a lenient policy on treatment would be inconsistent.

Main arguments against the motion were:

Since smoking is not banned, how can treatment be legitimately denied to law-abiding citizens?

It is unfair to discriminate against a lifestyle choice, what about those who participate in dangerous sports? There are risks associated with everything in real life.

Banning smoking may lead to other restrictions on the freedom of citizens in the British society, and the state should not be given so much power.

Denial of care can undermined the physician’s relationship with the patient. Doctors are supposed to help people, not tell them how to live their lives.

The tax that smokers pay on cigarettes covers most of the healthcare costs of the NHS.

Somewhat worryingly, considering most in the room are to be future physicians, the motion won.

Introduction

Hello and welcome to the first ever post in the sparkly new AGGS medical society weblog.

For all intents and purposes this weblog shall function both as a journal and a forum for debate. It would be useful if you could check this address regularly as this is where details of upcoming sessions will be posted. Articles and debates will also be posted on a weekly bases.

Submission to the weblog is open to everyone. Please send articles and debate proposals to me at Esmaraldo@gmail.com.

It should be noted that articles are expected to be related to medicine, and should be of a reasonable length with evidence of sound research. Debate proposals should offer some initial arguments, though a simple unelaborated motion will also be accepted.

Participation is vital as an active society is a healthy society. So blow the dust off your keyboard and start typing. And if you need further incentive to write, articles and arguments can also be quite helpful for when you are preparing to apply to medical school. (whipsers UCAS)