CliveUK

I think thorazine is called chlorpromazine over here Don. As one of the older antipsychs, I really can't remember when I saw it last used - ages and ages ago.

Ah, these are the tensions you have to live with as a nurse. You can't "make" people better, they do that for themselves.

Self-injury is just another form of coping mechanism for some people. You say later on in this thread that she says she has gone down the therapy route and found it useless. Seems to me like she has found a space in her life for her cutting, a way of dealing with it and a way of functioning in her everyday existence. I'd say she is perfectly safe to work with residents.

Me too StuPer. ECT is a controversial treatment, but in terms of side-effects, it's probably safer than some anti-depressants.

StuPer - I've never advocated for meds alone as a treatment for depression. My feelings are that the chemical imbalances which are a feature of depression may - when the depression is still "mild to moderate" - be amenable to change through effective therapy (i.e CBT) that encourages learning (and thus neuromodulation) and without the need for medication. However, there comes a point when the depression is so severe that no amount of talking to the person will do anything. What you need to do then is tweak the serotonin and then, once the person's brain is actually functioning again, attempt therapy. However, I tend to think that normal human interactions - passing the time of day, talking about ordinary things, showing concern and kindness - are as effective or even more effective than formal therapy. lsyorke - as you know, I've read and been very moved by the struggles and hardships your son and you have been through. Yes, there are serious problems with the way drugs are marketed, with the behaviour of pharmaceutical companies and with the prescribing practices of some doctors. However, none of that detracts fromthe fact that millions of people (including my partner) owe their current well-being and perhaps even their lives to anti-depressant medication.

StuPer - it is rather convenient, isn't it, that certain schools of counselling/therapy consider themselves too mysterious and unquantifiable to be researched adequately? Which allows them to get away with the self-proclaimed tales of their efficacy - a bit like religion, really: "we can't prove it one way or the other, you just have to believe". I imagine Rogerian counselling could lend itself to - at the very least - a qualitative review. And given that Dissociative Identity Disorder and False Memory Syndrome are both creatures of the consulting room, artefacts of the therapist/client relationship, then I would say that certain forms of therapy are actually more damaging than anti-deps. In contrast to some of my earlier statements on this forum, I have become more and more convinced of biological theories of depression, which is why I believe (and research tends to back me up) that neurotransmitter modification and the kind of neuromodulation which effective therapies like CBT provide are the only truly proven effective measures.

Over here, the counselling and therapy industry is totally unregulated, except through informal, voluntary regulation by organisations representing therapists of various flavours. This is why I have a healthy dose of scepticism about therapy and therapists. The only therapies with any proven efficacy are cognitive behaviour therapy and solution-focussed therapy. There is virtually no convincing evidence for the benefit of psychoanalysis, Rogerian counselling, psychodynamic approaches and all the other ever more obscure schools of brain-fiddling. I think most of it is a con, frankly, unintentionally perpetrated by well-meaning people who have swallowed the therapy myths hook line and sinker. Belief in some schools of therapy is more akin to religious belief than anything else. If I had depression, I'd be asking them to give me the drugs then try and get me a CBT therapist but don't let them "humanistic" counsellors loose on me please!!

There is next to no evidence for the effectiveness of "counselling". And seeing as "counsellors" don't even need to be licensed or registered to set their service up, you could be allowing rank amateurs to have access to your brain. Give me the drugs any day of the week.

Hypothetically. In fact, none of the studies has demonstrated conclusively that ventricular enlargement is a feature of schizophrenia.

In the field of psychiatry, I don't think you can ever say "OK that's it, we've done all we can". It's the nature of the beast, and I would be strongly opposed to any measures which, basically, punished patients for having the temerity not to agree with the psychiatrist. They already have to cope with mental health legislation, without having any further sanctions and restrictions placed on their lives.

Short answer - no. Long answer - NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO!

Horses for courses, I suppose. Some kids get on with them, others don't. I guess the point is that the drugs companies should have been upfront and honest about the side effects, allowing patients a real choice, rather than practising the worst kind of snake-oil salesmanship in pushing SSRIs as some sort of panacea.

Is there published evidence Hukilau - do you have a reference?

Don't most antipsychotics interfere with prolactin levels, hence the galactorrhoea some women experience and the erectile dysfunction in men? Would that lead to gynaecomastia? I owuld have thought any young man growing breasts as a result of drug treatment would be entitled to some free corrective surgery - but that may just be my naivete about American health care systems. Over here, he'd get it on the NHS no problem.

The Liverpool University Neuroleptic Side Effect Rating scale (Day et al 1996) sounds like the kind of thing you're after. It's a 51 item checklist of side effects and patients are asked to rate how much they have experienced the side effect over the past month. It includes extrapyramidal side effects, hormonal side effects and so on. As it was originally devised as a research tool, it also includes some "red herrings" to avoid the possibility of people over-rating themselves. I guess you could take these out if you weren't keen on that idea: it does seem a bit underhand. I have a copy you're welcome to have.

Your reply assumes that process groups are effective for acutely-ill patients. I have yet to see any evidence that this is the case.

Don't worry about screwing up - all of us have done it at some time or other. Nobody expects you to be perfect. If you have the yearning to be a psychiatric nurse, then I say go for it!

I would like to see the reference that says brain surgery is beyond the scope of practice of nurses. I've never seen it, and yet it is generally accepted that it is, and nobody would be advocating nurses just having a rummage around in someone's cranium, but calling it something other than brain surgery so it's OK. It's my personal opinion that sitting round in a large group with a bunch of acutely ill people all experiencing wildly different things and "talking about feelings" is highly inappropriate. I fail to see how this helps patients.

I don't think psychotherapeutic groups are at all appropriate for acute inpatients, nor do I think it appropriate for untrained nursing staff to be blundering about trying to run them. Specific psychoeducational groups with a definite focus (hearing voices; medication; occupation and employment) are a much more sensible option. Either that or low-level activity groups. The kinds of problems which bring people into hospital are not really amenable to the kind of psychodynamic group therapy some contributors to this thread seem to be advocating. Why do our poor patients have to be therapised to death? How about just giving them something nice to do? Why does everything have to have the tag "therapy" dangling from it?

Acute in-patient units are not appropriate for more than a very short-term crisis admission for people with BPD. However, over here in the UK, I'm sure it's the same as over there in the US: BPD patients up the ante by carrying out ever more dramatic acts of self-harm in a bid to extend their hospital stay. Some of them inevitably end up detained under mental health legislation. Experience tells me this allows them to avoid responsibility for their actions and be kept away from whatever stresses and strains are outside of hospital and which led them into hospital in the first place. They are perhaps the most frustrating and infuriating group of patients to deal with. The havoc they can cause on acute units, well...I don't need to tell you about it I'm sure. And yes, it does gall to see them sucking attention and time away from people with mental illnesses. Nurse Ratched offers some excellent strategies for dealing with BPD patients. But I think the best thing you can do for them is to advocate for their swift discharge.

The outcomes stack up pretty well, actually. Here in the UK, ECT is only given for recalcitrant depression that hasn't responded to antidepressant treatment.

Over here in the UK, we have an organisation called NICE (National Institute for Clinical Excellence) who have evaluated ECT and produced useful guidance to its use and efficacy. You can download a copy of their guidance here: - http://www.nice.org.uk/page.aspx?o=68305

We have two examples of her behaviour that lead you to think she might be mentally ill: - one seems to me to be a heightened concern about an ex-partner. Perhaps the ex was abusive (her description of him "going postal" suggests this): it is not uncommon for people who have suffered violence to be over-vigilant. The other example seems to me to be the kind of hyper-vigilance and anxiety about the baby's wellbeing and her ability to cope that again is not uncommon in mothers of new babies. I would hesitate before proceeding on the basis that this woman has a mental illness, a conclusion reached after a chat with a counsellor and a look on the Net. If you go looking for personality disorder, you can find it in everyone!

Interesting take on mental illness, but I'm afraid I don't think delusional thinking can be classed as 'fantasy', not unless you accept that any belief (such as the world being round, needing oxygen to live) is a 'fantasy' as well.

Hmm - well, my first thought is what qualifications does your counsellor have that make her able to decide your DIL is "paranoid", without having seen her or heard her side of the story? I would be wary of proceeding to offer you advice on the untested word of a "counsellor" - here in the UK, anyone can set themselves up as a counsellor, regardless of qualifications or experience. I don't believe it is any different in the States. As for the poster who mentioned Andrea Yates - seeing as we have no real evidence to suggest this woman does indeed have paranoid delusions, nor do we know the content of those delusions (if they exist) nor whether they present a risk to her son, your comment is highly inappropriate. It could well be that this woman is suspicious only of the original poster, in which case her decision to draw back from contact is a wise one. It could also equally be true that this so-called paranoia is nothing more than the kind of friction that stems from a long history of interpersonal conflict between the original poster and her DIL. We just do not know nearly enough about this situation to make any sort of judgement nor to offer any sort of advice.