An artist’s representation of their mental illness

PBobby Bakererformance artist Bobby Baker kept a diary of drawings charting her struggles and eventual recovery from cancer and depression. The Guardian has a slideshow, with voiceover by Bobby Baker herself, showing some of the drawings. It’s well worth a look.

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Delirium: Essential Facts – a slideshow

MBBS Course Director for Mental Health Andrew Teodorczuk has produced a slideshow with voice over covering some of the essential data relating tot he condition delirium. It is available on Vimeo and can be found below:

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Video of a challenging interview

A few years back colleagues at Newcastle General Hospital put together some teaching materials around interview skills. This video shows an interview of a man with depression who, due to his level of irritability, is somewhat difficult to engage with in the interview.

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New video from SSC student

During his SSC to develop a psychiatry teaching video, fourth year medical student John Hayton, chose to look at the topic of deliberate self harm. The result is a video entitled, “I can’t stop thinking about it…” In the film, a role-player and John talk about her recent suicide attempt.

The following is from John.

As medical students undertaking rotations in mental health medicine, on other wards, and in our future careers as doctors we will come across individuals who have recently attempted suicide. As the film describes, despite a recent decline in the suicide rate, it is still the third largest contributor to premature mortality in the UK. So considering how we would approach taking a history from patients following a suicide attempt is an important skill to learn.

It’s useful when talking to patients in a new and unfamiliar situation, to use communication skills that have already been learned. For example; remember to find a private environment to speak to the person, to establish good rapport, and to be gentle in your questioning.

Taking a history of a suicide attempt does not differ from taking a history of presenting complaint in any standard medical history. There are critical questions which are important to ask when establishing suicidal intent:
What did the person do/take, and how? Did they believe that what they did would prove lethal? Did they intend to kill themselves? How long had they thought about it? What preparations had they made? What precautions did they take to prevent themselves being discovered? Had they let anyone know what they were doing? And finally, how did they feel about surviving?

Such questions can be difficult, not just for the patient, but also for the medical student. So it’s important to remember a few key things: don’t offer false reassurance; don’t avoid the word suicide; mentioning suicide does not cause suicide; and don’t be afraid to return to questions later, depending on responses.

Finally, it’s very important to monitor your own feelings and attitudes. Suicide and deliberate self harm are tough emotional problems to deal with. You should not be worried if they bring up strong emotions in you. You can always discuss this with more experienced colleagues.

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DSH – Guest post by SSC student John Hayton

There is increasing interest in psychiatry, or at least it is more visible, amongst the student body with an active student society and many students requesting Student Selected Components (SSC) in psychiatry. This post is by one such student. John Hayton is a Stage 4 student currently carrying out an SSC generating a video for use on this site. Here’s what John has to say.

The orange ribbon of self-harm awareness day

The orange ribbon of self-harm awareness day

The 1st of March is Self-Injury Awareness Day. In response, The Guardian has published a personal account from someone with a history of deliberate self-harm:

Deliberate self harm (or DSH) is a category which covers both self harm with and without suicidal intent. DSH without suicidal intent might include cutting or burning themselves on the arms, legs or abdomen, hitting themselves, self-poisoning or asphyxiation. Some DSH is a suicide attempt which was unsuccessful, some deaths do occur after DSH with no suicidal intent. So its very useful to look at the picture holistically: was there any plan to kill themselves, was there any thought that the action could lead to death. Did they take any actions that would isolate themselves to reduce the chance of discovery before the DSH event?

Motives for DSH include a means of expressing distress, a means of asking for support or escaping from situations which the person feels unedurable.

If we look at this account knowing this: what things can we see there? What can we learn from it?

I am currently working on a video project to teach students how to take a history and risk assess a person with self harm, and this account is so very valuable because it allows us to understand what DSH meant to this person. By understanding the person, we can help them, and others overcome deliberate self harm.

John Hayton

If another students wish to generate material for this site please feel free to send it to me.

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Dopamine and the anticipation of pleasure

American biologist and author Robert Sapolsky.

American biologist and author Robert Sapolsky.

Dr. Robert Sapolsky work as professor of biology and neurology at Stanford University and as a research associate with the Institute of Primate Research at the National Museum of Kenya. Here he talks on the “Science of Pleasure California Academy of Sciences”.

The New York Times in describing his account of his early years as a field biologist said that;

“If you crossed Jane Goodall with a borscht-belt comedian, she might have written a book like A Primate’s Memoir.”

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Epigenetic clue to schizophrenia and bipolar disorder

Same genes, different activity

Same genes, different activity (Image: Image Source/Getty)

There’s an interesting article and an editorial in the New Scientist about epigenetics a subject highlighted in a previous post linked to a Radio 4 broadcast. The New Scientist article  addresses the issue that whilst monozygotic twins share genetic material the risk of developing schizophrenia if your identical twin has it is less that 50%. What the studies reference is new evidence that people with schizophrenia and bipolar disorder have changes in gene activity caused by their environment.

Jonathan Mill at the Institute of Psychiatry, King’s College London, and colleagues scanned the genome of 22 pairs of identical twins – chosen because one twin in each pair was diagnosed with schizophrenia or bipolar disorder.

As expected, the twins had identical DNA. However, they showed significant differences in chemical “epigenetic” markings – changes that do not alter the sequence of DNA but leave chemical marks on genes that dictate how active they are. These changes were on genes that have been linked with bipolar disorder and schizophrenia.

The full article is well worth a read

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At the Royal College of Psychiatrists’ Annual Postgraduate Medical Education Conference last week. The Dean (Robert Howard) was talking about the need for inspiring teaching and recommended that we start by thinking about who inspired us. Looking for some resources I looked for and came across some Oliver Sacks (neurologist and author; probably best known for “The Man Who Mistook His Wife for a Hat”) videos about Gilles de la Tourette syndrome. Due to Rob’s talk the previous week I was reminded how Oliver Sacks had inspired me and in particular my interest in the grey land between psychiatry and neurology. Searching around further I came across the following. It’s Oliver Sacks talking about the visual hallucinations of Charles Bonnett syndrome at the TED conference. Hopefully you’ll be inspired too…

Oliver Sacks: What hallucination reveals about our minds

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The Killing of Kelly Thomas

Usually in trawling the internet one comes across curios or items that are of passing interest and hopefully highlight educational issues. Sometimes, however, what is turned up just makes you plain angry. Stigma as an issue has been highlighted previously and one can be thankful that what is covered in the article below is rare. Nonetheless an aware ness of what can go wrong when agencies of the state confront mentally ill people is important.

Here’s a quote from the LA Times

The Orange County district attorney is set to announce Wednesday whether criminal charges will be filed against six Fullerton police officers involved in a violent confrontation that led to the death of a mentally ill homeless man.

A coroner’s report in the controversial death of Kelly Thomas, 37, was handed over late Tuesday to Dist. Atty. Tony Rackauckas, but the findings have not been made public.

Witnesses have alleged that Thomas, a familiar figure in downtown Fullerton, was repeatedly shocked with a stun gun and beaten until he was unconscious by officers. On a video, Thomas can be heard over the sound of a Taser calling out for his father.

Police have said they were simply trying to subdue Thomas.

Thomas died five days after the July 5 confrontation when he was taken off life support.

The associated video carries a warning advising viewer’s discretion due to the violent images shown. I would add that even without the violent images what is contained is distressing. The first discusses citizen journalism
The second is that from his family

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New mental health legislation resources uploaded

Whilst we had updated our mental health legislation resources not so long ago with the opening of our NUMed campus there’s a clear need to have materials that match the needs of students in Malaysia as well as the UK.

NUMed Staff | May 2011

NUMed Staff | May 2011

To this end a number of new resources have been uploaded. First is a new page and handout considering the impact of culture on mental health and diagnoses. This, whilst reflecting the needs of our Malaysian campus, is equally important int he UK where we have patients from many cultures presenting to services. The other new addition are updates to our handouts on mental capacity and mental health legislation. These cover core principles but with the addition of consideration and contrasting of the situation in England and Wales and Malaysia (note Scottish and Northern Irish legislation are not considered).

Hopefully all these new resources will be of use. As always comments are welcome.

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