Defining mental illness

In the ‘Overview‘ section of this site the handout (linked to the TSM introductory lecture for the ‘Tired all the time’ case) discusses the difficulty of making psychiatric diagnoses. The lecture and handout refer to ICD-10 and DSM-IV but both are being reviewed with the next iterations of both classification systems due out soon. There is an interesting article in Wired magazine that includes an interview with Allen Frances who was lead editor of DSM-IV where he talks of his concerns over DSM-V.

Allen Frances

Allen Frances is worried that the DSM-5 will "take psychiatry off a cliff." | Photo: Susanna Howe; photographed at Café Sabarsky, Neue Galerie, NYC

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Consequences of trauma

Sometimes you’ll come across something worth posting serendipitously and not from a source that you would normally associate with medical resources. Today was one of those days. My usual RSS feed from Singletrack magazine contained their “Midweek Mini Movies” feature. Amongst the various gems were two videos about downhill mountain biker Tom Wheeler

Back in March Tom Wheeler head out for a fairly normal weekend of downhill racing. One crash later, he’d ripped four nerves from his neck, leaving his right arm paralysed and his world a very different place. In this three part series he’s followed from the crash through his tough times trying to to cope with the mental and physical effects of his injury – and his determination to get back onto his bike…

You’ll see that there will be three films in all but only two have been posted at the point of writing this. Part 1 details Tom’s love of biking and how he sustained a brachial plexus injury.

Part 2 is best described in Tom’s own words…

“I did mention in Part 1 that I had experienced serious damage to my brachial plexus… In my case I had torn 4 of the 5 nerves permanently out of my spine leaving my right arm completely paralysed. The one nerve still remaining has been grafted with nerves from my leg and side and may give me some limited movement within my bicep and forearm. I spent close to 2 weeks in hospital with 3 MRI scans which themselves were pretty daunting and then spent 13 hours straight on the operating table.

It was a horrible feeling lying on the floor after the accident trying to work out what had happened, it was a messy situation to be in and I’m just glad I have only lost the use of my arm, I could have lost so much more. The first couple of weeks after leaving hospital were so hard, I went from being a super active guy on the bike 4-5 times a week and in full time work to a guy who couldn’t stay awake for more than a couple of hours and found it extremely difficult to dress himself.

One thing that has taken me by surprise is the nerve pain, I had thought that it couldn’t be too bad if I can’t feel my arm at least it can’t hurt, how wrong could I be. I have a constant tingling pain in my hand and have waves of electric shock and crazy pulsing pains.

Every day is hard but I’m just so glad to be recovering and back in work. I still love mountain biking and don’t plan on stopping any time soon, its actually pretty rad riding one handed!”

When Part 3 is available I’ll post it here.

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Friday video

Only one or two new videos this Friday as I’m busy updating the site with new videos and content. This first is from Vimeo and is  a letter written and narrated by a mother longing for her child. It’s a powerful piece.

“A mother’s love for her child is like nothing else in the world. It knows no law, no pity, it dares all things and crushes down remorselessly all that stands in its path.” Agatha Christie.

The second, again from Vimeo, is a project by Gus Cummins where he strives to share some of the sensations of his temporal lobe seizures, episodes which leave him without language or memory (temporarily dysphasic and amnesic) yet still (partially) cognitive. He constructs choreographic maps of his movement during seizures using medical video. The soundtrack is intended to convey the quasi spiritual feeling typical of his seizures and the distorted receptive language of dysphasia.

Posted in alcohol, organic, substance use, video | Leave a comment

Eating disorder video posted

Whilst the video content isn’t new, having previously been available as a RealMedia file on the old teaching website this has been re-edited, reformatted and some content added before being posted on Vimeo. It sets out the story of ‘Beccy’ who has anorexia nervosa and discusses her symptoms, body image and use of an eating diary with a number of professionals from an eating disorder MDT.

Beccy’s story

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Materials of interest

Friday is the day I usually try and trawl the interweb to try and find resources of interest for teaching or just for interest.

The first item is a short animated film about panic that manages to convey the impact of the experience.

Maybe not as much fun but still of value is a short information film by NHS Westminster talking about the services they provide for people with learning disabilities, in particular around physical and sexual health.

InControl, a national organisation, have produced a video on how people with learning disabilities can take control of their lives.

A couple of items on Radio 4 have been of interest this week. The first, entitled “Kill Factor” examines how soldiers are taught to kill and the psychological effects of becoming a killer. “When soldiers kills someone at close quarters, how does it affect them? This most challenging and traumatic part of a soldier’s job is often wholly overlooked.” Click here to listen (opens a new window). The other looks at  the relationship between conditions during early development and the impact on the health of future generations. “The First 1000 Days: A Legacy for Life” can be streamed (opens a new window) or downloaded (right-click and “Save as”) as a podcast

Finally, although not specifically related to psychiatry “NoBody’s Perfect” is a documentary which shows Niko von Glasows search for eleven people who, like him, were born disabled due to the side effects of the drug thalidomide, and who are prepared to be photographed for a calendar. And photographed naked, allowing those people who would otherwise glance furtively at ‘thalidomiders’ to take a good, long look. In the process Niko discovers a range of fascinating characters who have learned to lead an impressively ‘normal’ life, which incorporates their disability.

With black humour, and paying no heed to political correctness, “NoBody’s Perfect” gives a portrait of twelve extraordinary personalities who react with curiosity, enthusiasm or horror (like Niko himself) to the project.

Posted in anxiety, genetics, learning disability, physical health, sexual health, video | Leave a comment

Reforming education: “ADHD is a fictitious epidemic”

A smartly animated talk by Ken Robinson primarily discussing the need, in his view, to reform education but with a nicely articulated sideswipe at the claim some people make that there is an epidemic of ADHD.

httpvh://www.youtube.com/watch?v=zDZFcDGpL4U

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NHS reforms

The Guardian has been hosting a series of ‘live’ blogs on the NHS reforms and yesterday was the turn of mental health. Participants included Dinesh Bhugra (President of the Royal College of Psychiatrists), Tim Kendall (Joint Director of the National Collaborating Centre for Mental Health), New Statesman columnist Laurie Penny and Guardian journalist John Crace. It’s worth a read.

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New video by SSC student

Each year I offer medical students the opportunity to make a teaching video to illustrate something that they feel would aid the teaching of psychiatry to medical student as part of a Student Selected Component (SSC). This year Matthew Higgins a Stage 4 student put together a video illustrating some features of schizophrenia. It’s been posted on the schizophrenia page and can be seen below with a description by Matt.

Grant’s story: “I just knew…”

The patient’s description of a delusional mood and atmosphere is typical of the prodromal phases of schizophrenia. In the video he describes simply not feeling right and a strong sense that something bad was about to happen, but despite his certainty, he is unable to explain what made him feel this way at that time.

He describes the moment when he first realised the significance of his delusional mood during a brief encounter with a neighbour. He attaches delusional meaning to a normal perception, demonstrating delusional perception. He is convinced as to the significance of this seemingly innocent everyday interaction and his absolute conviction is impervious to the interviewer’s logical reasoning.

Subsequent to this encounter the patient develops delusions of persecution and experiences persecutory 3rd person auditory hallucinations.

Posted in psychopathology, schizophrenia, student generated, video | 1 Comment

The impact of mental illness

Help!We tend to forget about families. In times of crisis it’s necessarily the patient who comes first. We are probably good about thinking of the carers, this quite correctly has been a focus for services for some time, but what about the children. Do we ever really understand and appreciate the impact of mental illness on the children of patients?

This is beginning to change. The Royal College of Psychiatrists has been producing training materials for those involved in treating mental illness focussing on the needs of their children and the “YoungMinds” project has highlighted the impact of stigma not only on those youngsters who are ill but who have parents with mental illenss.

The Guardian has published an article in which the author writes of her own experience and how, many years after the event she was able to talk to her mother about a previously unexplained period when her mother was ill. Not talking to children about a parent’s mental illness usually occurs as a result of the best of intentions but to exclude children can have profound implications for them, laying foundations for subsequent problems.

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PTSD in rescuers

Michael Ferrara in Aspen, October 2010  (Paolo Marchesi)

Michael Ferrara in Aspen, October 2010 (Paolo Marchesi)

We all know of the consequences of experiencing major trauma first hand. PTSD has even become an ‘acceptable’ mental illness albeit with concerns about its subversion and overuse due to litigation. An article in Outside magazine describes the experience of PTSD in a psychologically robust individual experienced in being a ‘first responder’ following many traumatic events. It’s well worth a read.

“Looking back over his nearly 30 years as a highly decorated first responder in Colorado’s Roaring Fork Valley, Michael Ferrara has trouble pinpointing the exact moment when his life began to unravel. His ordeal arrived not all at once but in a long spool of assaults on his soul and psyche. A plausible starting point, though, might be March 29, 2001, and a nightmare that occurred at the airport in Aspen.

One fine warm day this past August, Ferrara and I decided to walk over to the site. His six-year-old mountain-rescue dog, a German shepherd named Lhotse, led the way. Ferrara wore sweats and trail-running shoes. His skin was ruddy from the sun, his graying strawberry-blond hair cropped short. We stopped outside the Aspen airport’s fence, which is designed, among other things, to keep herds of elk off the tarmac. Ferrara squinted through the sun as a Learjet taxied and then shot into the sky.

“I’m OK with this,” he assured me. “I’ve learned to recount without reliving—it’s part of the therapy.”

The weather was snowy and cold on that evening nearly ten years ago. One minute past seven o’clock, a Gulfstream III came in on an instrument approach. Fifteen friends from Los Angeles, most of them in their late twenties, had chartered the jet for a few days of spring skiing to celebrate a buddy’s birthday. Something went wrong on the final descent. The pilot apparently couldn’t see the runway. A wing tip caught the ground, the plane flipped, and the tail segment broke off. Then the plane exploded into flames.

Ferrara, who at the time was both a Pitkin County sheriff’s deputy and an assistant coroner, was among the first to arrive. Over the years, he had worked on a half-dozen small-engine-plane crashes in the mountains around Aspen. In other jobs as a paramedic, ski patroller, high-angle rescuer, and avalanche specialist, he’d often dealt with blood and trauma and heartache. Among scores of incidents, he was first on the scene when the late senator Robert Kennedy’s son Michael Kennedy, 39, fatally struck a tree while skiing in Aspen in 1997. Ferrara was steeped in the stoic culture of the first responder, and instinctively knew how to take charge in chaotic situations. But he wasn’t prepared for this.

In the swirl of the dome lights, through the flickering of a dozen fires, Ferrara drank in the surreal horror of the crash. The first charred and bloodied body he came upon was still buckled to his seat, his cell phone ringing in his pocket. Then, out of the corner of his eye, Ferrara saw something jammed into the elk fence: a hunk of flesh, dripping with serous fluid. Ferrara spent that terrible evening with fellow officers, assembling body parts into plastic bags. It was one of the worst tragedies in Aspen’s recent history. All 18 people, including the crew, were killed. Ferrara got home at four in the morning, smelling like jet fuel. He stripped out of his gore-smeared clothes and left them in the front yard.

As he told me all this, he blinked and blinked, as though waiting for tears that wouldn’t come. “The thing is,” he said, “I drive by here every day. It’s a reminder. A trigger. People jet here all year long to have fun in this playground. Nobody comes to Aspen thinking something like that is going to happen. They look at these beautiful mountains and see paradise. I look at these same mountains—and sometimes I see another side.”

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