Wednesday, August 15, 2012

I heart behavorial health

Posted by Kristen Gardner at Wednesday, August 15, 2012

I continue to gain experience with adolescents as I attend morning reports from the nurses to get the scoop on the kids behavior. Then, we round every morning and speak for about 10minutes with each kid. We ask, how are you doing today, what emotions are you feeling, was there anything hard about yesterday, any concerns you have? Currently, we have a child on the unit with complex, severe tics. For those of you that do not know what tics are, they are semi-voluntary and often repetitive movements which can manifest as physical or vocal movements. They can be described as “suppressible yet irresistible.” Thanks Wikipedia, good to know. Some drugs can induce tics such as stimulants and neuroleptic (antipsychotics). The patient on the unit is always tugging at her shirt (complex tics), flailing her arms and legs, and twisting and turning constantly. Additionally, it is interesting because she is very somatic (e.g. my eye hurts, my tooth is infected, etc.). She is such a sweet heart though! I have included a link to a youtube video of a brave girl I found who recorded herself when her tics were particularly bothersome. This way you can observe what I mean.

Another girl on the unit has this extremely inappropriate voice- very low pitch, rough, old man voice. She speaks in this tone all the time. It is very unusual! She also has a problem remembering people. Add this to her social awkwardness and you get things like staff members being referred to as Mr. Weirdo. I never thought I would be so excited to hear a child call someone Mr. Turtle because at the least the staff member’s name actually starts with a “T.” And lets be honest, it is better than Mr. Weirdo.

One focus of my preceptor for this rotation is to develop my interviewing skills by teaching me how to perform not only a mental status examination but a complete psychological evaluation (mental status exam, history present illness, psychosocial history, past psych history, family history, social history, medication history, medical history, etc). I am really thankful for this opportunity, as one of my goals was to gain this experience coming in to this rotation. It can take about 1-1.5 hrs to conduct such an interview; therefore, it is quite an extensive evaluation. Sometimes, it can be very challenging when patients have a disorganized thought processes (loose associations, tangential thought, circumstantial thought) or they are extremely guarded from paranoia or preoccupied with psychotic symptoms. It is just something you have to work through by gaining experiences and empathy is critical. Even something as simple as, “I am sorry you had to go through that. It must have been very hard for you.”, after a patient describes a past suicidal attempt.

I have had so many great patient experiences on this rotation. Now, all my experiences are not 1:1 interactions with patients. Many of them are simply observing them during research rounds where the psychiatrist interviews the patient in front of the entire clinical and research team (sometimes 40 people depending on the day and service).  This setting also offers it benefits though.  For example, this setting would benefit people who are intimidated at the thought of interacting with a patient that has severe mental illness such as schizophrenia, severe depression, and patients expressing suicidal thoughts and discussion of past attempts at self-harm or suicide. The benefit comes from being allowed to get comfortable with the difficult discussion topics that will arise when speaking with patients. 

Difficult conversations.
#1. A patient with severe depression was asked, “What bothers you the most?” Answer: Described frustration with the fact that they do not care and that they just want to be able to love someone.

#2. A patient with schizophrenia was asked, “What bothers you the most?” Answer:  Described problems with memory and concentrating and how they wanted to be able to read their books again.

#3. A patient describing a past suicide attempt. He started having dark thoughts. He asked his mom to come home because he didn't want to be by himself since he was having those feelings. The mom could not come home because she was out shopping.

These interactions evoke such strong emotions. It makes it difficult for me to comprehend how anyone with experience working with these patients does not feel compelled or motivated to devote their entire life to improving their care. That is how passionate I am about this specialty. These patients are struggling with things that people without the illness take for granted: the ability to read, to think clearly, not be distracted by hallucinations, to love someone, to be happy, to live freely without paranoia that someone is after you….I think you understand my point. Also, you have to respect the resilience of the patients from enduring countless medication trials. I just look up to these patients so much!

I hope each of you will consider this specialty! Until next time!

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