As I am currently on my second week of my Mental Health placement, I have seen a range of interesting patients with suspected split personality disorders and bipolar disorder. To me, it is incredibly fascinating to think about how suboptimal mental health can result in individuals manifesting behaviour that is not characteristic of them. For instance, one of the patients I saw in clinic had Asperger’s and Tourette syndrome, and she visualised seven different personalities in her mind which emerged at random times.
Treating patients with mental health disorders is especially challenging as it encompasses treatment of both mental and physical health symptoms. One of the patients I saw on my Community Placement was a retired army veteran suffering from post-traumatic stress disorder and severe anxiety. Alongside mental health symptoms such as paranoia, low mood and poor concentration, he also complained of palpitations, sweating and poor appetite. His treatment therefore consisted of a combination of cognitive behavioural therapy and a beta-blocker to slow his heart rate.
One of the things I have also realised about Psychiatry as a specialty is how different the history taking structure is. As part of extracting a history from patients, we are required to establish an elaborate social history (which may include childhood events, support networks and hobbies) and pre-morbid personality (i.e. how the patient was different before his or her deterioration in mental health). This not only requires time, but also the establishment of a good rapport with patients so they are comfortably able to confide their symptoms.
I find it thoroughly interesting how mental health disorders can truly transform a patient’s identity and make them act and react in ways that are not necessarily personal to them. Understanding patients with psychiatric illnesses requires a great degree of empathy as they may be unwilling to believe that there is anything wrong with them (possibly due to the absence of physical manifestations of illness or due to delusions) and therefore may not engage with treatment. It is therefore essential to convey to patients the importance of managing their condition and how treatment can benefit them.