[Discussion] Case study and discussion.

[Callypigia]

Here’s an interested case from today:

A 61 year old female, Mrs. M, has a long standing diagnosis of Schizoaffective Disorder. At baseline she hears voices, though they are usually murmurs while she is medication compliant. She is chronically depressed and anhedonic with a blunted affect. Her husband is a 67 year old veteran. She is on disability and he is on a small military pension. They are both hoarders. They are being evicted (their home was condemned due to having no electrical power or running water), and for the last three months her case manager has been trying to find housing for them. They earn too much for low-income housing, but they have terrible credit, and not even local slum lords will rent to them. Their eviction date is 5/18.

She comes into the office today smiling from ear-to-ear. Mrs. M says, “Two days ago my stress became too much. The voices have been getting worse. I was hearing 20 different voices telling me I was worthless and to kill myself.” She continues, “I had made up by mind to go through with it. I tied a belt around a rafter and was starting to put my head in it.” She paused for a moment, “then this voice came out of nowhere. It said, “Everything will be fine.” All the other voices stopped. I felt this intense joy radiating from me. All I could do was cry I was so happy.” She continued to smile, “I went to bed, didn’t tell my husband anything. The next day the voices were still gone. An old family friend we hadn’t talked to in years called me out of nowhere and asked, “Are you looking for a home?” I just said, “Yes; how did you know?” He told me, “I don’t know. I just had an old rental come back on the market and I felt like I needed to ask you before I list it.”

The home was in their price range and they are moving next week. She says she’s still symptom free. Needless to say, staff has different opinions on this case. I’m curious what you think.

 

[Sagebee]

What about the case do you want to know also is this a real person or a fake scenario you guys are discussing?

 

[Cfighter]

Forgive me as I might have missed something (I am awfully tired and am descending towards loopy tired), but from what I took this sounds nothing more than simply a schizophrenic elderly woman with a "known" backstory of hearing voices hearing another voice telling herself to not commit suicide. And then, by pure coincidence (or perhaps even a case of Deja vu) an old family friend asks this woman and her husband if they are looking for a place to rent.

Now, if you're asking for our thoughts in an attempt to gather our opinions on how this to be interpreted—then thats my two-cents. This is a pretty simple, straight forward prompt with a few relatively easy things to explain (kind of). However, if you're asking for our thoughts in an attempt to try and turn this into a religious topic (as this prompt reeks of religious undertones/divine intervention) then I would ask you just stop while you're ahead as those kind of threads almost never are "discussions" but are almost always nothing more than annoyances that clog up the base.

 

[Nobel]

20 different voices? Sounds like a absurd lie to your own mind.

Spoiler

You must be registered for see images

 

[Callypigia]

What about the case do you want to know also is this a real person or a fake scenario you guys are discussing?

It's real. That's why I said this happened today. I don't need to know anything. I'm just curious about your interpretation, but you are welcome to ask me for more details.

Forgive me as I might have missed something (I am awfully tired and am descending towards loopy tired), but from what I took this sounds nothing more than simply a schizophrenic elderly woman with a "known" backstory of hearing voices hearing another voice telling herself to not commit suicide. And then, by pure coincidence (or perhaps even a case of Deja vu) an old family friend asks this woman and her husband if they are looking for a place to rent.

Now, if you're asking for our thoughts in an attempt to gather our opinions on how this to be interpreted—then thats my two-cents. This is a pretty simple, straight forward prompt with a few relatively easy things to explain (kind of). However, if you're asking for our thoughts in an attempt to try and turn this into a religious topic (as this prompt reeks of religious undertones/divine intervention) then I would ask you just stop while you're ahead as those kind of threads almost never are "discussions" but are almost always nothing more than annoyances that clog up the base.

People have the right to post topics in General Discussion of any undertone they wish as long as it follows the forum guidelines. Different cultures view mental illness in different ways, which facilitates discussion. You gave your shallow analysis - which I'll give you the benefit of doubt since you are tired. It actually is not baseline for her long history of symptoms. If you don't probe deeper on issues then you limit your understanding. If you want to come at me with neurological studies (especially regarding activity in the temporal lobe), I'm all ears, because that's what I did with my colleagues. Either way our office found the case very atypical, and we treat thousands of SMI (Serious Mental Illness) people each year.

 

[Sagebee]

It's real. That's why I said this happened today. I don't need to know anything. I'm just curious about your interpretation, but you are welcome to ask me for more details.



People have the right to post topics in General Discussion of any undertone they wish as long as it follows the forum guidelines. Different cultures view mental illness in different ways, which facilitates discussion. You gave your shallow analysis - which I'll give you the benefit of doubt since you are tired. It actually is not baseline for her long history of symptoms. If you don't probe deeper on issues then you limit your understanding. If you want to come at me with neurological studies (especially regarding activity in the temporal lobe), I'm all ears, because that's what I did with my colleagues. Either way our office found the case very atypical, and we treat thousands of SMI (Serious Mental Illness) people each year.

Well I'm happy she didn't go through with it and how things are working out for her. How did your office end up hearing this story.

Whatever was ailing this woman might be gone for the time being but it could come back and needs to know how to deal with it.

I am curious what are the underlying causes of mental illness and what exactly does these medication they are on do for them. I hear in most cases they don't want to be on them because they find themselves docile while on it?

 

[Pumpkin Ninja]

Forgive me as I might have missed something (I am awfully tired and am descending towards loopy tired), but from what I took this sounds nothing more than simply a schizophrenic elderly woman with a "known" backstory of hearing voices hearing another voice telling herself to not commit suicide. And then, by pure coincidence (or perhaps even a case of Deja vu) an old family friend asks this woman and her husband if they are looking for a place to rent.

Now, if you're asking for our thoughts in an attempt to gather our opinions on how this to be interpreted—then thats my two-cents. This is a pretty simple, straight forward prompt with a few relatively easy things to explain (kind of). However, if you're asking for our thoughts in an attempt to try and turn this into a religious topic (as this prompt reeks of religious undertones/divine intervention) then I would ask you just stop while you're ahead as those kind of threads almost never are "discussions" but are almost always nothing more than annoyances that clog up the base.

God bless your soul, my child. He has miracles in store for you if you have faith.

OT: Never lose hope.

 

[Callypigia]

Well I'm happy she didn't go through with it and how things are working out for her. How did your office end up hearing this story.

Whatever was ailing this woman might be gone for the time being but it could come back and needs to know how to deal with it.

I am curious what are the underlying causes of mental illness and what exactly does these medication they are on do for them. I hear in most cases they don't want to be on them because they find themselves docile while on it?

She told me directly. There is a high likelihood that she will have a symptoms relapse. If she doesn't then she needs to be in a medical journal. Historically she's never reported a full remission of symptoms, nor reported supportive, pleasant voices. I thought it was an unusual case study with a happy-ish ending. It just stuck with me.

In terms of Schizophrenia diagnosis, we don't really know what causes it. They've found some genetic links through twin studies. There are also a lot of environmental factors, mostly in fetal development posited. Drug use during pregnancy is also indicated.

In my practice I would say that the common thread I've noticed is severe childhood trauma. Of course environmental/genetic factors are blurred in those situations as well. I've actually wondered if there was a link between schizophrenia and severe PTSD. I had a veteran with no familial history of psychosis. He came back from Afghanistan experiencing such vivid flashbacks to trauma that they were presenting as auditory and visual hallucinations. Pharmacologically speaking, many anti-psychotics with a higher efficacy rate like Invega and Risperidone have antagonist effect at α1 and α2 adrenergic receptors, as well as serotonin and dopamine receptor sites. My mentor who has been practicing psychiatry since the late 1950's has said many times, "we don't really know why they work."

 

[Ryóma]

Isn't this type of thing supposed to be confidential though? ~_~

 

[Erotic L]

The modern world is becoming more and more negligent of spiritual events. Miraculous healing can happen, it's what makes us question some things and how they've possibly happened. It's because reality isn't even a substantial subject that we can say for certain that is what it is. You can't even prove that the people around you a in all certainty who they are and aren't clandestinely robots facading human bodies. That's to say that there's nothing we can use to differentiate real events from paranormal events.

If that woman's case has been closely observed for a very long time and she's suddenly fine after say, a long term as 5 years. There's no reason or whatsoever to deny her case when she was on medication for all that time and it didn't work until recently. The medication could well have just starting working, but an ignorant person will say that the medication took all of that time to only start functioning in her body now while an objective mind would assume the possibility of a phenomonal intervention.

And yeah, this means taking religious views into account and that'll only end up in a pointless querrulous argument, so it's better to not delve into it.

Damn though this has got to be strange even if you're religious. Schizophrenia is rarely cured if at at all.

 

[Erotic L]

Isn't this type of thing supposed to be confidential though? ~_~

Her identity still clandestine brate.

 

[Cohle]

I think 80% of mental illnesses are aspects of our being society doesn't know/teach you how to deal with.

 

[Erotic L]

I think 80% of mental illnesses are aspects of our being society doesn't know/teach you how to deal with.

Never seen you around.

 

[Yubel]

I think it was very uplifting to read this thread. Since we have no idea why the voices disappeared we can't do anything to prevent them from suddently appearing again, I really hope that's not the case however. I'm happy for this woman and I hope in my heart that others with mental illness can find the same relief.

With that said, are there any possible connections you can make from what you know about this woman and the voice she heard? If not, do you have any guess as to what may have prompted this? I'm sure you or the people you work with had similar cases, is there any common denominator when comparing different cases? Age? Time of day? Emotional state? Any specific actions shared among them?

 

[Chikombo]

Don't think she will live happily ever after things come and go but it was nice to hear it.

 

[JENchuuriki]

As I was reading, I really felt pity for the woman and her husband. They're old not to have a decent home. Don't they have any children to at least help them? But I guess this is another topic to discuss. Also, retirement savings is a must. Needless to say, for the young people who work for their future need to save for their retirement and not to waste too much money on unnecessary things.

I believe it's a kind of a miracle. That sometimes science can't explain.
Good thing, she did not end herself and left her husband alone. I hope things will go well for them.

 

[Callypigia]

As I was reading, I really felt pity for the woman and her husband. They're old not to have a decent home. Don't they have any children to at least help them? But I guess this is another topic to discuss. Also, retirement savings is a must. Needless to say, for the young people who work for their future need to save for their retirement and not to waste too much money on unnecessary things.

I believe it's a kind of a miracle. That sometimes science can't explain.
Good thing, she did not end herself and left her husband alone. I hope things will go well for them.

Well, for people who can barely can afford food by the end of the month, I think retirement savings are not an option. There is definitely a social class difference in financial responsibility. Many of my patients would rather spend $400 a month on cigarettes than fix their car. Especially with mental illness; life is so difficult and they feel so hopeless that they actually get excited being awarded $750/mo in disability.

 

[Narushima]

Not too long ago as a medical student I had the privilege of listening to a lecture by a cancer-survivor who talked about his chronic battle with severe depression following a colectomy that has left him severely compromised in quality of life.

Despite admitting to being suicidal the man refused the standard pharmacological therapy for his depression and had become a born-again Christian. He ascribes his remission from chronic and severe depression to Christianity.

I personally do not believe in that sort of thing and, should I become a physician, will only offer the standard evidence-based medical care to my patients, but I have come to accept that we ought to offer them autonomy so long as it does not endanger them. It may be placebo but if it relieves even a little of their suffering, it will not receive disrespect from me.

Spontaneous remission, though rarely of complete extent, from schizophrenia is a well reported occurrence in the medical literature. Nor is religious and miraculous embellishment of remissions by patients a rare occurrence in medical practice as any physician who has practiced long enough will tell you.

Some hours ago a user on the main reddit sub I follow (dedicated to the Stoic philosophy as established by Zeno of Citium and associated with Epictetus, Aurelius and Seneca, not the adjective stoic in the English language) wrote about his struggle with his own mortality:

You must be registered for see links

"I don't want to write a long post, but I had a realization today that I thought might be interesting to others.

I am in my mid-30's, I have a young family, and I am just reaching a place in my career that I am proud of. But in November I was diagnosed with Stage 3 (maybe 4) colorectal cancer. Since then I have had multiple surgeries (including an ileostomy) a full course of radiation, more doses of chemotherapy than I care to count, and the whole spectrum of side effects that you can imagine with this sort of thing (I still have my hair. You don't always lose your hair). Neuropathy, nausea, cold sensitivity, pain all over, you name it.

To make it even more interesting, I recently learned I have dysplastic nevus syndrome (tons of atypical moles) and at least one mole is early-stage melanoma. While it is curable by cutting the thing out, they had to remove a massive chunk of my back to ensure they don't leave anything and risk a recurrence of melanoma. So today I went in for what I thought would be a minutes-long procedure, only to find out it would be a few hours of poking, numbing, cutting, and stitching.

Now with all of this back story, I do not intend to complain. I mention it because, as I was lying on my stomach, trying not to crush the ostomy near my belly button or disrupt the excision procedure with my shaking to stay balanced, I realized that stoicism has saved my mind. I was reflecting on the sad absurdity of my situation and I recognized that I have stayed sane, in large part, due to the stoic perspective I have been cultivating for the last decade. Each moment of suffering is tolerable because my mind is prepared before the suffering has begun. My body survives the repeated punishment because my mind maintains steady control of itself.

That's not to say I don't suffer or have moments of shock and self-pity. It's just that, each step of the way, whether it be planned or a surprise, stoicism has trained me to right the ship of my emotions faster and more effectively than any other philosophy could have. I never could have prepared myself to deal with so much cancer so early in my life, but I almost instinctively recognized the process I would need to go through emotionally to survive, and I was able to do it with more or less grace.

Here's the real takeaway, though: I not only believe that stoicism enables me to stay sane and move forward; I believe it is the only perspective that could have enabled me to stay sane. When I find myself at rock bottom and looking down, I see no alternative to the stoic acceptance that my mind automatically begins seeking. Absolutely anything else would be insanity and emotional misery.

I said I wouldn't go long and I did anyway. I'm just really grateful I discovered this philosophy so many years ago and decided it was worth pursuing. Whatever hope I have for a meaningful future is due to my stoic perspective.

Tl;dr: I've had a cancerous year and I'm still emotionally stable, thanks to stoicism."

Personally if I were to become afflicted with chronic or terminal disease, I do not care for miracles – only the character to face the condition in the manner user jkrac has.

 

[Callypigia]

Not too long ago as a medical student I had the privilege of listening to a lecture by a cancer-survivor who talked about his chronic battle with severe depression following a colectomy that has left him severely compromised in quality of life.

Despite admitting to being suicidal the man refused the standard pharmacological therapy for his depression and had become a born-again Christian. He ascribes his remission from chronic and severe depression to Christianity.

I personally do not believe in that sort of thing and, should I become a physician, will only offer the standard evidence-based medical care to my patients, but I have come to accept that we ought to offer them autonomy so long as it does not endanger them. It may be placebo but if it relieves even a little of their suffering, it will not receive disrespect from me.

Spontaneous remission, though rarely of complete extent, from schizophrenia is a well reported occurrence in the medical literature. Nor is religious and miraculous embellishment of remissions by patients a rare occurrence in medical practice as any physician who has practiced long enough will tell you.

I prescribe whatever works for a client, especially if the therapeutic option can have minimal direct physiological interaction with the patient's body and still be effective. You'll find in most psychiatric clinical trials a surprisingly small variance in efficacy between placebo groups and drug groups. New research is coming out as well that many SSRIs may actually be creating long-term damage to Serotonin receptor sites, turning a single depressive episode into chronic dysthymia or even recurrent major depressive episodes. Long-term effects of antipsychotics I see often are akathisia, Tardive Dyskinesia, gastrointestinal effects, and Parkinsonism. Many of these come from first generation anti-psychotics, but newer medications lack the longitudinal research to conclude different long-term results.

One of the medications we prescribe for anxiety is Buspirone. Its benefit is largely placebo effect, but it is useful for people in recovery who we can't prescribe Benzodiazepine class drugs. Another is Hydroxyzine, which is an antihistamine; basically just Benadryl. Even in non-pharmacological treatment options like psychotherapy, efficacy is tied more to expectation than actual intervention.

I teach mindfulness exercises and meditation in a psychotherapy group, and for those who take it serious, they find positive results in emotional regulation and distress tolerance. I am really not going to argue against anything that yields positive results in mental illness treatment. If there is a god that cures illness, then I won't stand in his way.