clinical practice, week one.

”It is important to just be there for the patient. You are not there to express yourselves, but to allow the patients to express themselves. You will find it surprising how normal psychiatric patients seem to be. However, please remember that these people are sick and there for a reason. Neither are you to view them as performers in a freak show.

Be on your best behaviour, wear clothing that does not appear provoking. Be on time. Don’t feel guitly about sitting around and having nothing to do. On the contrary, this will be a place where time is freely available. However, if you have been paying proper attention to the lectures, you will find that there actually is a lot to do on a psychiatric ward.

The nurses will expect you to participate actively in discussions. Don’t be afraid to express your opinions and ask questions, yet do so wisely, at the right time and the right place.

Keep an open mind.

Set clear limits and boundaries.

Do not reveal any personal information. Even if they seem like harmless questions.

Don’t be afraid… and don’t build any expectations. I expect all of you to do well. Good Luck!”

With these rather weighty words I left the school building Thursday the 17th of April, anticipating the best, worst, frightening, enlightening, eventful and uneventful. To be honest, I had no idea what to truly expect.

On Monday, the 2st I entered the Helsinki university psychiatric centre. It was 7:15, the nurse who was on night shift greeted me and showed me to the office where the smell of freshly brewed coffee invaded my nostrils, causing my empty stomach to convulse with protest.

About one and a half weeks have gone by now, and I am still coming to terms with the fact that I am doing the one clinical placement that I feared right from the start of my studies.

But I’m still alive and kicking!

Stay tuned for more…

The award winning film ‘one flew over the cuckoo’s nest’ does not give a reliable picture of what psychiatric wards are like.

Mental Health Tip: Don’t worry…be happy! dumm de dumm dee dumm…

Cool stuff for Nurses in Finland

Are you a nurse/nursing student in Finland?

Are you a member of the Sairaanhoitajaliitto (nurse’s association)? If so, do you get the the Sairaanhoitajaliitto Magazine every month?

If you answered yes to all of the above questions, and have not yet noticed the great benefits that you have been missing out on, take a second to read about this:

On the back of the magazine, you will find your name, above which is a number. This is your ID number for the association. When you go to the website (click on the banner above or on the link on left sidebar) you can use this number to access the ‘Jäsennetti’ (memeber’s intranet). Through this you can access the Ovid Essential Nursing Collection (through which you can access the full texts of 40 different nursing journals). Another great thing is the Duodecimin terveysportti-palvelut, through which you can access the following services:

• Pharmaca Fennica (the finnish national Formulary for drugs)
• Lääkeopas (The Pharmaca Fennica’s drug directory and articles on drugs etc)
• Hoidon perusteet (fundamentals of nursing)
• Diabetes-tietokanta (here you find everything you could possibly need to know about diabetes and care thereof)
• Lastenneuvolaopas (Nursing of babies and children Directory)
• Potilasohjeet (all the official instructions for patient education)
• Terveystieteiden Sanakirja (The medical terms dictionary, several different languages-very very useful!)
• SPR:n Veripalvelut oppaat (the finnish red cross’s blood services directory)
• Toimenpideluokitukset (Interventions classifications)
• ICD-10 (The WHO International Classification of Diseases)

There is plenty of other stuff to explore there, so if you’d like to find out more, check out the intranet for yourself from the comfort of your home. Normally these services are only available through hospital intranets, schools/universities and libraries. If you have not started your ‘X-files’ collection, which is the little book where you write down all interesting info on diseases and meds, then these services are great way to access all kinds of information. I Myself did not actually notice this great service until my class mate Gema kindly pointed it out. I’m totally into this now. The first thing I did was type ‘dissociation disorders’ in ovid and I found a really interesting article which I am going to use for my next essay (‘Access and manage somatization’;(2003) Maynard, Carolyn K. The Nurse Practitioner).

This is totally a prayer answer to our ‘Googling prohibited’ Dilemma (We are forbidden from using any information in our essays as references obtained through Google).

That’s all for now. Furthermore, I wish you all a happy spring!

Health Tip: Always read the instructions and label (that long piece of paper that is folded up and crammed into the box) of medication, before using. I hope that everyone to takes this advice seriously. Medications are not sweets, and they should always be kept out of reach of children. Even if they’re just Strepsils.

Interesting email

‘The Psychiatry chronicles 3′ – from my lecture sketchbook.

I don’t usually write about the countless emails that people send me (countless…ahem…), but just the other day I got an interesting piece of spam that I deemed worthy to mention here. Don’t worry, Sender will remain anonymous (even though I am sure that anonymity is not an issue here).

I recently posted a quick little post on Psychiatry , which is what we are being educated on at the moment. Soon afterwards, I received an email with huge bold capital letters: Psychiatry is the effective tool to put down and subjugate the people to the rule of big business under the cover-up of false ”medical treatment”. It rambled on about what cruel and inhumane treatment the famous historic Psychiatrists subjected their victims to, how therapies are worsening conditions rather than helping them. The second part of the email was headed with ‘Are we really that ill?’ which was an excerpt from this article, which indeed rambled on about normal people being over diagnosed.

Now I am no warrior for or against the cause of psychiatry. But I definitely know, and even knew before my lectures in mental health, that there is a difference between healthy, and unhealthy behaviour. What I also know is that Every human being on this planet is not without problems!

I can say that I myself need therapy or counseling at some point, and that I also have issues. The difference between perhaps (note the perhaps there) my behaviour and that of an institutionalised patient, is that I know that I have problems and I want to sort them out. Most importantly, I don’t let my problems affect my work or studying. Some people are not able to cope with their problems, and so they get out of hand. This is when they will need help. Drugs and therapies are designed to help people, not subjugate them.

What I have learned as well, is that some people behave abnormally or in a dangerous way because of trauma or physiological changes to the brain. A good example is the post traumatic stress disorder which can result in uncontrolled anxiety, flashbacks, and even aggressive behaviour due to atrophy in some parts of the brain caused by the trauma. Stroke victims have a very high incidence of suffering from depression, which I have witnessed myself whilst working with stroke victims. Another brilliant example would be the effects of drug dependence on mental health. Need I say more?

In two weeks I will be starting my clinical practice at an acute open psychiatric ward. Once I have witnessed more, and become more knowledgeable, I shall write more on this subject. Until then,

Peace (of mind)!
Health tip: If you feel a bit down, or a bit too high, talk to someone. Talking always helps. And if you happen to see someone who might be a bit down or a bit high, lend an ear. You might save that person from a lot of trouble.

‘The psychiatry chronicles 5′- also taken from my lecture sketchbook.

SCN9A- the pain gene

And now, again it is time to look at some interesting medical stuff!

‘Pain solution III’ by swengali  

Can you imagine never ever feeling pain in your entire life? Before you guys start shouting ‘Cool!’ or ‘awesome!’ or even ‘Heretic!’, Read this:

An SCN9A channelopathy causes congenital inability to experience pain

‘The complete inability to sense pain in an otherwise healthy individual is a very rare phenotype. In three consaguineous families from northern pakistan, We mapped the condition as an autosomal-recessive trait to chromosome 2q24.3. This region contains the gene SCN9A, encoding the [alpha]-subunit of the voltage-gated sodium channel, Na 1.7 which is strongly expressed in nociceptive neurons. Sequence analysis of SCN9A in affected individuals revealed three distinct homozygous nonsense mutations (S459X, I767X and W897 X). We show that these mutations can cause loss of function of Na 1.7 by co-expression of wild-type or mutant human Na 1.7 with sodium channel [beta]1 and [beta]2 subunits in HEK293 cells. In cells expressing mutant Na 1.7, the currents were no greater than background. Our data suggest that SCN9A is an essential and non-redundant requirement for nociception (Pain) in humans. These findings should stimulate the search for novel analgesics that selectively target this sodium channel subunit.’ ~ ( Abstract from: Cox, James J. et al 2006. Nature vol 444(7121) )

So basically, aside from all the genetic code language, it means that there are people in existence who do not feel pain at all. The researchers described that they all suffered from burns, broken bones and malformation caused by ‘Reckless behaviour’ or by letting injury go unnoticed. These people do not understand that doing certain things would be dangerous because they have never felt the warning message that pain would have sent to their brains that something is damaged. One boy described was performing street theatre and demonstrated dangerous acts like pushing knives through his arms. He died before he turned 14, jumping from a roof top and hitting his head.

I heard about this weird gene while attending a lecture in post op pain management, and decided to search for SCN9A in Ovid. I got some fairly good results with just that one word, and I printed out three relevant articles (full references at the bottom). The Quoted Abstract is from the article by the pioneers in this subject (I think), and describes the quest for the gene responsible for this phenomenon. They travelled all the way to Pakistan to examine a handful of people that were reported to be deficient of all pain. They found them all to be healthy, normal individuals that really did not feel any pain. Another article was about Developing a new generation of analgesics based of this gene, and then another was about different neurological disorders that might be due to mutations in other similar sodium channels (I could not miss that one).

This is a very interesting discovery and the whole neurology world is up in arms at the possibility of finding ‘a new generation of pain medication’ that would target this specific gene, which has been named the ‘Pain Gene’.

Until then, we just have to make do with grinning and bearing.

Health tip: If it hurts, don’t do it!

_____________________________________________

References:

Sodium channel mutations in epilepsy and other neurological disorders. Meisler, Miriam H.; Kearney, Jennifer A. The American Society for Clinical Investigation, Inc. v 115(8), August 2005, p 2010-1017

An SCN9A channelopathy causes Congenital inability to experience pain. Cox, James J. et al; Nature. v 444(7121), December 2006 p 894-898.

Studies Suggest New Approaches to Pain. Friedrich, M. J.; JAMA. v 298(1) july 2007, p 27-28.

Blogroll

The Helsinki Polytechnic Nurse’s College (Stadia) can also become a fully functional hospital in times of crisis.

Photo courtesy of Gema Fova

Here are some links to some awesome blogs:

A medical student blog is by a guy studying medicine at Harvard. He also makes videos about his study experiences and posts them on youtube. I guess I could say that He is my primary inspiration for starting this blog. Shares a lot of useful information in his posts. I also like his writing style.

It’s a nursing thing Is a nice little blog I discovered somewhere. A student nurse from America writing about her experiences. I think she has graduated by now.

The secret wave 101 is by a doctor in America some where.I discovered on the WordPress front page one day, and I just instantly fell in love with this blog (the writing style, of course). Check out his ‘Vignettes’, short stories from his residency times.

Fred Fry international you might have noticed his comments on some of my posts. Writes about maritime stuff, politics, and follows news in Finland (Married to a finn is he). I am ever so grateful for his support.

and lastly Fat Doctor is one that I cannot miss. Absolutely hillarious, heart warming, thought provoking, excellent blog about life seen through an Hospitalist fighting with weight and balancing Job, family, life and everything else. Someone I really look up to.

Psychiatry

In the middle of psychiatry courses now. Lots of fun.

Have been very inspired during lectures:

‘Whether the egg or the chicken came first depends on whether you side with Pavlov (behaviourist) or Piaget (cognitivist)’- DOA

More can be seen at my little gallery younglass

I have to start cleaning up the posts on this blog…some of them are way too long and can be broken up in separate posts. I wonder how to keep chronological order though? anyway, I am on a psychoanalytic spree at the moment. Sure causing my poor teacher some headaches (as I always do hehehe).

Call me the teacher’s pest! =]

Health tip: You may not look a gift horse in the mouth, but you may look a gifted chicken in the …..

(P.s. ’sanity is statistical’ – 1984, George Orwell)