Management

As mentioned above, whilst these patients are often described as hostile—and relationships with neighbours, the general practitioner, and local police have frequently been affected by their psychotic symptoms by the time that psychiatric referral is made—they are often also extremely lonely. Without entering into collusion, it is always worth taking the time to listen to the patient's account of her persecution and it is not difficult to express sympathy for the distress she is experiencing. Sometimes a brief admission to hospital or the establishment of regular community psychiatric nurse visits can be rendered acceptable as an attempt to 'get to the bottom' of whatever is going on. Once a relationship of trust and support has been established, patients will often accept medication and visits from members of the psychiatric team without really ever developing any insight into their condition. Telling the patient directly that she has a mental illness is probably the quickest way to join a list of perceived persecutors, and hence use of the Mental Health Act should be reserved until all else has failed. Even though this may mean that the patient does not receive antipsychotic medication, the provision and maintenance of a relationship of trust with a member of staff who can absorb complaints about, for example the neighbours, will do more to relieve distress than an enforced prescription. Relatives and friends can be advised to encourage the patient to reserve discussion of such complaints to the time that the community psychiatric nurse visits, if this is possible. There is no single strategy that is best for all patients. For most, interventions delivered to their own homes (community psychiatric nurse or volunteer visits, home helps, and meals on wheels) seem to be the most acceptable, and although some will respond well to the activities and company provided by a day hospital or centre, many will decline to attend. These patients are often persistent and able complainers and may have highly restricted and encapsulated delusional systems. Their complaints about neighbours or the home environment are sometimes taken at face value by social services staff. It is therefore not uncommon to discover that, by the time of the first psychiatric referral, a patient has been rehoused at least once in the preceding months. As a general rule, even if it results in a brief reduction in complaints from the sufferer, the provision of new accommodation is followed within a few weeks by a re-emergence of symptoms. The obvious distress this causes is sufficient reason always to advise patients and social workers against such moves unless for non-delusional reasons or following successful treatment of psychosis.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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