Wednesday, 6 February 2008


Today I saw a lady with Parkinson's disease, visual hallucinations and confusion. She wasn't delirious, she'd been like this for a goodly while and her GP had excluded causes of an acute confusional state (and kindly sent me all results of relevant investigations). Her husband (and 3 children who visit in turn daily) care for her very well indeed. On looking at things with her I saw her problems as almost all biomedical, arising through Lewy Body dementia and benefiting from medication. Out comes the FP10, she gets a prescription.

Today I saw a lady who was always anxious, always worrying, had done all her life. She's fretting over her grandchildrens' health and over how appropriate it is for them to go on holiday to "for'n parts" now. On looking at things with her I saw her problems as almost psychosocial (and psychological not psychiatric).

Today I saw a lady who's anxious and worried but only when alone. With family or friends all is well. On looking at things with her I saw her problems as almost all social, with loneliness being the paramount issue (which she volunteered and agreed was the case).

Today I saw a gentleman who's anxious and worried much of the time against a background of word finding difficulties and poor recognition. He's not readily consoled by friends or carers (he's in 24 hour care now, in a good EMI Residential Home). History, clinical course, mental state and imaging studies confirm he's got vascular dementia. His mood symptoms are caused by structural damage to his limbic system. On looking at things with him I saw his problems as almost all physical (caused by strokes wiping out the bits of his brain necessary for moods to be normal), with no cure and role for medication at the moment.

There's often talk about different models in mental health.

I think the only credible approach is to have no one model. I flit from one sort of formulation to another, I think we have to if we're striving to be patient centred.

Biological, physical, psychological, social, systemic and environmental factors all affect all of our lives. When mental health is impaired, it's only by looking in different ways with different folk that we can focus on what's best for them, at that time.

1 comment:

Dr Andrew Brown said...


Like Forrest Gump, I've nothing more to say about that. :-)