Psychiatry (RETROSPECTIVE POST)

Psych (6 Weeks)

Our Psychiatry Rotation was done at the APU (Acute Psych Unit), which was in a separate building from the main Hospital. However our first Week included Lectures at another Hospital from an eminent Psychiatric Consultant. We also got to hear a Speech from a Schizophrenia Advocate about his Experiences with Schizophrenia and the Healthcare System which was a bit touching. I was internally amused that he also had Flat Affect, and I was able to detect the Parallel about how his Condition came to control his Life, and his ways to cope with it. Like ASD, Schizophrenia also comes as a Spectrum, although it’s typically much later onset, however at least they (along with ADHD) have the Convenience of official Medications to control any acute Symptoms. Even with Asperger Syndrome, you don’t stop thinking about it every day. You don’t want to define yourself by your Condition, but it affects the way you process Information and analyze Things that frequently you feel like an Alien or an Amateur Anthropologist on a foreign Planet.

I wonder if De-Institutionalization is the best thing for certain Psych Patients. Understandably there were significant Abuses in the massive Psychiatric Institutions in the past, which I think was also secondary to the Paternalistic Culture of Medicine, however I do see some Merit in that System. Currently, there apparently isn’t enough Funding to get all of the De-Institutionalized Psych Patients to adequately integrate into the Community, which to some Degree poses more harm to both the Patients and possibly the Public.

On a note, the recent and tragic Stabbing of Dr. Michael Wong (Neurosurgeon) at Western Hospital in Melbourne, by a Patient who was supposedly Psychotic and was a poor English-Speaker seemingly demonstrate Gaps in the Welfare of such Patients, who really should’ve been stabilized prior to being released.

Psychiatry was considered a “scary” Rotation by a lot of the Students, so very few from my knowledge went to the APU to clerk Patients, with the exception of supervised Clerking in Tutes by the Psych Registrars. I was warned that a lot of the Psych Patients in the APU were potentially aggressive or manipulative due to comorbid Personality Disorders (predominantly Cluster B), so I had to wear a Security Alarm when speaking to them. I ended up going through a lot of Patient Files to read their Medical Histories and learn how their Psychiatric Conditions have evolved, and how it was managed. I must say I found this very engaging, almost like reading an exciting Novel or Biography.

I did manage to speak to 2 Patients - a Woman with Bipolar Disorder and an Aspie Guy who was around my Age. 

I’m not allowed to disclose the presenting History due to Confidentiality Issues, but it was so fascinating / surreal to see a person display the Textbook Symptoms of a Medical Condition, especially a Psychiatric one. The Woman was still in a Hypomanic Phase, and looked elated and chatty. She stated that she hasn’t had much Sleep or Food to eat (due to low Appetite) recently, and told me a lot about her Personal Life, which whilst I didn’t mind at all due to the Open-ness, was apparently inappropriate to NTs as it was being “Overfamiliar”. She spoke rapidly but I was still able to follow her Train of Thoughts. In some ways it was actually easier for us to engage in Conversation as there were lots of different Topics to talk about. My perception was that it was easy to develop Rapport with her, to the Point where I actually gave her a small Present for her Birthday during her Admission. In Retrospect, I realized this was “Unprofessional” and was told by my Psychiatrist that such behaviour could distort the Professional Relationship, particularly as people in Hypomanic or Manic Phase are vulnerable to being exploited, plus the fact that she was only being “Overfriendly” coz she hasn’t been adequately medicated yet, and that the “Stabilized” her would have a higher Guard on par with most NTs. 

The Woman was fearful of the Aspie Guy coz he was being very noisy, which I presume was making sounds as a Stimming Activity. I found this amusing and sad as Aspies are usually quite “Soft” and “Innocent” if unprovoked (into Meltdowns) and would make very weak Enemies due to their intuitively reduced Theory of Mind and likely Executive Dysfunction to execute any malicious Plans whilst getting away with it very difficult if not impossible. I suppose she doesn’t know about his Diagnosis, and I wasn’t sure if I was allowed to tell her due to breaking Confidentiality, but I told her that he’s also experiencing Discomfort of another sort.

The Aspie Guy was actually a lot harder for me to talk to, which surprised me. I told him that I read his Personal History and was trying to explain that he’s not Alone, and that I have similar Symptoms and Experiences to him but have various Coping Mechanisms, and would be happy to teach him what I knew, but he seemed to be in Denial about his Diagnosis, sadly. It was actually quite frustrating for me at the time trying to reason with him coz I felt like I was looking into a Mirror of myself when I’m extremely grumpy, although I suppose in super-Meltdown mode as a Child, I couldn’t be reasoned with either.

I felt that I let him down coz as an Aspie, I was supposed to be empathetic towards his Experiences, and that I didn’t do “well” enough, in contrast to the Woman with Bipolar Disorder. In Retrospect however, I think he had overlapping Issues of Sleep Deprivation and Agitation over being in a new Environment filled with “Strangers” (other Psych Patients) that wouldn’t be conducive to Mental and Physical Rest. Certainly from my Sleep Problems in the past, I’ve done things that I never would’ve done if I was well-rested, plus I had impaired Cognition. I briefly discussed his Case with his Case Worker who actually agreed that the APU was NOT the appropriate Place for him to be managed, but there was a HUGE shortage of appropriate Facilities for ASD Adults in Strife to be referred to, which is why he was here for now. I hope his situation has improved by now...

It made me wonder how much I could decompensate in the future to the Point of needing a Psychiatric Admission myself... : S 

Introduction to Asperger Syndrome

I created this blog because I wanted to educate people a bit about Asperger Syndrome, and also to let them know about my issues and experiences surrounding it, and how it affects me as a Medical student etc.

Although Asperger Syndrome is becoming an increasingly known condition, with worldwide diagnosis rates increasing significantly since its introduction to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) in 1994, lots of people still haven’t heard of it. Far more people however have heard of the term “Autism”, and when they hear that Asperger Syndrome is a form of Autism, lots of stereotypes and misconceptions pop up in their mind. I’ll try to clarify these confusions by defining Asperger Syndrome more accurately.

Firstly, Asperger Syndrome is a pervasive developmental disorder that lies within the Autistic Spectrum. The Autistic Spectrum is basically a spectrum of conditions that range in severity of certain issues, primarily social impairment, communication difficulties, and stereotypy (repetitive behaviours). Sensory issues are also extremely common among people on the Autistic Spectrum.

ASDs (Autism Spectrum Disorders) are NOT mental illnesses!

Asperger Syndrome is considered to be a high functioning form of Autism in the sense that there is no mental retardation (IQ is 70+), and no noticeable impairment in practical verbal/written language skills. In fact, many Aspies have above average IQs and/or Hyperlexia (superior reading ability). This is different from Classical/Kanner Autism (lower functioning), in which there is a noticeable language skill delay or impairment, and significant prevalence of mental retardation***.

ASDs do NOT automatically equate to mental retardation!

***( In fact, I disagree with the notion that most Classical Autistic people considered mentally retarded are retarded, due to the methodology used to test their IQ, but that’ll be discussed in another post in the future.)

HOWEVER, what people with Asperger Syndrome and others with ASDs do have is social impairment, in the sense that they don’t have the intuitive ability to read non-verbal cues and gauge social situations in real time like NTs (Neurotypicals, ie non-Autistic people). And there are also innate difficulties and/or absence in performing certain non-verbal activities, like eye contact and expressive body language. Also, most people with ASDs communicate and understand things differently to NTs, so many Autistic people have trouble in understanding jokes, sarcasm, and irony, or they interpret it differently, especially in the literal sense.

All this leads to many misunderstandings in communication between people with ASDs and NTs, and either party can be easily be offended or made upset. The people with ASDs are then seen to be “weird”, “arrogant”, “rude” etc by certain NTs because their behaviours are perceived to step outside what was expected by society’s social norms. The person with ASD DIDN’T intend to appear that way to the NT, because they interpreted the situation differently by not recognizing the non-verbal social cues and other contextual features.

Likewise, the NTs’ behaviour can also be irritating, irrational, upsetting or confusing etc to the ASD person who tends to view things in a logical and practical perspective.
It also makes people with ASDs more vulnerable to bullying and abuse by certain NTs who are intolerant of those who are different from them. This is a major problem that ASD people suffer from at school and in the workplace, and makes it harder for ASD people to attain and maintain employment.

ASDs involve communicating and seeing things DIFFERENTLY!
It’s both an impairment AND an ADVANTAGE (to be discussed next time)!

People with ASDs, and especially those with Asperger Syndrome, ARE capable of learning about contextual communication, and understand and produce non-verbal cues towards NTs, but it’s a time consuming, manual process that’s usually learnt intellectually, and not intuitively like NTs.

Stereotypy is also a symptom of those with Asperger Syndrome (and other ASDs). It basically involves certain repetitive physical movements and/or activities. It is also called “Stimming”, and is actually quite soothing and comfortable for the person who does it. It’s meant to be a way to manually stimulate oneself or calm oneself when they are stressed. The typical examples cited in other ASD literature include hand flapping, and rocking back and forth. If you physically force or punish an ASD person to stop stimming, chances are they’ll be quite angry or upset.
Sometimes, we don’t even realize we’re doing it automatically! For me, my stims are walking in circles, pacing back and forth, and twisting my hair. However, when I’m fully engrossed in study or work, or when I’m enjoying myself doing something else like watching TV, then I usually stop stimming because I’m already stimulated doing other things.
Stimming is often viewed to be a bad thing and inappropriate in public by NTs, so many Aspies learn to control their behaviour and only stim when at home, in a private place, or in the company of people who are fine with it.

A narrow range of interests, or special interest, is very common in people with Asperger Syndrome, although not officially part of the DSM-IV criteria. An Aspie can be fascinated with a subject or hobby and learn as much as they can about it through encyclopedias, the internet, CD-ROMs etc, eventually becoming very knowledgeable in the matter. The subject could be trains, cars, teddy bears, quantum physics, Calculus, chess, anything!
It’s one of their joys in life, and is very important for positive self esteem, and they’ll be very happy to talk about their interest if asked about it. It’s much easier for them to make friends who share the same special interest with them.
If their special interest or small range of interests is in a field that has “real world value”, especially in the Scientific field, they can later on turn their special interest into a career and be very successful through their enthusiasm and hard work.

So in conclusion:
1. Asperger Syndrome is an Autism Spectrum Disorder that has no practical cognitive or linguistic impairment.

2. Asperger Syndrome involves an innately “impaired” and different communication style with Neurotypicals, difficulty forming friendships compared to NTs, along with repetitive activities.

3. People with Asperger Syndrome are perfectly capable of making friends and having intimate relationships, providing they work on certain social skills and/or meet the right people.

4. People with Asperger Syndrome are NOT stupid, because Social Skills =/= Intelligence.

5. Special Interests and Sensory Issues are very common among people with Asperger Syndrome.

6. Asperger Syndrome has many disadvantages as well as advantages!