12. Chăm sóc sức khỏe tâm thần

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Jack: Have you changed the patients 'dressings? That's the first thing on my list.
Paula: No, I haven't done them yet.
Jack: Mrs. Eriksson's blood pressure needs to be taken. Have you done that yet?
Paula: Yes that was the first thing did.
Jack: I What about Mr Sissoko's temperature? Have you taken it?
Paula: Yes, I've done that. It's lower than it was.
Jack: It says here that somebody spilt their orange juice. Have you cleaned the floor?
Paula: That's the next thing on my list, so no. I haven't done that yet.
Jack: And Mrs. Wong needs some tests. Have you taken a urine specimen from her?
Paula: She's having a shower at the moment, so I haven't had a chance yet.

Psychiatrist: ... so let's move on. Next on the list is new patient Delroy Moseki. For those of you who don't know him, he is 51, admitted on Tuesday. Who is Mr. Moseki's nurse therapist?
Nurse therapist: It's me doctor.
Psychiatrist: Paul. Thank you- Can you take over?
Nurse therapist: Yes. Er … Delroy … The notes say that when he was admitted last Tuesday he er … appeared normal in his movements and posture. However, he didn't know where he was and what was happening. He avoids eye contact, and has spoken to none of the other patients, as far as I know. The night staff report that he has some sleepless nights. He shouts out in the night and wakes other patients. I think he has a auditory hallucinations.
Psychiatrist: Yes, that's in the notes. He hears voices. Have you done any tests?
Nurse therapist: Yes, the charge nurse on night shift has tested him. He names objects correctly, but forgets them almost immediately. He gets frustrated easily, and often cries. It's also very hard to understand what he says-
Psychiatrist: Thank you Paul. Now I'd like to ask some questions…
The novelist Andre Malraux suffered from Tourette syndrome, which showed in a nervous facial tic and muscular and vocal activity. He was well-known for his energetic style of public speaking.
Signs and symptoms
Tourette syndrome is a nervous disorder which first appears in childhood. A person with Tourette syndrome has frequent, repetitive motor and vocal tics (repeated movements or sounds that you cannot control).
Vocal tics may consist of repeating somebody else’s words, or sudden outbursts of swear words.
Tourette tics are often worse when a sufferer is tired or under stress. Sufferers can hold back their tics for hours, though this leads to a strong outburst of tics later.
Motor and vocal tics are classified as either ‘simple’ or ‘complex’. Simple tics are sudden, short movements, and complex tics are movements or speech that use more than one set of muscles.
The novelist Virginia Woolf suffered from bipolar disorder. She had her first mental breakdown when she was thirteen, and made several suicide attempts. She killed herself when she was 59 by walking into a river.
Schizophrenia - the facts
Every year 1.5 million people worldwide are diagnosed with schizophrenia. It is a mental illness which has periods called 'psychotic episodes'. During a psychotic episode, a sufferer shows disturbing changes in behaviour. They may seem very cold and unemotional, using few facial expressions, and say strange things in a slow, flat voice. They may lose all interest in life and spend days doing nothing at all, not even washing or eating. These distressing symptoms are shocking for family members who, of course, remember what the sufferer was like before the onset of the illness.
During a psychotic episode there may be hallucinations. Hearing voices that other people do not hear is the most common type of hallucination. The voices give orders and carry on conversations. Sometimes the voices swear and make threats.
Someone with schizophrenia may have delusions, believing for example that they are a famous, historically important person, or that people on television send them special messages.
People with schizophrenia may not think logically. They are isolated because conversation with them is very difficult, so they have no one to communicate with.
It is relatively common for schizophrenia sufferers to commit suicide - 10 per cent of people with schizophrenia (especially younger adult males) kill themselves. Violence and threats against others, on the other hand, are not symptoms of the illness.
There is medication that can reduce the symptoms, but it often has bad side effects, and some sufferers discontinue treatment because of this. Although many sufferers can continue to lead a relatively normal life, it has been estimated that no more than one in five individuals recovers completely, and most will require long-term treatment.
We do not yet know the cause of schizophrenia. Researchers have looked at links with genes, with brain development, with infections before birth, and with traumatic life events.
Juliet Francisco
I’ve just finished my training and I am now a qualified mental health nurse. The course was in two parts, half general nursing and half mental nursing. I’ve studied a lot of theory but the real learning has come from my placements in psychiatric wards.

My first placement was on a ward for elderly people. The patients were all very quiet but I was still terrified when I started. I thought some of the things the patients said and did were really strange.

One day I took a relaxation group. But no one told me that doing relaxation can start a psychotic episode. We were all lying down on the floor – all nicely relaxed. Suddenly a woman in the group started screaming. I was so shocked that I almost screamed too.

Another time I took a patient out for a walk round the town. Suddenly he ran off down the street. What should I do? Run after him? No, I took a chance. I was just standing watching him. He stopped and looked back. I smiled and gave a friendly wave then turned around and walked slowly back towards the hospital. A minute later he joined me. He was laughing. I was quite proud of myself that day.

Mental illness is far more common than cancer, diabetes, heart disease or arthritis. One person in three suffers some sort of mental illness at some time in their lives.