Tag Archives: Community Psychiatric Nurse

Changes

This week has been rather eventful and yet, nothing really did happen. A lot of changes are on the horizon for me, yet nothing has really changed yet.

First, I found out a few weeks ago that next week, my primary day activities staff will be leaving the day center. It is great for her, as she’ll embark on a new and challenging path in her career. For me though, it’s quite hard. Some of my other staff and family have been askign whether I mind at all, since I’ve been struggling at day activities and she was the one who filed the incident report that led to my day activities hours being cut. Yes, I do mind, since despite this, I like this staff a lot.

Then on Thursday, I found out that my CPN is leaving too. It’s also to embark on a new and challenging path in her career, but it’s sad nonetheless. My CPN and I have had quite a few misunderstandings over the ten months so far that we’ve worked together. However, I’ve noticed that I did make progress. It seems odd, since both my husband and my psychiatrist have been commenting on how I didn’t get far on the DBT course yet and it’s apparently my CPN’s fautl. Apparently, she should be limiting my bringing up only indirectly related topics.

I know the nurse practitioner who will be replacing her already from my intake interview last year. It is a slight disadvantage that he’s male, but other than that, I think I could get along with him just fine. However, it’s still a bit stressful that so many people are leaving at the same time. After all, my nurse will also be taken off my case. We’re not yet 100% sure who will be replacing her.

On Friday, I had a meeting with my psychiatrist. We discussed my progress on the DBT course, my medication and I mentioned I’ve been rather depressed lately. I did say it’s been going on for half a year already, so if I can hold it together for that long, it must not be that bad. She ignored this comment and proposed to increase the dose of my citalopram from 20 to 30mg. It’s a bit scary, since I’ve been on 20mg ever since 2010 with no med review whatsoever and I didn’t even know why I’d been prescribed it. IN this sense, I like it that my psychiatrist did ask to see me in a month’s time for an evaluation. I really do hope the med increase will help with mood improvement.

Update on Day Activities

I have not written a diary-style entry in a while, even though I hoped it’d help me write more often. The past few weeks have been rather eventful with things needing to be worked out for my day activities. Not that anything concrete has come out of it yet, but today, I am hopeful that something will.

In early February, we had a “big meeting” to discuss how to proceed now that my day activities hours were cut and I would maybe have to leave this day center. It was decided that we’d involve the Center for Consultation and Expertise (CCE) to help us detail my support needs. In the meantime, my home support hours were doubled as to give my support coordinator some time to help me find a new place.

My CPN took it upon herself to call the CCE. I don’t know how the conversation between her and the CCE person went, but they concluded eventually that my problem was mainly my blindness. I didn’t understand why, since I’d been almost kicked out of day activities for self-injurious behaviors and meltdowns – not your average blind person’s everyday behavior. The whole thing frustrated me to no end, as blindness agencies have consistently said that my main problem is definitely not my blindness and now the CCE was referring me back to them.

When I read my CPN’s notes on the meeting in which she told me about her conversation with the CCE, I got an idea where the misunderstanding had come from. She wrote about my anxiey regarding demands in light of my having to learn new skills. I figured she’d told the CCE person about the recommendation that I get independent living skills training, which is not the CCE’s department. They offer consultations in situations where the client falls through the cracks because of severe problem behavior, after all. Resistance to demands does not necessarily present with severe problem behavior, I suppose.

When I asked my CPN for clarification though last week, I found out that she doesn’t even believe I have severe problem behaviors. I’m not 100% sure either that my behaviors are severe enough for the CCE, but my CPN’s reasoning for dismissing my problem behaviors altogether was rather strange: I wouldn’t be able to be married if I had problem behaviors. She also mentioned that I wouldn’t be able to live independently in that case either, which I understand. Then again, with today’s budget cuts to mental health and long-term care, once living in the community, you’d need to be virtually dead to be admitted back to an institution. Maybe a virtually dead person is the kind of case the CCE usually works on too, and in all fairness, I’m not dead.

I was badly triggered by my CPN’s comments. What mostly triggered me was her saying that I had “escaped” an institution. I hadn’t. I had been kicked out.

Later last week, my support coordinator talked to my CPN about her feeling that we should at least try to get the CCE involved based on my full story. We worked on the application this afternoon, but didn’t finish it yet, as I was getting overwhelmed.

As for finding me a new place for day activities, we currently have two organizations we’re still in contact with. Both are organizations serving primarily intellectually disabled people. Neither has offered me an orientation meeting yet, but at least neither has rejected me yet. Two other organizations did reject me and several others, we are still thinking on contacting but are most likely unsuitable.

N – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, day 14. Today’s letter is N. Another late post, because I slept through the day yesterday so wasn’t able to schedule it. Here goes.

Neuropsychiatry

Neuropsychiatry is the branch of psychiatry specializing in the effects recognized brain diseases have on people’s mental health and behavior. Of course, mental illnesses have a biological component too, but neuropsychiatry is particularly interested in conditions like epilepsy, Parkinson’s Disease and brain injury. Some psychiatric institutions have specialized neuropsychiatric units or outpatient clinics. Mine has both. The inpatient unit is mostly for people with brain injury. In my institution, a neurologist is in charge of directing the care on this unit.

Neurotransmitters

Neurotransmitters are chemicals that the brain cells use to communicate. They commonly have multiple functions, hence the side effects of psychiatric medications affecting neurotransmission. Well-known neurotransmitters are serotonin and dopamine.

Serotonin is thought to play an important role in mood. A deficiency in it can cause mood disorders, such as depression or bipolar disorder. Unfortunately, an excess of serotonin caused by antidepressant use can cause serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome is particularly associated with a type of old-school antidepressants called MAOIs.

Dopamine plays a role in different physical and mental functions. Dopamine is necessary for movement. Parkinson’s Disease is caused by a degeneration in the dopamine-producing cells in the brain. On the other hand, an excess of dopamine is linked to psychotic symptoms. First-generation antipsychotics (such as Haldol) block the brain receptors for dopamine. Like I said however, dopamine is necessary in movement. Hence, peoople on first-generation antipsychotics commonly experience tremors and muscle stiffness similar to Parkinson’s patients. This movement disorder associated with antipsychotic use is called Parkinsonism.

Nicotine

Many people with mental illness smoke. Among people with schizophrenia, as many as 90% do. It is well-known among smokers that cigarette-smoking relieves stress. This coul be psychological dependence though. However, research shows that nicotine actually helps decrease psychotic symptoms specifically. It is not just a matter of psychological dependence on nicotine that causes people with schizophrenia to experience fewer symptoms after smoking. As such, schizophrenics might unknowingly use nicotine as self-medication.

Nurse

Obviously, mental hospitals employ nurses as support staff. Their primary tasks are to observe and facilitate the patients’ day-to-day functioning. Obviously, administering medications is a common task. However, nurses also use psychosocial interventions.

Community psychiatric nurses (CPNs) are employed by outpatient clinics to help support patients in the community. They often do some form of psychosocial counseling and are also often employed as case managers. As such, they do some tasks formerly done by social workers.