South African Psychiatry - February 2019

PERSPECTIVE
IT WAS CAPTIVATING FOR ME TO
IDENTIFY THE SYMPTOMS OF PSYCHOSIS
AND THOUGHT FORM DISORDER IN
THE PATIENT. HE WAS RESERVED IN THE
BEGINNING OF THE CONVERSATION BUT
AFTER ESTABLISHING A GOOD RAPPORT,
HE OPENED UP MORE.
I wrote up and gave a case presentation for this
patient in the ward round as well. It was great to
have been able to integrate all the information,
come up with differential diagnoses and feedback
on the Mental State Exam of the patient.
I also learnt compassion. Learning people’s stories
and their backgrounds teaches you to become
empathetic. This experience taught me to think and
feel, and to relate to others and to the world in a
genuine and meaningful way. A colleague and I
clerked a patient in the closed women’s ward. It
was extremely sad to hear her story and to touch
on aspects of her life that hurt her the most. She
was alone and hardly any of her family members
would visit, let alone speak to her. Interviewing her
was very tricky as she was on edge nearly the entire
conversation. But after seeing her, I certainly started
looking at other patients differently. Instead of just
seeing a person to interview, I began respecting their
stories more.
Interacting with many patients, I noticed a
correlation between xenophobia and mental illness.
Many patients I saw were from surrounding countries
who came to South Africa to make something of
themselves but ended up institutionalized. A patient
I remember mentioned to me that he could not get
a job for around 6 months because he was from
Malawi and once he did, he was not paid as well
as the other employees and was an outcast among
the employees. Another patient from Lesotho was
found roaming the streets of Braamfontein and
was diagnosed with dementia caused by extreme
trauma. People come to this country with high hopes
but end up sick because of the many stressors they
encounter in this country.
Another important lesson I learnt was professionalism
and self-respect. During a ward round in the closed
ward, a patient screamed at the doctor and accused
her of keeping her in the ward despite trying her
best to get better and of treating her as merely a
case file. The doctor in charge handled the situation
calmly, responding respectfully to all her concerns
and validating her emotions. This interaction was
powerful, and I was amazed at her expertise.
An experience that ‘popped my patella’ was that of
Electroconvulsive Therapy (ECT). ECT, I learnt, is used
to treat patients with treatment-resistant depression
(TRD) 2 and as an adjunct to non-clozapine
antipsychotic medication for treatment resistant
schizophrenia 3 . Inducing therapeutic seizures in
patients to give symptomatic relief of symptoms
seemed unethical to me. Witnessing the process is
heart wrenching. The long-term effects are, however,
promising. This made me realize that some aspects
of psychiatry are hard to digest, but what is important
is the wellbeing of the patient.
A story with a happy ending came from the Lufuno
Neuropsychiatric clinic. I sat in on an outpatient
group therapy session which made me extremely
happy. The patients have mild neuropsychiatric
symptoms but manage to live ordinary lives with the
help of therapy and medication. They share their
victories and failures in group which uplifts them and
inspires others in the group.
In conclusion, my visit to Tara was an incredible one,
with lots of learning involved. I learnt many lessons
which can’t be taught in a lecture room and my
appreciation for psychiatry and its aspects has
quadrupled.
REFERENCES
1. Tromp, B., Dolley, C., Laganparsad, M. & Govender,
S., 2014. SA’s sick state of mental health. Sunday
Times, 8 July, pp. 1,4.
2. Magnezi, R. et al., 2016. Comparison between
neurostimulation techniques repetitive transcranial
magnetic stimulation vs electroconvulsive therapy
for the treatment of resistant depression: patient
preference and cost effectiveness. Dovepress, pp.
1481-1487.
3. Zheng, W., Coa, X.-L. & Ungvari, G. S., 2016.
Electroconvulsive therapy added to Non-
Clozapine Anti-psychotic medication for
Treatment Resistant Schizophrenia: Metaanalysis
of Ramdomized controlled Trials.
PLOS one, Volume 10.
ANTIDEPRESSANTS – ANOTHER PERSPECTIVE
Shall I compare you to a modern plague?
Thou art more insidious and more craved
You calm the rough winds for today
But ultimately make me sign a lease on the
summers I see
Sometimes too devious for the eye of another to
clutch
The storm that simmers inside this form
As every blossoming flower you turn into a crusted
frame
You are changing nature’s way to claim
But thy eternal summer shall not fade
As pharmaceutics hold you in high care
Death brags that you are its new associate
Eternal exhaustion is the only thing that grows
In this garden of despair
Of which the seeds you have sown
Written by Kajal Patel
Kaja Patel undertook an elective at Tara Hospital as a GEMP 2 student - 2018 Correspondence: 862101@students.wits.ac.za
62 * SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019