JASKIRAT KAUR
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CONTENTS
Introductioni
About the Organisation
Substance abuse and dependence
Alcohol abuse and dependence
Psychiatric Disorders
Cases
Key Learning
Daily Dairy Report
Review of Literature
References
Introduction
SAMBAL PSYCHIATRIC & DE ADDICTION HOSPITAL AND BEHAVIOUR MANAGEMENT AND RESEARCH CENTRE
Sambal psychiatric and de addiction hospital came into existence in 2000 by the name of “Samadhan”. It was found by the three directors Dr. Shashi Rai (M.D. Psychiatrist), Dr. P.K. Khattri (Clinical Psychologist/senior Counsellor) and Dr. Rajiv Kumar Shrivastava (Social Scientist). It was renamed as “Sambal” in year 2006.
It is a psychiatric hospital that admits patients with psychiatric disorders and patients of alcohol/drug dependence. The cases (of psychiatric disorder) observed were those of paranoid schizophrenia, bipolar disorder, somatoform disorder, severe depression and schizo effective seasonal symptoms.
SCHIZOPHRENIA- It’s a mental disorder characterised by hallucination, delusion, false beliefs, distorted thinking, disoriented functioning, etc. It has various sub types. The case observed was that of paranoid schizophrenia. Paranoid schizophrenics are often paranoid, suspicious and fearful of anything and everything. Symptoms accompanied by hallucinations particularly auditory and perceptual disturbances.
BIPOLAR DISORDER- It can be characterised by periods of elevated mood and depression. Elevated mood is specifically called mania or hypomania. Symptoms are such as abnormal feeling of happiness and excitement or in contrast exteremely irritable, sleep deprivation, sometimes suicidal tendencies as well.
Somatoform disorder- These are characterised by bodily symptoms such as pain, sensations disability, blindness, sexual malfunction in addition to symptoms like frustration and stress.
Severe depression- Mental disorder characterised by pervasive low mood, low self esteem, disinterest and suicidal tendency etc.
Psychiatric patients and patients of substance abuse are provided with proper medications (not mentioned), therapies and counselling sessions by the hospital. They are provided with music therapies, yoga therapies, motivational n family counselling etc. The hospital also focuses on managing the behaviour and adjustment of patients with the environment.
Substance Abuse or Dependence
Substance abuse and dependency are very common in our society and other countries also. Substance abuse defined as a pattern of harmful use of any substance for mood-altering purposes. The use of substances that affect mood and behavior is normal. There are substances that can be abused for their mood-altering effects that are not drugs at all — inhalants and solvents — and there are drugs that can be abused that have no mood-altering or intoxication properties. Substance Dependence include more severe forms of substance use disorders and usually involves a marked physiological need for increasing amounts of substance to achieve the desired effects. Dependence in these disorders means that an individual will show a tolerance for a drug and experienced withdrawal symptoms when the drug is unavailable. Tolerance defined as a need for increased amounts of the substance to achieve intoxication or desired effect, or with diminished effect with continuous use of the same amount of substance. Withdrawal symptoms are physical symptoms like sweating, tremor and so on.
Alcohol Abuse and Dependence
Alcohol abuse and dependence are major problems in our country. Alcohol abuse is associated with over half the deaths and major injuries suffer in automobile accidents each year. Alcohol abuse and dependence in our country cut across in all ages. Alcohol abuse and dependence means that any person engage in drinking alcohol too much or every day. It effects the person’s life in every area like work , in home. Alcohol dependence also known as alcoholism. The person is depend on alcohol physically or mentally. Alcohol abusers are different alcohol dependence, because alcohol abusers are not physically addicted but they failure to understand the problems or risks that harm to themselves and others. They can control and change their drinking patterns.
Psychiatric Disorder
Psychiatric refers to mental illness and mental health problem. Psychiatric disorders may be defined as mental or behavioural pattern that causes impairment, disability or hamper normal physiological and mental functioning and which is not socially or developmentally normative.
Types of Mental Illness
There are many different conditions that are recognized as mental illnesses.
Anxiety disorders
Mood disorders
Psychotic disorders
Neurotic disorders
The cause and consequence of such disorders depends on various factors such as individual’s personality, living and working environment, genetic reasons, etc. These disorders may be transient or chronic in nature depending upon the intensity of the disorder. Some of these disorders can be treated to an extent while the effect of others can be decreased up to a level through medications and therapies.
Some psychiatric disorders are considered to be most serious such as schizophrenia, personality disorders, etc. Such disorders are characterised by various long term symptoms respectively.
Cases
Case No – I
001 is a Patient of Bipolar and facing the problem for last 1and half years. She stayed here from last 25 days. In the second week , she was hyper active, voilent and believed in God sung a bhajan firstly forced by the counsellor then she starts. In the last week she was active but not violent and sung a bhajan continually move her fingers on thumb like to count. She learn singing from her own house. When she come she faced a problem of insomnia.
Case No – II
002 is a patient of chronic paranoid schizophrenia. He had been admitted in Sambal for over 40 days. The counsellor reported that when he was admitted, he had not bathed for days, had not ate for probably over 48 hours, was in shabby outfit and was unwilling to do or say anything. He always say no in every things. Counsellor ask to read a newspaper and daily routine activity he did not take a part. But in the last week he was first time take initiative in the routine activities.
Case No – Iii
She is diagnosed with somatoform disorder. She was admitted in the hospital during the fourth week. During the fourth week when the patient was observed, it was seen that she had swelling and burns all over her body. The counsellor reported that she complained of having severe headache attacks and was first given painkillers, then painkiller injections and then eventually hard drug injections, which caused inflammations on her body. This week she was provided with heavy medication due to which she was asleep most of the time. In the last week, it was observed that the inflammations on the body and the swelling had decreased to an extent. She reported that she had “life threatening” headaches. When she could not bear it, she went to the doctor who prescribed her the injections and after a while she became unable to “manage” without those injections. But then these inflammations started to happen and she was taken to this hospital as “her treatment for her pain had already been happening from this very hospital”. She also reported improvement in her burns and headache after she came to the hospital
Key learning
During the five weeks of internship, observed the cases of bipolar, paranoid schizophrenia, obsessive compulsive disorder, alcohol dependence and capsule dependence. It was observed that most of the cases are alcohol dependence and drug abuse. Most of the patients were come back for the same problem like alcohol dependence and drug abuse mostly. The behaviour patterns of the patients were same characterized such as anxiety, aggression, distorted speech and distorted attention. When the medication was provided to these patients and detoxication was done, they acquired delirium condition for about 5 to 7 days with respect to the level of drug/alcohol dependence. In the case of psychiatric patients, two of the patients were permanent at the hospital. A case of paranoid schizophrenia and a case of severe depression along with schizo effective seasonal symptoms. The behaviour pattern observed in the patient of paranoid schizophrenia was disoriented speech, suspicion, unwillingness to perform any task, disobedience and pattern of saying “no”. The case of bipolar disorder was also observed to be hyper active, participating, creative, mumbled up and speedy speech and noise sensitive at times. He also claimed to be God. Also pattern as pain, stress, frustration and anxiety were seen in the patient of somatoform disorder. The difference in treatment patterns for addicted as well as psychiatry patients were also observed. Example. The addicted patients were given yoga therapy, music therapy and cognitive therapy along with the medication. Whereas psychiatry patients were given heavy medications then gradually motivational counselling and then further therapies. The behaviour pattern of the counsellor during the activity sessions with the patients, was also observed.
Daily Reporting
In the first week, Introduction with the counsellor, the receptionist, kitchen staff, the attendants of the patients. Took a round of the hospital female wards- ground floor -1 general ward with three beds. private wards with two beds each. male wards- first floor 2 general wards. Noted expenses of the patients both IPD and OPD.
It starts with normal routine things which he needed that is related to food or any other thing. Then start with prayer. Some of the patients pray with closed eyes and fold hands. Some of them to see the chart in which prayer was written. Then counsellor gave the newspaper to read it one by one. Mostly patients read the newspaper but one or two patient do not read it. Patient refuse to read it and one is illiterate. Five out of two weeks game are played by the patients and the counsellor. In one week only patients take part in game (word formation in Hindi). It take 3 rounds with time limit. In the other week all were participate in the game including counsellor and including us. The game was word formation with last word in any language in Hindi or English. In three weeks counsellor told a moral story to the patients and in one week the counsellor asked old patients to told a moral story. In the last week , old patients were better from the previous weeks. Some new patients come and some old patients were gone. Old patients that were not active in the last four weeks but the patients were active and take part in daily routine activities like bath, wash clothes. There were noticeable changes in the patients.
Review of Literature
Substance abuse and dependence disorders are common problems in our society (Adelson, 2006)
An estimated 10.3% of adults in the United States develop drug (substance) use disorders on an illicit drug at some point in their lives, with about 7.7% developing a drug abuse disorder and about 2.5% developing a drug dependence disorder (Compton et al., 2005).
About 8% of adult Americans develop alcohol abuse or dependence disorders (Lemonick, 2007).
People with one drug use disorder, such as alcohol dependence disorder, often present with another, such as cocaine dependence disorder (Stinson et al., 2005).
References
Adelson , Warren; Hoving, Thomas; Wyeth, Andrew(2006). Andrew Wyeth: Helga on Paper. New York: Adelson Galleries.
American Psychiatric Association (2012). DSM-5 Development: R Substance Use Disorder
Barker, R. L. (2003). The social work dictionary (5th ed.). Washington, DC: NASW Press.
Compton, W., Thomas, Y., Conway, K & Collvier, J.(2005). Development in the epidemiology of Drug Use and Drug Disorders. American Journal of Psychiatry, 162(8) p 1494-1502.
Kinny, J. (2003). Lessening the grip: A handbook of Alcohol Information (7th ed.) New York, NY: McGraw-Hill.
Lemonick, M.D.(2007). The science of addiction, Time, 42-48.
Stinson, F.S.; Grant, B.; Dawson, D.A.; ET AL. Comorbidity between DSM–IV alcohol and specific drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence 80:105–106, 2005.
