tag:blogger.com,1999:blog-44860286486108776502023-09-20T01:20:44.870-07:00The Service User Perspective (SUPER).Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.comBlogger63125tag:blogger.com,1999:blog-4486028648610877650.post-60146785996322212532015-02-03T06:48:00.000-08:002015-02-03T06:48:12.806-08:00HIV prevention advice for people with serious mental illnessThe human immunodeficiency virus (HIV) is a condition in humans in which our immune systems steadily begins to fail and allows life-threatening infections and cancers. People with mental illness have higher than usual rates of HIV than in the general population. Despite this, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. A significant number of people with mental health problems are sexually active and engage in HIV-risk behaviours such as having multiple sexual partners, not using condoms and trading sex for money or drugs. In addition, during relapse, mental illness may lead people to engage in practices they would not usually be engaged in.<br />
<br />
The provision of HIV prevention advice could enhance the physical and social well being of people with mental health problems. HIV health advice can take many forms. Advice is the active provision of information. It has an education component and is delivered in a gentle and non-patronising manner. Advice from a healthcare professional can have a positive impact on behaviour and may motivate people to seek further support and treatment.<br />
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The review's aim was to assess the potential beneficial or harmful effects of HIV prevention advice in people with serious mental illness (SMI). A search for randomised trials comparing HIV prevention advice with standard care for people with SMI was run in January 2012. However, no studies or trials were found. Policy makers, health professionals, researchers and people with mental health problems need to collaborate to produce evidence-based guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV. Better guidance and information about HIV in people with mental illness could be found by conducting well-designed, simple and large studies on this important topic.<br />
<br />
Ben Gray, Senior Peer Researcher, McPin Foundation. http://mcpin.org/ <br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com49tag:blogger.com,1999:blog-4486028648610877650.post-55618712606132360282014-11-03T05:53:00.000-08:002014-11-03T05:53:20.807-08:00Cannabis: A precursor of psychosis.Cannabis is often the precursor of psychosis, especially paranoia. Anecdotally it seems to exacerbate psychotic moods and symptoms. My own view is that it cannot possibly benefit sufferers and it seems risky to prescribe it (if I have correctly understood the summary) at all. I remember Professor Robin Murray saying some years ago that cannabis was implicated in the causation of mental illness. Well, he should know and I don't suppose his views have become obsolete.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com6tag:blogger.com,1999:blog-4486028648610877650.post-56727192546292308742014-11-03T05:47:00.001-08:002014-11-03T05:47:48.403-08:00Acupuncture: Used more widely.Larger scale trials are needed with or without medication, unless the latter option is too risky. I would vouch for the benefits of acupuncture to support well-being and would like to see it used more widely.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com1tag:blogger.com,1999:blog-4486028648610877650.post-25679588237646265492014-10-28T05:27:00.000-07:002014-10-28T07:34:37.178-07:00Cannabis for schizophrenia: the need for people's views.The cannabis summary raised many questions for me as it has, I believe, been indicated that the drug can bring on psychosis rather than treat it. Surely there is some good, well-based research around that can do good to the people who have psychosis, and can suggest steps to improve treatments and care. <br />
<br />
It seems to me that what is missing is the views of parents and partners of patients who can give their take on what the patients are reporting. Only then will the true picture of the situation of people with psychosis be available, as patient views would be ratified - or contradicted - by those involved in their care long-term.<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com2tag:blogger.com,1999:blog-4486028648610877650.post-87012997051370783872014-10-28T05:20:00.000-07:002014-10-28T05:20:14.455-07:00Cannabis and psychosis: A carer's view.There does not seem to be much rigorous research on this subject. I feel the effect of cannabis on the developing brain of teenagers cannot be overstated, articles always allude to "an increased risk of psychosis" but what this means in reality, the devastation of mental health problems and schizophrenia particularly is never explained or demonstrated. <br />
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Our son started experimenting with cannabis when he was fourteen and we feel strongly that this contributed to his developing schizophrenia from about the age of seventeen. It became apparent during his prolonged stay in a psychiatric unit under a section that he was also treatment resistant. Only when he was treated with clozapine which had to be augmented did he begin to stabilise. <br />
<br />
The doctor treating him felt that he, in his practice, was seeing more young men like this and he felt that the brain being bathed in these illicit drugs during adolescence was a contributory factor. <br />
<br />
Our son managed to procure cannabis whilst in hospital under section and was cautioned and fined for this despite at the time not being deemed fit to make decisions. Fortunately he now no longer smokes cannabis but has to take medication and lives in supported accommodation. He is now 23 years old and is just beginning to have a life again.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com8tag:blogger.com,1999:blog-4486028648610877650.post-23529345869254579922014-10-28T05:16:00.000-07:002014-10-28T05:16:22.192-07:00Cannabis for schizophrenia: Unpredictable and disastrous.Cannabis - No! That is something I gave up because one day I started feeling alarmingly weird, dizzy and disorientated. This is complete madness, not just because of the drug and its effects, but because of the disorganised, chaotic lifestyle of drug users. I know a few people who continued using cannabis well into old age. In every case, they are less than they could have been.<br />
<br />
I believe that all mind altering drugs are harmful. The ideal psychiatric system would be Open Dialogue, a non-invasive method with a very minimal use of drugs. ANY mind altering drug is just a short cut, panic measure, which might work for a short time, but with unpredictable and often very disastrous long-term effects.<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-52190999110367371012014-10-28T05:11:00.000-07:002014-10-28T05:11:41.312-07:00Acupuncture: Placebo and 'snake oil'?Concerning acupuncture, I really don't know, I had it once for back pain and it didn't do anything. It may be harmless and could have a placebo effect. A bit of a worry that desperate people might pour money into something akin to 'snake oil'.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com1tag:blogger.com,1999:blog-4486028648610877650.post-6334576854065646992014-10-28T05:06:00.000-07:002014-10-28T05:06:11.620-07:00Acupuncture, culture and fear of needles: A carer's perspective.I have to say that for the Acupuncture summary, whereas in China putting needles into people's skin may be normal, in the UK it is not a cultural norm. My daughter would not tolerate acupuncture, I believe, as she hates injections and blood tests - and most other medical interventions. She would benefit more from the social side of any treatment - the care shown and the attention paid her. The confusion of these factors would have to be dealt with if any really valid research was undertaken into the effectiveness of the treatment.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-21439821866320213962014-10-28T05:02:00.000-07:002014-10-28T05:02:33.053-07:00Acupuncture for schizophrenia: A service user's viewI have experienced the effectiveness of acupuncture for physical pain (lower neck has had some pretty strong peer-reviewed evidence of effectiveness, I believe). I don’t know about mental state other than the many reports I’ve had about acupuncture being successful with stopping tobacco smoking. This has always been auricular acupuncture, though, which is quite specialised.<br />
<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-11545534602918366492014-10-28T04:59:00.000-07:002014-10-28T04:59:08.120-07:00Comment on the latest two summaries.I have no experience of these two summaries (Cannabis for schizophrenia and Acupuncture for schizophrenia), but from the short summaries you sent, I get the impression that they do not work?Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-48820884393846428632014-10-24T03:49:00.000-07:002014-10-24T03:49:23.535-07:00Acupuncture for schizophrenia.Although acupuncture or Traditional Chinese Medicine has been practised for over 2000 years in China and the Far East, especially in Korea and Japan, it is a relatively new form of treament for physical and psychological conditions in the West. Acupuncture inserts needles into the skin to stimulate specific points of the body (acupoints). The aim is to achieve balance and harmony of the body. <br />
<br />
Schizophrenia is a serious mental illness and is usually treated using antipsychotic medication. However, although effective, antipsychotic medication can cause side-effects (such as sleepiness, weight gain and even dribbling). Acupuncture has been shown to have very few negative effects on the individual and could be more socially acceptable and tolerable for people with mental health problems. Acupuncture may also be less expensive than drugs made by pharmaceutical companies, so reducing costs to individuals and health services. <br />
<br />
This reviews looks at the effectiveness of various types of acupuncture as treatment for people with schizophrenia. An update search for studies was carried out in 2012 and found 30 studies that randomised participants who were receiving antipsychotic medication to receive additional acupuncture or standard care. <br />
<br />
Although some of the studies did favour acupuncture when combined with antipsychotics, the information available was small scale and rated to be very low or low quality by the review authors, so not completely provable and valid. Depression was reduced when combining acupuncture with antipsychotic medication, but again this finding came from small-scale research, so cannot be clearly shown to be true. The review concludes that people with mental health problems, policy makers and health professionals need much better evidence in order to establish if there are any potential benefits to acupuncture. <br />
<br />
This means that the question of whether acupuncture is of benefit to people, and whether it is of greater benefit than antipsychotic medication, remains unanswered. There is not enough information to establish that acupuncture is of benefit or harm to people with mental health problems. <br />
<br />
See more at: http://summaries.cochrane.org/CD005475/SCHIZ_acupuncture-for-schizophrenia<br />
and<br />
https://twitter.com/BenGray40Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-48122312265489618442014-10-24T03:44:00.000-07:002014-10-24T03:44:10.847-07:00Cannabis for schizophrenia.Many people with the serious mental illness and schizophrenia smoke cannabis but it is not known why people do so or the effects of smoking cannabis. It is unclear what the best methods are that help people to reduce or stop smoking cannabis. Cannabis is the most consumed illicit drug in the world – amounting to 120 to 224 million users. Cannabis, which is usually smoked or eaten, gives a feeling of well-being, but in high doses it may also cause mental illness or psychosis. Clinical evidence suggests people who have schizophrenia have a worse overall outcome from using cannabis, however, there are some people with schizophrenia who claim that using cannabis helps their symptoms and reduces the side effects of antipsychotic medication. This review aims to look at the effects of cannabis, both its use and withdrawal, in people who have schizophrenia. A search for trials was conducted in 2013, eight randomised trials, involving 530 participants were included. Five trials investigated the effects of using a specific psychotherapy aimed at reducing cannabis intake, two investigated the effects of antipsychotic medication for cannabis reduction and one investigated the use of cannbidiol (a compound found in cannabis) as a treatment for the symptoms of schizophrenia. <br />
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The results of the review are limited as trial sizes were small and data were poorly reported. <br />
<br />
Overall, there is currently no evidence for any intervention, whether it is psychological therapy or medication, being better than standard treatment or each other in reducing or stopping the use of cannabis. More research is needed to explore the benefits of medication or psychological therapy for those with schizophrenia who use cannabis. It is unclear if cannabidiol has an antipsychotic effect.<br />
<br />
See more at: http://summaries.cochrane.org/CD004837/SCHIZ_cannabis-for-schizophrenia<br />
and <br />
https://twitter.com/BenGray40<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com4tag:blogger.com,1999:blog-4486028648610877650.post-67812073780832497212014-09-29T06:08:00.001-07:002014-09-29T06:08:31.352-07:00Experts by ExperienceThe Experts by Experience group was invited to comment and share their lived experiences on two summaries (1. Post natal psychosis and 2. Sedatives for aggression or agitation).<br />
<br />
See what they said below.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-72550342461540631002014-09-29T06:05:00.001-07:002014-09-29T06:05:45.450-07:00Further research is needed on sedativesFurther research on sedatives would be useful and on the side effects. Disagreeable side effects can mean that patients stop their medication, leading to the need for emergency measures.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-81838644933791697932014-09-29T06:02:00.000-07:002014-09-29T06:02:00.818-07:00An expert by experience shares her story about sedatives and use of restraint.RESTRAINTS USE IN MENTAL HEALTH.<br />
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I can only answer this from a carers point of view. I understand that in some cases when a person is so distressed that they are on the verge of harming themselves or someone else, they need to be stopped. At the moment restraint as a last resort may need to be used. But some research should be happening to find a better way. Restraining someone is barbaric. <br />
<br />
When people are already badly distressed and in fear, this method just adds to it. It should only be used as a last resort, and not just because someone has come into hospital under section three of the mental health act in an agitated and distressed state. <br />
<br />
My son was never a threat to other people, only to himself, he was always respectful to the police and doctors even when in the midst of psychosis, and terrified of everyone. Yet when taken in hospital by the police he was restrained and given an injection, and if they had taken time to talk to him I know he would have complied.<br />
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When he really needed help because he was a threat to himself, and already tried by cutting his own throat and told the doctor "he was really scared and didn't want to die", they took no notice. I asked if they could give him something to calm the voices and help him get some sleep, they said not until bed time and they did nothing. <br />
<br />
After I left him he walked out and found a building where he jumped to his death. They didn't restrain him, in fact they didn't do anything, not even keep him safe.<br />
<br />
Restraining someone is not the answer,<br />
<br />
There has to be a better way, where are the crisis action plans? Where are the Recovery Centres? A place both carers and service users can learn about the best way to approach and deal with a crisis before it escalates. <br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-14716642675994985052014-09-29T05:54:00.001-07:002014-09-29T05:54:49.871-07:00Worries about post natal psychosisWith post natal psychosis there is the problem that a mother may well hide the fact that she is unwell, because of fears that the baby may be taken away and she herself locked up.Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-55825055680322502042014-09-29T05:50:00.000-07:002014-09-29T05:50:34.903-07:00An expert by experience shares their view on post natal psychosisI'm afraid (or should that be glad!) that I have no personal experience of post natal psychosis but I am shocked that the review couldn't find any research into the treatments available to mothers and their families in need of intervention, despite recent high profile cases. <br />
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As with so many areas of treatment for mental illness, outcomes are determined by the luck of the draw .... by the chance of being spotted by the right person at the right time. Training midwives and GPs to become that right person must surely be a good start. Giving them the time and knowledge to provide appropriate interventions (drugs, family support and talking therapies) is the obvious follow-up. Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-49610562584078929202014-09-29T05:44:00.000-07:002014-09-29T05:44:51.542-07:00Women's mental health after giving birth: an expert by experience shares her story.About a month after my first child was born I had post natal depression. Didn't know anything about it or reconsider what was happening. I just found it difficult to bond with my daughter, I was able to care for her needs, but I was sad and troubled, very tearful, and had difficulty in cuddling and nursing her, which added to my misery. I felt ill physically as well as mentally.<br />
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I was lucky to have had a good health visitor, who saw I was different from the first couple of times she had visited and took me to my GP where I found support through the coming months.<br />
<br />
When my second child was born I was very aware of the symptoms and sought help as soon as I recognised the signs so did not suffer so badly, the second time. There are such high expectations on a pregnant woman from family friends and medical staff, it is a shock after the birth when all this expected wonderment and fulfilment is not there, then to feel depressed as well is hard enough. <br />
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Psychosis may be rare and only affect a few, but during the pregnancy it's not mentioned, post natal depression can be dismissed if you ask about it, yet forwarded would be better, for the woman and their partners. <br />
<br />
There should be more research, has there ever been any?<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-21978932912894236592014-09-26T08:24:00.002-07:002014-09-26T08:24:55.593-07:00Experts by ExperienceThe experts by experience group has been asked to comment on two summaries.<br />
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The group is comprised of 20 people (service users and carers).<br />
<br />
They have been asked to add their lived experience to summaries on:(1) postnatal psychosis; and (2) sedatives for aggression and agitation.<br />
<br />
These will be posted in the near future. Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-24363137111026953502014-06-27T01:50:00.000-07:002014-06-27T01:50:08.242-07:00A Service User Shares Their ExperiencesI read in the Schizophrenia Commission about them including pharmacists in the treatment of patients, which I think is long overdue.<br />
<br />
We have everybody else in a Ward round- surely the pharmacist should be included!<br />
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My own hospitalisation experience dates back to, initially, 1983 and most recent in 2001.<br />
I think I am a recovered schizophrenic!<br />
<br />
I can really sympathise with the carer who feels her son was nearly killed by Clozapine,<br />
and also with all the side effects of drugs- the dribbling, tardive dyskinesia, etc.<br />
<br />
I get restless feet all the time. I get too much spit in my mouth. I move my jaw, sort of clicking it, an involuntary movement.<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-31583023620332439262014-06-23T04:29:00.001-07:002014-06-23T07:58:04.454-07:00A Carer Speaks Out.I do think, when one is a patient, or by extension, a relative, it is hard to speak out. <br />
<br />
<br />
1. When one is in an angry or disturbed state of mind, one cannot, physically, think straight.<br />
<br />
2. Very often one is not believed.<br />
<br />
3. Going back over things, actually causes MORE pain.<br />
<br />
My son doesn't seem to want to complain, although I feel he has been quite unfairly treated, I guess the above, or something like that, is the reason.<br />
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<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-1993286456406929122014-06-06T06:32:00.001-07:002014-06-06T06:32:58.516-07:00According to an Expert by Experience and Carer: The discussion about transferring research into evidence-based practice is a very valid one, especially with regard to the Schizophrenia Commission and NICE guidelines recommendation that psychological therapies should be offered as a matter of course, alongside pharmaceutical interventions, from the very start of the treatment..... not left until the drugs, with all their acknowledged side effects, have 'stabilised' the poor patient into a state of readiness to 'receive' talking therapy. In our area, the waiting lists for psychological therapies for people with severe and enduring mental illness are running at around 2 years.<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0tag:blogger.com,1999:blog-4486028648610877650.post-58535898152525164512014-06-06T01:28:00.000-07:002014-06-06T01:34:06.329-07:00An Expert by Experience writes about side effects of her son.Dribbling, tardive dyskinesia (which I have witnessed in my son) slurred voice (I was once traumatised by phoning a helpline and somebody had a horribly slurred voice) are in my opinion, appalling. I do not think a drug should be licensed, if it produces these effects.<br />
<br />
Several years ago, my son was forced to take Clozapine, on the orders of a desperate, burnt- out and frankly very incompetent psychiatrist. My son, ended up on a medical ward, on intravenous drip, immobilised, vomiting, vomiting, vomiting, non-stop for a whole week. I was going mental, phoning psychiatrist who tried to fob me off with "it's a virus". I asked if anyone else on the psychiatric ward, where my son was imprisoned at the time had come down with a virus. He said no. As viruses are normally very catching, this alarmed me. I protested, but was completely ignored.<br />
<br />
At the end of the week, thank God, the psychiatric nurses, placed around my son's hospital bed, to stop him escaping (he had run off to France, was okay for three months, ran out of money, come back, readmitted to hospital), alerted the psychiatrist that the vomiting might be due to the Clozapine. Clozapine withdrawn, torture ended temporarily.<br />
<br />
A few years later, I came across an article, some unfortunate had died, obstructed bowel, directly caused by Clozapine. The coroner had ruled, as mental patients, object to taking care of their physical health, the doctors could not be blamed, so my panic had been justified. My son could have died, the psychiatrist could have got away with killing him.<br />
<br />
At a tribunal regarding my son, I voiced my horror at the terrible side-effects, I was completely discounted, ignored, brushed aside as if I was stupid and unreasonable.<br />
<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com5tag:blogger.com,1999:blog-4486028648610877650.post-76669381360896902212014-06-02T06:05:00.000-07:002014-06-02T06:05:28.891-07:00An expert by experience writes about side effects.It is difficult for us to make definitive comment on the efficacy of various forms of medication, we can however offer some observations and experiences:<br />
<br />
1. The side effects of weight gain and dribbling are apparent on a wide scale with many mental health patients. Our son is affected by both. We understand that Clozapine can affect the part of the brain that measures hunger and appetite. The patient then continues to overeat and consequently gain weight. I wonder if there is any evidence of medication affecting an individual’s metabolism? Dribbling is a particularly unfortunate side effect, causing embarrassment and loss of self-esteem. Medication is often prescribed as an antidote but, with relative poor outcomes.<br />
Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com1tag:blogger.com,1999:blog-4486028648610877650.post-7033571476969313892014-06-02T04:37:00.001-07:002014-06-02T06:03:16.052-07:00An expert by experience shares their view about physical and mental health.Physical health care monitoring for people with serious mental illness.<br />
<br />
“People with mental health problems often have complex and long-term difficulties with their physical health such as weight gain, smoking and heart problems. They sometimes do not take care of themselves, have inactive lifestyles and may not be able to cope with daily life or work. People with mental health problems have higher rates of diabetes, lung disease, cancer, heart problems, HIV/Aids and other infectious diseases.”<br />
<br />
Mental Health of a patient can only be viewed at different stages. I prefer to give them a colour spectrum. Green when they are well. Amber when they are moving into a transitional stage towards psychosis or depression. Red when they are in psychosis or deep depression. <br />
Green = Amber = Red<br />
<br />
1. At the Green stage, the patient has a good sense of well being. They are happy. Makes plans for future. Take on projects. Socialise with family and friends. Get involved in social and extra curricular activities. Note: this can only happen to this level if the psychiatric medication is not interfering with the natural progress of their wellness. By this I mean, the side effects of unnaturally lowered metabolism. Side effects of Cognitive functions being inhibited or switched off in some cases depending on dosage. Side effect of intellect being suppressed. Side effect of Perception eroded. And many more. But these are just basic criteria for the patient to be happy and fully compos to be in the Green zone. <br />
<br />
2. At the Amber stage some patients are so well acquainted with their illness, that they will know the change has or is coming over. They may not always be clued enough to seek advice/ help at this stage. Something I have always done. I knew when I hit the Amber. But have waited many times for it to subside which has eventually taken me to Red. This is a mis- calculation. Amber stage should never happen if you are fully recovered. If you hit Amber, the chances are you are really going on to progress into Red stage. And that’s where a small increase in dosage of the medication nips in the bud the progression of illness to Red. <br />
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3. Red stage . It is advisable to be hospitalised at this stage. Only if it is for a brief spell to monitor the diminishing cycle of psychosis or acute depression. <br />
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Therefore given the 3 stages of the cycle of mental wellness/illness, I refer to the paragraph above that people with mental illness cannot cope with daily life or take care of themselves and smoking does become their only source of pleasure. Consequently comfort eating is also a big issue. <br />
<br />
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Ben Grayhttp://www.blogger.com/profile/12038475449372798592noreply@blogger.com0