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Broadswordbabe
08-05-2010, 12:00 AM
Hi

My central character cared for a mother who had a mental illness (I'm thinking schizophrenia at this point, but I may need to do more research first to see if it's appropriate).

The character, who is in her 20's, starts having some strange experiences and is afraid that she may be showing signs of her mother's illness. Assuming that she is sufficiently disturbed by what is happening to seek help, and that she is both experienced in dealing with her mother's illness and a generally practical, sensible person, would a GP be her first port of call? And can anyone tell me what sort of questions she would be asked, or what sort of tests she would be given, given the family history etc?

Her strange experiences are in fact really happening and involve meeting demons and other creatures who change physically in front of her eyes, and possibly she also experiences the effects of magic, though I'm not sure what those will be yet. I assume the type of experiences she's having will make a difference to the way a doctor responds to her?

I hope this is sufficient detail, please ask if there's anything else I can say that will be helpful. I'm absolutely in outline stage at the moment, though, so I'm not sure of much yet. And I'm aware I'm asking a lot!

shadowwalker
08-05-2010, 12:53 AM
Assuming that she is sufficiently disturbed by what is happening to seek help, and that she is both experienced in dealing with her mother's illness and a generally practical, sensible person, would a GP be her first port of call? And can anyone tell me what sort of questions she would be asked, or what sort of tests she would be given, given the family history etc?


If she hadn't had any experience with MI, she'd probably go to a GP first - but she's been dealing with her mother's, so she should know better. She may not want to go to her mother's doctors, but she would definitely go to a mental health specialist. She would be given a full physical (including blood tests, etc, to rule out an organic cause), give them a family history, typically take at least one written psychological test, and then have several "talk" sessions.

wheelwriter
08-05-2010, 07:35 AM
And can anyone tell me what sort of questions she would be asked, or what sort of tests she would be given, given the family history etc?
I think they would ask her if she is taking any new medications and if she has been experimenting with any recreational drugs. I believe they would ask her about her symptoms - is she is having auditory and visual hallucinations, how do they manifest, how often does it occur, when does it occur, has her sleep been altered, any traumatic events...Also blood test/lab workup.

I think being in your 20's is a common onset age for schizophrenia.

My experience is was with people who were already diagnosed, so I'm not sure.

Chris P
08-05-2010, 07:45 AM
I think a GP would be a good start. If she was referred to a psychiatrist/psychologist, she might be given the MMPI (Minnesota MultiPhasic Inventory), which (when I took it in the 1980s) asked a bunch of questions and ranked your answers to a statistically most likely diagnosis. The pysch would then hone in on the few most possible to make a proper diagnosis.

Oops! You're in London. I'm not sure if England uses the MMPI, but they probably have similar.

Wiskel
08-05-2010, 01:31 PM
She would almost certainly go to her GP first.

The Gp would do a basic screen.
They'd ask questions about symptoms which would include asking about mood, hallucinations, delusions, etc. They'd also ask about biological symptoms like sleep, appetite, concentration and memory. They'd ask about risk and if the person had thought about harming themselves or others.
They'd ask questions to see if it was something other than mental illness. They ask about drugs and alcohol and they'd do a physical screen to make sure this wasn't a confused state related to an infection. They'd probably run some blood tests also.
They would probably refer on to a mental health team.

In a lot of the UK, the first person you meet if you're referred as an emergency is a mental health nurse. They can involve a psychiatrist if they want to. If you're referred to a clinic then you might meet the psychiatrist first.

Things may be different in the US, but there is a great belief on these boards that mental health teams use loads of questionaires to make a diagnosis. That isn't true. Psychologists use lots of questionaires and scales. Sometimes nurses do to. Their training isn't in recognising mental illness. They are often the first line as they're cheaper than psychiatrists, who typically rely on their experience and knowledge. If we use scales, it's usually further down the line and for other reasons. Scales can be useful to demonstrate to a person that their symptoms are getting better if they repeat the same scale after a period of treatment. The government also likes scales to demonstrate treatment effect.....it's all about targets and proving things work. Complete a scale on referral...another on discharge and the government can prove that your treatment either was or wasn't a waste of time.

A psychiatrist uses their session to put together a mental state examination. They assess:

Appearance and behaviour - Is the person looking after themselves? Are they pleasant or defensive? What's their eye contact like? Any unusual behaviour? Any signs of hallucinations like eyes flicking or distractibility?

Speech - Too fast, too slow or ok? Does the tone vary or is it flat? Do they keep changing the topic? Can they stay on track? Any problems with fluency? Any signs of thought disorder like forgetting what they were saying? Any really odd changes of subject?

Mood - What's it like from the patient's point of view and mine? Any patterns? Does it match the situation....are they grinning while talking about losing a relative or sad when talking about winning the lottery? How are they sleeping, eating and concentrating? Have they thought about harming themselves?

Thoughts - Can they think clearly and express themselves well? Any delusions? (abnormal and false beliefs that you can't argue away?) Any paranoia? Any beliefs that might tempt them to harm someone else? Do they think people can read their mind or alter their thoughts?

Perceptions - Any hallucinations?

Insight - Do they recognise they're ill? (if they are) Do they want help?


Around this they also ask about the person's life, job family, etc. They want an idea of when the symptoms started and how frequent they are. How the person is coping with them. They want to know about medical and family history and if they take any medications, and they ask about smoking, alcohol and drug use.

Would be happy to flesh any of this out if it would be helpful.

Craig

Broadswordbabe
08-05-2010, 01:36 PM
That's massively helpful, everyone, thank you. And yes, I'm in the UK, and so is my character, so UK standard procedures are what I'm looking for.

Craig, you're a star - I may need to come back and pick your brains again at some point, in the meantime thank you so much for this.

frimble3
08-06-2010, 10:12 AM
Will she find out about the demons and the magic? If she realises that what's happening to her is real, how will she think about her mother's symptoms? Will she wonder if her mother might have been normal, but bedevilled, like she is? I assume that being her mother's caregiver has affected her in some way.

shaldna
08-06-2010, 08:17 PM
I don't know about other mental illness, but here depression is 'diagnosed' using a multiple choice quiz.

I kid you not.

It has questions like 'in an average week, how often do you feel down?'

The NHS, wonderful, isn't it?

Kenn
08-06-2010, 10:48 PM
Only a psychiatrist can diagnose a serious mental disorder such schizophrenia or other type of psychosis (not a GP). A patient inevitably needs a referral from their GP to speak to one in the UK (even if they are paying privately). This means seeing the family doctor. Visual hallucinations would almost certainly set alarm bells ringing but the GP would still ask about drugs, sleeping habits, stress etc. to rule out alternative causes. It is highly unlikely that he or she would not refer the patient even if he suspects it is not a serious psychiatric disorder. Other questions would be asked (relating to suicidal thoughts, self-esteem, social interaction, etc.) to try and establish a background. Diagnosis would then be made by the psychiatrist based on questions (the only way that you can identify phsychiatric disorders). Craig is probably right in that the patient would not fill out a questionnaire for a serious disorder, but the diagnosis would still be heavily based around questions which might be otherwise on a questionnnaire. Without those, a diagnosis would be somewhat arbitrary. It is highly likely the psychiatrist would arrange a brain scan (MRI or CT) to rule out brain damage, especially if the onset was sudden. Something worth thinking about is that hallucinations are not restricted to sight (i.e. they can affect all of the senses).

shaldna
08-07-2010, 12:22 AM
Actually I have to say that craig is amazing at these questions. He really helped me out a while back on my question abotu mental illness which could be of some use to you.

http://www.absolutewrite.com/forums/showthread.php?t=176673

Wiskel
08-07-2010, 08:31 AM
I have the slight advantage of being a consultant psychiatrist, and the boards are generally more fun than my real paperwork!


Craig

Guardian
08-07-2010, 08:36 AM
Wow, I'm in about the exact scenario of your MC only a bit younger and hopefully I won't get an onset of schizophrenia. My mother is better now, too, but if you want any first-hand experience of what it's like growing up with that crazy mess? Yeah, just send me a PM.

Mr Flibble
08-07-2010, 01:57 PM
And if you want to know what it's like being on the receiving end of those questions, just ask.