Inside Psychiatric Ward; Why Relapse?


Postpartum Struggle (Courtesy)

By: Raymond N Mgeni

Worth Noting:

  • Harming others is one of criteria for admission for a mental ill patient. The person will be admitted and given post admission medications including sedation. Sedation is among best ways to calm the mind for a mental ill patient as you consider number of days whereby the person was awake and never slept for days.
  • Following different drugs required for the first day of admission including antipsychotics (drug for mental illness treatment) the patient will start coming to normal by assessing mental status examination which assess mood components, insight, memory, orientation and gives a room for progress of a patient following medication initiation.

There is need to invest and give priority to mental health in our African communities as mental health touches everyone. In 2020 under World Health Organization (WHO) report was about 262 million people around the world suffer from depression. Depression is among few mood disorder that is leading in the list to cause suicides cases across the globe. You can wonder what will be the severity of other mental illness like schizophrenia and bipolar? There is about 300 mental illness from different spectrum. You can see how mental health is going to be a global problem in years to come.

A mental ill patient can experience psychiatric experiences like hearing voices or seeing things where others don’t hear or see at all, can experience sleep disturbances, aggression, and disorganized speech and disorganized behaviors. And sometimes a mental ill patient can harm others and kill due to disturbed mind. Mental illness can affect anyone regardless of age, race, status or sex. This alarms all of us to focus on mental health advocacy and promotion.

Recovery from mental illness hospitalization takes time. When a person experience psychosis there is a chance for relapse later due to number of reasons. Before knowing reasons for relapse. Just imagine you are in a psychiatric ward. In a psychiatric ward consists of male and female ward whereby there are a number of different mental illness cases. In female ward, you can find cases like postpartum psychosis whereby a lactating mother develop psychotic features like disorganization in speech and behaviour, hallucinations, delusions and aggression. But in male ward will be common to see psychosis relating to substances use like alcohol, cannabis, schizophrenia, brief psychotic with stressors and etc.

Harming others is one of the criteria for admission for a mental ill patient. The person will be admitted and given post admission medications including sedation. Sedation is among the best ways to calm the mind for a mental ill patient as you consider number of days whereby the person was awake and never slept for days.

Following different drugs required for the first day of admission including antipsychotics (drug for mental illness treatment) the patient will start coming to normal by assessing mental status examination which assess mood components, insight, memory, orientation and gives a room for progress of a patient following medication initiation.

As the patient stays in the ward, there is progress will be observed and discharging the patient will be a next plan. Following discharge few months later you see the same person is readmitted. Why relapse? Can be a question of priority and concern.

Stoppage of drugs following the patient become full emission of symptoms is a major cause for relapse. Many patients who readmitted was few days or weeks stopped to take medications following feeling they were completely healed. Antipsychotic drugs are helping to remove psychiatric features and help a person to start to experience normality following abnormal presentations in behaviors, speech and thoughts. A mental ill patient is not advised to stop medication alone without directives from a mental health expert. Drugs for mental illness should not be stopped abruptly but with dose reduction up to drug holiday. Drug holiday is a part of mental illness management following assurance of remission of mental ill symptoms on consistent drug taking and drug reduction without any warning signs of relapse of mental illness.

Second reason is lost follow up via psychiatric clinic whereby visiting clinic has a lot of advantages to a patient and relatives in knowing the progress of the patient, opinions on drug reduction, psychoeducation and other integrated therapies like psychology clinic.

Stress can be a trigger for relapse. Stress affect neurochemical composition of chemicals in the brain. Dopamine is among of chemical responsible for pleasure and when a person is in depression, this chemical goes down. This results to less motivation, depressed mood, feeling empty which predispose to suicide. But also stress can predispose a person to take alcohol excessively.

Continuation of alcohol and cannabis or other substances causing psychosis is another path leading to relapse for many cases especially adults. Heavy taking of alcohol impair cognitive functions and expose a person to relapse.

Situations associating with sadness like funerals or burials can irritate someone and relapse occur at instant.

Family support on helping risky groups is needed to prevent relapse. Reminding them about time to take medications, preventing them to repeat bad habits like use of cannabis or taking alcohol and last to be there as a support during tough times for mental ill patients such as loss of their loved ones. We all need to hold hands in helping our communities from the burden of handling mental illness.

Dr. Raymond N Mgeni
+255 676 559 211
raymondpoet@yahoo.com
Psychiatric Department
Mbeya Zonal Referral Hospital

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