Hospital or Healer for mentally ill

[TKI]

Hello all,

after 8 years of suffering we are looking for a cure - could be a hospital or a healer - for the mentally ill sister Wandee (27yrs) of my wife.

We regularly - every month - attend appointments at the local rural hospital. But the medication could not cure the sickness only soothen the symptoms by tranquilizers and sedatives.

The story:

Wandee, 19yrs, married since one year, common son with her husband (1/2 yrs), husband dies in an accident during work, high voltage (worked for PEA), Wandee is griefing, very sad, but not sick yet, starts to work at a restaurant to sustain the family, a male customer stalks her, she drinks the coke he brings to her house, in the same night she gets a nervous attack, has very strong headache, starts to scream, gets insane, rips off her clothes, runs naked through the streets. Ever since then she lost her mind. This is eight years now. Symptoms are: apathy, lack of interest, aggressive attacks, panic attacks.

We tried two different hospitals. But both of them are not specialized. Can only prescribe sedatives.

We are looking for a cure. It could be a hospital. Or a healer, if she/he is trustworthy and successful.

Thanks for your attention.

Any help will be appreciated.

[Sheryl]

Where in Thailand do you live? There are specialized government psychiatric hospitals here. Which one to go to depends on which region you live in.

[TKI]

Hello Sheryl, thank you. We live in Thong Pha Phum, Kanchanaburi Province. Do you know a suitable government psychiatric hospital in our region?

[Sheryl]

For Kanchanaburi I think it would be Srithanya Hospital in Nonthaburi http://www.srithanya.go.th/

Or might be the Galaya Rajanakarindra Institute in Buddhamonthon https://www.facebook.com/pages/Galya-Rajanagarindra-Institute-Department-of-Mental-Health/129519873767074

If she gets a letter of referral from her local hospital she can be treated for free there, so ask for this. They should have referred her a long time ago, but perhaps they were not aware of how severe she was or that she wasn't responding well to their treatment - Thai patients tend to tell doctors what they think they want to hear and to be unassertive with them.

Be forewarned however that is she has either a pyschosis or a serious mood disorder (as seems likely), there is no "cure" in the sense of treatment that will completely eradicate the problem such that she no longer needs any treatment. She will likely have to be on medication for life, and the medications will at best control the symptoms such that she can lead a pretty normal life, but not eradicate the underlying disorder, there is nothing that can do that (though it often decreases in severity as the patient ages - albeit with severe flare ups for women around the time of menopause).

However, there is a good chance of getting a clearer diagnosis and better medication regimen at a dedicated pysch hospital.

It will be important for family members to accompany her and be proactive in describing her symptoms and response to any new medications. They also need to be politely but firmly assertive with the local hospital in asking for a referral letter.

[Sheryl]

P.S. As with any government hospitals -- and especially specialized ones -- long waits and crowded conditions are the norm. Some of these hospitals have after hour clinics, a quasi-private arrangement whereby the senior doctors can be seen by appointment. This will not be covered under the "30 baht" scheme but costs are pretty reasonable and it can be worth it to have more time spent by the doctor and to go straight to a senior doc as care will others be largely by residents in training under their supervision. It is possible that medications will still be covered under the free system though, I am not clear on that point.

[Morakot]

Many temples also provide basic care for people in need.

This might be useful if the person suffers from moderate anxiety problems, where a type of "talking therapy" or counselling might help with the immediate problems .

[andrew55]

Dear TKI,

You are fortunate that Sheryl has given you so much good advice. Many hospitals in Thailand dealing with mental illness are dodgy. They need to be recommended to you.

The best diagnosis available is vital.

There will be a drug that has the most positive effects traded against side effects. Hopefully the symptoms may become less acute.

Once the best medication is found then causes of the illness can be considered and longer term treatment worked out.

Good luck and bless you for doing something.

[johnatong]

OP

Are you sure this behaviour is not induced by the use of illegal drugs ? (Stuff like "yabba", "crystal meth" etc)

[Morakot]

Once the best medication is found then causes of the illness can be considered and longer term treatment worked out.

Medication is not necessarily alway the answer. Apart from acute phases where the person presents a danger to herself and others, the quality of life tends not to improve greatly for people who are merely given medication.

There might be range of underlying causes, such as substance misuse as John points out, or bereavement problems, or what not. Many mental ill-health problems often appear together (for example substance abuse and depression) and often require complex intervention that can only be provided in a regional hospital. But we also know that people who are treated/ hospitalized far away from their normal environment tend to less well in comparison to those who are treated locally.

Travelling from Kanchanaburi to Nonthaburi by car for a treatment appointment will include a min. 4 hours return journey; this will not possible by public transport in one day as a return trip, especially with someone in an advanced stage of deterioration. Without access to private transport this would require accommodation or hospitalization which may not be a viable option for the person or her family.

[andrew55]

OP

Are you sure this behaviour is not induced by the use of illegal drugs ? (Stuff like "yabba", "crystal meth" etc)

Fair question johnatong but the OP seems pretty in touch with the situation and has stated the history. It's not always drug induced.

[johnatong]

OP

Are you sure this behaviour is not induced by the use of illegal drugs ? (Stuff like "yabba", "crystal meth" etc)

Fair question johnatong but the OP seems pretty in touch with the situation and has stated the history. It's not always drug induced.

With respect the OP says " Symptoms are: apathy, lack of interest, aggressive attacks, panic attacks."

In that context my question was very relevant.

[Sheryl]

It sounds to me like it may be an actual psychosis. Which is consistent with the age of onset. But of course needs proper psychiatric evaluation to determine. If so then counseling etc would not be appropriate. Psychosis is quite different from depression, anxiety disorders and other neuroses which do respond well to skilled counselling, CBT etc.

There is no avoiding the need for medication if is is a psychosis or bipolar disorder.

[andrew55]

OP

Are you sure this behaviour is not induced by the use of illegal drugs ? (Stuff like "yabba", "crystal meth" etc)

Fair question johnatong but the OP seems pretty in touch with the situation and has stated the history. It's not always drug induced.

With respect the OP says " Symptoms are: apathy, lack of interest, aggressive attacks, panic attacks."

In that context my question was very relevant.

Accepted.

[Morakot]

[...] psychosis [...] If so then counseling etc would not be appropriate.

Sheryl, there seems to be some confusion here with regard to psychosis and CBT. Please review current guidance.

In the United Kingdom, the National Institute for Clinical Excellence included cognitive behavior therapy (CBTp) in its preferred list of treatments for schizophrenia [1]. This therapy has also been considered in the Schizophrenia Patient Outcome Report Team guidance in the United States and has been recommended. [2] Reviews of studies of CBTp have suggested that they are useful for the treatment of schizophrenia. [3,4,5,6,7,8,9,10,11,12,13]

Please let me know if you need some further information or access to the literature for private study purpose.

References

1. NICE. Schizophrenia: Core interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. 2003. Available at: http:\\www.nice.org.uk. Accessed October 19, 2007.

2. Lehman AF, Kreyenbuhl J, Buchanan R, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull 2004;30:193-217.

3. Cormac I, Jones C, Campbell C, Silveira da Mota Neto J . Cochrane Library.(Issue 1) Oxford, UK: Update Software; 2003. Cognitive behaviour therapy for schizophrenia (Cochrane Review).

4. Pilling S, Bebbington P, Kuipers E, Garety P, Orbach G, Morgan C . Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 2002;32:763-782.

5. Thornicroft G, Susser E Evidence-based psychotherapeutic interventions in the community care of schizophrenia. Br J Psychiatry 2001;178:2-4. FREE Full Text 15. NHS Centre for Reviews and Dissemination Psychosocial interventions for schizophrenia. Eff Health Care. 2000;6:1-8.

6. Dickerson FB Cognitive behavioral psychotherapy for schizophrenia: a review of recent empirical studies. Schizophr Res 2000;43:71-90.

7. Dickerson FB. Update on cognitive behavioural psychotherapy for schizophrenia: review of recent studies. J Cogn Psychother 2004;18:189-205.

8. Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2001;189:278-287.

9. Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis. Schizophr Res 2001;48:335-342.

10. Pfammatter M, Junghan U, Brenner H. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull 2006;32:S64-S80.

11. Zimmermann G, Favrod J, Trieu V, Pomini V. The effect of cognitive behavioural treatment on schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005;77:1-9.

12. Sensky T. The effectiveness of cognitive therapy for schizophrenia: what can we learn from the meta-analyses. Psychother Psychosom 2005;74:131-135.

13. Gaudiano BA Is symptomatic improvement in clinical trials of cognitive-behavioral therapy for psychosis clinically significant? J Psychiatr Pract 2006;12:11-23.

[johnatong]

[...] psychosis [...] If so then counseling etc would not be appropriate.

Sheryl, there seems to be some confusion here with regard to psychosis and CBT. Please review current guidance.

In the United Kingdom, the National Institute for Clinical Excellence included cognitive behavior therapy (CBTp) in its preferred list of treatments for schizophrenia [1]. This therapy has also been considered in the Schizophrenia Patient Outcome Report Team guidance in the United States and has been recommended. [2] Reviews of studies of CBTp have suggested that they are useful for the treatment of schizophrenia. [3,4,5,6,7,8,9,10,11,12,13]

Please let me know if you need some further information or access to the literature for private study purpose.

References

1. NICE. Schizophrenia: Core interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. 2003. Available at: http:\\www.nice.org.uk. Accessed October 19, 2007.

2. Lehman AF, Kreyenbuhl J, Buchanan R, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull 2004;30:193-217.

3. Cormac I, Jones C, Campbell C, Silveira da Mota Neto J . Cochrane Library.(Issue 1) Oxford, UK: Update Software; 2003. Cognitive behaviour therapy for schizophrenia (Cochrane Review).

4. Pilling S, Bebbington P, Kuipers E, Garety P, Orbach G, Morgan C . Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 2002;32:763-782.

5. Thornicroft G, Susser E Evidence-based psychotherapeutic interventions in the community care of schizophrenia. Br J Psychiatry 2001;178:2-4. FREE Full Text 15. NHS Centre for Reviews and Dissemination Psychosocial interventions for schizophrenia. Eff Health Care. 2000;6:1-8.

6. Dickerson FB Cognitive behavioral psychotherapy for schizophrenia: a review of recent empirical studies. Schizophr Res 2000;43:71-90.

7. Dickerson FB. Update on cognitive behavioural psychotherapy for schizophrenia: review of recent studies. J Cogn Psychother 2004;18:189-205.

8. Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2001;189:278-287.

9. Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis. Schizophr Res 2001;48:335-342.

10. Pfammatter M, Junghan U, Brenner H. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull 2006;32:S64-S80.

11. Zimmermann G, Favrod J, Trieu V, Pomini V. The effect of cognitive behavioural treatment on schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005;77:1-9.

12. Sensky T. The effectiveness of cognitive therapy for schizophrenia: what can we learn from the meta-analyses. Psychother Psychosom 2005;74:131-135.

13. Gaudiano BA Is symptomatic improvement in clinical trials of cognitive-behavioral therapy for psychosis clinically significant? J Psychiatr Pract 2006;12:11-23.

The NICE Guideline is complex and includes this statement

"Early intervention in psychosis services should aim to provide a full range of pharmacological, psychological, social, occupational and educational interventions for people with psychosis, consistent with this guideline"

https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendations#first-episode-psychosis-2

I have not read of any advise which argues that an acute psychosis be treated by CBT alone.

[Morakot]

[...] psychosis [...] If so then counseling etc would not be appropriate.

Sheryl, there seems to be some confusion here with regard to psychosis and CBT. Please review current guidance.

In the United Kingdom, the National Institute for Clinical Excellence included cognitive behavior therapy (CBTp) in its preferred list of treatments for schizophrenia [1]. This therapy has also been considered in the Schizophrenia Patient Outcome Report Team guidance in the United States and has been recommended. [2] Reviews of studies of CBTp have suggested that they are useful for the treatment of schizophrenia. [3,4,5,6,7,8,9,10,11,12,13]

Please let me know if you need some further information or access to the literature for private study purpose.

References

1. NICE. Schizophrenia: Core interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. 2003. Available at: http:\\www.nice.org.uk. Accessed October 19, 2007.

2. Lehman AF, Kreyenbuhl J, Buchanan R, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull 2004;30:193-217.

3. Cormac I, Jones C, Campbell C, Silveira da Mota Neto J . Cochrane Library.(Issue 1) Oxford, UK: Update Software; 2003. Cognitive behaviour therapy for schizophrenia (Cochrane Review).

4. Pilling S, Bebbington P, Kuipers E, Garety P, Orbach G, Morgan C . Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 2002;32:763-782.

5. Thornicroft G, Susser E Evidence-based psychotherapeutic interventions in the community care of schizophrenia. Br J Psychiatry 2001;178:2-4. FREE Full Text 15. NHS Centre for Reviews and Dissemination Psychosocial interventions for schizophrenia. Eff Health Care. 2000;6:1-8.

6. Dickerson FB Cognitive behavioral psychotherapy for schizophrenia: a review of recent empirical studies. Schizophr Res 2000;43:71-90.

7. Dickerson FB. Update on cognitive behavioural psychotherapy for schizophrenia: review of recent studies. J Cogn Psychother 2004;18:189-205.

8. Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2001;189:278-287.

9. Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis. Schizophr Res 2001;48:335-342.

10. Pfammatter M, Junghan U, Brenner H. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophr Bull 2006;32:S64-S80.

11. Zimmermann G, Favrod J, Trieu V, Pomini V. The effect of cognitive behavioural treatment on schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005;77:1-9.

12. Sensky T. The effectiveness of cognitive therapy for schizophrenia: what can we learn from the meta-analyses. Psychother Psychosom 2005;74:131-135.

13. Gaudiano BA Is symptomatic improvement in clinical trials of cognitive-behavioral therapy for psychosis clinically significant? J Psychiatr Pract 2006;12:11-23.

The NICE Guideline is complex and includes this statement

"Early intervention in psychosis services should aim to provide a full range of pharmacological, psychological, social, occupational and educational interventions for people with psychosis, consistent with this guideline"

https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendations#first-episode-psychosis-2

I have not read of any advise which argues that an acute psychosis be treated by CBT alone.

Absolutely correct! That's the whole point, we do not merely rely on medication alone and psychological intervention are not excluded or inappropriate. Thanks!

[Sheryl]

It is impossible to provide CBT to a schizophrenic until they are brought back in touch with reality through medication.

[Morakot]

It is impossible to provide CBT to a schizophrenic until they are brought back in touch with reality through medication.

According to whom? The literature seems to suggest otherwise. Most studies focus both on recent onset patients and those with treatment-refractory symptoms. A randomised controlled trial of cognitive behavioural therapy in early schizophrenia concluded: 'CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.' [1]

Shôn Lewis, Nicholas Tarrier, Gillian Haddock, Richard Bentall, Peter Kinderman, David Kingdon, Ronald Siddle, Richard Drake, Julie Everitt, Karen Leadley, Andy Benn, Katy Grazebrook, Cliff Haley, Shahid Akhtar, Linda Davies, Steve Palmer, Brian Faragher, Graham Dunn

The British Journal of Psychiatry Sep 2002, 181 (43) s91-s97; DOI: 10.1192/bjp.181.43.s91

[TKI]

@johnatong: it is no drug abuse, but we pretty much think we are right in assuming that the coke which was given to her by the stalker 8 yrs ago probably contained some drug. Until then she was perfectly fine. But on the same day she consumed the coke the illness started

@Sheryl and andrew55: Thank you ever so much for all your kind efforts and good advice. I know a lot more now than before - thanks to you - and will make the approach of getting her treated in one of the two hospitals you mentioned. Many thanks and regards, Tobias

[johnatong]

@johnatong: it is no drug abuse, but we pretty much think we are right in assuming that the coke which was given to her by the stalker 8 yrs ago probably contained some drug. Until then she was perfectly fine. But on the same day she consumed the coke the illness started

@Sheryl and andrew55: Thank you ever so much for all your kind efforts and good advice. I know a lot more now than before - thanks to you - and will make the approach of getting her treated in one of the two hospitals you mentioned. Many thanks and regards, Tobias

Whatever you believe !

But get the lady care which will not be obtained from a rural hospital.

The lady needs competent assessment (which will not be obtained from a "healer" ) and appropriate treatment.

I wish you all well on what might prove to be a difficult journey.

[wjcdavies]

Try the local house of prayer...