It’s All In Your Head
AJN emphasized mental illness in the latest issue (see this post on their blog), so I have been thinking about my own attitudes and observing my coworkers’ attitudes about it. Not uncommonly I hear “it’s suptratentorial,” meaning the patient has psychological issues.
As luck would have it, since I read this material and had the topic in mind, I have had a bizarre succession of patients with various manifestations of mental illness. As an ED nurse, I have a lot of mental health patients anyway, but lately it’s a psychiatry bonanza. I’ve specifically looked at how these conditions affect patients’ physical health, and the AJN article is absolutely correct: depression, stress, and anxiety are a legitimate and often overlooked contributor to physical illness.
What does “just anxiety” really mean, for example? Does that mean anxiety is not a real health condition or that it doesn’t deserve serious treatment? Tell that to the 20-something patient I had years ago in the CCU who was developing heart failure from chronic PTSD. Yes. His heart beat so quickly that his left ventricle enlarged in an effort to keep his body perfused. CHF is, I believe, a legitimate health concern. “Just anxiety” differentiates an acute emergency (e.g., an actual right-now myocardial infarction) from an ongoing health issue (e.g., tachycardia and shortness of breath treatable with simple medications and/or therapy), but it does nothing to give appropriate attention to the risk factor at hand. Would we say “it’s just a thrombus” to someone who had a TIA? No. We take that seriously because it is an indication that other bad things may be on the horizon. Why are depression, anxiety, and, for that matter, addiction treated any differently?
I wonder if nurses simply like stuff we can fix quickly or easily and therefore dislike stuff that we aren’t quite sure what to do about. If you have high blood pressure, I know I can bring that down in a few minutes. If your heart rate is too high, I can slow that down right quick. If you are in pain, I can soothe that. But if you are depressed and hopeless, I’ve got basically nothing to offer you other than a sympathetic ear, and even that is neither quick nor a fix. I can stop a panic attack with ordered medications, but that is very temporary.
There is also no hard-and-fast physiologically evident connection between psychiatric issues and the body. If you have COPD, I can wax eloquent on the physiology of the changes in your lungs. If you have diabetes, I can tell you all about your body’s dysregulation of insulin and blood sugar. But if you are schizophrenic, all I have is vague statements like, “they think it may be genetic and has to do with dopamine.”
Perhaps nurses need to step back and evaluate our attitudes about mental illnesses to see whether we can improve patient care. Even if the patient’s visit is not specifically for a mental illness, the mental condition may very well affect his or her physical health and treatment. Psychiatric medications may affect medications we are giving for a physical emergency, or they may affect the patient’s perception of the emergency. They may even precipitate the emergency (e.g., neuroleptic and serotonin syndrome).
What do you think about mental illness? Be honest. Maybe it’s time to consider it more seriously during patient interactions.
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