Tuesday Day 3

Start off with a presentation on depression prior to the visit to the out-patient clinic. Still a problem of starting on time with students arriving between 9 and 9.30. Told at beginning of day that time to go to the out-patient clinic has changed to 10 rather 11 – just have to roll with this and not be too bothered about timetable today having to be rearranged at short notice.

Went to outpatient clinic today and the group I was with saw three cases – a 25 year old man with untreated depression currently on olanzapine. His main complaint was that he was anxious although he also had several depressive symptoms and he was clear that he had been better on amitriptyline in the past so we suggested he change back to this. The second man was an 18 year old who started to be ill 8 years ago when chopping down trees with his father and he felt that he was being attacked by insects. Since then he has been socially withdrawn and has not had any schooling. Currently he lives at home with his family and spends most of his time in his room. He was taking 100mg chlorpromazine each day plus 3mg of risperidone and was predictably overweight with extra pyramidal symptoms. He had been diagnosed as having “schizophrenic mania”. At interview he was notably withdrawn and made poor eye contact with a lack of any spontaneous movement. It was difficult to know what was going on here but we recommended that his antipsychotic medication be rationalised and that he have a trial of an antidepressant. The last patient was a middle aged man with epilepsy who was well controlled on carbamazepine and tegretol – but when he stopped his seizures came back.

Apparently lithium is not used in Sudan because of the need for monitoring so they mainly use sodium valproate.

Then back to Gizera Hospital for a presentation on suicide and self-harm – tried videos but sound quality not ok. Interesting discussion with one of the group about suicide bombers being mentally ill – very aware of not wanting to tread on any cultural toes. A recent article in Psychology Today looks at this - my simple understanding is that doing dreadful things, like murder, is rarely due to mental illness. Need TV quality sound.

After prayers lecture on bipolar disorder by Sophia. Then violence, role play of hypomanic patient by the students and quick quiz.