Thursday, January 29, 2015

Study group discussion: Addictions, Mental health

Guys, what's mental health/addictions care like in your countries? Intertwined with primary care or no? It's a huge issue here (Canada) but there's a lot of stigma and lack of political push to get anything done, and these people often suffer from "physical" comorbidities because they don't trust the system. I'm interested in your thoughts.

In India, the majority of cases we see are schizophrenia and alcoholism when it comes to mental health.
The stigma here is because the infectious disease burden is too much and that's why mental health doesn't get that much political attention.
But overall, people who reach hospitals trust doctors and it is very much intertwined with primary care.

People get a pretty wide range of mental health things around here, although in child and youth it's mostly anxiety disorders or conduct disorder, sometimes depression.  In emergency psych there's a lot of schizophrenia spectrum and suicide.   There's actually a dedicated eating disorders program as well (for children youth and adults).  The problem with mental health services, though, is the lack of resources.   There's a 4 month waiting list for the eating disorders program, for example.  I think thats a problem in other countries, too, but I don't know.   Does anyone know stuff about resource allocation to mental health programs in other health care systems?
Currently in Canada.  I used to live in Hong Kong.
The mental health care system is even worse in Hong Kong.

I only start ward rounds next year so I'm not sure how accurate is my take on mental health... But depression is very common here (Singapore) because life tends to be very fast paced here!

In Honduras, we see addictions to alcohol, glue and Benzodiazepines.
Glue? Like glue sniffing?

Yeah, they smell glue here. It's very cheap and you can use it  many times. And paint thinner too.

Had read about it in forensics class but never thought it is actually prevalent!

Dendrite sniffing is common here (India)

I believe it. We get a lot of hand sanitizer stolen around here. (Canada)

Apparent cases coming to see psychiatrist eye is a small proportion.


Dendrite is one kind of a glue.

I'm a bit surprised too. Maybe it's naiveness or lack of exposure to such news... But the last time I heard that people used thinners or glue or nail polish to sniff was in my psych class.

I suppose almost all volatile substance can be used this way.

I have to admit, glue and paint thinner smells good.

I see lots of it in emerg... Mostly, the homeless. Its very sad.

So how do they present clinically?

Sort of like asphyxia? That's what I had read..They keep sniffing and in a daze forget to breathe.
Had a case a few weeks ago where this guy inhaled those cans of air dusters used to clean computers.

Hypoventilation, respiratory acidosis.

He just kinda passed out on the side of the road, but became conscious rather quickly once we talked to him.

Decreased LOC usually, sometimes combative, crazy heart rates. Mostly they just look inebriated. 

Super paranoid. Depends on what they abused.

They present with very serious brain damage. Usually they dont come to the hospital, they die from TB and AIDS in the streets without medical attention.

What we get in our emergency is mostly organophosphorous poisoning.

OP poisoning is very prevalent out here. It's the only thing farmers have access to!

Atropine then pralidoxime.


If we're unsure of the pesticide, we don't prescribe pralidoxime.

Here (Honduras), farmers are always getting snake bites

Barba amarilla they call them.

Oh. We get snake bites too.

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