M ental I llness C oncerns A ll	The Inquiry starts off with the heart rending treproduction of a last letter. DrE. had gotpast a number of episodes of a manic-depressive illness which began when a medical student, and although phases of illnesss returned during her training and early career, they did not interrupt unduly a brilliant progress in what she chose to do. Unfortunately, colleagues are properly apprehensive about that which is unpredictable in a condition like this where it is not possible to predate illness breakdown or determine under what circumstnces it will become a major concern, Careers often have to be suspended during recurring periods of this illness, and the consequencs of that and what trumoil may have been created during mood illness, makes employment and re- employment, a chancy business which any employer finds it dificult to contain, especially when there is a responsibilty in post for the safety and well being of others. Medical people with this condition are usually advised to take up non clinical careers. Dr E had chosen psychiatry, of itself, it's lead figures often founded upon uncertain and worrying decision making. DrE had embarked upon a pregnancy. Post natal mood disorder so often will occur where there has been previous affective illness, that suitable contingency arrangements should always be made in advance, taking into account a measure of the strength of the potential supporting and weakening networks behind the individual. There should have been time to take all this into account, and to make certain decisions in advance That became more difficult when her consultant psychiatrist who had previously guided the management of her condition retired. Then there was some kind of disagreement, not made up, beween husband and the father, so that an extended famly support and presence, perhaps could not be established. It is not clear how far the affective illnesses and their consequences and the needs for that had been made clear to her husband, or he own family. What can be anticipated during pregnancy is that medication will have had to be suspended. As that medication must have been there to be of use, some kind of protocol has to be prepared in place for after the birth, anticipating that there will be a recurrenece of illness, at a time when breast feeding, and general care demands on a new mother will be at maximum. Here it was established that lithium had been effective, and that Porzac- an ssri drug, may have been helpful. They would jave been stopped and the timing of a restart should have been in place in the latter three months of the pregnanacy. lithium could have been restarted during the last month although the circulation changes around birthing would make monitoring more dificult. Certainly it could have been restarted within days of the birth, and if it was clear that the ssri drug had been useful, that could also have been recommenced. To do this there would have to be reassuring convincing meical attention, and a reliable medical based support intrusion for ongoing assessment. Other observers and supporters could have been brought in upon medical insistence. Plan B for immediate intervention would alraedy be set up, providing for the facilities which would best bring about acceptance anda comfortable compliance Even an arrangement for a puerperal life in complete observation mode for months, might have been there in in acceptable conditions if forethought had prepared the ground. That was not done The lifelines were not there, and were not called in. It is not clear whether DrE had good memories of successful teatment in the past. She had had three courses of ECT, which suggests tablet medication had not been found successful, and would not be again. ECT is a disrupting line of treatment , requiring a stable support system in place.DrE dreaded it . Although a psychiatrist was she reminded that puerperal mood states clear away in due coiursem often leaving aftersis to nine months without treatment inthe natural course of events. Every phase of this illness does clear away eventually, leaving normality restored, and even professionally knowledgeable people must be given the constant reassurance that this is the case , even with doctors, even those familiar with psychiatrey, although stressing to supporters that it does take time, and confidence has to be repeatedly maintained. Dr E had picked upher life before, and that would have needed emphasising by someone carrying conviction, perhaps from someone who had previously acquired that trust, who may be was not available here, all being new to her. All the more reason to be demonstrating thoroughness. back to Inquiry List back to Home page.   back to Inquiry Link page       E-mail reaction is welcome mica@didgy.freeserve.co.uk