Psychiatry Patient: Physically WELL; Mentally ILL

21 Feb 2013

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Doctors in a Psychiatry word

Psychiatry remains an ever interesting specialty for me, and the reason is obvious: it begins where the other medical specialties end. Basically, it is the study of a person’s mental wellbeing or otherwise, where the derangement is not in the physical or physiopathology in origin but rather psychopathologic in nature; which is to say that the problems reside primarily in the psyche i.e. the mind. Meaning that a mentally-ill patient is sick but he might as well be looking fine without any trace of sickness from his/her affectation. This is the interesting thing about mental illness.

In the same vein, it is quite apt to say that psychiatry is the closest per social medicine since the social environment has a notable influence in its aetiology and possibly resolution.

The above explains why psychiatrists in the western world actually have more patients’ patronage than the other medical specialties. This is not necessarily to say that there are more frank cases of psychiatry patients over there than say in our environment; but it actually reflects the fact that the other societies seem to appreciate the fact that mental illness goes beyond frank madness called psychosis, which is when somebody is said to have gone out of his mind completely. Psychiatry is much more than this.   It involves an understanding of the fact that minor unpleasant symptoms like poor sleep, undue irritability, reduce or excessive sexual drive, reduced appetite in the absence of physical illness or undue and excessive eating ability, talkativeness, ascribing special power to oneself where none exist, low energy drive, undue tiredness in the absence of physical stress and illness etc could be the earliest signs pointing to the fact that all is not well with mental make-up of an individual. 

From the aforementioned it is necessary to point out that psychiatry is concerned with various forms of mental instabilities starting from the mild to major forms. Examples are anxiety neuroses, obsessive and compulsive disorders, mild and major depressive illnesses, substance (i.e. hard drugs including alcohol) abuse disorders, schizophrenia, phobias, affective disorders including manic – depressive illness etc.

My concern, in this series on mental illnesses as enumerated in the following passages, is to outline those signs and symptoms manifesting mental illness both in the acute and chronic form, with particular reference to Affective disorders especially manic disorders.

Affective Disorder

Affective Disorder is an entity that connotes two extreme components potentially existing in phases in the same individual. These components are Mania at one end of the pole and Depression at the other end; meaning that a fellow with aggressive disorder might be having an attack of mania, which is all aggressive and outgoing for the moment and at a later period, can also come down with depression: becoming withdrawn to self, exhibiting low mood among others.

As the name indicates, affective disorder implies that the psychopathology i.e. the problem is with the mood and the inner feelings of the individual. At the mania pole of the disorder the individual feels excessively happy, quite elated, thinks overtly but ridiculously highly of himself/herself etc and at the other end of the pole, there is the exhibition of the opposite of this in form of depression. During the attack of depression the individual felt low mood, very sad such that unexplainable tearfulness may be present and he thinks very lowly of himself/herself to the extent that he contemplates suicide among others.


An understanding of the mental illness refers to as mania and its milder form – hypomania will suffice with some real life examples elaborated below.

An example will suffice here, some years ago at the University of Ibadan, Ibadan, was the story of a  self-proclaimed prophet appropriately called Daniel, who claimed to possess the special power to tame the lions at the U.I’s zoological garden. With this belief, the prophet went to town to test his special power, and in he went into the lion’s den. With a rare confidence, he approached the lion with the aura of a shepherd among his flock. What followed was an initial hesitation from the lion before the animal attacked the prophet and made a dinner meal out of him.

Delusion of grandiose

The above is one of the numerous examples of the manifestation of one of the symptoms of mania called ‘delusion of grandiose’, where the individual thinks highly of himself beyond the actual reality and this could also connotes the possession of special powers like the one mentioned above.

It is necessary to point that other symptoms must exist together to cumulatively add up to a diagnosis of mania or in the milder form - hypomania. The list includes the following symptoms among others:


The individual feels unduly very happy beyond what can be explained by the present reality of things. You ask him for an example, what’s his mood like and he answered that he his very, very happy with an expression on his face that convened this happiness in an infectious way indeed. This becomes instructive when the reality on ground does not fit in with such feeling of undue happiness; say for an example, when some kind of disaster has just occurred to the individual.


Here the individual functions socially well but find himself indulging in physical activities that are rather much more than the ordinary comprehension for a normal individual. The fellow might be involved with carrying out all alone some domestic tasks that ordinarily normally take about four or more people to undertake.


This is sensory experience in the absence of a stimulus; there are various forms of hallucination. These involves seeing things (visual), hearing things (auditory), feeling strange movement on the body (tactile) or smelling things (olfactory) etc in the absence of real stimulus. You then have a situation when the fellow claimed to be seeing things that others present are not seeing. Hearing voice(s) talking to him, which others present cannot hear etc.

Easily Irritable and highly Intolerant

This is a manifestation of undue intolerance of others’ views, and this is coming out of the fact the fellow thinks he is specially placed above and beyond others. Any attempt to draw him to the point of conjecture soon lead to an indecorous outburst, which is not appropriate for the time and moment.

Increased appetite

A mania patient may find himself/herself developing a feeling and urge to fill the stomach indiscriminately beyond what is considered appropriate; with this development, it is more likely for the individual to add more weight in the course of the illness, provided food is actually sufficiently available to eat in the first instance.

Pressure of speech

This involves the vocalization of many ideas in a rush, trying to say many things at the same time though the subjects of the ideas are usually related. I should also add that mania patients not unusually exhibit feature of talkativeness and an accompanying high sense of humor, such that when they are still functioning well they easily arrest the attention of their audience.

Increased sexual desire and sexual dis-inhibition

Here the individual develops increased sexual drive that is out proportion to his usual desire and this may include making sexual advancement to those individuals he/she is not expected, per culture and tradition, to make sexual overtures to. This could also extend to forceful sexual seizure as in attempted rape or actual raping.


This involves excessive religious activities in the strict meaning of the word – excessive, that have gone clearly above the normal practice and expectations from the individual.

Self-important ideas

The fellow thinks highly important about himself, he might think of himself as the governor of his State of residence or as the President of the country. More interesting thoughts may involve the thinking that he is the genius/ discoverer of some phantom and real earth-breaking discoveries.      

Undue Generosity and Spending Spree

This is a common manifestation in maniac patients, where the fellow engage in dashing out his things during attack in a Father Christmas-like fashion, this could also involve the parting away with a large part of his money usually to both soliciting and unsolicited individuals.

Increased Energy

Here the fellow developed an increased energy level within; he sleeps so little say for just two hours in the night but wakes up refreshed and carries on with the day’s activities with a renewed vigor without any facial dullness or other signs of poor sleep.

The above elaboration gives an appreciable understanding of this not-uncommon psychiatry illness called mania, which interestingly has equal preponderance in both males and females. It also gives an insight into the science of psychiatric.

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