Mental Health

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Warning Signs

Changes in feelings such as fear and anger are a normal part of life. Personal situations, such as a divorce, loss of a job, or strained relationships with family or friends can cause emotional stress, thus making a person feel sad or blue. These are not unusual reactions. However symptoms that last longer than 2-3 weeks require attention.

Certain thoughts and feelings associated with some experiences, however, may be warnings of more serious problems and the need for mental health intervention. It is not always easy to spot these warning signs, or figure out what they mean—qualified mental health professionals should be consulted in order to make an accurate diagnosis.

The following feelings and experiences may be warning signs:

  • finding little or no pleasure in life
  • feeling worthless or extremely guilty
  • crying a lot for no particular reason
  • withdrawing from other people
  • experiencing severe anxiety, panic or fear
  • having very low energy
  • losing interest in hobbies and pleasurable activities
  • having too much energy, having trouble concentrating or following through on plans
  • feeling easily irritated or angry
  • experiencing racing thoughts or agitation
  • hearing voices or seeing images that other people do not experience
  • believing that others are plotting against you
  • wanting to harm yourself or someone else

Myths

KIDS WILL BE KIDS

Myth: Teenagers don't suffer from "real" mental illnesses — they are just moody.
Fact : One in five teens has some type of mental health problem in a given year.
— National Institute of Mental Health/Harvard University Study June 2005

Myth: Talk about suicide is an idle threat that need not be taken seriously.
Fact : Suicide is the third leading cause of death among high school students and the second leading cause of death in college students. Talk about suicide should always be taken seriously.
— Jed Foundation


Myth: Childhood mental health problems are really the result of poor parenting.
Fact : If someone in your family has a mental illness, then you may have a greater chance of developing the illness, but mental illness generally has little or nothing to do with parenting.
— Surgeon General's Report on Mental Health

JUST SNAP OUT OF IT

Myth: Mental illness is not real and cannot be treated .
Fact : Mental disorders are as easy to diagnose as asthma, diabetes and cancer with a range of effective treatments for most conditions.
— Surgeon General's Report on Mental Health

Myth: We're good people. Mental illness doesn't happen to my family .
Fact: One in four families is affected by a mental health problem.
— National Alliance for the Mentally Ill

Myth: Eating disorders only affect celebrities and models.
Fact: Each year eating disorders and binge eating affect 24 million Americans. Eating disorders claim more lives each year than any other mental disorder.
— National Institute of Mental Health

IT'S JUST THE BLUES
 

Myth: Children are too young to get depressed, it must be something else.
Fact: More than two million children suffer from depression in the United States and more than half of them go untreated.
— US Center for Mental Health Services

Myth: It's not depression, you're just going through a phase.
Fact: Nineteen million adults in the United States suffer from some form of depression every year.
— National Institute of Mental Health

Myth: Senior citizens don't get depressed, it's just an expected part of aging.
Fact: Five million older Americans suffer from clinical depression and account for 20% of all suicides.
— Surgeon General's Report on Mental Health

THEY'RE JUST WEAK

Myth: A homeless person with a mental illness has little chance of recovery.
Fact: Homelessness can be significantly decreased when people are connected to case management, supported housing and related services.
— US Department of Housing and Urban Development

Myth: People who abuse drugs aren't sick they are just weak.
Fact: Over 66% of young people with a substance use disorder have a co-occurring mental health problem which complicates treatment.
— Surgeon General's Report on Mental Health

Myth: Troubled youth just need more discipline.
Fact: Almost 20% of youths in juvenile justice facilities have a serious emotional disturbance and most have a diagnosable mental disorder.
— US Department of Justice

WE JUST CAN'T AFFORD IT

Myth: Insurance doesn't need to cover mental health, it's not a big problem.
Fact: Fifty-four million Americans are affected by mental illness each year, regardless of ethnicity, sex or socioeconomic class.
— Surgeon General's Report on Mental Health

Myth: Doctors are too busy treating physical problems to deal with mental health.
Fact: Up to one-half of all visits to primary care physicians are due to conditions that are caused or exacerbated by mental illness.
— Collaborative Family Healthcare Coalition

Myth: Mental illness is a personal problem not a business concern.
Fact: Depression is the leading cause of disability in the United States over back problems, heart disease and liver failure.
— World Health Organization

 Mental Health Facts for Adults

  • 57.7 million adults suffer from a diagnosable mental disorder each year, 6% of adults suffer from severe mental disorders.
     
  • Major depressive disorder (depression) affects 14.8 million adults and is the leading cause of disability for people ages 15-44.
     
  • Bipolar disorder affects 5.7 million adults each year.
     
  • In 2002 over 31,000 people died by suicide.
     
  • 2.4 million adults suffer from schizophrenia.
     
  • Anxiety disorders are the most common mental disorders. Approximately 40 million adults suffer from anxiety disorders including, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and specific phobia).
     
  • Approximately 13% of adults suffer from one of three types of eating disorders, which include anorexia nervosa, bulimia nervosa and binge-eating disorder.
     
  • The mortality rate among people with anorexia is estimated to be 5.6 percent per decade, which is about 12 times higher than the death rate due to all causes of death among females ages 15-24 in the general population.
     
  • 4.1% of adults experience Attention Deficit Hyperactivity Disorder (ADHD) each year.

All statistics provided by the National Institute of Mental Health

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Depression

What is Depression?
Depression is a medical Illness & not just a feeling of hopelessness. It's more then just feeling sad.

How common is Depression?
It's as common as the Common Cold. According to the World Health Organization, it's the Third Most Common Illness in the World after Infectious diseases & Heart disease. It's the 4th to the 10th most frequent diagnosis made by the family doctor.

Who is at risk to get Depression?
All of us are! An alive human being (with fair intelligence) is the greatest risk!! As confirmed by scientific data ¼ to 1/3 of us are going to have it once in lifetime. Every 3rd female and every 5th male will have it at least once.

What are the causes of Depression?

  • Biological
  • Psychological
  • Social

Biological causes:
I.Chemicals/Neurotransmitters: Neurotransmitters are the chemical messengers, which are critical in the transmission of nerve impulses in our brain and nerves. The level of certain neurotransmitters, NORADRENALINE & SEROTONIN are decreased in the brain. Most of the medications used for treating depression (Anti depressants) help in elevating the levels of these chemicals in the brain.

II. Genetic: For every possible physical and mental feature there is a gene in our cells. So is a gene for Depression. The parents of a depressed person are at a higher risk for depression. If a sibling has depressive illness then there is a 15% chance, that it will be there in another sibling .If the onset of depression is after the age of 40 yr. then chance of it being genetically transmitted is less.

   
III. Hormonal imbalance: Though the exact mechanisms are not understood but imbalance of female sex hormones can lead to depression. Depressions in the postmenopausal and post partum (after delivery) period are the examples.

Psychological causes:

I. Personality/ Attitudes: Following types of personality traits predispose to depressive illness.

  • Very ambitious
  • Anxious
  • Obsessive/perfectionist
  • Setting very high standards for self

Persons having above traits/attitudes are more likely to experience depressive episodes in their lives as compared to people who don't have such type of personality.

II. Coping strategies with life events: How we deal with stressful events like separation/divorce/death, etc. determines how predisposed we are to depression. People who are

Impulsive

Aggressive

Self centered

Are more likely to have depression.

Social causes and social supports:

A lot of stressful life events like death/divorce/disease predispose to depression.

Interpersonal relationships matter a lot - good relations with the friends / spouse / siblings have a positive effect in preventing depression.

Single people are more prone to depression than couples.

Similarly, studies have found divorced persons to be more prone to depression.

What are the features of depression?
Most of the people who feel low and depressed are given a lot of advice by friends and relatives. It is automatically assumed that these feelings of low energy / low mood are just a matter of time and would get better if the individual made a little effort to feel good and happy.

Persistence of such feelings of lethargy / low energy / low mood despite all this indicates that the person may be suffering from clinical depression. Following are the features that a depressed individual experiences.

Biological features (duration - 15 day or more)

  • Decreased sleep--- the person gets up very early in the morning say, at 3 am & can't sleep again. Frequent awakenings. Poor quality of sleep.
  • Decreased appetite/ weight
  • Dryness of mouth
  • Constipation
  • Reversed diurnal variation - everybody feels better in the morning but a depressed patient feels worst in morning & slightly better in noon to evening.
  • Generalized body ache - lot of poorly localized pains and aches like headaches, abdominal pains.
  • Easily fatigued & lethargic.
  • Panic features like palpitations and sweating.

Psychological features
I. Sadness of mood
II. Decreased pleasure & interest in activities which they enjoyed previously
III. Decreased attention, forgetfulness, like forgets where he/ she has kept things.
IV. Easily irritated
V. MOST IMPORTANTLY, OCCASIONALLY NO WISH TO LIVE.
BAD NEWS IS THAT THIS CONDITION CAN BE FATAL. 40% OF ALL SUICIDES REPORTED ARE IN PEOPLE WITH DEPRESSION.

GOOD NEWS IS, IT IS EASILY DIAGNOSABLE & EASILY TREATABLE.

What are the treatments available for depression?
A number of medicines are available suitable to different Patients. Broadly these are termed as Anti Depressants. These drugs remain the mainstay of therapy for depression.

There are certain important things to be kept in mind regarding anti depressant use:

  • ADEQUATE DOSE, FOR ADEQUATE DURATION IS THE CARDINAL RULE.
  • SOMETIMES SMALL DOSES FOR LESS DURATION IS GIVEN BY NON SPECIALISTS It leads to incomplete recovery with frequent relapses.
  • Antidepressants are NOT sleeping pills.
  • THEY ARE NOT HABIT FORMING.

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Anxiety Disorder
All of us have experienced some form of anxiety in our lives; those sweating palms before the start of an examination; the pounding heart on going to the stage are all features of anxiety.
A little anxiety is good in the way that it helps us focus on the task at hand and the body also channels it resources to meet the demands of the job. All of us experience milder forms of anxiety - stress, worry or tension - but when these symptoms collect (or are denied), they can quickly build upto a crescendo. This kind of an anxiety can be severly incapacitating.

Features of Anxiety
People who suffer from anxiety tend to experience physical symptoms such as palpitations, tremors, sweating, gastrointestinal discomfort, diarrhoea, muscle tension, shortness of breath, blushing and confusion. The first step in diagnosing an anxiety disorder is to rule out a physical cause: asthma, diabetes, seizure disorder, inner ear problems and hypothyroidism can all produce symptoms associated with anxiety.

Physical conditions can create or exacerbate anxiety as well. Also, those who suffer from cumulative stress may create a physiological condition (such as insomnia or impotence) that in turn makes the stress worse - initiating a destructive cycle. Over time, stress can raise blood pressure,contribute to ulcers, or impair neuroendocrine regulatory systems in the brain - the very one which control mood and anxiety disorders.

Without early intervention, some anxiety cases can become chronic. But many people - especially men - feel that seeking help is a sign of weakness. This is true for nearly all anxiety or mental health problems.

Experts believe that some of the fault lies in our culture, in which men aren't supposed to be fearful. Men buy into this myth themselves, say psychologists. They'll insist that it's a medical condition, like a cardiac arrest, even after that's been ruled out. The fact is, with true panic, the experience in the body feels almost the same as a heart attack.

10 ways to cope

  • Admit your need, and then seek professional help.
  • Have a physician check for a physical cause of anxiety symptoms.
  • Practise muscle relaxation and abdominal breathing regularly.
  • Engage in regular physical exercise.
  • Eat nutritiously. Eliminate caffeine. Stop smoking.
  • Practise meditation and creative visualization.
  • Learn positive self-talk and disregard negative messages.
  • Identify and express your fears.
  • Determine what meditation and / or alternative therapies are right for you.
  • Explore the deeper side of your anxiety; give meaning to your suffering.
What will help:


Dietary Changes:
Doctors recommed eating plenty of complex carbohydrates
Vegetarian diet; it has been shown that people with vegetarian diet tend to be calmer than meat eaters.
Vitamin supplements also tend to help.

Lifestyle Changes:
Avoiding sugar and caffeine
Stop Smoking
ExerciseStudies show that people with vegetarian diet tend to be calmer than meat eaters. Meat and dairy products leave acid residues in the body, which can slow down the digestive tract. The result is the under-absorption of vitamins and minerals, which adds to the body's stress load. Physicians often use vitamin supplements to treat anxiety: 100 milligrams of a complete B-complex vitamin daily and 1000 milligrams of time-released vitamin C twice a day.

Exercise is vital, having a direct impact on the physiology that supports anxiety. Tension can be relieved by music workouts, which allow for more rapid metabolism of excess adrenaline. Exercise also stimulates the production of endorphins, the natural body chemicals that spur a sense of well-being and relaxation.

Another mind-body connection happens when people hyperventilate, which both reduces and alkalizes carbonic acid in the blood, sensitizing the nervous system and heightening anxiety. Diaphragmatic breathing is a key to calming the body and balancing the emotions. Learning breathing techniques allows the person to relate to anxiety in a new way.

Identifying specific anxieties can help clarify both the work that's needed and how best to cope, though some techniques seem effective across-the-board. Psychologists recommed a regular form of meditation, employing creative visualization and positive affirmations, in which the anxiety sufferer can find peace through images of comfort. This starts the process of acquiring a sense of control. Through meditation, a person can begin seeing himself more positively.

Anti-anxiety drugs provide relief, even if temporarily, while beta blockers (cardiac and anti-hypertension medications) stabilize the fight-or-flight response. Although some people report side effects to these drugs, remarkable successes have been recorded.

Given the potential for addiction, behavioural therapy is an important adjunctantive treatment to medication. The important thing is to reach out to people coping with such ills, say psychologists, so that they are able to control the symptoms rather than. the symptoms controlling them.

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PANIC ATTACKS

What is a Panic attack?
Panic attack is a sudden onset of apprehensions (anxiety) which can present with,

  • chest pain/ discomfort
  • sweating
  • tremors
  • choking sensation/ breathlessness
  • nausea/ vomiting
  • fainting / syncope/ feeling dizzy
  • Feeling of impending doom, as if something is going to happen.
But doctor, I am not anxious at all, I have no problems, my life is going very smooth, what is the cause?

The cause of a Panic Attack is a sudden release of chemicals known as Adrenaline and Noradrenaline in our blood stream, because of more active Sympathetic Nervous System. The Sympathetic Nervous system has a lot of nerves going to the heart as well, so a sudden overactivity of this system leads to excitation of the Heart and manifests as palpitations & chest pain.

Genetic predisposition could also be a cause.

Psychological factors may not be very obvious but can be covert cause of anxiety.

How can I differentiate between a Heart Attack and a Panic Attack?

  • In a Panic Attack the Chest Pain is generalized (not localized to left side of the chest) as in a heart attack.
  • It does not get relieved with anti Angina drugs.
  • A lot of other symptoms e.g. nauseating sensation & feeling of impending doom, as if something is going to happen, are present in a Panic Attack.
  • A Normal E.C.G in the presence of an attack.

What should I do? Should I forget about it thinking that was just a panic attack?
No, you need treatment for this. A tendency for Panic Attacks cannot be wished away. You need to consult a psychiatrist for proper evaluation and treatment.

A Psychiatrist? I am not mad!! Why a Psychiatrist?

It’s a big myth that Psychiatrists are only for mad people. Psychiatrists are for sad people, for anxious people and a lot of other problems, which may not present with a psychiatric or mental symptom but have a psychiatric basis.

Self-medication, like taking Sleeping Pills or Anti Anxiety drugs can in fact be harmful. Ignoring the symptoms can also lead to difficult situations.

What is the treatment of Panic Attack? Just antianxiety Drugs?

No, Antianxiety drugs are one of the treatments. To decrease the levels of Adrenaline, Noradrenaline & hyper stimulation of nerves of the Heart other drug are also available.

Antidepressants also have an important role to play but they have to be taken under supervision of a psychiatrist

Are these drugs Sedative and/or Addictive? If a Start them once do I have to take them Always?

No, They are not sedatives; they are not addictive and need not be taken always. Normally it’s a course of 8 months to 12 months, after which the chemicals are brought back to the balance. Once there is improvement they have to be gradually tapered by your Doctor (but a full course of 8 –12 months is necessary).

Any other methods of treatment?

  • Yes, Relaxation exercises.
  • Breathing exercises.
  • Counseling &,
  • Psychotherapy
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Electroconvulsive Shock Therapy (ECT)
What is an E.C.T?
Electroconvulsive shock therapy involves passage of small amount of electric current for a very short duration across the brain, which leads to convulsions.

If current is passed through brain does it not cause burn /harm to the brain?

No, in E.C.T as small as 25 Joules of electric current is passed through the brain. In comparison, in case of a heart failure due to rhythm disturbances, as much as 200-300 joules are passed through the heart.

Numerous studies have demonstrated the safety of the procedure. In fact scientific studies have shown that patients who have received upto 100 ECTs in their lifetimes have not had any long term side effect or damage.

Is it not an old /out dated treatment?
Yes it is old treatment, 50 years old, and has still survived in medical field as a useful form of therapy, but it is not outdated. It is still one of the effective and widely used treatments in India.

But it must be used for very serious cases. Only for very seriously mad patients when drugs stop acting?
No, more than the MAD people it is for SAD people It can be very effective to lift up Depression .It can be used as the treatment of 1st choice in some illnesses e.g. Depressive & Catatonic stupor.

It must be given only to very young & healthy people who can bear the shock.
No, in fact, it can be given to old patients and pregnant women also. These people are more prone for side effects of drugs so E.C.T is much safer. It poses no danger to a pregnant woman.

So can a single shock treatment cure me from my illness?
No. The way we have a course of antibiotics for 5-7 days similarly ECT is also administered as a course of 6-8 sessions.

What are the side effects of E.C.T?
Saying NONE will be wrong, but side effects are much less compared to the useful effects. The commonly observed side effects include:
  • Headache
  • Bodyache.
  • Forgetfulness (which is not permanent ) which remain for months only & memory is normal after that.

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Obsessive Compulsive Disorder (OCD)

The Boy could not stop washing his hands.......

The woman could not stop checking the lock.....

The man could no stop himself from praying to God again & again......

How common is OCD?
Out of every 10 patients coming to the psychiatrist, one patient is suffering from this illness.

But why can't these people simply stop it?
That is the PROBLEM. They are not mad people. They realize that it is Irrational /Inappropriate but it is a recurrent thought / impulse which is not in the control of the person (patient) and is called Obsessive thought. They try to stop or ignore it but cannot do it.

The thought is followed by some rituals /acts which are called Compulsion. A combination of obsessive thoughts followed by compulsive actions is known as an Obsessive Compulsive Disorder.

Oh yes!, I know somebody my office. We always feel the he's obsessed with cleanliness. His table, his dresses are always spotless. Is he suffering from an Obsessive Compulsive disorder?

What are the other presentations of this disease?
Other presentations are:
  • Pathological doubt which leads to repeated thoughts of hurting someone followed by rituals of crying or counting etc.
  • Reflected sexual thoughts and imaginations followed buy rituals of praying etc.
  • Excessive praying on religious concern out of keeping with the person's background.
  • Excessive concern about symmetry & precision.
  • Hoarding & collecting.
  • Rituals that few things have to be done in a specific order

Does this disorder come in childhood, or at any age?
The OCD usually presents at the age of 20-30 yr. If it presents in older age (in 4th decade) it usually comes after a stressful situation in life. The person has some problem in life e.g. death of some dear one, problem in marriage etc. In such cases DEPRESSION may be the main illness, which presents in the manner.

What is the cause of Obsessive Compulsive Disorder?
It's a multi factorial illness, that is to say that a variety of factors and their combination is responsible.

  • Important contribution is of certain brain chemicals. Their decreased presence is considered to be a factor. One such chemical is Serotonin.
  • Inheritance is another importance contributing factor. Sometimes some close relative in family suffers from this illness.
  • Personality of the person might be very perfectionist.
  • Upbringing from childhood can have an important role.

Is OCD treatable?
Yes, Very much.

How?

  • The most important thing is to believe that it is an illness like any other illness (like Pneumonia or Typhoid).
  • The person is sick & he /she's not doing it deliberately to harass others.
  • It requires active intervention by a specialist doctor (a psychiatrist).
  • There are medicines available, which are very effective.
  • There are other methods like Psychotherapy and Behaviour therapy.

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Demystifying visit to a psychiatrist

Consider the following facts: 
  • One in five adults have a diagnosable mental disorder.
  • One in four families will have a member with a mental illness.
  • Less than one-third of the children under age 18 with a serious disturbance receive any mental health services.
  • Depression is the third most common illness in the world.

Despite overwhelming evidence that mental illness is very extremely common, visit to a psychiatrist remains something of a mystery and a taboo. People are afraid to go to a psychiatrist because they feel that psychiatrists are strange people who do strange things.
He/she looks into your eyes and knows all the secrets of your heart.
He/she makes you lie down on a couch and takes notes.
He/she may even hypnotize and know things, which you don't want to tell.

Well, nothing of the sort happens, psychiatrists employ scientifically proven therapies and not any witchcraft. Following is an attempt to give an overview of the various therapies/techniques commonly used in treatment on mental illness.

Psychotherapy


This is the most commonly used technique.
The first step is VENTILATION that is, the patient expresses all his/her distressing/stressful experiences/emotions. The person is able to tell all his conflicts to a professional person who is able to understand them better than his friends/relatives.

An active listening by the psychiatrist in itself is a very good therapy (much like the confessions to a father in the church).

The second step is when the patient, with the help of the psychiatrist looks into his/her patterns of coping with stress. He tries to introspect into his own emotions, which is called INSIGHT in the technical language.

   
The third step is when the patient with the help of the therapist decides to change the thinking and behaviour, which he feels, are not able to help him/are impediments to handling a stressful situation.

Cognitive therapy
The psychotherapy deals more with emotions and support in stress whereas cognitive therapy mainly works with your faulty beliefs. Cognitions are learnt beliefs and thoughts, which every person has as a part of his/her personality.

They are the slogans or principles that we use to deal with different situations in our life. Few slogans are healthy and help in coping well. Some of the slogans on the other hand are unhealthy, irrational prejudices and biases. It is these irrational beliefs that the cognitive therapy aims to help.

Behaviour therapy

Here the focus is on behaviour and not emotions and thinking. Some particular behaviours like,
Fear of blood and injection so the person faints at the sight of them.
Fear of crowded places (known as claustrophobia) so that he cannot travel in a bus.
Feels everything is dirty and has germs and washes her hands repeatedly (Obsessive Compulsive Disorder).

These behaviours are very distressing to the patient and behaviour therapy aims at helping these by a few techniques.

I. Relaxation: the patient is taught to relax his body and mind so that he doesn't have palpitations and sweating on seeing blood.

II. Gradual exposure and systemic desensitization: the patient is gradually exposed to the feared object so that he is desensitized to it e.g. visiting increasingly more crowded rooms (in cases of claustrophobia).

III. Exposure and response prevention:
patient is exposed to dirt and not allowed to perform the behaviour e.g. washing hands.

All these techniques are used under the guidance and supervision of a specialist.

Psychoanalysis:

Freud introduced this technique. It is a very long-term therapy, which requires many months (and perhaps the one requiring a couch and the doctor listening and taking notes..!), and so is not commonly used.

It involves talking to the person and thereby understand the childhood experiences and conflicts, which might have resulted into the present illness.

The patient also understands about the childhood conflicts and this is called gaining insight into his/her emotions.

Hypnotherapy

Perhaps the most mysterious sounding of all the techniques used but it in no way is witchcraft. It just involves taking the person to a special state of consciousness (with his consent), where it is possible to look into the unconscious processes of the mind. The advantage is that usually operating defenses, which prevent the true insight into the conflicts/causes, can be overcome.

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