PSYCHOLOGICAL MEDICINE Dr. Shamanthakamani Narendran M.D. (Pead), Ph.D. (Yoga Science)
Obsessive compulsive disorder (OBC)
A psychological or behavioral disorder in which anxiety is the primary characteristic; defense mechanisms or any of the phobias are the adjustive techniques which an individual learns in order to cope with this underlying anxiety.
In contrast to the psychoses, persons with a neurosis do not exhibit gross distortion of reality or disorganization of personality.
A functional nervous disease, or one for which there is no evident lesion.
A peculiar state of tension or irritability of the nervous system; any form of nervousness.
TYPES OF NEUROSIS
Anxiety disorders - not all cases would be classed as a "neurosis"
Depression - only really a "neurosis" if mild depression
Post-traumatic stress disorder
Some of the possible causes of Neurosis are included in the list below:
Some of the symptoms of Neurosis include:
Symptoms depend on the type of neurosis
Self-awareness of psychological problems
Disturbance of social life
Disturbance of personal relationships
Treatments for Neurosis include:
Treatment depend on the type of neurosis
Mood disorder / Mental illness
A group of mental disorders involving a disturbance of mood, accompanied by either a full or partial manic or depressive syndrome that is not due to any other physical or mental disorder.
Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation;
e.g., manic episode, major depressive episode, bipolar disorders, and depressive disorder.
COMMON MOOD DISORDERS
Bipolar Disorder – an affective disorder characterized by the occurrence of alternating periods of euphoria (mania) and depression.
Depression – A temporary mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation or less frequently agitation, withdrawal from social contact, and vegetative states such as loss of appetite and insomnia.
Extreme mood swings punctuated by periods of generally even-keeled behavior characterize this disorder.
Bipolar disorder tends to run in families. This disorder typically begins in the mid-twenties and continues throughout life.
Without treatment, people who have bipolar disorder often go through devastating life events such as marital breakups, job loss, substance abuse, and suicide.
Mania-expansive or irritable mood, inflated self-esteem, decreased need for sleep; increased energy; racing thoughts; feelings of invulnerability; poor judgment; heightened sex drive; and denial that anything is wrong.
Depression-feelings of hopelessness, guilt, worthlessness, or melancholy; fatigue; loss of appetite for food or sex; sleep disturbances, thoughts of death or suicide; and suicide attempts.
Mania and depression may vary in both duration and degree of intensity.
Although scientific evidence indicates bipolar disorder is caused by chemical imbalances in the brain, no lab test exists to diagnose the disorder.
In fact, this mental illness often goes unrecognized by the person who has it, relatives, friends, or even physicians.
The first step of diagnosis is to receive a complete medical evaluation to rule out any other mental or physical disorders.
Anyone who has this mental illness should be under the care of a psychiatrist skilled in the diagnosis and treatment of bipolar disorder.
Eighty to ninety percent of people who have bipolar disorder can be treated effectively with medication and psychotherapy.
Self-help groups can offer emotional support and assistance in recognizing signs of relapse to avert a full-blown episode of bipolar disorder.
The most commonly prescribed medications to treat bipolar disorder are three mood stabilizers: lithium carbonate, carbamazepine, and valproate.
When a person's feelings of sadness persist beyond a few weeks, he or she may have depression.
According to the National Institute for Mental Health, three to four million men are affected by depression; it affects twice as many women.
Researchers do not know the exact mechanisms that trigger depression.
Two neurotransmitters-natural substances that allow brain cells to communicate with one another-are implicated in depression: serotonin and norepinephrine.
Changes in appetite and sleeping patterns; feelings of worthlessness, hopelessness, and inappropriate guilt; loss of interest or pleasure in formerly important activities; fatigue; inability to concentrate; overwhelming sadness; disturbed thinking; physical symptoms such as headaches or stomachaches; and suicidal thoughts or behaviors.
Four or more of the previous symptoms have been present continually, or most of the time, for more than 2 weeks.
The term clinical depression merely means the episode of depression is serious enough to require treatment.
Major depression is marked by far more severe symptoms, such as literally being unable to drag oneself out of bed.
Another form of depression, known as seasonal affective disorder, is associated with seasonal changes in the amount of available daylight.
Some types of cognitive/behavioral therapy and interpersonal therapy may be as effective as medications for some people who have depression.
Special bright light helps many people who have seasonal affective disorder.
Three major types of medication are used to treat depression: tricyclics; the newer selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAO inhibitors). Electroconvulsive therapy uses small amounts of electricity applied to the scalp to affect neurotransmitters in the brain.
WHAT IS MENTAL ILLNESS?
Mental illness is very common. About one in four people in Britain has this diagnosis, but there is a great deal of controversy about what it is, what causes it, and how people can be helped to recover.
People with a mental illness can experience problems in the way they think, feel or behave.
This can significantly affect their relationships, their work, and their quality of life.
Having a mental illness is difficult, not only for the person concerned, but also for their family and friends.
Mental illnesses are some of the least understood conditions in society.
Because of this, many people face prejudice and discrimination in their everyday lives.
Unlike the images often found in books, on television and in films, most people can lead productive and fulfilling lives with appropriate treatment and support.
For some people, drugs and other medical treatments are helpful, but for others they are not.
Medical treatment may only be a part of what helps recovery, and not necessarily the main part.
It’s important to remember that having a mental illness is not someone’s fault, it’s not a sign of weakness, and it’s not something to be ashamed of.
Seeing someone’s problems solely as an illness that requires medical treatment is far too narrow a view.
It discourages people from thinking about the many different influences on someone’s life, on their thoughts, feelings and behaviour, which can cause mental distress.
It may also prevent people from exploring the various non-medical treatment options that are available.
For these reasons, some people prefer to talk about mental or emotional distress, rather than mental illness.
HOW IS IT DIAGNOSED?
Psychiatrists have classified mental distress into different categories, or diagnoses.
Making a diagnosis helps a doctor to assess what treatment is needed and to predict what is likely to happen.
It can also be a relief to a distressed person to be able to put a name to what is wrong. But there are limits to diagnosis.
Each person’s experience of mental distress is unique and it can be misread, especially if there are cultural, social or religious differences between doctor and patient.
Different doctors may give one person completely different diagnoses.
Simply focusing on the symptoms can mean that not enough attention is paid to the person as a whole, and to their situation.
Their experience may hold a meaning for them, which no medical diagnosis can do justice to.
If a diagnosis becomes a label, it can be very damaging.
For example, instead of being seen as a parent, writer, mechanic or student who has schizophrenia, a person may be seen as ‘a schizophrenic’, as though this diagnosis summed them up.
It’s important to remember that a diagnosis does not have to determine the whole course of life, and may come to be a relatively minor part of an individual’s identity or history.
It’s possible to recover completely from mental distress and many do.
Sometimes, people even emerge from the experience feeling stronger and wiser.
Others get over the worst, but remain vulnerable, and relapse from time to time.
Some don’t recover, and will continue to receive treatment in the long term.
Psychiatrists aren’t able to predict, accurately, what each individual outcome will be.
Recovery is possible with all types of mental distress but, unfortunately, people are sometimes told that they won’t recover.
Such statements can become self-fulfilling because they add to existing feelings of hopelessness.
It’s important never to give up, whatever told.
WHAT FORMS CAN MENTAL DISTRESS TAKE?
Mental distress takes many forms.
The terms used to diagnose them are sometimes words that are in everyday use, for example, ‘depression’ or ‘anxiety’.
This can make them seem easier to understand, but their familiarity can mean underestimating just how severe and incapacitating these conditions may be.
Some of the most commonly diagnosed forms of mental distress are
Manic depression (Bipolar disorder)
WHAT ARE THE CAUSES OF MENTAL DISTRESS?
There are many opinions about what causes mental distress.
It’s part of a wider debate about what makes people the way they are, whether their personality is shaped by the life experiences they have gone through, or whether it’s determined by their genetic make-up, inherited from their parents.
It’s possible that some people are more vulnerable to mental health problems, which could be triggered by stressful or traumatic events.
The following are some of the possible causes of mental distress.
It may be due to any one of these factors, or to a combination of them.
Difficult family background
Stressful life events
Users of health services are increasingly being consulted about treatments and conditions in the hospital and the decisions made about how health services are run and what they provide.
Above all, they want to have more say in their own treatment.
This means being properly informed about the undesirable effects of drugs, for example.
It also means being offered choice: residential crisis centres as alternatives to hospital; talking treatments as an alternative or complement to drugs.
They want to be seen as individuals, not simply as passive cases.
By far the most common type of treatment is prescription medication, given by a general practitioner (GP) or psychiatrist.
Depending on the diagnosis, there are a variety of drugs commonly used.
Different types of medication can be used to help someone calm down, or to help them sleep (minor tranquillisers), to lift depression (antidepressants), or control disturbing thoughts (antipsychotics).
The great advantage of drugs is that they can help people to keep going.
Millions go to work each day, or look after their children, while taking them.
Without drugs they might have lost their jobs or been separated from their families.
These drugs don’t ‘cure’ mental distress.
Medication can relieve the symptoms of mental distress, but the underlying problems often remain.
Drugs can also have side effects that may make people feel worse rather than better.
They need to be used with caution.
Taking minor tranquillisers can be seriously addictive, while antipsychotics in high doses can cause permanent damage to the central nervous system.
Talking treatments, sometimes in combination with medication, can be very successful in helping people deal with mental distress.
Professionally qualified therapists and counsellors are specially trained to help people to a better understanding of themselves, and to overcome difficulties in their lives.
There is a wide variety of talking treatments, and they may be available in the hospital (through GP surgeries) or privately.
GPs often employ counsellors, who are trained to listen, and who may once or twice a week.
They can help to deal with specific issues, such as bereavement, or to find strategies for managing life better.
Longer-term psychotherapy, individual or in groups, helps understand the origins of the problems in the past and to bring about change in the present.
There can be considerable overlap between counselling and psychotherapy.
Psychotherapists can offer up to four sessions per week.
Some work with a sliding scale of fees. GP can also refers to a psychologist who can provide cognitive behavior therapy.
This is a short-term treatment, usually one session per week.
It can helps to identify and change unhelpful patterns of thinking and behaving.
ELECTROCONVULSIVE THERAPY (ECT)
ECT is a controversial medical treatment for mental illness.
It involves passing an electric current through the brain, under anesthesia, to produce a seizure similar to a fit, with the aim of relieving severe depression.
ECT can cause unwanted side effects in some people, including drowsiness, confusion, memory loss, headaches and nausea.
HOW TO IMPROVE MENTAL HEALTH?
Facing up to problems
Finding someone to talk to
A class of mental disorders including anorexia nervosa, bulimia nervosa, pica, and rumination disorder of infancy.
Eating disorders are characterized by a preoccupation with weight that results in severe disturbances in eating and other behaviors.
Eating disorders include anorexia nervosa, bulimia nervosa and binge-eating disorder.
Other variations of eating disorders occur, such as purging without bingeing, chewing and spitting without purging, and anorexic behavior with less severe weight loss.
Most people with eating disorders are females. Males also can develop eating disorders, but do so less frequently.
The exception is binge-eating disorder, which appears to affect almost as many males as females.
Treatments for eating disorders may involve nutrition education, psychotherapy, family counseling and medications.
SIGNS AND SYMPTOMS
Anorexia nervosa . Essentially self-starvation, this disorder involves a refusal to maintain a minimally normal body weight. In severe cases, anorexia can be life-threatening.
Bulimia nervosa . This involves repeated episodes of binge eating, followed by ways of trying to purge the food from the body or prevent expected weight gain. People can have this condition and be of normal weight.
Binge-eating disorder . This is characterized by frequent episodes of overeating without purging.
Signs and symptoms of anorexia nervosa
Weight loss, sometimes achieved by self-induced vomiting, abuse of laxatives, use of diuretics or exercise
Refusal to maintain normal body weight, sometimes weighing 15 percent or more below normal body weight
Intense fear of gaining weight
Negatively altered body image
In females, menstrual changes or the absence of menstruation
Anxious or ritualistic behavior at mealtimes
Irregular heart rate
Baby-fine hair covering the body (lanugo)
Brittle nails and hair
Low blood pressure
Signs and symptoms of bulimia nervosa
Recurrent episodes of binge eating
Feeling that cannot control eating behavior
Eating much more food in a binge episode than in a normal meal or snack
Following a binge with efforts to prevent weight gain – such as self-induced vomiting, using laxatives or other medications, fasting or excessive exercise
Unhealthy focus on the body shape and weight.
Damaged teeth and gums from gastric acid contained in vomit
Swollen cheeks from regular vomiting
Signs and symptoms of Binge-eating disorder
Recurrent episodes of compulsive overeating not followed by purging
No control over eating behavior
Feelings of shame or guilt
Increased blood pressure and cholesterol levels
It's often difficult to distinguish between an eating disorder and the whims and fads of adolescence.
Parents need to be alert to sustained changes in dietary habits, not the occasional quirks that are part of growing up.
Many teenage girls, and some teenage boys, go on diets to lose weight and stop dieting after a short time.
As a parent, be careful not to mistake occasional dieting with an eating disorder.
However, dieting can be a problem when the child stops gaining weight during pre-adolescent years, because the child should be gaining as much as 10 pounds a year.
Other behaviors that may indicate the child has a potential eating disorder:
Not wanting to eat meals with the family
Frequent, long visits to the bathroom during or just after meals – teenage child may run water to obscure the sound of induced vomiting
Excessive exercise or preoccupation with weight.
Doctors aren't sure of the exact causes of eating disorders.
It appears that a variety of factors are involved, including genetics, family behavior and culture.
In some instances in people with eating disorders, researchers have found the biological systems in the brain that govern appetite and digestion are not functioning properly.
Part of the explanation may also be the messages that the media in modern, economically developed nations send to young people, particularly females.
These messages are that excessive thinness is attractive.
To be as thin as some teen idols and models requires some people to achieve and maintain a weight that's not healthy.
Although it's possible for some idols and models to be both thin and healthy, the trouble arises when some young people aren't able to sustain those body shapes without an unhealthy – for them – amount of weight suppression.
For some young people, the media message of thinness contributes to a distorted body image.
A bright, high-achieving 14-year-old who is rational in every other way may come to believe that 90 pounds is the ideal weight for her 5-foot-4-inch frame, when 110 pounds is actually the average weight for a girl that age.
Gradually, she may begin skipping meals, denying herself the fuel her body needs to develop normally.
She may get thinner and thinner, but still believe she is fat.
Eventually, she may become so undernourished that she needs to be admitted to a hospital for treatment of anorexia.
Gender . Teenage girls and young women are more likely than teenage boys and young men to develop eating disorders, though eating disorders do occur in teenage boys and young men.
Age . Although eating disorders can occur in midlife, they are much more common during the teens and early 20s.
Family influences . People who feel less secure in their families, whose parents and siblings may be overly critical or whose families tease them about their appearance are at higher risk of eating disorders.
Heredity . Eating disorders may be more common in people who have close family members with eating disorders.
Emotional disorders . People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder. People with anorexia tend to have perfectionist traits. Some with bulimia have problems with impulse control.
Excessive exercise . People who participate in highly competitive athletic activities are at greater risk of developing an eating disorder.
WHEN TO SEEK MEDICAL ADVICE
Eating disorder – severe weight loss or alternating between binge eating and strict dieting.
Because denial often is a part of eating disorders, seeking medical advice may come only at the insistence of a family member or friend.
If notices the signs and symptoms of eating disorders in a family member or friend, urge that person to talk to a doctor.
SCREENING AND DIAGNOSIS
Doctor will perform a physical examination and asks a number of questions about eating habits and medical history.
The questions may focus on the history of dieting and binge eating, whether it is self-induce vomiting or use laxatives, exercise routine, perceiving how the body image, and thinking how others perceive the body image.
Doctors diagnose eating disorders based on symptoms and eating habits.
Besides recording the weight, a physical exam will helps to determine any side effects of an eating disorder.
These complications may include problems with gums or teeth, bloating, unusual heart rhythms, loss of bone density, anemia and changes in menstrual cycle.
Complete blood count (CBC).
Other imaging tests. Tests such as a computerized tomography (CT) scan may reveal damage to the brain or digestive tract.
Bone density test.
Tests of the function of various organs. May order more extensive blood tests to detect the blood levels of hormones, enzymes, proteins, electrolytes, vitamins and other substances to gauge the performance of various organs, such as liver, kidney, thyroid, pituitary gland and ovaries.
People with anorexia have a greater variety of health complications and a greater risk of death than do people with bulimia.
However, both eating disorders can result in serious health problems.
The most serious health risk from anorexia is death, either because of the effects of severe weight loss or by suicide.
It's estimated that as many as one in 10 people with anorexia will die from complications of the disorder.
Other problems include:
Heart disease . Anorexia can cause irregular heart rhythms and result in smaller heart muscles. Heart disease is a common cause of death for people with anorexia.
Hormonal changes . Changes in reproductive hormones and in thyroid hormones can cause absence of menstruation (amenorrhea), infertility, bone loss and retarded growth.
Nerve damage . Anorexia may cause brain and nerve damage, seizures and loss of feeling.
Digestive problems . Anorexia can cause constipation and bloating.
Imbalance of minerals and electrolytes . Body needs adequate levels of minerals, particularly calcium and potassium, in order to maintain the electric currents that keep heart beating. Disruption of the body's levels of fluids and minerals creates an electrolyte imbalance. Unless restored, this imbalance can be life-threatening.
The related health problems aren't as severe for bulimia, partly because most people with bulimia maintain a normal weight. Complications may include:
Teeth and gum problems . The presence of gastric acid in the mouth from regular vomiting may cause damage to teeth and gums.
Low potassium levels . The purging process tends to make the body dehydrated and lower the level of potassium in the blood. This can cause weakness and irregular heart rhythms.
Digestive problems . Purging may cause irritation of the walls of esophagus and rectum. Repeated purging may also cause constipation.
Abuse of medications . The variety of over-the-counter drugs may use during purge cycles may cause a drug problem. Some medications used include laxatives, diuretics, appetite suppressants and ipecac, a drug that induces vomiting.
This eating disorder can cause a variety of complications, including:
High blood pressure
Elevated cholesterol levels
Type 2 diabetes
Severe cases of anorexia may require immediate hospitalization in order to rehydrate the body, restore electrolyte balance, and begin nutritional rehabilitation and weight gain.
For anorexia, dietitian wants to set on a course to gradually gain weight.
To treat either anorexia or bulimia, doctor recommends nutrition education, psychotherapy and family counseling.
Doctor may also prescribe medications to reduce bingeing, vomiting and preoccupation with food or to treat the depression and anxiety that may be associated with eating disorders.
Follow a regular schedule of meals.
Stop eating when you're full, not stuffed.
Eat healthy, well-balanced meals.
Take vitamin and mineral supplements.
Exercise regularly, but in moderation.
Regular checkup . Discussing about proper weight and proper nutrition.
Boosting self-esteem . Get involved in activities that interests and that are personally rewarding. These may include learning a new skill, developing a hobby or participating in a social group in the church or community.
Improves family's dynamics . Work to improve the atmosphere of acceptance and inclusion in family. Often, low self-esteem can lead a child into anorexic or bulimic behaviors. Show love to the child and find ways to say good things about your child.
Be realistic . Don't accept what some of the media portray about what's a normal weight and what's an ideal body image.
Any objectively unfounded morbid dread or fear that arouses a state of panic.
The word is used as a combining form in many terms expressing the object that inspires the fear.
Giving a public presentation makes many people nervous.
But it makes worry for weeks ahead of the event, and may even start to feel sick if thinking more about it.
Or, perhaps anxious about driving through a tunnel – go miles out of the way to avoid it.
A phobia is a persistent irrational fear of an object or a situation that's generally considered harmless.
Accompanying the fear is a strong desire to avoid ‘what you fear’ and, in some cases, an inability to function at normal tasks in the job and in social settings.
Phobias are among several anxiety disorders, which also include panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder and generalized anxiety disorder.
Treatment may helps to reduce the fears and helps better manage the object or situation that makes anxious.
SIGNS AND SYMPTOMS
Common phobias include:
Specific phobias . These include a fear of: enclosed spaces (claustrophobia); animals, particularly spiders, snakes or mice; heights (acrophobia); flying (pterygophobia); water (hydrophobia); storms; dentists; tunnels; bridges; not being able to get off public transportation quickly. There are many other simple phobias.
Social phobia . More than just shyness, social phobia involves a combination of excessive self-consciousness, a fear of public scrutiny or humiliation in common social situations, and a fear of negative evaluation by others.
Fear of public places (agoraphobia) . Most people who have agoraphobia developed it after having one or more panic attacks. Agoraphobia is a fear of being alone in a place such as a mall or an elevator or a room full of people, with no easy means of escape if a panic attack should occur.
Having a phobia may produce the following signs and symptoms:
A persistent, irrational fear of a specific object, activity or situation.
An immediate response of uncontrollable anxiety when exposed to the object of fear.
A compelling desire to avoid and unusual measures taken to stay away from ‘what you fear’.
An impaired ability to function at normal tasks because of the fear.
Often, the knowledge that these fears are out of proportion with the stimulus.
When facing the object of phobia, an experience of panicky feelings, such as sweating, rapid heartbeat, avoidance behavior, difficulty breathing and intense anxiety.
In some cases, anxious feelings when merely anticipating an encounter with ‘what you fear’.
Much is still unknown about what causes phobias.
There may be a strong correlation between the phobias and the phobias of parents.
Children may learn phobias by observing a family member's phobic reaction to an object or a situation.
An example of a common learned phobia may be the fear of snakes.
WHEN TO SEEK MEDICAL ADVICE
Simply feeling uncomfortable or uncertain about an object or situation may be normal and common.
If phobia isn't disrupting the life, it's not considered as a disorder and may not need treatment.
But if fear becomes irrational and uncontrollable to the point that it affects the social interactions or job duties, may have a disorder that requires medical or psychological treatment.
See the doctor or a mental health professional such as a psychiatrist or psychologist.
Psychiatrists are medical doctors – be sure to see the medical doctor to rule out other causes for the anxiety.
SCREENING AND DIAGNOSIS
Doctor will likely ask to describe the symptoms, how often they occur and what triggers them.
Sometimes physical disorders occur along with anxiety disorders.
As with other anxiety disorders, will probably undergo a complete physical exam so that the doctor can determine whether health conditions other than phobias could be causing symptoms of anxiety.
Phobias sometimes occur along with other anxiety disorders and may be accompanied by depression, abuse of alcohol or other substances, or eating disorders.
Doctor may try to identify other mental disorders that may exist before suggesting a course of treatment.
COMPLICATIONS Having a phobia may cause other problems, including:
Social isolation . If presence of phobia, avoid social situations and public places.
Depression . The avoidance of many activities that other people find enjoyable in their personal and professional lives may lead to become depressed.
Substance abuse . Some people with phobias turn to alcohol or other drugs to deal with stress. This unwise and unhealthy choice can lead to abuse of alcohol or other drugs.
Doctor or a mental health professional may suggest medications or behavior therapy or both to treat phobias.
Most people don't get better on their own and require some type of treatment.
The objective of treatment is to reduce anxiety and fear and helps to better manage the reactions to the object or situation that causes them.
Beta blockers – blocking the stimulating effect of epinephrine (adrenaline) and anxiety, including increased heart rate, elevated blood pressure, pounding of the heart, and shaking voice and limbs.
Antidepressants – commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs). Act on the chemical serotonin, a neurotransmitter in the brain that's believed to influence mood.
Sedatives – benzodiazepines helps to relax by reducing the amount of anxiety. Sedatives need to be used with caution because they can be addictive.
Desensitization or exposure therapy focuses on changing the response to the feared object or situation. Gradual, repeated exposure to the cause of the phobia may help in learning to conquer the fear.
eg., if afraid of flying, the therapy may progress from having think about flying to looking at pictures of airplanes, to going to an airport, to sitting in an airplane, and to finally taking a flight. Some major airlines offer programs to help adjusting to flying.
eg., a group of people with the same fear may all sit in an airplane together, but the airplane won't take off.
Cognitive behavior therapy is a more comprehensive form of therapy.
It involves the patient and the therapist learning ways – can view and cope with the feared object or situation differently.
Learn alternative beliefs about the feared object or situation and the impact it has on life.
There's special emphasis on learning to develop a sense of mastery and control of thoughts and feelings.
Simple phobias usually are treated with behavior therapy.
Social phobias may be treated with antidepressants or beta blockers, along with behavior therapy.
Agoraphobia, especially when it's accompanied by a panic disorder, is usually treated with SSRIs and behavior therapy.
COPING SKILLS If phobias persistently causes anxiety and cause disruptions to the life on a daily basis, seeing doctor is a necessary first step along a course of professional treatment. But to deal with everyday anxieties, whatever their cause, try these coping strategies:
Take action . Determine what's making anxious and address it.
Let it go . Try not to dwell on past concerns. Change what can and let the rest take its course.
Break the cycle . When feeling anxious, take a brisk walk or delve into a hobby to refocus.
Self-care . Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety. Don't turn to alcohol or unprescribed drugs for relief.
Talk to someone . Share problems with a friend or a counselor who can help to gain perspective. Ask doctor about support groups in the area for people who have phobias.
M E N T A L R E T A R D A T I O N
Mental retardation is described as below-average general intellectual function with associated deficits in adaptive behavior that occurs before age 18.
Sub-average general intellectual functioning that originates during the developmental period and is associated with impairment in adaptive behavior.
The American Association on Mental Deficiency lists eight medical classifications and five psychological classifications; the latter five replace the three former classifications of moron, imbecile, and idiot.
Mental retardation classification requires assignment of an index for performance relative to a person's peers on two interrelated criteria: measured intelligence (IQ) and overall socio-adaptive behavior (a judgmental rating of the individual's relative level of performance in school, at work, at home, and in the community).
In general an IQ of 70 or below indicates mental retardation. (mild = 50/55-70; moderate= 35/40-50/55; severe = 20/25-35/40; profound = below 20/25); an IQ of 70-85 signifies borderline intellectual functioning.
CAUSES, INCIDENCE, & RISK FACTORS
Causes of mental retardation are numerous, but a specific reason for mental retardation is determined in only 25% of the cases.
Failure to adapt normally and grow intellectually may become apparent early in life or, in the case of mild retardation, not become recognizable until school age or later.
An assessment of age-appropriate adaptive behaviors can be made by the use of developmental screening tests.
The failure to achieve developmental milestones is suggestive of mental retardation.
A family may suspect mental retardation if motor skills, language skills, and self-help skills do not seem to be developing in a child or are developing at a far slower rate than the child's peers.
The degree of impairment from mental retardation has a wide range from profoundly impaired to mild or borderline retardation.
Less emphasis is now placed on degree of retardation and more on the amount of intervention and care required for daily life.
Risk factors are related to the causes.
Mental retardation affects about 1% to 3% of the population.
Causes of mental retardation can be roughly broken down into several categories:
Unexplained (This category is the largest and a catchall for undiagnosed incidences of mental retardation.)
Trauma (prenatal and postnatal) – intracranial hemorrhage before or after birth; lack of oxygen to the brain before, during, or after birth; severe head injury
Infectious (congenital and postnatal) – congenital rubella; meningitis; congenital CMV; encephalitis; congenital toxoplasmosis; listeriosis; HIV infection.
Chromosomal abnormalities – Down's syndrome; defects in the chromosome or chromosomal inheritance (fragile X syndrome, Angelman syndrome, Prader-Willi syndrome); chromosomal translocations
Failure to meet intellectual developmental markers
Persistence of infantile behavior
Lack of curiosity
Decreased learning ability
Inability to meet educational demands of school
Note: Deviations in normal adaptive behaviors depend on the severity of the condition. Mild retardation may be associated with a lack of curiosity and quiet behavior. Severe mental retardation is associated with infantile behavior throughout life.
SIGNS AND TESTS
Development significantly less than that of peers
An intelligence quotient (IQ) less than two standard deviations below the mean (This is frequently classified as a score below 70 on a standardized IQ test where 100 is the mean.)
Adaptive behavior score
Abnormal Denver developmental screening test
The primary goal of treatment is to develop the person's potential to the fullest.
Special education and training may begin as early as infancy.
This includes social skills to help the person function as normally as possible.
It is important for a specialist to evaluate the person for coexisting affective disorders and treat those disorders.
Behavioral approaches are important in understanding and working with mentally retarded individuals.
EXPECTATIONS / PROGNOSIS
The outcome is related to the aggressiveness of treatment, personal motivation, opportunity, and associated conditions.
Many people lead productive lives while functioning independently; others require a structured environment to be most successful.
Inability to care for self
Inability to interact with others appropriately
Genetic : Prenatal screening for genetic defects and genetic counseling for families at risk for known heritable disorders can decrease the incidence of genetically caused mental retardation.
Social : Government programs to insure adequate nutrition are available to the underprivileged in the first and most critical years of life, which can reduce retardation associated with malnutrition. Social programs to reduce poverty and provide good education can impact the mild "retardation" associated with impoverished and lower socioeconomic status. Early intervention in abuse and deprivation will also help.
Toxic : Environmental programs to reduce lead and mercury exposure and other toxins will reduce toxin-associated retardation. However, the benefits may take years to become apparent. Increased awareness by the public of the effects of alcohol and drugs during pregnancy can reduce the incidence of retardation.
Infectious : The prevention of congenital rubella syndrome is probably one of the best examples of a successful program to prevent one form of mental retardation. Constant vigilance, such as in the relationship of cats, toxoplasmosis, and pregnancy, helps to reduce retardation that results from this infection.
Obsessive-Compulsive Disorder [OCD]
A type of anxiety disorder whose essential feature is recurrent obsessions, persistent, intrusive ideas, thoughts, impulses or images, or compulsions (repetitive, purposeful, and intentional behaviors performed in response to an obsession) sufficiently severe to cause marked distress, be time-consuming, or to significantly interfere with the individual's normal routine, occupational functioning, or usual social activities or relationships with others.
What is OCD?
OCD is an anxiety disorder.
People who have OCD are often or always troubled by ideas or images that stick in their mind.
These thoughts, called obsessions, are sometimes bizarre.
They cause to feel anxious and force to behave in ways that make no sense.
May perform repeated, ritualized acts to reduce the anxiety. These acts are called compulsions.
OCD affects between 1% and 2.5% of people in this country.
Men with OCD usually begin having symptoms from 6 to 15 years of age, women in their early 20s.
HOW DOES IT OCCUR?
The cause of OCD is unknown.
It tends to run in families. Some studies show that parts of the brain work differently in people with OCD.
Some forms of OCD may be related to strep infections. OCD often occurs along with mood disorders such as other anxiety disorders, depression, and bipolar disorder.
SIGNS & SYMPTOMS
If presence of OCD – usually aware that obsessions or compulsions are keeping from living fully and well.
Behavior as foolish or pointless, but it is very hard to change it.
Obsessions often concern doubts about matters of safety (like whether to shut off the stove).
Sometimes thoughts have to do with a fear that something awful will happen or that will do something terrible (like kill loved ones for no reason).
Spend hours each day performing compulsive acts.
The behavior may seriously disrupt the everyday life.
Some of the typical compulsions or rituals of OCD include:
Cleaning : Fearing germs, shower several times a day or wash hands until the skin is cracked and painful.
Repeating : To reduce anxiety, may repeat a name or phrase many times.
Completing : Do things in an exact order and repeat each step until things are done perfectly.
Checking : Fear harming self or others by forgetting to lock the door or unplug the toaster, checking over and over again to see that it is done.
Hoarding : May collect useless items that repeatedly count and stack.
People with OCD often have depression or the symptoms of depression. These include:
Inability to make decisions.
OCD symptoms often create problems in relationships and daily living.
In extreme cases, may become totally disabled.
Unable to leave home because spend the days doing rituals or having obsessive thoughts.
There is no lab test for OCD.
Health care provider will make the diagnosis by talking to patient and someone closer about the symptoms.
He/she will ask very specific questions about the type of obsessions or compulsions you have.
Patient may have OCD if obsessions or compulsions:
Causes marked distress
Take more than an hour of time a day
Get in the way of normal routine, work, social activities, or relationships.
Health care provider may ask such questions as:
Do you have troubling thoughts that cannot ignore or get rid of no matter how hard you try?
Do you keep things very clean or wash hands a lot more than other people?
Do you check things over and over, even though know that the oven has been turned off or that the front door is locked?
Health care provider will check to make sure that a medicine or drug is not adding to the symptoms. Also, because fears (phobias) and depression can occur along with OCD, it is important for the health care provider to be able to tell which is which.
Antidepressant drugs and behavior therapy are very helpful in treating OCD.
The type of behavior therapy most often used to treat OCD is called exposure and response prevention.
It consists of having confront fears head-on by gradually increasing the exposure to them.
With help from the therapist, learn to overcome the anxiety.
If, for eg., washing hands all the time because of fear being dirty, doctor may stand at the sink and prevent washing hands until the anxiety goes away. This process also involves learning ways to relax, such as breathing exercises.
HOW LONG WILL THE EFFECTS LAST?
Symptoms of OCD can be effectively managed with treatment.
Without treatment, the disorder may last a lifetime, becoming less severe from time to time, but rarely going away completely.
In some people, OCD occurs in episodes, with years free of symptoms before a relapse. Advances in therapy and new medicines are helping many people with OCD live productive lives.
Including patient’s family in the therapy.
May benefit from reading books and viewing videos on OCD, and from joining support groups.
Follow provider's instructions for taking medicine and don't miss the therapy sessions.
Know that you are not alone.
There are millions of people affected by OCD, and there are national groups devoted to helping people with this disorder.
Remember that over 90% of people with OCD can manage this disorder with proper treatment.
INTEGRATED YOGA MODULE FOR COMMON PSYCHIATRIC DISORDERS
Sithilikarana Vyayama (loosening exercises)
Spinal twist and Spinal stretch
Forward and Backward bending
Alternate toe touching
Relax by walking
Alternate Bhujangasana and Parvathasana
Side leg raising
Quick relaxation technique (QRT)
Deep relaxation technique (DRT)
Vibhaga pranayama (Sectional breathing)
Surya Anuloma pranayama
Sitali/ Sitkari/ Sadanta
Meditation (Dhyana Dharana)
General considerations : The tolerance and needs of people with neuroses may vary considerably. Beside yoga these people may benefit from various forms of psychotherapy.
Contraindications : Usually little limitations. Sometimes long relaxation and meditation is not tolerated well because of the unpleasant thoughts and powerful memories which can arise.
Recommendations : Relaxation, physical exercises of yoga, many yoga practices according to individual needs.
Contraindications : In severe mental problems like schizophrenia or drug induced psychoses long meditation and relaxation may increase problems. This effect can be even stronger in unfamiliar environment. Also stimulating pranayamas (Kapalabhati, Bhastrika, practices with long internal breath retention) can activate unresolved problems and conflicts and should be usually avoided in severe mental problems.
Recommendations : Karma yoga, simple physical practices such as Pavanmuktasana, brief Savasana, support and understanding.
Contraindications : All practises activating the body and mind shortly before going to sleep.
Recommendations : Relaxation practices are very beneficial, at the end of relaxation a student should not force himself/herself to sleep but should simply remain relaxed and wait. Balanced and regular life style are important.