Tuesday, 26 July 2011

When the Mind is Disturbed

Published in Panorama

When the mind is disturbed

Javed looked around furtively for known faces before entering the Psychiatric clinic. Once inside, he began pouring his cup of woes to the specialist. He was no doubt distraught and insisted that someone was doing magic on him. He was convinced that some supernatural power was passing electricity through him, in his entire house and even while he was at the swimming pool!

Janson was terrified of getting behind the wheel when vehicles were plying alongside his own. He was complaining of palpitations, sweating on the forehead, of feeling anxious, tremulous and nervous. He was constantly fearful of being involved in an accident while driving!

Loveena was severely depressed as she allowed random thoughts to plague her mind. She desperately wanted to get help but would not bring herself to have a psychiatrist examine her; she’d rather get to a physician whom she knew, may not be able to help her much.

Says Dr.Sanjay Khanna, Psychiatrist, Zulekha Hospital, Sharjah, “Whenever you come to a psychiatrist, you fear being labeled as crazy or loony, or worse still, insane. But this is a misconception a lot of people have, something I wish to dispel! People are held back by social taboos and the stigma that has come to be associated with psychiatry. I want to impress upon people the fact that a visit to the psychiatrist does not imply any such thing; rather people must take help before their problems assume serious proportions and even treatment becomes difficult.”

Dr.Khanna further reassures, “If a person comes to me and I see that there is a very mild problem, I wouldn’t even prescribe any medicine! Treatment methods have changed and the entire approach is holistic. We emphasize on alternative methods like yoga, breathing exercises, relaxation techniques, psycho-therapy, counseling and lifestyle changes.”

Tension headaches, migraine, anxiety, depression, epilepsy, sleep disorders, eating disorders particularly in youngsters, addictions, phobias, manias, schizophrenia, bed-wetting, thumb sucking, nail-biting and such other mannerisms in children, would all come under the purview of psychiatry, according to Dr.Khanna.

A number of these conditions, he says, are very common here in the UAE, particularly among the expatriate population. Being away from family, kith and kin, a feeling of insecurity with respect to their jobs, all these magnify their anxiety levels and often lead to anxiety disorders and depression.

“Broadly we can classify most patients into two categories, neurotics, as in the case of Janson and Loveena, and psychotics, as seen in the case of Javed. Put very simply, the neurotics are aware of their problem, their fears and phobias while the psychotics lack “insight”; they carry on with life without realizing they have some problem. However, most of the cases we get are the neurotics and very little, say about 5% of the cases may be psychotics.”

Dr.Khanna reveals, “In fact, diagnosis is very easy in the case of psychotics because their actions are so easily perceived by those around them. These individuals do not talk or behave normally, they often skip bath, pick up some dirt from outside, don’t care to groom themselves presentably, are very excited; they often abuse and beat people without reason and have a tendency to be violent. These people often talk a lot, talk big and in the air.”

What exactly leads these people to behave the way they do? “Heredity factors, environmental factors and biological factors may be responsible for the conditions,” opines Dr.Khanna. “Our brain and nervous system are controlled by neurotransmitters or a type of messengers that carry impulses. The regulation of these neurotransmitters may be disturbed due to environmental pressures, family conditions and socio-cultural factors. This leads to the thought process of the person being disturbed. Because the neurotransmitters are basically responsible for thinking, when the thought process is changed, it leads to psychological problems.”

As far as the neurotics are concerned, a majority of them suffer from depression, anxiety disorders including Obsessive Compulsive Disorder, stress Disorder and eating disorders. Dr.Khanna explains, “People may suffer bout of depression simply for no reason. Alternatively, it may stem from traumatic events in life, tragic experiences, severe or long standing illness. Not only that, nobody is truly immune to depression and it may affect the young and the aged, equally.”

How does depression manifest itself? Says Dr.Khanna, “Depression mostly presents as headaches and other bodily symptoms like pain all over the body, palpitation, tremors, sweating and numbness. Because of these physical manifestations, the victims first seek the help of physicians,” says Dr.Khanna. “When all investigations are done and nothing is found, they begin thinking along the lines of psychology. And unfortunately, these are the people who seek help very late because for a long time they get a lot of advice from well-meaning friends and family. As far as anxiety and depression are concerned, they are caused by the influence of a gamut of factors which include heredity, psychological and environmental factors. The symptoms of the two are often over-lapping and difficult to draw the exact dividing line between them. Sometimes, the problem could be in the brain, when the neurotransmitters are not functioning right. In such instances, they require to be treated with specific drugs.”

The depressed give way to frequent sadness, moods, exhibit a sense of hopelessness and helplessness, are pessimistic, take no interest even in the routine activities, keep away from work and people, give way to feelings of guilt, are given to crying and laughing bouts, can’t stay focused on anything. “At the peak of depression the victim might turn suicidal when emergency measures may be needed to treat him.”

What’s the kind of time it takes for depression to progress to this suicidal state? Dr.Khanna clarifies, “There is no fixed time duration for this progression because the onset of depression itself may be acute or chronic. In the acute situation the condition progresses within 10 days; in the chronic case, it can involve even a year or two.”

Once diagnosed as being neurotic or psychotic, what is the treatment modality. “In some cases, mere counseling may be sufficient alongside therapies like yoga, meditation and the like. In other instances we may have to use a variety of drugs in addition to these therapies,” says Dr.Khanna. “However, we take recourse to ECT or Electro Convulsive Therapy in those psychotic patients who are not controlled on drugs, are not responsive to them or are not co-operative enough to take the drugs, or when the disease is in such a serious condition that we have to do something very urgently. Say for instance, the person is homicidal or suicidal; we have to take immediate action as the patient may not be in a position for the drug to take action and calm him. Similarly, we also use it in the severely depressed who contemplate suicide.”

What is the duration of treatment with ECT or Shock treatment as it is commonly known? “Ideally it’s a course of 6-14 sessions, depending on the severity of the condition,” explains Dr.Khanna. “Most of the times 6 shots are enough. These are given twice or thrice a week, under general anesthesia in the operation theatre. The current we pass through the brain is hardly of 1-2 seconds duration. It is not a painful process when given by proper hands with a good machine. Also, since the patient is under anesthesia, he doesn’t feel anything.”

Are there any side effects from the procedure? “There is no absolute contra-indication of ECT except in cases where there is some intra-cranial tension or tumour in the brain. There may be headache for a few days after the procedure and also amnesia for a temporary period of time, say about 6 weeks, within which time the person recovers completely. If all necessary investigations are done prior to an ECT, the risk from it is practically not there at all,” assures Dr.Khanna.


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