Wednesday, November 13, 2013

Alternative therapies and Psychiatry

A lot of my patients ask me about the role and effectiveness of treatments other than those available in the Modern Medical methods such as I use. I feel the decision about which system of medicine to choose is entirely of the patients. No doctor should discourage or condemn another form of treatment.

These approaches include faith healing, prayer, magical- religious rituals, homeopathy, ayurveda, siddha, etc

In Psychiatry, no treatment or belief system has been found to be clearly ineffective. Especially, for common mental disorders (CMDs) such as mild forms of fearfulness, depression, low energy states, difficult personalities, etc there is no rule that ONLY treatments of modern medicine work. By their nature these disorders have increasing- decreasing pattern.  Based on their values and beliefs, patients may recover from such problems by use of alternative approaches.

For major mental disorders like schizophrenia, bipolar disorder, severe forms of depression, obsessive compulsive disorders and severe personality disorders, modern medicine works better and faster and more predictably.

Of the well-organised systems of medicine like homeopathy or ayurveda or Unani, I would say that people should always go to qualified and experienced professionals. MBBS. MD persons who later practice these forms of medicine by reading books are to be avoided as they are nothing but quacks. Patients should follow the instructions of their doctors and find out what is the reasonable time by which they can expect improvement. One should always make a time-bound plan. If you are not improving within a reasonable time or even getting worse, then you should really consider changing the doctor or system of medicine.

Patients can choose any form of treatment. But I strongly recommend a practical approach. Please choose whatever gives you results in reasonable time and fees. Always take a psychiatric opinion about the diagnosis and prognosis. Sometimes people spend so much time doing these things that their illness becomes severe and beyond repair by any form of treatment. Otherwise they spend so much money, there is none left for proper treatment. Taking an opinion prevents this problem by letting you know what you are dealing with in advance.

There has really been no research comparing the effectiveness of different systems of treatment for different psychiatric disorders. There is also no research about how different forms of medicine will interact when given together. So if any patient asks me what is better, or can I take both together then I can give no  answer. I really never argue with people who claim some forms of treatment have absolutely no side-effects and offer absolute cure. Because I know Psychiatric disorders are not like that. They are not diseases but disorders and the dysfunction permeates every corner of the individual. Most are chronic and caused by brain changes. So it is very difficult to target the 'abnormal' portion and treat in such a focussed way as to have no side effects. Or to rid the body of the abnormality so easily.

Thursday, July 25, 2013

Preschoolers behavior management- continued

I live in a joint family. That’s why I am unable to give time to my daughter. Please guide me.
You will have to make up your mind about changing the situation and then do the following:
1.       Communicate to your family that your daughter being your responsibility, you will have to keep aside some time exclusively for her on a daily basis. Recruit your husband in helping you, first.
2.       Negotiate with your family to share some responsibilities like attending functions- everyone need not attend all functions
3.       Go slow on trying to take excessive responsibilities just to please someone
4.       Be open to taking help from other family members or even paid help, rather than doing everything on your own
5.       Try to do your tasks in an easy way and if possible, using electrical appliances. You will save time and energy and use that with your daughter
6.       Be opportunistic- plan in advance what you will do the next time you get some time off. You need not always be taking your daughter’s studies- you can chat with her, play with her or go shopping with her

माझा मुलगा समनवयस्क मुलांबरोबर मिक्स होत नाही. त्यांच्यावर चीड-चिड करतो. तो त्याच्या पेक्षा मोठ्या मुलांबरोबर मिक्स होतो. त्याबद्दल काय करावे?
आपल्या पेक्षा मोठ्या मुलांबरोबर मिक्स होण चांगलंच आहे. पण आपल्या पेक्षा लहान किवा आपल्या वयाच्या मुलांशी जमवून घेणं पण महत्वाचा आहे. त्यासाठी त्याला कसे वागायचे ते समजावा आणि तो खेळत असताना त्याच्या बरोबर राहून त्याला मार्गदर्शन करा. हळू-हळू त्याला सवय होईल.

माझा मुलगा वर्गात किवा घरी एका जागी स्थीर बसत नाही, त्यावर उपाय सांगा.
एकाग्र वाढवण्याकरता कौसेलिंग चा उपयोग होतो का?
५-६ वर्षांपर्यंत मुलं अस्थिर असू शकतात. अस्थिर मुलांना शक्य तितकं सोपं आणि छोटी काम द्यावी. काही सांगायचे तर थोडक्यात सांगावे. सतत लक्ष ठेवून शांत पणे त्यांना मार्गदर्शन करावे. त्यांना मारू नयेत, कारण तुमच्याकडून मारण्याची सवय ति शिकतील.
जर मुल अतिच चंचल असेल किवा ६ वर्षानंतर सुद्धा चंचल असेल तर त्याची वैद्यकीय तपशनी करून घेतली पाहिजे. जर चंचल पण खूप कमी प्रमाणात असेल तर फक्त कौन्सेलिंग नी सुधारणा होवू शकते. चंचलपणा साठी औषद आणि कौन्सेलिंग दोन्ही करणे उत्तम.

मेरी daughter हर चीज तोडफोड करती है. पुस्तक फाड देती है. इसके क्या कारण हो सकते है?
इसके दो कारण हो सकते है. एक- आपका ध्यान पाने के लिये वह ये सब करती है. तो यदि आप उसके साथ समय बिताए, उसके साथ खेले तो इसका उसे लाभ होगा. दूसरा- शायद उसे मालूम नही कि इन चीजो क सही इस्तमाल कैसें करना है. तो उसे समझाए. फिर चीज उसके हाथ मे दे. यादी फाड-तोड करती है तो चीज निकाल ले. हर बार ऐसे ही करे. इससे उसे पता चलेगा कि गलत बर्ताव करने पर चीजे उसे नही मिलेंगी. तो धीरे-धीरे उसमे सुधार होगा.

माझ्या मुलांना त्यांच्या खेळण्यांपेक्षा स्वयंपाकघरातील भांडी आवडतात. त्याबद्दल काय करावे?
काहीही करण्याची गरज नाही. जमलं तर त्यांना स्वयंपाकघरातली काम सांगा आणि शिकवा.

My child becomes very self-conscious when any relatives come home. He then does not go for potty for several days causing constipation. How can I solve this problem?

This problem has to be solved urgently. Try to find out if has any specific fears. If he is not able to tell you directly, please take him to a counselor. They will help you to find out about his fears and guide you about his management.

Wednesday, July 24, 2013

Pre- schooler's behaviors- 21-07-2013

I had gone for a lecture for parents on 'Managing Pre-school children' organised by Vidya Prasarak Mandal of Dahisar. I am uploading the questions and their answers, that followed the lecture.

 पहिल मुल शांत आणि दुसरं मुल मस्तीखोर असत असे आहे का? अशा मस्तीखोर मुलाला पहिल्या   शांत असलेल्या मुलाबरोबर वाढवताना काय अधिकची काळजी घ्यावी?
Birth order प्रमाणे स्वभाव वेगवेगळा होतोच, असे नाही. पहिल्या मुलामध्ये independence, leadership असते असे काही संशोधक म्हणतात. तसेच दुसर्या मुलामधे creativity असते. प्रत्येक मुल वेगळ असत हे मान्य करून त्यांचे संगोपन केले पाहिजे. एक मुल मस्तीखोर असल्याने त्यालाच जास्त लक्ष देणे, किव्हा त्यालाच जास्त शिक्षा करणे, असे होता कामा नयेत. शांत मुलाला आपले मत, आवडी- निवडी मांडायला वेळ आणि संधी द्या. मस्तीखोर मुलाला दुसर्याचे ऐकायची सवय लावा. दोघांना एकमेकांशी नीट वागण्याची सवय लावा.

Sometimes children show totally opposite behavior at the same time, that is, aggression as well as suddenly emotional or crying. How to handle it?
Young children do show mood changes. Some children are moody by nature. This is because their nervous system is immature and because they have not learnt about mood-management. Young children should be closely supervised/ watched at all times. If you can prevent the child from getting hurt, hungry, wet or bored- then many of these mood swings can be avoided. Talking to the child, playing with him and just describing his/ your activities while he is playing by himself will keep the child entertained and feeling secure.  After every little while the child will come to you; giving him a hug, rubbing his back, touching his nose and such other affectionate touches can recharge him emotionally. If he is mildly upset speak to him from a distance and see if he can calm himself down. If this does not work or if he gets very upset, go near him and soothe him immediately by just holding him or his hand. After he calms down check what has happened and solve his problem. Sometimes he may just feel lonely or frightened of some noise/ insect which you may not even have noticed. So reassure him and encourage him to go back to his play.

Give some tips for aggression control. Sometimes makes stories, but whether they should be believed or not?
Children are normally very aggressive between the ages of 3-6 years. So do not get disturbed if your child has started becoming aggressive. You must remove all dangerous and delicate objects from your house and avoid taking your child to any place with such things, till you have learnt to confidently manage your child in such situations. If you have not provided proper environment to the child and the child is merely playing; it is your fault. Secondly  all young children need constant watchful companionship. Give clear instructions in very short about what is expected of the child. If you see that the child is becoming very excited distract him very calmly into some  activity (Colouring, seeing pictures, giving him some water, looking through window or some housework) and do this activity with him till he calms down. It is not right to stand somewhere, instruct the child and expect him to follow you- remember he is a child. If he hits another child, making him say sorry to that child and put him in a corner for 2-3 minutes- do this every time. Most important is that you be very calm and speak in a very soft voice and slowly in very short sentences, no matter how much your child’s aggression has provoked you. Your child will copy you. Slowly your child will learn to manage his natural aggression. It will usually take several months to 1-2 years for you to teach him this. Be patient and persistent.
Children do make fantastic stories. If you are in the habit of playing with your child and chatting with him regularly and are providing him proper supervision at all times, you will be able to judge for yourself about what to believe and what not to believe. So inculcate these parenting habits first.

जी मुलं लाजरी आहेत त्यांना इतरांबरोबर कसं confident बनवावं?
तुमच्या मुलाचा स्वभाव सौम्य असेल तर त्यात काही गैर नाही. प्रत्येक व्यक्ती ‘dashing, bold’ झालेच पाहिजे असे काही नाही. तुमचा मुलगा इतर मुलांबरोबर खेळताना त्याला बघा- तो मित्रांबरोबर नीट खेळत असेल, त्याचा म्हणणं मांडू शकत असेल- तर त्याचा स्वभाव बदलण्याची काही गरज नाही. तो भित्रा असेल तर त्याला समजावा आणि जी मुले त्याच्यासारखी सौम्य आहेत त्यांच्याबरोबर खेळण्याकरिता घेवून जा. त्याने कसे वागले पाहिजे हे त्याला परत परत शांत पणे समजावा. काही महिन्यानंतर त्याचा भित्रेपणा हळू-हळू कमी होईल. त्याच्या स्वभावाची निंदा अथवा टिंगल करू नयेत.

I am a working mother. My son goes to school happily but whenever he sees me in school, he immediately starts crying and wants to come near me. Please tell me how to deal with it?

If your child is crying and wants to come near you, there is nothing to be embarrassed about. Tell him 1-2 times, very calmly, to wait. If he is not listening you must allow him to come near you and pick him up. Talk to him about it at home and explain to him what is expected of him. Repeat this calmly and with equal enthusiasm every time. Inform him that you will visit school before you do so. Whenever he follows your instruction even partially, you can reward him by looking very pleased, praising him (particularly in front of relatives) and giving him a hug. dont look very upset or disappointed, rather you must ignore it if he repeats the undesirable pattern. Slowly he will learn the expected behavior. 

Friday, June 28, 2013

EMOTIONAL CONNECT WITH YOUR CHILD

The most common problem encountered by parents nowadays is 'How to connect with my child?'. The common advice is 'talk to your child' I would say- talk as less as possible to your child.

Talking continuously can benefit only an extremely young infant, less than 6 months old. The essential skill or quality for being an effective parent is the ability to play and be playful around your child. And the main thing is to listen and respond- not just to talk.

Spending quality time is essential for creating an emotional connection with the child. Parents are unable to give enough  "quality" time to their children,. I have found that this malady  can affect all types of parents- even housewives who spend 24 hours at home and have someone to take care of their house or fathers who work from home.  A parent can give "quality" time only if the parent enjoys being with the child

 Ask yousrself whether you really enjoy being around your child? Without going into the reasons or justifications for this lack of enjoyment, confess it to someone- the best candidate for this confession is a counselor/ psychologist/ psychiatrist. The reason is- other people/ professionals are prone to be in denial that such a thing can happen or else may judge you as an 'abnormal' parent.

There are two reasons for not being able to enjoy being with your child
1. parental mental illness
2. ineffective and inconsistent parenting due to which child misbehaves
Lack of time is never an issue- if you enjoy being with your child you will be drawn to find time and once you are with your child you would not realise how time flies.

I have found that unless these factors are corrected, no amount of effort in any other way can correct the parent-child relationship.

In a nutshell- connect with yourself first- then connect with your child


Friday, April 19, 2013

PSYCHOTHERAPY AND COUNSELING

Psychotherapy is an important type of treatment available for mental illness. The lay person, fed on Bollywood concepts and Hollywood fantasy love the idea of 'therapy' or 'counseling'.

Firstly, Psychotherapy and counseling are NOT the same. Whereas, both involve discussing with and guiding the patient- the impact of each is very different. Most significantly psychotherapies can be used to treat some forms of mental illness whereas counseling cannot treat mental illness.

A counselor essentially does all or some of the following- understand the problem, allow patient to share her feelings and emotions, give emotional support during crisis, discuss the options available, choose the best solutions and execute the solutions. Some types of counseling involves givng the patient facts and information, and helping them make a choice and lifestyle change. examples are pre-admission counseling, diabetes counseling, infertility counseling. It focusses more on here and now aspects of the patient's life and cannot bring about large changes in the psyche.

Psychotherapy, on the other hand, is extremely specialised form of treatment involving working with the patient to change his/ her thought process. It is rigourous and often manualised and can bring about major changes in the patient including treating symptoms of mental illness. As of now psychotherapy can be used to treat mild and moderate depression, anxiety disorders, phobias, obsessive compulsive disorders, personality disorders, relationship disorders and childhood behavioral disorders. It cannot treat severe forms of mental illness. No counselor can or has helped anyone to cure mental illness.

I come across patients or their family members who are determined to have ONLY psychotherapy and nothing else. Their demands are usually due to being misinformed about the therapy.

 First misconception is that therapy is freely available. Actually properly qualified and trained therapists are very few and far between. All therapists are not expert at handling all types of problems. And such therapists are invariably extremely busy. So one needs to check first if a therapist is available and accessible.

Secondly patients feel that merely by 'talking out' they will feel better. This is completely false. Therapy is akin to learning a new language and involves learning, study, practice and dealing with failure. One had to set aside time for therapy, for practising the lessons of therapy and also the money needed for all that. In my experience, this is the commonest shock that people get. For a population used to buying everything from domestic help to laundry service- therapy is completely different. Just because you are paying someone does not mean they are going to relieve you of the hard work. The hard work is all from patient's side only!Therefore, therapy cannot be administered to any unwilling or unmotivated person.

Another common misconception is that therapy is harmless or has no side effects. Therapy involves spending significant amounts of your time and money. It will alter you as a person and therefore change your relationships with others. Sometimes therapy involves taking risks- such as exposure tasks, behavioral experiments, etc. And these factors can work as side effects.

Therapy is definitely very good modality of treatment available to us. The patient should undergo a comprehensive evaluation and discuss with their doctors about the options available. Choose therapy if it is feasible option. Your therapist should constanlty monitor you for worsening of illness- if tht happens go back to your doctor for medication. Choose therapy in addition to medication. It will make your recovery faster, more robust and at lesser doses of medication.

Choose your therapist carefully. The therapist should be qualified, trained and experienced in treating your illness. The therapist' clinic should be accessible and fees affordable. These latter two aspects lead to lots of drop-outs in the middle phase of therapy. Decide whether you are comfortable with your therapist and getting desired results, periodically. Steer clear of therapist who dont respect you or with whom you are uncomfortable. Your therapist deserves respect and priority. Cultivate your therapist by respecting their privacy, arriving on time, paying them and not irritating them by constant phone calls. Get the most out of your therapy by expressing your problems freely, making notes, deligently doing your homework and going for sessions regularly, as planned.

Make therapy a positive educational experience.

Sunday, January 27, 2013

REMEMBERING TO TAKE MEDICINES

Sometimes patients report to me that they have forgotten to take the medicine.

Most psychiatric medicines are 'long acting', which means their action lasts more than 24 hours. So if anybody misses a dose, they will not face any immediate consequences. The good part of this is- patient remains without symptoms even if one medicine dose is missed. The bad part is- even if the patient wants to take the medication without fail, there is no symptom by which his body may remind him that a dose has been missed.

Even though psychiatric medications are long-acting and do not give symptoms if 1-2 doses are missed, I would recommend that patient MUST take every dose without fail. This is because all psychiatric medications depend on 'steady' drug levels in the body for their proper action. The drug levels remain steady only if medicne is taken very regualry. Besides, a person who forgets to take one dose is likely to miss many doses. Eventually the drug levels will fall so low that medication becomes ineffective.

 A patient who remains well inspite of missing some doses, will begin to feel that he is well and probably does not need medication. A patient who takes medicine irregularly but falls sick, may feel that the medicine is ineffective. By forgetting even a few doses, the patient runs the risk of misinterpreting the effectiveness of his medications at the least. At the worst, he may suffer a relapse.

In my exprience, forgetting is a genuine problem. All patients should take proper action once they realise that forgetting is a problem for them. In the initial phase of treatment, every patient should be closely supervised by a responsible relative. Medicines should not be with the patient. Every dose should be given to the patient by the relative, and the relative should stay there till a few minutes after the patient swallows the medicines. After the patient recovers, relatives should remind them to take medicines and set up some way to check that the patient is taking medicine regularly. Both patient and relatives should keep track of the medicine stock, to ensure proper availability.

A pill-box is a very practical way to organise doses. It also helps to keep track of the doses and the stock of medicines. By keeping the pillbox in prominent place and checking frequently, forgetting can be reduced. Patient should try to tie up medicing-taking with some regular activity such as teeth brushing, breakfast, etc. One can go as far as storing the medicine near the toothbrush or keeping it near the breakfast cutlery. Soon it becomes a part of the regular routine. Whenever the patient forgets to take medication, he will feel odd as if something is missing and that will remind him to take medication. Some patients maintain a chart to keep record and minimise forgetting.

Taking medicine regularly is a habit like any other. Initially one has to make effort to include it in our routine. But soon it becomes a part of our subconscious memory and we will automatically be drawn to take medicine when the time comes.

Some patients do not like to take medicines. Because of this dislike, their mind makes them forget to take medicines. This is 'motivated forgetting'. If this is the problem, the patient and family should discuss with the Psychiatrist their true feelings about the medicines. Otherwise the forgetting is likely to continue, inspite of trying all of the above.

Monday, January 14, 2013

MEMORY AND EXAMS


 

Before exams most students wish for a sharper memory.  A sharp memory means: they want to remember lots of information with minimum effort and maximum certainty.

Students should note that just like body-building, memory-building is a gradual process to be done regularly over a long period of time. There are no quick-fixes. Some students wish take medicines to improve their memory.

 THERE IS NO MEDICINE TO IMPROVE MEMORY OVERNIGHT.

I have seen some students using sleeping pills to make themselves calm, or to get a night’s sleep (as exam tension makes them sleepless). They may become too drowsy, unable to concentrate and unable to recall learnt material during exams, if the dosing is not appropriate.  Sometimes, youngsters get the unexpected result of feeling very restless, irritable and severely anxious with these medicines. Hence, these medicines should be taken strictly under the supervision of a Psychiatrist.

As you are studying very hard, your brain gets very tired and the need for sleep increases before and during exam time. Some students try to suppress the extra sleep by having some drugs, coffee, tea, tobacco, listening to fast music, etc. In an emergency situation, these measures MAY (no certainty) help for a day or two. But after that, the brain becomes fatigued and memory and concentration are impaired. Most of these ‘activating’ substances can precipitate severe anxiety. So you might feel nervous right when you need to be calm.

DRUGS AND MEDICINES ARE NOT THE ANSWER TO LAST-MINUTE EXAM PROBLEMS

If you have not studied at all, then the best option for you is to accept the reality that it cannot be done in such a short time- and start studying for next year’s exam. If you have studied, but not finished then get your teacher/ someone who knows the subject to advise you about the most important things to study and buck up. If you have studied regularly- have no fear- nobody can stand between you and success.

Have a plan of study that involves studying mostly during daytime (that’s the time you will be writing your exam. So it is worthwhile training your brain to work hard at that time). Your day should include at least 40 minutes of physical exercise and at least 1 hour of rest (not watching TV) and eight hours of sleep. Eat a balanced nutritious meal with lots of fresh vegetables, fruits and water. Your brain is an energy-guzzler, so you will need more calories. Your brain is 70% water and a dehydrated brain cannot work properly. So drink plenty of water, and avoid tea/ coffee as they tend to dehydrate the brain. These measures will keep you energetic and fresh. They will maintain your fitness so you don’t fall ill during exams.

THE ONLY WAY TO HAVE A SHARP MEMORY IS TO HAVE A WELL-TRAINED, WELL RESTED, HEALTHY BRAIN IN A FIT BODY

Tuesday, January 8, 2013

CONTACT DETAILS- UPDATED ON 8-1-2013

This post is in response to the many mails I get about how to seek an appointment.

If you are a NEW patient, that is, seeing me for the first time- appointment is not required.

I see all new patients at Jewel Hospital, Andheri Link Road, Opposite Cooper Hospital, Next to Presto Laundry, Vile Parle West, Mumbai. Juat show up between 4-6 pm an any Saturday evening.
I rarely take leave; still I recommend that you check I am in office by phoning the Hospital.

All patients who have met me at least once, know how to take follow up appointments; so that's not included.

See you!