REPAIR A RUNNING CAR

I have often wondered if there is any time that a running car gets repaired? I have seen cars being serviced in record time during races, but they do stop for it to be done. But in mental health, we are expected to treat the patients while they are in action continuously.

A lot has been written about the loss of concept of 'convalescence'. But in psychiatry its worse- patients don't want to stop even when actively and severely ill. Particularly if the patient is a child or adolescent- the parents rarely allow any concessions in their packed schedule or attempt of various exams. Even celebrity sportsmen take a break when injured- but our patients- never do.

I often feel like I am continuously running to catch up with a running car and simultaneously trying to change its tires. When I do any intervention and expect result- instead patient has gone and stressed themselves out further- forget being over the initial problem- now there is a new problem to handle.

If only people would take it a bit easy and allow the body to heal- that would ensure they recover with minimum medication, minimum side effects and it will be a proper recovery. They should go back to work and life slowly and as advised.

When we talk about Juvenile crime.

https://www.hindustantimes.com/cities/mumbai-news/minority-report-why-juvenile-crime-is-on-the-rise-101664128656202.html 

Social and rule- based behavior is a legitimate part of mental health. For ages there has been the question 'Mad or Bad?'. In my work I am frequently required to deal with behaviors that reflect thoughtlessness, callousness, predatory or depravity. A good number of my patients are children and adolescents. When I read the above article- I thought it was a good piece of reporting; in terms of the observations made and impressions collected from experts. But it also carried a bias- it seems that children from certain backgrounds are upto to something and that progresses to Juvenile crime. A few of my thoughts and observations follow.

I observe that children from less disadvantaged backgrounds also show such behaviors. But they get timely help or worse- their folks make sure the matter never reaches the authorities. Parents of these children put up a fight against the world to safeguard their child's right to misbehave- later they start moving homes or schools in the belief that other kids are spoiling them or being unsupportive. The true commonality between these children and those from poorer backgrounds is deprivation- deprivation of close and balanced adult supervision, deprivation of role models, deprivation of emotional structure, deprivation of limit setting and deprivation of treatment for medical issues like hyperkinetic disorders and learning disorders.

Children of all backgrounds need sufficient time and space to explore, take risks, learn social behaviors and expend their energies (both mental and physical). There could not be a single person in the world who did not think of a painful prank, shirk some work, gain some pleasure by pulling down peers or simply be upto something to 'see what happens'. Boredom and unfettered imagination are the key features of a normal child who is capable of thinking and learning. Surroundings catering to such needs must be provided in the community. Which means unstructured space and time- but under the eye of a caring adult who steps in, though just enough for course correction. We adults have failed to provide this to children. For various reasons our children are left free to learn from their mistakes- how to progress and master them not to correct them. And we get into the picture only to indulge and misguide or punish and stonewall. A child with hyperkinetic disorder and learning issues suffers from greater boredom and inability to engage in curricular learning. But parents refuse to treat children based on their false pride and misinformation.

Juvenile offending can be reduced only if children's need for emotional support and exploration is regarded as legitimate and we make space for their needs in society. A large well- patrolled park with free access to kids, a good after school program, adolescent vocational training and robust medical treatment of developmental problems- all these are needed simultaneously. The community should think if they want landscaped garden with expensive shrubs that is 'free of troublesome' children or a large park where youngsters of all ages can grow into useful members of community.

WHAT IF I MISS A DOSE?

 

Medications for mental health are usually 'long acting'. This means that every dose of medication is able to work for several hours, usually exceeding one full day. Yet there are some things that one needs to understand before answering the common question – "What will happen if I miss one dose of the medicine".

If you observed yourself taking medication, you would have noticed that the response is not immediate. In fact, there is usually an adjustment period with some discomfort before the medication begins to work as intended. The adjustment effects are because of the body's response to the 'new' drug and somewhat unfamiliar changes in the body's chemistry. But the intended effects are delayed because firstly the medication has to achieve 'steady state levels' in the body. This means a certain level of medication has to be maintained in the body at all times. This happens after you have taken the medication for 5to7 days. After that the medication begins its work and the symptoms reduce slowly.

So if you miss a dose- the reverse effect occurs. As the steady state is already achieved, your disease symptoms remain under control. If you have any side effects of medication- you will not experience them that day and so feel better than usual. Thus the usual experience on missing a single dose is to actually feel better overall. However, some medications have an additional action to calm you down and this is a sort of 'short term' effect. For these particular medications, you will begin to feel a withdrawal effect 6 to 10 hours after the missing the dose. The withdrawal can vary from mild uneasiness to miserable degree of dizziness and nausea. The withdrawal symptoms also depend on the persons metabolism, state of mind that day and other diseases and medications. The longer term problem with occasionally missing a dose, is that the steady state level becomes reduced overall- so the medication becomes ineffective and symptoms of the disease come back in a 'relapse'.

Thus the best thing to do is to make sure you do not miss a single dose anytime. As a doctor, I find it difficult to respond to the question because you are not SUPPOSED to miss any doses. So its a scenario that I would rather prevent totally than prepare you for.