Personality Disorders & Others

 

 

 

Marriage counseling,Personality Disorders and others

 

 

What are the personality disorders?

 

Disorders of personality are abnormal exaggerations of normal traits, though some of these disorders also show symptoms not seen in normal people. Differences in personality between people depend on their genetic make-up and on their life experiences, and these differences show up in the relative strength of emotions and behaviors. Maladaptive personality traits can improve with psychosocial interventions and over time, though not completely. Although residual effects will remain, it is worth the effort since medical interventions are likely to fail except in very few cases.

 

The following table illustrates some of these personality traits and their maladjusted extensions:

 

PERSONALITY TRAITS

MALADJUSTED

NORMAL

NORMAL

MALADJUSTED

Expressed Traits

Very High

High

Low

Very Low

LEVEL OF ANXIETY

Fear

Worrisome

Calm

Oblivious to threat

LEVEL OF ANGER 

Rage

Defiant

Even-tempered

Does not protest when exploited

LEVEL OF  SADNESS

Depressed

Pessimistic

Not easily discouraged

Unrealistic optimism

LEVEL OF SELF-CONSCIOUSNESS

Extreme embarrassment

Self-conscious

Self-assured

Shameless

LEVEL OF IMPULSIVITY

Highly impulsive

Self-indulgent

Restrained

Over-restrained

LEVEL OF VULNERABILITY

Helpless

Fragile

Resilient

Fearless

LEVEL OF BONDING

Intense attachments

Warm

Reserved

Cold

LEVEL OF ASSERTIVENESS

Dominant

Forceful

Passive

Submissive

ENERGY LEVELS

Frantic

Energetic

Slow-paced

Lethargic

LEVEL OF EXCITEMENT-SEEKING BEHAVIOUR

Reckless

Adventurous

Cautious

Apathetic

EMOTIONAL LEVEL

Manic

Cheerful

Sober

Grim

LEVEL OF FANTASY

Unrealistic

Imaginative

Realistic

Concrete

TYPE OF BEHAVIOUR

Eccentric

Unconventional

Predictable

Mechanical

TYPE OF IDEAS

Weird

Creative

Pragmatic

Closed to new ideas

QUALITY OF VALUES

Radical

Flexible

Traditional

Dogmatic

ABILITY TO TRUST

Gullible

Trusting

Cautious

Suspicious

LEVEL OF HONESTY

Child-like

Honest

Shrewd

Manipulative

ALTRUISM

Selfless

Generous

Frugal

Greedy

COMPLIANCE LEVELS

Meek

Obedient

Critical

Combative

LEVEL OF MODESTY

Self-denigrating

Humble

Confident

Boastful

LEVEL OF COMPETENCE

Perfectionist

Efficient

Casual

Lax

LEVEL OF ORDERLINESS

Obsessive

Methodical

Disorganised

Sloppy

LEVEL OF RESPONSIBILITY

Rigidly Principled

Dependable

Easy-going

Irresponsible

LEVEL OF DRIVE

Workaholic

Diligent

Carefree

Aimless

LEVEL OF SELF-DISCIPLINE

Single-minded

Self-disciplined

Leisurely

Negligent

LEVEL OF DELIBERATION

Indecisive

Reflective

Decides quickly

Rash

LEVEL OF SOCIABILITY

Attention seeking

Sociable

Independent

Isolated

 

Stress Related disorder

  • When a person is exposed to a threat, direct or indirect, actual or anticipated, leading to a bodily experience of stress, it is called “stress experience”. These events or objects are then called “stressors”. 
  • “Stress Experience” is a physical and psychological state that promotes or impairs the adaptive capacity of a person due to the impact of a stressor mediated through the autonomic nervous system. 
  • stressor and stress experience result in a set of “stress responses”. These are reactions to their experiences. These responses can be “adaptive” or “maladaptive” causing “stress-related disorders” (Post-traumatic stress disorder-PTSD). 

Post-traumatic stress disorder (PTSD)

Most manifestations of stress related abnormal behaviours last only for a brief period and is supported by family, friends, peers and traditional healers etc. Professional support by a counselor is given to help the person cope with future adaptation only when the stress related behaviour becomes harmful to self or others. Medications are also used only when there is a threat to self or others. Relaxation, CBT (to understand how one can manage stress effectively) are modes of management if there is a risk of inadequate coping by the individual. Most people who are left alone to cope with stress quite well.

 

What is work stress?

Recent changes in the workforce, due to rapid development in technologies, robotics, increasing young population without jobs, poor earning capacity to meet daily needs, lack of permanancy in emplyment etc. have increased uncertainities of life, workloads and demands for higher performance, giving rise to employment becoming more precarious and more insecure. Experience of these unpredictabilties are sometimes manifested as "work-stress". They are not dissimilar to other forms of stress in a person who is not employed.   

 

"Stress Experience":  The person's bodily response to stress


Mind (Psychological aspects of stress experience that responds to medicines)

  • Chronic anxiety
  • Depression
  • Suicide


Behaviour (Stress responses that a person need to control by self)

  • Alcohol/substance misuse
  • Social isolation
  • Marital difficulties

Body (Organ responses to stress that are amenable to medications)

  • Irritable bowel symptoms
  • Lack of appetite
  • Stomach ulcers

Immune system (Long-term effects of unmanaged stress experience)

  • Lowered resistance to infections
  • Chronic asthma
  • Possible increased risk of cancer

Heart (Long-term effects of unmanaged stress experience)

  • Heart disease
  • Heart attack
  • Stroke
  • Hypertension

 

Can We Eliminate Stress? 

 

Some degree of stress adds to better performance in life. Excessive stress, however, may make one ill. Hence, the goal is not to eliminate stress altogether, but to cope with it and to use it to one's advantage. One needs to find the optimal level of stress that will motivate but not to overwhelm one.

There is no single level of stress that is optimal for all people. What is distressing to one may be a joy to another. If you are experiencing stress symptoms continuously and feel that it is affecting you adversely, you have gone beyond your optimal stress level; you need to reduce the stress in your life and/or improve your ability to manage it.

 

How Can We Manage Stress?

  • People cope with stress in a variety of ways. Some fight it, others run away from it and some use a combination of both.
  • Determine what events distress you e.g. Psychiatric illness, Physical illness, Family problems, Work problems etc.
  • Change problems that are within your power to change.
  • Avoid exposure to stressors that you cannot change.
  • Accept those you cannot avoid or change.
  • Increase control over emotional and physiological stress experience through relaxation exercises and/or through the use of medicines. 

Learn to moderate your physical and psychological reactions to stress. When people learn to relax, using relaxation exercises, their overall level of autonomic arousal is reduced. People who are able to relax are also more likely to think rationally and be able to restructure their negative response to stressors.


Physical  and physiological steps to control stress experience

 

HOW CAN WE CHANGE MALADJUSTED RESPONSES TO STRESS?

  • Counseling

A clear understanding of stressful events and coping play a major role in determining the responses to stress. Counselling aims to help people become more aware of their experiences to stressors, educate them on how stressors negatively influence emotional and behavioural responses and teach them a variety of effective emotional and behavioural adaptive skills.

 

  • Medication

Medicines are of help to people who struggle with severe stress resulting in depression, suicidal thoughts, severe anxiety etc. and are often complimentary to counseling. Unsupervised long-term use of medication is not recommended.  Untreated major work-stress can lead people to be less efficient and underproductive, poor income earners, sad and irritable, unfriendly with limited socialization, inability to become leaders, anxiety prone, leading poor quality of family life etc. Therefore, it is necessary to detect severe distress in people who are undergoing stressful work-life and start interventions early.

 

Gender Identity Disorder

Gender identity disorder is used to describe a male or female who feels a strong identification with the opposite sex and feels distressed because of his or her actual sex. The disorder is not because of their identity with the opposite sex, but a term to describe the emotions resulting from such identification. They are uncomfortable with their present sexual role and have a desire to alter their bodies. Causes of gender identity disorder are not fully known even today. A mismatch between the body and an internal sense of gender is not a mental illness. One of the most common questions that parents of children with gender identity disorder ask is, "Is it just a phase?" Unfortunately, there is no way to know for sure. Not all young children who feel this way do feel so in their adulthood.

 

Gender identity disorder entered the psychiatric nomenclature in the DSM-III in 1980. It was traditionally thought to be a psychiatric condition meaning a psychiatric disease. Current research suggests that development that determines biological sex happens in the mother’s womb. Anatomical sex is determined by chromosomes that contain the genes and DNA. During early pregnancy, all unborn babies are female because only the female sex chromosome inherited from the mother is active. After the eighth week of pregnancy, the chromosome from the father becomes active. If the father contributes an X chromosome, the baby develops as a female. If the inherited chromosome from the father is a Y  the fetus develops male characteristics. There are several other causes of gender differences, including hormonal changes, exposure to drugs related to sex hormones etc. For example, if there are excess female hormones generated in the mother with a male fetus, anatomical sex from the genitals may appear to be male, while the gender identity that comes from the brain could be female. Similarly, exposure to progesterone or other estrogenic drugs may be associated with atypical gender role behavior. There are also chromosomal abnormalities that lead to gender identity. Sexual orientation is partly heritable in men, thanks to studies of families in which some people are straight and some people are gay. There are probably multiple genes involved, each with a fairly low effect, that will increase the chances of some being gay. There is no substantive evidence to suggest parenting or early childhood experiences play a role in sexual orientation.

 

There are three main categories of sexual orientation within the heterosexual–bisexual-homosexual continuum. Homosexuality is a romantic attractionsexual attraction or sexual behavior between members of the same sex. It is an enduring pattern of emotional, romantic, and/or sexual attraction to people of the same sex. The relationships of a person with gender identity spectrum are equivalent to heterosexual relationships in essential psychological respects. Homosexual relationships and acts have been admired or condemned, depending on the form they took and the culture in which they occurred. A term transgender is used to describe someone who feels his or her body and gender do not match with each other. Transvestism is the practice of dressing and acting in a style or manner traditionally associated with the opposite sex.

 

Some of the questions that are commonly asked for confirmation of adult homosexuality are as follows. Do you feel strongly that your gender identity is at odds with your biological sex? Do you often feel that your feelings and reactions towards another person are more in line with how someone of the opposite gender would feel or act? Are you currently dating, sexually active or in a relationship(s)? There can be many variants of these questions for practical use.

 

Treatment for people with gender identity disorder focuses on treating depression and anxiety and improving self-esteem. Many people do not see their gender identity disorder symptoms as requiring treatment. People with gender identity disorder request hormone and surgical treatments to suppress their biological sex and acquire those characteristics of the opposite sex. Because of the irreversible nature of the surgery, candidates for sex-change surgery are evaluated extensively and are often required to spend a period of time before integrating themselves into the cross-gender role before the procedure begins. Significant social, personal, and occupational issues may result from surgical sex changes, and the patient may require psychotherapy or counseling after the change too. Available information seems to indicate that reparative therapy is ineffective.

 

Many people feel attracted to people of the same sex. For some people, these feelings can be very intense. Some people find that these feelings change over time. Some of them are bisexual, meaning they are attracted to both men and women and have relationships with both. Some people are not attracted to anyone. With time, someone who is homosexual will realize that not only are they sexually attracted to members of the same sex, but that this attraction is not transitional. However, for some people, homosexual experiences are part of a transitional or experimental phase in their youth.

 

 Coming to terms with confusion about identity can have both positive and negative effects on many aspects of a person's life, including social relationships, work, and self-esteem. It can take a long time too. Coming to terms is not a single action. It is a process that begins with a feeling of being 'different' to other people of the same sex. Sometimes they recognize that they are not very interested in people of the opposite sex but more often they feel they are not really interested in things which are supposed to be appropriate for their sex. Different people cope with the emotional upheaval of identity confusion in different ways. Some people deny it to themselves and try to avoid thoughts and feelings which may confirm they are homosexual. Others persevere with heterosexual relationships to try and 'convert' themselves. In some extreme cases, people may try to avoid confronting their feelings by expressing strong homophobia or turning to drink and drugs in order to find temporary relief from them.

 

Making the decision to tell others that you are homosexual, bisexual or transgender can relieve a great deal of stress and unhappiness and build self-esteem, as well as help improve relationships. However, there are also risks associated with telling others, and it is important to think carefully about how you could cope with the potential consequences of telling others. Friends and family may not react in an understanding way, and relationships can be changed significantly. Having time to fully come to terms before telling others can mean you are more prepared to deal with any misunderstanding or prejudice you may face. Telling others does not mean that you have to tell everybody. Many people chose to tell first to people who they think are more likely to react positively. It not only helps them get an idea of how people may react but often means that they will have someone to support them when they tell others. Some people may never be able to accept your true gender identity. This is not something that you can change, and it can be very hard to feel rejected by someone you are close to.

 

There are also many stereotypes surrounding homosexual and bisexual relationships. As with heterosexual couples, homosexual relationships can also be short-lived or long-term. Many relationships get strained sometime during life, resulting in poor functioning and producing self-reinforcing, maladaptive patterns. There are many possible reasons for this, including insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication or poor problem-solving skills, ill health, third-party influences and so on. Changes in situations like financial state, physical health etc. also have a profound influence on the actions of the individuals in a relationship. Often, it is the interaction between people, rather than the behavior of just one person that causes such maladaptive conflicts. These need to be explored collaboratively and discussed openly so that the core values can then be understood and changed when no longer appropriate. This implies that each person takes equal responsibility for awareness of the problem as it arises, awareness of their own contribution to the problem and making some fundamental changes in thought and feeling. The next step is to adopt conscious changes to the inter-personal relationships and evaluate the effectiveness of those changes over time. Counseling focuses on clearing past issues that continue to affect your present situation while developing new skills to solve your current issues. It replaces resentment with respect and replaces arguments with caring responses. New skills build intimacy without sacrificing one's individual identity. Working individually and together, people can heal old wounds, gain the abilities to addresses conflicting priorities and betrayal of trust.

Common signs of relationship problems:

1.The feeling of having grown apart

2.Arguments, nagging or angry silence

3.Lack of intimacy and affection

4.Persistent and unresolved problems

5. Feeling unappreciated

6. One's needs are not appreciated by the partner

7. Communication becomes one-sided, hostile, sarcastic, angry or absent.

8. Partners spend little or no time alone

9.Trust issues – dishonesty/lies, affairs, unexplained absences, secrecy regarding email, phone and text message.

It is also more 'here and now' and deals with new coping strategies and about seemingly intractable problems within a relationship. These sessions also encourage the client to make steady progress in a caring and supportive manner.

 

Counseling for Same-Sex Relationships

Infidelity, intimacy or sexual concerns, difficulty in communicating – same-gender couples experience the same relationship issues as heterosexual couples. There can also be added difficulty of maintaining a strong relationship within a society that is hostile.

 

Relationship counseling for gay couples gives you a non-judgemental environment in which to explore your relationship. In same-sex relationships, couples have a high level of initial rapport and understanding. It can add to the emotional intensity in the beginning. However, when this initial phase ends and the early passion lessen. Then there is a feeling of disillusionment and fear that things won’t work out. In addition, how open and expressive one partner is of their sexuality may be in conflict with that of their partner. There may also be difficulties with being close, with one partner longing for closeness and the other finding closeness suffocating. 

 

 

 

MARRIAGE COUNSELING

Stages of Marriage

A marriage is a relationship that moves through different phases and develops certain common patterns:

 

Passion

This stage happens at the beginning of the relationship and is characterized by intense romance and attraction.  It is a relatively short-lived phase and lasts for a brief duration in the beginning.

 

Realisation

After the initial passion, it begins to fade. There is a more realistic vision of their life together. In this phase, each person sees their partner as a human being,  with flaws and shortcomings. Disappointment sets in.

 

Rebellion

In this phase, each partner’s self-interest comes to the fore. They lead to power struggles. Anger and frustration, and cause major rifts in the marriage.

 

Cooperation

When different life stressors appear in their day-to-day life, intimacy is put on the back burner and couples work on managing their lives.

 

Reunion

After children have left them couples rekindle their relationship as friends.

 

Disruption

In this phase, the couple faces serious life situations and they deal with them together. During this time, the couple can become closer or drive themselves apart. It can occur at any time in a marriage.

 

Old age

In this stage, the couples explore a new life together.

 

While divorce may be necessary for some, others may wish to try to salvage whatever is left of the marriage. Here are the good reasons for meeting a psychiatrist for marriage counseling.

 

  • Communication has become negative. Negative communication can be due to one partner feeling depressed with psychiatric illness, an introverted personality, insecurity and so on. Negative communication also includes physical abuse, as well as other nonverbal communications.
  •  When one or both partners consider having an affair, or one partner has had an affair.
  • When the couple seems to be “just occupying the same space.” When couples become more like roommates than a married couple, this may indicate a need for counseling.
  •  When the partners do not know how to resolve their differences.  If a couple is stuck due to very stubborn personality traits, suspiciousness or obsessive-compulsive disorder, a psychiatrist may be able to get them moving in the right direction.
  •  When one partner begins to act out on negative feelings.
  • When the only resolution appears to be separation. Spending time away from home does not usually resolve the situation. Instead, it reinforces the thought that time away is helpful, often leading to more absences.
  •  When a couple is staying together for the sake of the children. Children are generally very intuitive and intelligent. No matter how couples may think they are able to fake their happiness, most children are able to tell.

 

 

All marriages are not salvageable in the process of marriage counseling, some couples may discover it is healthier for them to be apart

 

Marriage is a social and legal contract between people to create an institution in which interpersonal, emotional and sexual relationships, are acknowledged in a culturally appropriate manner. It includes arranged marriages, marriages out of family obligations, marriages to establish a legal nuclear family, marriages for legal protection of children or public declaration of commitment to each other and so on. 

 

Individuals in a relationship also come with different value systems. Hence, societal factors like the social, religious, group and other factors that shape a person's behavior are also considered while counseling. It is advantageous for all in relationships to interact with each other and their society with minimal amounts of conflicts.

 

Many relationships get strained sometime during life, resulting in poor functioning and producing self-reinforcing, maladaptive patterns. There are many possible reasons for this, including insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication or poor problem-solving skills, ill health, third-party influences and so on. Changes in situations like financial state, physical health, and the influence of other family members can also have a profound influence on the actions of the individuals in a relationship. Often, it is the interaction between people, rather than the behavior of just one person that causes such maladaptive conflicts.

 

Relationship influences are reciprocal and it takes all the people involved, to manage problems in a marriage. A solution to the problem and setting relationships back on track requires a reorientation of perceptions and emotions of all people concerned. These need to be explored collaboratively and discussed openly so that the core values can then be understood and changed when no longer appropriate. This implies that each person takes equal responsibility for awareness of the problem as it arises, awareness of their own contribution to the problem and making some fundamental changes in thought and feeling. The next step is to adopt conscious changes to the inter-personal relationships and evaluate the effectiveness of those changes over time.

 

 Counseling focuses on clearing past issues that continue to affect your present situation while developing new skills to solve your current issues. It replaces resentment with respect and replaces arguments with caring responses. New skills build intimacy without sacrificing one's individual identity. 

 

Common signs of relationship problems:

1.The feeling of having grown apart

2.Arguments, nagging or angry silence

3.Lack of intimacy and affection

4.Persistent and unresolved problems

5 Feeling unappreciated

6 One's needs are not appreciated by the partner

7 Communication becomes one-sided, hostile, sarcastic, angry or absent.

8 Partners spend little or no time alone

9.Trust issues – dishonesty/lies, affairs, unexplained absences, secrecy regarding email, phone and text messageCasual sex.

 

Marriage counseling It is also more 'here and now' and deals with new coping strategies about seemingly intractable problems within a relationship. These sessions also encourage the client to make steady progress in a caring and supportive manner. During marriage counseling, regardless of the origin of the problem and whether the clients consider it an "individual" or "family" issue, involving all partners in solutions is often beneficial.

 

 Couple therapy can explore what is lacking in your current relationship and solve the problem.

 

1. Your counselor will be interested in your current problems and issues in your relationship.  “What’s it that brought you here today?”

 

2. Your counselor will inquire about how your relationship started. what’s drawn the couple to be together?  Why did they choose each other? Under what circumstances did they meet?

 

3. Your counselor will want to know about some of your individual histories. Are there any important historical issues that may have affected your life.

 

4. Your counselor will ask you what kind of relationship you desire. It’s important that you share what type of relationship you want to create with your partner.

 

5. Your counselor will be looking for your strengths as a couple.

 

6. Your counselor will ask you about your individual relationship blocks to know what you need to start doing differently to improve your relationship.

 

7. Your counselor will ask you to relate in a different way during the session to bringing about change in the relationship.

 

8. Your counselor will be giving you live feedback.

 

9. Your counselor will give you awareness homework for outside of the session.

 

10. Your counselor will regularly review your work.

 

A VERY IMPORTANT ASPECT TO BE REMINDED BEFORE ONE STARTS A MARRIAGE COUNSELLING IS TO CONSULT A PSYCHIATRIST, TO RULE OFF ANY POTENTIAL PERSONALITY  PROBLEM OR PSYCHIATRIC ILLNESS IN THE PARTNERS THAT CAN BE EASILY TREATED. MANY FAMILIES BREAK UP BECAUSE OF A TREATABLE PROBLEM IN ONE OR BOTH PARTNERS. HENCE BOTH PARTNERS NEED TO ATTEND THE PSYCHIATRIC EVALUATION TOGETHER.

 

 

Dementia

 

  1. Nutrition
  2. Control of infections
  3. Managing pre-existing illnesses
  4. Managing neurological problems
  5. Deterioration in memory and orientation
  6. Anxiety and Depression leading to anger
  7. Sleep
  8. Delusions and Hallucinations
  9. Whom should you consult and when?
  10. When should you give medicines?
  11. Support systems for managing dementia.
  12. Medical reviews and follow up

           Nutrition

Maintaining a healthy weight can be a challenge for  people with dementia. Difficulties of eating and drinking are more noticeable as dementia progresses and  weight loss is a common problem.

Supplements: vit d3, B'complex with zinc, Multivit, Omega3 fatty acids.

 

Control of infections


The respiratory and urinary tracts infections account for one-half and one-third of all infections. Since patients are effectively mute, symptoms such as dysuria, urgency, costovertebral tenderness, and suprapubic pain are rarely reported. One of the most common condition that people with dementia  get is pneumonia. Pneumonia symptoms can often appear similar to flu symptoms. They can be viral pneumonia, bacterial pneumonia or aspiration pneumonia. The treatment for pneumonia is antibiotics. There are vaccines to protect people from the most common kind of pneumonias. 

           Managing pre-existing illnesses

The presence of dementia may adversely affect the clinical care of other conditions and undermine a patient's ability to self-manage chronic conditions. In addition the diagnosis and management of co-morbid conditions become poor. As dementia dominates, clinical attention shifts away from the co-morbidity,  which can lead to increased morbidity and mortality. People with dementia and co-morbidities are likely to be hospitalized more often and spend longer in hospitals. These admissions are preventable. Regular reviews with family physician are highly desirable to reduce the effects of co-morbidity.

 

Managing neurological problems

Dementia often progresses in a step-wise fashion. For example, the person will seem stable for a period of time, then suddenly get much worse, then continue to alternate between stable periods and sudden drops in functioning. It can also occur after a single major stroke. Siezures, weakness of one side, poor urine and stool control, instability during walking, tremors of hands etc. are some of the neurological complications that require neurologist’s care.

Deterioration in memory and orientation

Loss of cognitive functioning, such as thinking, reasoning, and remembering and other behavioral activities that affects the person’s daily activities is known as dementia. In many cases, dementia is irreversible and incurable and deteriorate gradually. The progression is different in different people and depends on the underlying cause. These changes are inevitable and
has no respite other than in the cases of reversible dementias.

Anxiety and Depression leading to anger

Depression, anxiety, irritability, and agitation are some of the most common mood and behavior problems in dementia. It is quite depressing and anxiety-provoking to realize  that one is losing one’s mind. For patients with depression or anxiety, use of serotonin reuptake inhibitors (SSRIs) or Trazadone HCL, in low doses are useful. Sleeping tablets are usually not useful in these cases.

Sleep/reversal of sleep

Poor sleep in the night and contonuous sleep during day is a common pattern noticed in dementia. Sleeping tablets do not help correct this condition. At the most it can initiate the sleep, but the patient wakes up in the middle of the night and becomes restless again. Tolerance to these drugs develops very easily. Addition of antipsychotics like quetiapine, Olanzepine etc. in very low doses can help in giving fair degree of sleep.

Delusions and hallucinations

Delusion is an unshakable belief maintained despite being contradicted by reality or rational arguement. Hallucination is a visual or auditory experience of something which does not exist. Both these conditions can occur in dementia and needs to be contolled using antipsychotics such as amisulpride in low doses.

Whom should you consult and when?

In countries where one can access a geriatric practioner it is better to start there. In the absence of geriatirc practioner, in many countries, a GP or physician near your location is most suited to co-ordinate the managemnt of patients with dementia. The GP will be able to manage most pre-existing illnesses adequately and also refer to specialists as and when required, such as the neurologist or psychiatrist. The GP will also be able to follow up frequently at much lower cost and at much less waiting time taken in speciality hospitals. Overall this mode of management can give patients better comfort, less hospitalisation, less procedures, less hospital infections and less cost. Since many countries do not train GPs or Physicians in geriatric practice it is important to get a feed-back letter to your GP/physician, how manage the patient from here on, particularly in case of psychiatric and neurologic disorders. One has to also watch out for electrolyte imbalances that occur very frequently in these patients.

When should you give medicines to control abnormal behaviours?

Most patients with dementia deteriorate unless it is a reversible dementia. The physician or neurologist will evaluate for these conditions right at the beginning of their diagnostic process. Treatment for these conditions are quite different. In other cases the dementia is a process of aging that starts at different times for different people. Hence medicines for abnormal behaviour need to be used sparingly, only if the patient requires it or the care-givers expresses the need for easier management of patient. Use of minimal dosage of medicines to start with that are gradually increased or decreased according to the requirement is the mode of operation. Excess medication can make it also worse for the patient since the available normal functions may also get compromised with overdosage. This is the reason why frequent follow up is needed to adjust dosages of medicines and it is always better with nearby GP/Physician. There are no static dosage in managing patients with dementia!

Support systems for managing dementia.

"How to take care of the patient at home?" is a problem most people do not understand or know of. Hence I would suggest you go through the link above to learn about it. There are numerous things that one needs learn, do and modify. Hence go through these informations with attention.

Medical reviews and follow up

By now you will know roughly how to manage a patient if you have read everything above and gone through the links provided. The GP/physian is your core medical manager. He will visit you frequently at your home or examine the patient in his consultation as he feels it is required. He will refer you to the specialist on a regular infrequent intervals or when he finds there is some difficulty in management. There also times when the patient requires admissions. That will be decided by your GP/physician according to the need.