Know more about psychiatric diagnoses

Dr M.J Thomas (www.drmjthomas.com)

Many believe that all people have some degree of psychiatric illness. This is not true. Just as every person look different from one another, all people think and feel differently. What they think and feel at any given moment is not important to diagnose psychiatric illness. It is the consistency and pattern of thinking and the emotional reactions to them, its illogicality and inappropriateness, sustainability of its pattern over time despite attempts at correction and the duration of changed behaviour, are the parameters that help diagnosis. These changes affect the entire personality, verbal behaviour as well as non-verbal behaviour and affect most functions of the person. People decide to seek professional help when these changes give an appreciable distress to the self or to the peers and family. Use of medicines at this time can control the symptoms, if not cure them. However, to achieve beneficial results one needs to monitor the progress under his doctor’s expertise.

Illness of feelings

People usually have two distinct kinds of feelings, sadness, or happiness. How you express these feelings differ from person to person and from time to time. You may express them with anger, anxiety, or any other form of emotional expressions. Normally you are in control of these expressions. As human beings evolve further, they can control their expressions better and express it within their culturally sanctioned limits. However, in one’s own mind these feeling persist until one can switch them off. In normal circumstances people can voluntarily switch them off and focus on other thoughts that are more important. When a person becomes ill, his ability to switch off these disturbing thoughts weakens. The thoughts and the associated feelings persist and their expressions come out of control.

Affective disorders

‘Affective disorder’ is a state in which people lose control of their feelings. They present with an illness manifested by extreme sadness or depression, or extreme happiness or euphoria. People with this illness can have a continuous illness, episodic illness with normalcy in between or illness which changes from one mood to another periodically. They can express these mood changes in many forms such as anger, irritability, crying, social withdrawal, reduced interactions and so on, or being elated, overtalkative, overactive, hypersexual, grandiose, stubborn, and so on. Let us try to understand a little more about them.

CLINICAL DEPRESSION

A period of depressed mood, which lasts for several days or a few weeks, is a normal part of life. These feelings are often referred to as “depression,” instead of “sadness”. They typically do not constitute a clinical depression. People experiencing clinical depression, is likely to experience substantial changes in the mood, thinking, behaviour, activities, and self-perceptions. A depressed person often has difficulty making decisions. He dwells on negative thoughts continuously, focuses on unpleasant experiences which he cannot forget ever, describe himself as a failure, report that things are hopeless and feel as though he is a burden to others. The changes in mood result in irritability, anger, emptiness, anxiety and sometimes suicide.

For a better understanding, see this video about ‘clinical depression’: https://ihavenotv.com/my-depression

BIPOLAR DISORDER OR MANIC-DEPRESSIVE DISORDER

This is also a disorder of the mood just like clinical depression. However, in this illness people experience mood changes from extreme depression to extreme euphoria, alternating with each other. There are periods of normal intervals in between. Treatment of this illness is more complicated since the medicines used for depressive phase is different from that used for the euphoric phase, and the patient needs to be monitored frequently to identify the changes in mood and to institute quick corrections in medicines. For a better understanding, see this video about ‘bipolar disorder or Manic-depressive disorder’: https://www.youtube.com/watch?v=vcCBacPWLrc , https://www.youtube.com/watch?v=AMsyfoLb9C0

There are also mood stabilising medicines that control fluctuations. However, they are potentially very toxic and need strict supervision by the caregivers and the doctor. There are two such medicines used for control of bipolar or manic-depressive disorder. These are ‘Lithium’ and ‘Sodium Valproate.’ Lithium is most effective to stabilise the mood in persons who get strong symptoms of mania, while sodium valproate is more useful in persons who get primarily depression and mild forms of mania. Lithium is highly toxic drug if misused. Hence the caregivers need to take responsibility of administering lithium themselves.

Lithium should not be taken in double doses any time since blood levels can increase suddenly producing toxicity. It can result in unconsciousness and fits.
If the patient develops vomiting, watery diarrhoea or fever, lithium must be stopped immediately. Restart only after the disease subsides, only after a lithium blood test.
Mild tremors of hands appear occasionally. If it is severe consult the doctor.
Lithium levels and serum creatinine should be monitored at least once in 3 months.Lithium needs to be stopped if kidney has any problem.
Once in 6 months T3, T4, TSH should be checked to rule off thyroid disorder.

Disorders of thinking

Some people develop disorders of thinking. Emotional responses like depression are not the primary abnormality here. These persons get continuous thoughts about the same topic without being able to let go of it. These are called ‘obsessive thoughts.’ Because these thoughts are often unpleasant, they become very anxious. Anxiety leads them to do certain actions to control their thoughts. They are called ‘compulsions.’ They like to continue with the compulsions, so that the repetitive thoughts disappear. However, things do not work in such expected lines. One is always unsure of what will work. Hence, they always doubt if they are doing the right thing. These doubts make them more anxious. Finally, many of them become very depressed and can even end their life. There are specific medicines to control this illness, which is called ‘obsessive compulsive disorder’ or simply as ‘OCD’. However, one may have to take these medicines for a prolonged period to get results.

For a better understanding, see this video about ‘obsessive compulsive disorder’ or ‘OCD’ https://www.youtube.com/watch?v=TD-xPiwtyHA

Schizophrenias

Even though schizophrenias are comparatively rare, they are more talked about, since they are more dramatic in their presentation. Their presentations are striking, since these persons are strikingly illogical, suspicious and their perceptions too are illogical with auditory hallucinations. They can never be corrected with advice from others while they are ill. Their personality deteriorates over time, and they are ill at one glance. There are many types of schizophrenias and if treated early most people with this condition can return to normal life today. Treatment usually lasts a lifetime.

For a better understanding, see this video about ‘Schizophrenia’ https://www.youtube.com/watch?v=48YJMOcykvc

Other related topics

Dr M.J Thomas (www.drmjthomas.com)

Sleep

Sleep disturbance is a frequent problem in most cases of medical and psychiatric conditions, apart from situations of external distress. During stress, increased autonomic arousal gives rise to stress experience. This causes exaggerated reaction of different organs of the body, such as the brain, heart, lungs, and intestines, and so on, and results in anxiety. Anxiety has two components, a physical and psychological component. It activates the sleep centres in the brain to be over vigilant just as it makes all the bodily organs to be overactive. The disturbance in ‘sleep’ is the physical component, while the uncontrolled preoccupation with the distressing event is the psychological component. Eight hours sleep is restorative for the brain. Anxious person often finds it difficult to sleep and gets interrupted sleep or wakes up too early, resulting in inferior quality and inadequate sleep. His brain becomes poorly rested and anxiety gets prolonged. Relaxation exercises and treatment of causative factor can help people get proper sleep.

For a better understanding, see this video about ‘Sleep’

https://podcasts.google.com/feed/aHR0cHM6Ly9zbGVlcHdoaXNwZXJlcnBvZGNhc3QuY29tL3Jzcw/episode/OGNhOGE4YjItZDU1Yy00YThkLWJhMDAtODhkZmZjODg0MmUy?sa=X&ved=0CAUQkfYCahcKEwiA-YDTzaLwAhUAAAAAHQAAAAAQAg

Conflicts in marriage

Marriage is a relationship that moves through various stages. It starts with ‘passion,’ and later when passion fades, a more realistic view begins of seeing their partner as a human being with flaws. After this they enter a stage of rebellion, where each partner’s self-interest comes to the fore. However, when they are stressed due to outside forces, they come together in managing their lives. Finally, when children have left, they rekindle relationship as friends. During this stage they face serious life situations, which make them, come closer or drive themselves apart. At last, in old age they explore a new life together.

Many marriages get strained during life due to insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication, poor critical thinking skills, third-party influences, changes in financial state, physical health and so on. While divorce may be necessary for some, others may be able to salvage whatever is left of the marriage. Some of these problems can be sorted out with treatment. Negative communications are one such problem that is often due to depression in one partner, an introverted personality or insecurity. It can also include physical abuse. It can occur when partners have an extramarital affair. During this time, they can live like roommates rather than married couple. Many partners with stubborn personality, suspiciousness, or obsessive-compulsive disorder, can live in this way if not treated. Children are very intuitive and recognise the schism soon, irrespective of how couples’ fake happiness. Poor libido, erectile incompetence, extramarital relationship, performance anxiety and others are also causes of marital conflicts that may have some requirement for medical management.

For a better understanding, see this video about ‘Marriage & its conflicts’ https://www.youtube.com/watch?v=hXNV3b9-fR0 https://www.youtube.com/watch?v=tGNz-VjJIRw

Problems of people with same-sex attraction and bisexuality are like others. Some of these relationship problems can be managed with medical management apart from counselling.

For a better understanding, see this video about ‘Homosexuality & Bisexuality’ https://www.youtube.com/watch?v=qjOGKd5_aA4

Some of the personality types find it difficult to adjust in marital relationships. People with suspiciousness, rigidity and compulsiveness, attention seeking and borderline personality can be managed better with medical and counselling services in a combined fashion.

For a better understanding, see this video about ‘Marriage & Personality types’ https://www.youtube.com/watch?v=ugWf3fMAVvE , https://www.youtube.com/watch?v=lNF0wFb4EHE

https://www.youtube.com/watch?v=u5Fe1ea9BNs , https://www.youtube.com/watch?v=bs-xJc53tRQ

Anger

Intermittent explosive disorder is an impulse-control disorder characterized by sudden episodes of unwarranted anger. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts. A short temper can also be a sign of an underlying condition like depression. If your anger is causing you to hurt yourself or those around you, it is time to seek help. Anger often runs in families. One can identify the problem back to their parents, grandparents, and other extended family members. Many think this is a genetic condition. Antidepressants have a calming effect and can control rage and negative emotion.

For a better understanding, see this video about ‘Anger’ https://www.youtube.com/watch?v=ZLz2O41uXEo , https://www.youtube.com/watch?v=YwlwSByGOWY

Dementia

The aspects of dementia that requires attention are nutrition, infections, pre-existing illnesses, neurological problems, deterioration in memory and orientation, anxiety and depression, anger, sleep, delusions, and hallucinations. Difficulties in eating and drinking occur as dementia progresses. This leads to weight loss. Deficiencies of vitamin D3, B’Complex, zinc and multivitamins occur usually. Respiratory and urinary tract infections are common. Since patients are effectively mute, symptoms such as dysuria, urgency, costovertebral tenderness, and suprapubic pain are rarely reported. Treatment of pneumonia and urinary tract infections need to be controlled with antibiotics. There are also vaccines to protect people from the most common kind of pneumonias. Presence of dementia undermines a patient’s ability to self-manage chronic conditions. Regular reviews with family physician are highly desirable to reduce the effects of comorbidity.

Dementia often progresses in a stepwise fashion. For example, a person seems stable for a period, then suddenly get worse, then continue to alternate between stable periods and sudden drops in functioning. Stroke, seizures, weakness of one side, poor urine, and stool control; instability during walking, tremors of hands etc. are some of the neurological complications. Poor cognitive functioning, such as thinking, reasoning, and remembering that affect the person’s daily activities deteriorate. Progression of the symptoms is different in different people. Depression, anxiety, irritability, and agitation are some of the most common mood changes in dementia. For patients with depression or anxiety, use of medicines is useful. Sleeping tablets are usually not useful in these cases. Poor sleep in the night or sleeping continuously during day is a common pattern noticed in dementia. Sleeping tablets do not help correct this condition. Delusions and hallucinations can also occur in dementia and need to be controlled using antipsychotics. Dementia is a process of aging unless it is reversible. Hence medicines for abnormal behaviour need to be used sparingly, only if the patient requires it or the caregivers expresses the need for easier management of patient.

“How to take care of the patient at home?” is a problem most people do not know. There are numerous things that one needs to learn, do, and modify.

https://www.youtube.com/watch?v=hahvUXwTXE4 , https://www.youtube.com/watch?v=P0N5KXDT_iE , https://www.youtube.com/watch?v=i8bPX1HzMr8 ,

https://www.youtube.com/watch?v=cIx7mOV8FM8 , https://www.youtube.com/watch?v=cpV57QGdU7I , https://www.helpguide.org/articles/alzheimers-dementia-aging/tips-for-alzheimerscaregivers.

UNDERSTANDING CLINICAL DEPRESSION

There are several types of clinical depression, which involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity, and behaviour as well as disruptions in friendships, family and/or work. A clinical depression is different from experiences of sadness, disappointment, and grief familiar to everyone. This note will provide you with an understanding of the symptoms, causes, and treatment of clinical depression. A period of depressed mood, which lasts for several days or a few weeks, is a normal part of life and is not necessarily a cause for concern. Although these feelings are often referred to as “depression,” they typically do not constitute a clinical depression because the symptoms are relatively mild and of short duration and should be correctly mentioned as “sadness”. Moreover, these symptoms are often related to stressful life events and improve with positive life changes. A person experiencing clinical depression, however, is likely to be experiencing substantial changes in their mood, thinking, behaviours, activities, and self-perceptions. A depressed person often has difficulty making decisions; for example, the day-to-day tasks may seem overwhelming. A depressed person may also dwell on negative thoughts, ruminate on unpleasant experiences, describe him/herself as a failure, report that things are hopeless, and feel as though he is a burden to others. The changes in mood brought on by depression frequently result in feelings of sadness, irritability, anger, emptiness, and/or anxiety. There are also some types of depression, in which depressive episodes alternate with episodes of agitation and euphoria. A severe depressive episode can result in thoughts of death and suicide. The following checklist includes many of the symptoms typical of clinical depression. It is important to note however, that only some of these symptoms are necessary for a diagnosis of clinical depression.

Symptoms of Depression

A significantly depressed mood or general absence of expressions.
Inability to experience pleasure or feel interest in daily life.
Inexplicable crying spells, sadness, and/or irritability.
Sleeplessness or excessive sleep nearly every day. A substantial change in appetite or weight.
Fatigue or energy loss.
Diminished ability to concentrate.
Feelings of hopelessness or worthlessness.
Inappropriate feelings of guilt.
Lack of sexual desire.

Causes of Depression

Clinical depression is typically caused by a combination of biological, genetic, and stress factors. Many depressive episodes occur without any identifiable causes. Consumption of alcohol and addictive drugs may “mask” the symptoms of depression in some persons. It is important to remember that depressive disorders are treatable conditions. They are not the result of weakness, personal failure, or a lack of will power.

Things to Do

Eliminate the use of alcohol, sleeping tablets or addictive drugs.
Engage in some form of physical activity, such as walking one hour every day.
Get adequate amount of sleep at least for eight hours.
Seek emotional support from friends and family.
Modify your expectations and set realistic goals.
Eliminate or reduce unnecessary tasks so that your schedule is more manageable.
Consult a physician if you are experiencing any medical problems.
Seek early intervention, which may modify the severity of your depression.

Things to Avoid

Do not make long-term commitments or important decisions during a clinical depression unless necessary.
Reduce your involvement in activities that are stressful or overwhelming.
Do not assume that things are hopeless.
Do not assume responsibility for events that are outside of your control and feel guilty.
Do not avoid treatment as a way of coping with the illness by yourself.

Treatment of Depression

If symptoms related to a depressive condition are interfering with your ability to do routine, day-to-day activities, or they are disturbing significant people around you, you should consider seeking professional help. There is currently a variety of highly effective interventions available for treatment of depression, depending on what is necessary for each person. If you seek treatment, the recommendations you receive will likely depend on the specific symptoms you have experienced, their duration and severity, and any previous history of depression. There are some side effects associated with antidepressant medication, but the medication is often an effective and low risk form of treatment. Relaxation exercises that reduce the anxiety levels in the depressed persons are always quite beneficial for all people.

SUICIDE PREVENTION

Danger Signals

At least 70 percent of all people committing suicide give some clue to their intentions before they try. Becoming aware of these clues and the severity of the person’s problems can help prevent a tragedy. If a person you know is going through a particularly stressful situation, watch for other signs of crisis. Many persons convey their intentions directly with statements such as “I feel like killing myself,” or “I don’t know how much longer I can take this” (suicidal thoughts). Others in crisis may hint at a detailed suicide plan with statements such as “I’ve been saving up my pills in case things get really bad” or “Lately I’ve been driving my car like I really don’t care what happens” (suicidal plans). In general, statements describing feelings of depression, helplessness, extreme loneliness, and/or hopelessness may suggest suicidal thoughts. It is important to listen to these “cries for help” because they are usually desperate attempts to communicate to others the need to be understood and be helped. Often persons thinking about suicide show outward changes in their behaviour. They may prepare for death by giving away prized possessions, making a will, or putting other affairs in order. They may withdraw from those around them, change eating or sleeping patterns, or lose interest in prior activities or relationships.

Myths about Suicide

MYTH: “You have to be psychiatrically ill even to think about suicide”.
FACT: Most people have thought of suicide from time to time. Most suicides and suicide attempts are made by intelligent, temporarily confused individuals who are expecting too much of themselves, especially during a crisis.
MYTH: “Once a person has made a serious suicide attempt, that person is unlikely to make another”.
FACT: The opposite is often true. Persons who have made prior suicide attempts are at greater risk of committing suicide; for some, suicide attempts may seem easier a second or third time.
MYTH: “If a person is seriously considering suicide, there is nothing you can do”.
FACT: Most suicidal crises are time-limited and based on unclear thinking. Persons attempting suicide want to escape from their problems. Instead, they need to confront their problems directly to find other solutions – solutions that can be found with the help of concerned individuals who support them through the crisis period, until they are able to think more clearly.
MYTH: “Talking about suicide may give a person the idea”.
FACT: The crisis and resulting emotional distress will already have triggered the thought in a vulnerable person. Your openness and concern in asking about suicide will allow the person experiencing pain to talk about the problem, which may help reduce his or her anxiety. This may also allow the person with suicidal thoughts to feel less lonely or isolated, and perhaps a bit relieved.

How You Can Help

Most suicides can be prevented by sensitive responses to the person in crisis. If you think someone you know may be suicidal, you should remain calm. In most instances, there is no rush. Sit and listen to what the person is saying. Give understanding and active emotional support for his or her feelings. Most individuals have mixed feelings about death and dying and are open to help. Don’t be afraid to ask or talk directly about suicide. Encourage problem solving and positive actions. Remember that the person involved in emotional crisis is not thinking clearly; encourage him or her to refrain from making any serious, irreversible decisions while in a crisis. Talk about positive alternatives that may establish hope for the future. Although you want to help, do not take full responsibility by trying to be the sole counsel. Seek out resources that can lend qualified help, even if it means breaking a confidence. Let the troubled person know you are concerned, so concerned that you are willing to arrange help beyond that which you can offer.

OBSESSIVE-COMPULSIVE DISORDER

When a habit isn’t just a HABIT

All of us have patterns in our lives. We follow routines during most days, taking the same route to work or spending our free time in much the same ways. We all have patterns of behaviour, and most of us have reasons for doing things the way we do. In some people however, the patterns are not just patterns. They are patterns that have run wild, patterns with a mind of their own. Such people have strange rituals. They wash their hands too many times a day. They check to see that the lights are turned off so many times that they are late for work or cannot leave the house at all. To make matters worse, they are filled with unbearable anxiety or dread that something terrible will happen if things do not work their way. These people have obsessive-compulsive disorder. This disorder causes people to become haunted by repetitive thoughts (obsessions) or compelled to perform senseless, time-consuming rituals, or both (compulsions). Many people who have this disorder feel ashamed of their thoughts and behaviours and hide their condition. In recent years, awareness of obsessive-compulsive disorder (OCD) has increased, and effective treatments are available.

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an illness that traps people in seemingly endless cycles of repetitive thoughts that will not leave their minds (obsessions) and in feelings that they must repeat certain actions over and over (compulsions). The obsessions that intrude uncontrolled into the person’s every day thinking may be frightening, disgusting, painful, or trivial. Most people with OCD realise that their obsessions do not make sense, but they are not able to control or suppress them. They may be able to explain in detail what their obsessions are, but not why they appear. In most cases, the obsessions cause extreme anxiety. Feelings of discomfort or dread can build up to an unbearable level. To relieve their anxiety, some individuals with OCD feel they must do something. These feelings that they must repeat certain actions or rituals are their compulsions – the things they feel they must do to avoid some dreaded event or to prevent or undo some harm to themselves or others, as suggested by their obsessions. Often the rituals must be performed according to some rules. The rituals may be very simple and hardly noticeable, or they may be very elaborate. Rituals may be time-consuming, sometimes taking hours to finish so that they interfere with the person’s daily routine. Rituals do lessen anxiety, discomfort, or feelings of disgust, but only briefly. The fears and tensions soon return, causing the individuals to start their rituals all over again. People with OCD do not want to have obsessive thoughts, nor do they want to engage in time-consuming rituals. They do not get any pleasure from being the way they are when OCD takes hold of them. Most people with this disorder realise how senseless it is. Recognising the bizarre nature of their obsessions and compulsions, many conceal their condition from others. Eventually people with OCD may be discovered, or their obsessions and compulsions become so time-consuming that they can no longer function at home, on the job, or without developing conflicts with others.

TREATMENT

Most people with OCD can be helped with medication. It allows most people to lead normal lives. OCD is not only distressing to the persons affected, but also hard on the people who live with them. Family members react to living with a person with OCD in several ways. They may demand that the person stop ritualising. They may give continual reassurance. They may even participate in the rituals themselves, to pacify the individual and to avoid arguments. These may seem like the best tactics, but they do not improve OCD. If possible, families should not participate in the person’s rituals.

SOCIAL PHOBIAS

Social phobias start in adolescence and are based on a fear of scrutiny by other people, leading to avoidance of social situations. Social phobias can be discreet, for example for public speaking, eating in public, meeting with the opposite sex, or diffuse, involving all situations outside most familiar circles. Direct eye to eye contact may be particularly bothersome in some cases. Social phobias are usually associated with low self-esteem and a fear of criticism. The person with social phobia anticipates and ruminates over the problems that can occur in a social contact, resulting in avoidance of the situation and in extreme cases social isolation. They experience features of anxiety such as rapid heartbeats, trembling, sweating, upset stomach, diarrhoea, muscle tension, blushing and confusion. In some cases, these symptoms may be severe enough to take the form of panic attack. Some people with social phobia may use alcohol or drugs to self-medicate to help them get through social situations. Although alcohol or drugs may seem to help initially, they eventually become another problem in the life of the person with social phobia. The consequence of social phobia can be socially and economically devastating. It can result in a person dropping out of school, chronic unemployment and financial dependence, alcohol abuse, suicidal thoughts, and not getting married or having children. Social phobia is related to an imbalance of a chemical in the nerve cells. It also runs in families, especially among close relatives like parents and their children. Medication has proven to be helpful in treating social phobias. Gradual exposure to an anxiety-provoking situation until the patient learns to identify and modify behaviour that contributes to his or her social phobia is helpful.