Monday, 28 May 2018

Mental Health Support Groups | How They Can Help You

How Depression Support Groups Can Help You?


It can be lonely to try and deal with depression by all alone. Depression is draining and can impact not only your energy levels but also your hopes and future plans as well. By taking the first step and trying to deal with depression, it will go a long way on your road to recovery.


Mental Health Support Groups | How They Can Help You
Mental Health Support Groups

At some point, you may come to realize that it feels like an uphill battle trying to fight depression on your own. It is important not to keep yourself isolated when you are depressed – it will only make things worse.

 Do you have someone who can help you through depression?

 Someone who has been through depression themselves? If you can admit that you need help with depression, you are taking a step forward in the right direction.

By building supportive relationships, you can get help from others to deal with your depression. Depression support groups are a convenient way to build these relationships. It involves a group of people who don’t know who you are but have a good idea of what you are going through. They are going through or have gone through it depression themselves.

In a depression support group, you get the opportunity to speak about your problems and try to work them out with others. Often, everyone in the group has experienced depression or knows someone who has depression. You will work together with others by learning and teach the techniques you have used to deal with depression. Being in a group environment can speed up the time it takes to deal with depression as opposed to trying to deal with it on your own.

It is difficult to talk to others in your everyday life about depression, especially if they have not gone through it themselves. Having a depression support group will give you the opportunity to open up and share your own experiences. You will be able to listen to other people talk about their emotions and feelings.

Meeting with a depression support group is safe and has proved to work when the group is a right fit for you. Before jumping into a depression support group, you will need to have a few sessions with a mental health professional. These professionals can be therapists, psychiatrists, or primary caregivers. They will be able to determine which group you would best fit into.

Depression support group sessions are usually moderated by a licensed counselor. Their job is to give everyone a chance to speak and direct the conversation. They also track changes in the levels of depression amongst the members of the group.

Don’t expect your depression to be gone after the first session – that is not how it works. You will need to invest your time and build a level of trust among the other members of the group to fight your depression.

 You may be in a support group for a few weeks to a few months. But it is common to be part of the group for years, even if you have overcome your depression. You can always provide your insights with new and existing members who are currently depressed.

Depression support groups can have a great impact on your outlook on depression. Maybe one day just as the support group helped you, you will be able to return the favor and help others.

 Depression support groups can give you a sense of belonging. You can gain the confidence to start achieving small steps which once seemed too large to handle on your own. By having regular meetings, you’ll be able to connect with others just like yourself. You won’t have to be afraid of rejection, being misunderstood or called crazy.

During your first session, you will have the chance to introduce yourself. No one will force you to get into your story right away. Instead, you will just be listening to others and see how the meeting progresses. Take your time to get comfortable and when you are ready to speak up, tell your story. You can start by talking about what you have been through with depression and how it has affected your life.

By cultivating these new relationships in your support group, you can develop lifelong friendships. These friendships can last beyond the depression support groups. You can even have those people just an earshot away in case you go through some hard times again one day. You can even be that friend in need one day when someone else needs you to get through depression.

You might be afraid to tell your family or friends about your depression. That’s completely fine because depression is something that many people like to keep private. Don’t be scared or embarrassed to attend sessions with a depression support group.

Why? Because everyone is there for the same reason. No one will judge you. No one will give you a hard time. Most importantly, no one will give you empty advice such as “hang in there, it will get better” or “just stop being depressed and be happy”. 

You will hear real stories from real people face-to-face on how depression is affecting them. You will even hear about things they have tried which have helped them deal with depression.

Sometimes, just talking about your issues can make a difference. If you keep it bottled up inside, nobody will ever know and nobody can ever offer you any advice. At the very least, you are getting it out. At the very most, someone might have some suggestions on what they did in a similar situation. It might be something that you can use to help you with your depression.

Feel free to ask your family physician to point you in the right direction and refer you to a therapist who can help. You can also find online mental health support groups if you wish to remain anonymous. 

But if, you are still isolating yourself from a computer and it is better to have social interaction of this nature in person. Having interactions in person gives you the chance to express your emotions and build real relationships with people.

Thursday, 24 May 2018

Schizophrenia :Risk Factors, Treatment, and Antipsychotics

Schizophrenia: Risk Factors and Treatment



Schizophrenia :Treatment


Potential Psychosocial risk factors for Schizophrenia  include: 

  • Childhood diversity:
    • Emotional abuse
    • Physical abuse
    • Sexual abuse
    • Ignorance
    • Death of parents.

  • Migration, especially becoming a member of a lower socio-economic ethnic minority in an affluent nation.

  • Being born in the urban area.

  • Any life event full of stress 

  • Illicit Substance Use- Drugs which increase Dopamine activity (Cocaine, Amphetamine, Cannabis)  can cause psychotic symptoms similar to Schizophrenia. 

However, a greater proportion of patients with Schizophrenia use illicit drugs compared to the general population. While these drugs can cause psychotic symptoms,  it is unlikely that they actually cause Schizophrenia, but, in vulnerable individuals, they can-

    • Increase the frequency of relapse in a patient with Schizophrenia.

    • Bring forward the age of onset of Schizophrenia.

    • Can also interfere with the effectiveness of antipsychotics.



Treatment of Schizophrenia- General Principles


Antipsychotics (Neuroleptics) are the mainstay of treatment for Schizophrenia. If available, Cognitive Behaviour Therapy (CBT) may be used in addition to antipsychotic for treatment-resistant psychotic symptoms.



In severe, chronic Schizophrenia, the patient would need psychosocial rehabilitation.


Rationale for Anti-Psychotics

Dopamine Hypothesis of Schizophrenia: This states that Schizophrenia is due to an excess of Dopamine in the brain, so by decreasing the activity of Dopamine, Schizophrenia can be treated. 



Classification of Anti-Psychotics is as follows:

 1) Older / First Generation /Typical:
    
       a)    Chlorpromazine

       b)    Haloperidol

2) Newer / Second Generation / Atypical:

         a) Risperidone

         b) Olanzapine

         c) Quetiapine

         d) Clozapine



Clozapine: Clozapine is superior to antipsychotics as compared to other antipsychotics in managing 'Treatment Resistant'. Schizophrenia. ('Treatment Resistant' Schizophrenia: Schizophrenia that has not responded to at least 2 different antipsychotics given at an adequate dosage for an adequate period of time i.e at least 4-6weeks each.).




 About 20% - 30% of patients with Schizophrenia are Treatment Resistant. The most important thing to keep in mind is Clozapine has also an antisuicidal effect.



General Principles Of Using Antipsychotics:

   "Start Low, Go Slow"
  • Start at a low dose 

  • If needed, increase the dose gradually

  • Review mental state regularly

  • Monitor for side-effects

  • Avoid antipsychotics 'polypharmacy'(using more than one at the same time).

General Principles When Using Antipsychotics:


  • It usually takes at least 2 to 3 weeks for the antipsychotic effect to manifest, and a further 2 to 3 weeks for it to maximize.

  • If the patient improves, do continue medication for several months after recovery.

  •  If the patient does not improve, change to another antipsychotic.

Long-Term Maintenance Treatment for Schizophrenia:


Maintenance treatment is given to:
  • Maintenance control over symptoms.

  • Reduce the risk of relapse.

  • Improve the quality of life/functioning.

How long it needs to be given depends on:

  • A number of episodes.

  • The severity of the episodes.

  • Impact of episodes on functioning.


Other treatment options for Schizophrenia:
  • Psychoeducation

  • Cognitive Behaviour Therapy (CBT)

  • Family Therapy 

  • Art Therapy

  • Cognitive Remediation Therapy

  • Social Skills Training.






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Friday, 18 May 2018

Schizophrenia -Subtypes, Symptoms and Epidemiology

Schizophrenia Definition



The term Schizophrenia is derived from Greek which literally means 'split mind' (Schizo means to 'split' and phren means 'mind'). 


The term Schizophrenia was coined by the Swiss Psychiatrist Eugen Bleuler in 1908. Schizophrenia is different from Multiple Personality Disorder which is a Dissociative disorder. 

Previously the term 'Dementia praecox' is used for this illness.


schizophrenia causes


Clinical features of Schizophrenia 
  •  Schizophrenia is a 'Psychotic' disorder.

  • Psychosis is a condition in which the patient has experiences that do not have any basis in reality.

  • The two main psychotic phenomena are Hallucinations and Delusions.

Hallucinations
  • A hallucination is a sensory perception in the absence of sensory stimulus.

  • It can occur in any of the five sensory modalities: auditory, visual, somatic, olfactory and gustatory.

  • Most common type of Psychosis is an Auditory hallucination.

  • For example: 
    • Hearing voices from outside one's head (even when the patient is alone).

Delusions

A delusion is a false, fixed belief held by the patient with absolute conviction, despite evidence to the contrary and not shared by others from the patient's family or cultural group.

 In Schizophrenia, delusions usually have a persecutory theme for example:
    • 'My neighbor or someone trying to poison me.'

    • 'My movements are being monitored by the cameras, wherever I go.'

Sometimes they have a grandiose theme for example:

    • I am immortal.

    • I am the richest person in the world.



Positive and Negative Symptoms of Schizophrenia 

Positive Symptoms:

  •  Includes Hallucinations, Delusions and Thought Disorder.

  • Seen in the acute phase of the illness.

  • Tend to respond well to an antipsychotic treatment.

Negative Symptoms:

  • Include lack of motivation, lack of speech, poor self-care, etc.

  • Seen in the chronic phase of the illness.

  • Tend to respond well to treatment.

Main subtypes of Schizophrenia 



Paranoid Schizophrenia 

Hebephrenic Schizophrenia 

Catatonic Schizophrenia 

Simple Schizophrenia 

Clinical features of Paranoid Schizophrenia 

 Paranoid Schizophrenia is the main subtype of Schizophrenia that the doctors encounter in clinical practices.

 Duration for a diagnosis of Paranoid  Schizophrenia is one month. Some of the main clinical features are mention below:
  • Delusions, hallucinations and thought disorder are prominent.

  • Examples of delusional themes: persecution, jealousy, and grandiosity.

  • Examples of hallucinatory themes: commenting/discussing, threatening, bodily sensations.

  • Thought disorder manifest as incoherent and irrelevant speech.

Clinical features of Hebephrenic Schizophrenia 


  •   Incoherent, disjointed, rambling speech.

  • Aimless behavior rather than goal-directed.

  • Delusions and hallucinations are either absent or not prominent.

( Duration for a diagnosis of Hebephrenic Schizophrenia is one month.)


Clinical features of Catatonic Schizophrenia

Catatonic stupor is one if the most dramatic presentation, in a stupor the patient is mute or immobile.

 Duration for a diagnosis of catatonic schizophrenia is 2 weeks. Other catatonic signs include:
  • Posturing

  • Waxy flexibility

  • Negativism

  • Command automatism

  • Excitement

Clinical features of Simple Schizophrenia

The predominance of negativism symptoms are as follows:
  • Social withdrawal

  • Loss of motivation

  • Aimlessness

  • Apathy

  • Flattering of effect
A marked decline in social functioning and absence of positive symptoms.


Duration for a diagnosis of simple schizophrenia is 1 year.


Epidemiology of Schizophrenia
  •  Lifetime prevalence is about 1%.

  • Annual incidence is about 0.02 per 1000.

  • Lifetime risk may be about 40 percent higher in males.

  • The peak age of onset: 15 to 24 in males; about 5 to 10 years later in females.

Etiology of Schizophrenia

The exact cause of Schizophrenia is unknown. The general consensus from research is that there is a combination of different factors which include:
    • Genetic factors

    • Other biological factors

    • Psychological factors

    • Social (environmental) factors.


Other helpful resources-

Schizophrenia Treatment

NIMH


Monday, 14 May 2018

Misconceptions About Anxiety Disorders And Facts

Misconceptions About Anxiety Disorders


We often hear people say I have anxiety or I'm stressed out this is something hard to deal with. People with anxiety have probably experienced this fact which is something that's quite hard to deal with. Today we are going to talk about the misconception about anxiety disorder. 


When you have anxiety you feel quite a lot of the time that people don't understand and that people think it's something different than actual.

Which is really difficult and quite crippling thing to deal with and I don't think people always understand a big part of who you are.

 The only difference between somebody who is not understanding your anxiety just because they've never been taught about mental illness or they've never had it in their life. 

Also maybe they've never known anybody that has it just because they've never encountered anxiety or depression before.




So let's see what are the misconceptions about anxiety disorders that are taking over people who are dealing with.




Anxiety Facts

Misconceptions-


#1 Anxiety isn't a big deal

It's obvious that we all feel anxious sometimes and that's not an actual anxiety disorder, cause anxiety is something different it actually impairs our ability to work in our daily life.

Many people think that anxiety is not a big deal but in reality, they don't know how anxiety can affect your life and make it worse.




#2 Anxiety is not a real illness


Some anxiety depends on the situation, for example, we often experience it before having exams or job interviews or something when we gonna try something new.

But when the symptoms are real and physical such as dizziness, muscles tension, trouble breathing, heart palpitation, insomnia,  etc and you have the same feeling for more than months or year then you have encountered with real mental illness. (which is treatable though).





#3 Anxiety and Panic attacks are same


Both panic attacks and anxiety are both different to deal with.


Anxiety is a set of future fears in which you are more anxious about the next 5 minute or 5 hours or 5months/ years and it can exist for long if it not get treated on time.

Whereas Panic attack is a sudden uncontrollable fear and sensations that you feel. Panic attacks can be for last few minutes or for an hour.



#4 Anxiety disorders are not very common 



Millions of us live with some form of anxiety disorders and it's not something so unfamiliar that you have to treat yourself as alone who only does.




#5 We all are introverts


Have you ever been called introvert? Or, scared of big crowds?
And this is the misconception that many people think a person who suffers from anxiety is an introvert or doesn't like to get socialize because yes maybe a person having a social anxiety.


But social anxiety is totally different from generalized anxiety in which people actually want a part of the big groups.



#6 Anxiety  disorders are caused by stress


People often talk that anxiety disorders are caused by stress so reducing stress could help you to feel better and that's really what most people do when they feel a lot of anxiety they try to get stress out of their lives.

The causes of all the anxiety disorders are pretty complicated it's usually a combination of genetics or your inheritance.


#7 Switching negative  thoughts with positive thoughts



Maybe you have tried once this technique of fighting negative thoughts with positive ones but you failed because that doesn't actually work and this is something called paradoxical.



Unwanted thoughts tend to get stronger and more repetitive and in the result, your anxiety won't be going down and then you start getting mad at yourself. 


And on and on the inside of your head  it goes round and round and you can't actually make yourself  stop thinking something if you just stop  for a moment


#8  Push yourself

Another misconception is- to fix your anxiety you just have to push yourself a 'lil bit and things won't be the same but this is a  really offensive way to save somebody I guess. So if you have a friend or loved one who is going through anxiety never try to say these stuff  



Though people think that encouraging their friends or their loved ones or family members could help and I also personally support people by encouraging them. The thing you have to understand is, do not put unnecessary pressure on them it could be the worst thing that you ever do.

Pressure also plays a role to make your anxiety worse. People with anxiety can't deal with situations when they are suppressed by many things.




#9  Antidepressants will only make you worse

Hey! Antidepressant works best and nowadays there are many antidepressants available that you can take as prescribed. I will always encourage people who are going through anxiety to try antidepressants and do not listen to people who have never had an anxiety or depression.



#10  You won't get better unless they go through therapy 



You might have been to loads of therapists in the past and many of them were really not helpful but only had made you feel worse. Well, I don't mean that you shouldn't try therapy. In fact, you must try once. 



 But here what I wanna explain is you can help yourself by doing the stuff that makes you feel better with a non-pressure environment and setting a goal in your life and focusing on yourself.




#11  Therapy for anxiety- It's gonna take forever


Many people still have this misconception that therapy for anxiety is going to take them forever but the therapy which is called CBT (Cognitive Behavioral Therapy) and it is the most effective therapy used now to treat anxiety disorder it's not gonna take long or forever. 



#12 Medications are the only cure


As above mentioned CBT is now being most effective and helpful therapy for anxiety disorder, so we can state that medications are not the only way to get rid of anxiety disorders.


       So, those were the 12  misconceptions about anxiety disorders.


So, let me know if you ever had to face any of these misconceptions in your life.


Other helpful online resources do visit.




















Wednesday, 9 May 2018

Eating Disorders: Co-morbidity, Assessment, Management And Treatment

Eating Disorder: Assessment, Treatment, and Management


A considerable proportion of patients with Eating Disorders have other psychiatric disorders. Most common co-morbid illness is Depression, followed by Anxiety Disorders and Personality Disorders.


However, Psychosis, OCD, and PTSD are more common in Anorexia Nervosa as compared than in other eating disorders.
Secondly, Alcohol and substance misuse are the more common in Bulimia Nervosa than in other Eating Disorder.

comorbidity, treatment, management of AN,BN and BED


 Assessment For Eating Disorder - General Points

According to a medical report the majority of patients with Eating Disorder especially BN and BED do not receive proper treatment (either patient do not seek treatment or the diagnosis is overlooked). 

Here are the few points that could help for the assessment of Eating Disorder.


  • Take a comprehensive Medical History.

  • Measure the BMI (Body Mass Index).

  • Do a general physical examination, looking for the signs and symptoms of Anorexia Nervosa and Bulimia Nervosa.

  • Do routine blood tests before initiating the treatment.

  • Do a baseline ECG.

Management of Eating Disorders - Overview

  • There are a wide variety of treatments used for Eating disorders.

  • Normalization of nutrition and eating habits is a central goal in the treatment of patients.

  • As eating disorders tend to run  a chronic course, it is important to monitor and address, on an ongoing basis:

    • Psychiatric co-morbidities.

    • Physical health complications.

    • Changes in Social circumstances.

Management of Anorexia Nervosa-
  
Depending on the availability or need patient can be treated in a :

    • Routine Psychiatry Outpatients (Adult or Child and Adolescent Services) clinic.

    • General Psychiatry Inpatient Unit.

    • General Medical Inpatient Unit.

    • Specialist Eating Disorders Inpatients/Outpatients Unit.


Pharmacotherapy for AN

Based on the research, Atypical antipsychotics (Olanzapine) and Zinc supplementation could be beneficial.

 Moreover, it is important to identify and treat any co-morbid depression and anxiety accordingly, with antidepressants.



A rationale for using Atypical Antipsychotics in AN-
  • In order to help promote weight gain(Olanzapine could be beneficial).

  • To reduce hyperactivity (used by patients as a weight losing tactic).

  • According to some evidence from neuroendocrine studies that dopamine neurotransmission is increased in AN.

So, that means Antipsychotics that have dopamine antagonist effect might be helpful.

A rationale for using Zinc in AN-

 There is a zinc deficiency in AN and zinc plays an extreme role in neurotransmitter function, it has an appetite stimulant effect also.
 According to one study, it has been found effective and beneficial that a 14 mg of elemental zinc given daily for two months(as a suggested dose).



Treatment of Bulimia Nervosa-


  • Patients are generally treated as Outpatients.

  • CBT is the treatment of choice- either Individual CBT or Group CBT

  • Other CBT Options: web-based / Telemedicine CBT, Guided Self-help, Bibliotherapy(Self-help books).

  • Interpersonal Therapy may be another helpful option.

  • Education about Healthy dieting can be helpful.


Pharmacotherapy for BN-

 SRRIs (particularly high-dose of Fluoxetine) can be helpful in reducing bingeing urges and other obsessional preoccupation with weight.


 Antiepileptic Topiramate may be helpful as it has an appetite reducing the effect.



Management of Binge Eating Disorder

Studies show that it has a high placebo response. Similar treatment approaches as for BN.

  • Psychotherapy options:

    • CBT: Individual / Group/ Online/ Self- Guided Help/ Bibliotherapy.

    • Other psychotherapies: IPT (Inter-Personal Therapy)

  • Medications:

    • SRRIs (esp. Sertraline/ Esciatalopram / Citalopram), Imipramine, Topiramate, (Sibutramine is no longer approved due to risk of MI and stroke).

  • Weight loss treatment programmes / Individual coaching, etc can be helpful with obesity.



Other helpful Treatment Options for Eating Disorders


Exercise programmes (Light resistance training) this might be helpful in changing the patient's attitudes towards exercise and also may increase bone and joint strength.

  • Mindfulness training

  • DBT (Dialectical Behaviour Therapy)

  • EMDR

  • Yoga

  • Body Awareness Therapy

  • Estrogen Supplementation

  • Bright Light Therapy

  • Parenting skills training (parents need to create awareness among their children to reduce the risk of an eating disorder behaviors from an early age.)

Also, read 

          



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Saturday, 5 May 2018

5 Helpful Tips To Talk With Your Doctor About Social Anxiety

How to talk with your doctor about social anxiety?

This post is about my own personal experience. If I talk about my doctor he is very open to talking about social anxiety but for some other people, it might be in sort of awkward situations to speak up about their insecurities. 


So I hope this post will help people who are experiencing some of these challenges. I believe people with social anxiety have a harder time in communicating than most other people, so going to the doctor can be particularly frightening or unnerving. 

Here are few points that I am gonna share with you and I hope it will help you out.

Helpful Tips To Talk With Your Doctor About Social Anxiety


Firstly, make a complete list of all your queries and doubts related to your anxiety in a handwritten or on your phone before of all the things that you want to talk with your doctor and that would be easier for you to talk with your doctor

 If you have already those questions lists in front of you, so you actually don't forget anything like when you  become nervous or something because I know  what happens to people when they become  nervous they forget to say things that they had planned for discussion, 

So, better you can make a list and then so you won't be getting off from your track when you're in the room with the doctor. Therefore whatever the reason you have you're going to your doctor follow through with that list and talk with your doctor and surely something might help you.



Secondly, whenever you go to your doctor just remember that your doctor is there to help you, well a lot of doctors are there for the money but hopefully, you have a doctor who is there to help you and who wants to see you get better.


Thirdly, explain to your doctor about every symptom that you're experiencing, doesn't really matter if it's a big or little and can tell your doctor like what the most worrisome or bothersome symptoms are for you. 

There are a lot of different medications for social anxiety if you're not on medications yet and you think that it might be helpful just ask your doctor to add some if possible for you(according to your symptoms).



Fourth, if you're on medications and you think you need a dose change so you can explain to the doctor why you think you need to change your medication. 


So do not hesitate to tell your doctor the exact reasons. Maybe you're experiencing too many side effects and you want your dosage to be decreased or changed, tell your doctor that your experiences side effects because maybe a  decrease or change in dosage is what you all need. 



Fifth, now this one is very important that you got to think over it. Never decide at the last minute that you don't actually need to be with your doctor for help because that the most people used to do. 

So you better take a step ahead of your social anxiety to get rid of and remember that the reason you went to the doctor.


Important Note*

At the end of the day, you are paying your doctor or your insurance company to help you or maybe that doctor is being paid by someone to help you, so it's your right that you get a good and proper treatment for your social anxiety. 


Moreover, if you are not satisfied with your doctor in results of not getting a proper response and being not helpful to you anymore, so you have a choice to change your doctor and your medications as well.


Other helpful resources related to Social Anxiety Disorder  you may go through the following links


1

NIMH  Anxiety Disorders