31st May 2018 World No Tobacco Day

Today, 31st May 2018 is “ World No Tobacco Day” Learn to Say no to Tobacco! Tobacco chewing and smoking can lead to severe Addictons ! This can have disastrous consequences on physical and mental health. Quit Tobacco ! Be positive! Yes you can quit Yes you can do it

Mental health matters! Make mental health your priority

Today, 7th April 2018 is World Health Day. The theme this year is Universal Health Coverage, Everyone Everywhere. Health is wealth. The Indian Psychiatry Society Committee on Public Education and Awareness 2018 encourages psychiatrists to work towards enhancing public awareness on mental health and psychiatric disorders on this day of World Health Day. Just as physical health is important, so is mental health. A healthy mind and a healthy body go a long way to keep you productive, fit, happy and stress free. Keep your mind healthy and conflict free. Mental health care must also be available universally to everyone and everywhere. Stigma, misconceptions, negative attitudes can affect access to mental health care and can affect outcomes. Schizophrenia, Addictions, Dementia, Depression, Bipolar Disorder, OCD, Anxiety Disorders, Stress related disorders, sleep disorders, Sexual disorders, etc can affect your mental health and social functioning. It is advisable to seek professional help from psychiatrist and allied mental health professionals if one is feeling depressed, anxious, stressed, unable to cope, hopeless, helpless, fearful , etc. Life is beautiful. Stay healthy and make the best of it. 

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Q and A based approach to problematic behaviors in a child

Question :  My son , 10 years old has not been doing well in his studies upto my satisfaction. I feel he has the capacity to excel and put in more hard work , but he does not do so. He is developing to be very defiant and tends to oppose everything I say and has become very rebellious over past few months. He hardly studies but tends to spend more time at play and when we remind him that he needs to study more, he shouts back and closes his room and gets aggressive. He has started picking up quarrels with elders if they correct him. He has also become retaliatory, back answers, disobeys and is very disrespectful in his attitude towards elders. He was not like this a year ago. He was very sweet, obedient and hardworking child and now there are so many complaints coming from relatives and teachers regarding his behavior. I am really concerned about his behavior.  Can I just ignore it and be hopeful that it will become better with time. Can it get worse with time if left the same. Kindly guide me- (A concerned parent) 

Answer:

Dear parent,

It seems that your child is in some genuine distress. Empathize with your child.  Be supportive. Kindly do not judge your child or become more hostile to your child. Kindly understand your child that he is going through some problem which needs attention from a mental health perspective.  It seems that your child is experiencing some emotional and behavioral problems which needs to be evaluated so that your child can be helped better. It could be an indicator of oppositional defiance disorder in the child. His problems with studies also needs to be evaluated whether it is some problem in his level of intelligence or his attention span or learning difficulties or his behavior that is leading to his poor performance in studies. It is not good to ignore it as in many cases there is an established concept of psychological progression where in a simple behavioral problem in a child if left unattended can lead to oppositional defiance disorder which can lead to conduct disorder which can further lead to a personality disorder in adulthood. It can also if ignored  complicate into depression, substance abuse, educational drop outs and underachievement. Moreover he maybe having some psychological conflicts at home or with peers or at school which are unexpressed to his caregivers and are manifesting as behavioral problems at home .  Kindly consult a psychiatrist who shall clinically evaluate the child and plan certain investigations and psychological tests based on his clinical condition. He will definitely need behavior therapy and you as parents shall certainly benefit from parenting guidance in context of his behavioral problems. He shall benefit from a multidisciplinary approach comprising of psychiatrist, psychologist, educational counselor, etc to holistically cater to his emotional, behavioral and educational needs.

Am I parenting right? Am I parenting wrong? Myths and facts about parenting !

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• Myth 1: Parenting requires no skills!  Everyone does parenting right way all the time!
• Reality 1 : Parenting is a complex dynamic process requiring  constant hard work, skills and improvisation in today's challenging and advancing world. Parenting definitely is an anthropological evolutionary phenomena which has evolved around the ages! Of course, there is an instinctual biological phenomena in child rearing, yet social and individual factors play a holistic overlay. Every parent wants to be the best parent to his or her child and puts in his or her best shot . Yet, in the complex world we live in, struggling with jobs, finances, stress, etc parents can also make some mistakes in parenting unknowingly !  Parents may sometimes unknowingly displace their own stress on the child by getting angry, not being emotionally responsive, being hostile to the child, etc. Many parents struggle to strike the right balance in their personal and professional lives while parenting effectively. Everyone tries their best to do it right, however sometimes parenting can go wrong as well! 
• Myth 2: Parenting the child is a Mom's job Always !
• Reality 2: These are common expectations in a traditional society where the mother cares and rears the young ones and does the household chores and the expected role of the father is on earning money and providing basic necessities such as food, clothing, shelter, etc for the family. However, in today's modern times when both the father and the mother may need to work and earn money, it is very vital that fathers take on an equally important role in parenting and child rearing. 
• Myth 3: I send my child to the best costliest school so  I am the best  parent! Do I need to do anything more?
• Reality 3:  A mentality which some parents have is to expect that sending a child to the costliest available school is equivalent to being the best parent! They do not want to do anything more than that and according to their mentality they feel that as they are paying huge fees hence its only the school's job to cater for the development of the child. Some of these parents in this process may forget their own role of  providing values, teaching concepts of good and bad, disciplining, etc unknowingly! Its certainly good that you are able to provide for good quality schooling for your child . However, kindly do not forget your own duties in terms of spending quality time with your child, enriching your emotional bond with your children, caring and loving them irrespective of whichever type of school you send your child to!
• Myth 4 : Good parenting means buying lots of costly gadgets, clothes, gifts, etc for your children! 
• Reality4:    A common mistake is to substitute the lack of time spent with the child with costly, expensive gadgets and gifts for the child to make up. Your child needs you and your love more than anything in the world! Not your money!
• Myth 5 : Parents are always right! Child is always wrong! I am the parent! I know whats best for my child always all the time ! 
• Reality 5: Certain parents can have some rigid ideas such as that only they are right! Others are wrong when it comes in terms of their child! They also think that whatever decisions they make are the best decisions all the time across all stages of development for the child. There are different stages of physical, social, cognitive, emotional development in a child across different periods of infant, toddler, preschooler, school going, adolescent, etc. As the child start growing towards adolescent and then subsequently towards adulthood, parents need to introduce concepts of autonomy, collaborative decision, alternate thinking pathways, critical thinking, etc and show respect towards the child inputs, intelligence , emotions, etc and involve children and adolescents by seeking their thoughts and inputs. You might be in for a big surprise to know how much your teenager knows as well on these worldly matters! Certain matters like choice of higher education and  career decision may need a collaborative decision making. A parent deciding a career for  a child assuming the parent's view is supreme  may lead to problems in the child  especially if the child felt that he or she was  not willing for that career right from the beginning for that!

Do You Have An Eating Disorder?

• Food plays an important part in our life . It provides us energy and nutrients and plays a very vital role in physiological functioning of our bodies . Eating can make us happy as we bond over meals at home, workplace, luncheons, dinner, coffees, etc.

• " Healthy eating and regular exercising" is easier said than done in today's extremely fast paced workaholic stressful life!  Food and weight can have a problematic relation and can be a malady of sorrows for some as they see the scales showing increasing weight gain tendency! 

• Problems in eating on a psychological level exist for many people yet it is frequently ignored! Many  inadvertently become emotional eaters who may eat excessively to fight away the stress they face, the painful emotions they experience and the anxiety they feel without even being aware of it fully! Many willfully starve frequently by depriving themselves of basic energy and nutrients for that elusive figurine!

• Eating disorders can occur in both males and females. Nowadays there are rising trends in youngsters and adolescents as well! There may be an overlay of peer pressure, society perceptions, ideal body image , etc interacting with one's psychological development, family history,  stress, psychiatric and medical co-morbidity towards development of a significant eating disorder!

• Some of the symptoms of a possible eating disorder are eating unusually excessive amounts of food in short periods of time, not able to exercise control over eating, eating compulsively despite being full, eating excessively to cope with negative feelings of loneliness, sadness, unpleasant emotions, eating lots of junk food frequently,  skipping meals frequently, hiding food and throwing food secretly provided by caregivers, refusing to eat food, vomiting immediately after eating, eating impulsively and randomly without healthy routines, exercising way excessively beyond the regular fitness regimens in compensation to cope with guilty eating spells, going to the gym or workouts session erratically after  frequent spells of  consumption of very high caloric food, perceiving one's self to be fat despite being objectively thin and underweight, not able to stop disordered eating patterns despite developing medical complications related to the eating disorder,  feeling sad and distressed because of eating problems.

• Not all problems with eating are a full blown EATING disorder! Likewise not all individuals who are obese or underweight have an eating disorder! Medical conditions, hormonal problems, genetic overlay, etc can contribute in making a person fat or thin! No need to feel ashamed over your weight and body image! Be confident the way you are whether thin or fat! However for medical reasons it may be necessary to prioritize one's excessive weight gain or  weight loss! 

• Anorexia Nervosa, Bulimia Nervosa, Binge eating Disorder, Eating disorder NOS are various types of eating disorders. Anorexia nervosa individuals can have a morbid fear of becoming fat and may restrict intake of food excessively or use measures such as vomiting, laxatives to lose weight  and a body image distortion of being very fat despite objectively being thin. Bulimia nervosa can have symptoms such as eating excessively, emotional eating, feeling guilty about the eating pattern, compensatory excessive exercising to lose excess intake. Binge eating is characterized by eating excessive amounts of food in relatively short periods of time very frequently. There are standard diagnostic criteria in psychiatry classification such as DSM- 5 and ICD-10 which enable psychiatrists to clinically interview the patients and diagnose the conditions based on symptoms. 

• Untreated eating disorders can have implications on physical health leading to complications such as loss of menses,  osteoporosis and fractures, GIT disturbances, electrolyte disturbances, dental problems, cardiac problems,  etc. Eating disorders can also have co-morbid psychiatric disorders such as depression, OCD, anxiety disorder, substance abuse, personality issues, etc.

• If you think you or your near and dear ones have some symptoms of an eating disorder, it is advisable to consult a psychiatrist at the earliest. The psychiatrist will clinically evaluate you, try to understand your pattern of eating disorder, rule out co-morbid depression , stress or anxiety related disorder, counsel you and provide you cognitive behavior therapy for the eating disorder. The psychiatrist may also suggest some psychological assessments if perceived necessary to understand the problems with your eating. The psychiatrist may also suggest some medications for your pattern of eating disorder based on clinical expertise. The psychiatrist may suggest some investigations and references to other specialties such as medicine, pediatrics, endocrinology, neurology, surgery, gynecology,etc based on the symptoms and complications faced by the patient. 

• Outpatient or in patient based treatment setting for eating disorders depend on the diagnosed condition, severity of the condition, co-morbid medical problems, school of training, guidelines, etc. Multidisciplinary approaches consisting of psychiatry, clinical psychology, nutritionist counselling, etc may be helpful in holistic  management of eating disorders in collaboration with concerned specialties. 

Is Your Child Inattentive, Hyperactive and Impulsive? What is Attention deficit hyperactivity disorder (ADHD) ?

• Children and adolescents can have symptoms of inattentiveness, hyperactivity, lack of concentration, impulsivity, etc. Many a times, children experience some amount of inattentiveness and hyperactivity in the context of normal development .
  
  However, when these symptoms become severe, excessive, persistent, seen across multiple situations of classroom  setting ,  home setting , social setting, etc and the child is experiencing problems in his academics and social functioning because of these symptoms, then the child  may be having a disorder called ADHD ( Attention Deficit Hyperactivity Disorder).
• Children can have an Inattentive Type of ADHD where inattentiveness is the main symptom or they can have  Hyperactive - Impulsive Type of ADHD where excessive hyperactivity  and impulsive behaviors are  the  main symptoms  or they can have Combined Type of ADHD which has all features of  inattentiveness,  hyperactivity and impulsivity. It is found in both boys and girls, but reported to be more common in boys than in girls.
• There are standard clinical criteria in psychiatry classification systems such as DSM-V and ICD- 10 for diagnosing ADHD which are used by psychiatrists in evaluating whether your child is just experiencing some symptoms or a full blown disorder based on symptoms, settings, severity, developmental age, etc. There are  clinical rating scales which may be used to for additional assessments and plan interventions accordingly. 
• ADHD can lead to problems in academics and education as the child faces significant problem in focusing in the classroom, paying attention, gets distracted easily while studying and hence it can reflect in day to day school work and even affect his or her performance in exams. 
• A child with ADHD can also have problems in social behavior because of inability to sit in one place and impulsivity in behavior and can appear disruptive in classrooms. They can also have problems with their peers and can have problems in friendships because of their impulsivity, hyperactivity and behavioral overlay.
• Kindly consult a psychiatrist if your child is experiencing symptoms of ADHD. It may be preferable to consult a psychiatrist with expertise/ training in child and adolescent psychiatry if resources are  available  who can evaluate your child clinically, plan some assessments for ADHD, advise you certain blood tests and electrophysiological investigations as per expertise, guide you regarding role of medications to improve child’s attention and concentration  and role of therapies such as Behavior therapy, Parent management training therapy, etc . The psychiatrist will counsel your child to deal with his problems in studies and behavior and  suggest some therapeutic  tips to improve your child attention and concentration,  do psychological therapy for your child as per  clinical expertise and school of training in child and adolescent psychiatry. Parents  also be need to be taught positive parenting practices to improve the child's overall behavior and techniques to improve the child's attention and reduce problematic behaviors of hyperactivity and impulsivity.
• The psychiatrist may refer your child for a Neurologist consultation, preferably a Pediatric Neurologist if there are any neurological signs and symptoms in the child as per clinical expertise to rule out any neurological conditions which can have symptoms of inattentiveness, hyperactivity etc. Certain conditions like seizures and nutritional deficiencies can have inattentiveness and hyperactivity as symptoms which may need to be evaluated.  
• Multidisciplinary approaches comprising of child and adolescent psychiatry, pediatric neurology, child psychology, OT and educational liasion  are  useful for comprehensive assessment and holistic  management of the child with ADHD. 

Tips for Good Sleep: Sleep well for positive mental health !

Sleep is a an essential physiological function of the human body. Sleep plays a very important function in restoring the wear and tear of daily life and providing the desired rest and restitution to the body and mind. As we grow older, the quality of our sleep may change. When we are younger as in childhood we tend to have more hours of sound sleep but as we  grow older the number of hours we sleep and the quality of sound sleep can deteriorate significantly. Moreover, the demands of work, professional deadlines, travel stress, physical ill health, excessive gadgets usage before bedtime, mental stress, all of these can contribute towards poor sleep! Some of the common sleep problems are difficulty in falling asleep. difficulty in maintaining sleep, sleep disturbances such as bad dreams excessively, night mares, etc, sleeping too less or too much and not feeling fresh after getting up from sleep. In today's life style of travelling across the globe and night shifts can lead to disturbance in our body's natural circadian rhythm which can lead to jet lag, shift work sleep disorder, etc. Poor sleep quality can also be associated with cardiac events and accidents. Poor sleep can make us inattentive , irritable, distracted, restless, sleepy and groggy at our workplace and study place. A person having chronic untreated sleep problems can also have problems with efficiency and work performance.  Insomnia, Hypersomnia, Parasomnia are types of sleep disorders. Certain medical conditions, medications and substances such as alcohol, cannabis, nicotine can also interfere with sleep. Sleep disturbance is also a part of psychiatric disorders such as adjustment disorder, acute stress reaction, post traumatic stress disorder, depression, mania,psychosis, addictions, etc. Children can have bed wetting and night terrors during sleep. I have written some dos and donts which is not a fully comprehensive list, yet can be helpful for getting good sleep.

Dos:

1.It is preferable to stop late night use of gadgets, apps, internet, TV viewing if you are having problems in falling asleep. Learn to switch off from all of these everyday at least an hour before you go to sleep. 

2. Practice relaxation daily before going to sleep. Deep breathing exercises while lying on your bed with a focus on breathing slowly and being aware of each breath and slowing down your system with use of some positive images in your mind can help in falling asleep.

3. Late Evening prayers can helpful for sleep based on your own belief systems.

4. Eat light meals at bedtime and drinking a cup of warm milk can help in getting sleep.You may add almonds, cashew nuts, saffron, etc based on your preference. Taking a relaxing shower prior to bedtime can help sleep well. 

5. Do cut down on daily intake of excessive consumption of sugar, salt, oil,spices in your diet if you are experiencing severe gastrointestinal discomfort while falling asleep and also waking up at night feeling uneasy, bloated, acidity, pain in abdomen, etc. 

6. Monitor  daily intake of tea and coffee and cut down intake if you have problems with sleep.

7. Be positive at bedtime. Live for each day to its fullest ! Tell your mind positive self statements at bed time that " Yes, I am doing good! I am doing fine! Things are great! Life has been good to me! I shall conquer all my problems! No need to worry! Things are in control! Situation will get better! I can work something out! Life is beautiful! I am doing well for myself! Things will change for the best! "' These kind of positive statements said to yourself can help you gain  control over negative defeating thoughts which maybe coming in your mind at bedtime while you stare at the ceiling trying to fall asleep at night especially when you are facing difficult stressful times. 

8. Try to cut down on smoking and chewing tobacco. Seek professional help for deaddiction from nicotine and tobacco.

9. Try to cut down on alcohol if you are facing problems in sleep  related to alcohol. Seek professional help in quitting alcohol.  Drugs such as cannabis, cocaine, heroin, etc have harmful consequences on sleep and mental health. Seek professional help to quit from them.

10.Try to have a fixed schedule of sleeping at the same time and waking up at the same time everyday. Pay attention to your bed room, clean the bed room regularly, keep changing sheets regularly and keep replacing old bed sheets, pillows, pillow covers regularly. Pay attention to the right temperature settings and dress in comfortable night clothes as per your preference.

Donts:

1. Do not drink excessive caffeine, tea, stimulant drinks before going to sleep or  late evening if you are having problems falling asleep.

2.  Tobacco  can interfere with sleep and avoid smoking or chewing tobacco just before going to bed. Alcohol can interfere with sleep and avoid drinking alcohol before going to bed.

3.Do not indulge in drugs such as cannabis , cocaine, heroin,etc as they interfere with sleep.

4.Do not eat heavy meals or drink too much water just before going to bed.

5.Avoid excessive TV viewing or internet viewing just before going to sleep. Avoid excessive texting and playing online games just before going to sleep.

6. Do not do excessive rigorous exercise  very late evening if u are having a persistent problem in falling asleep  as it can switch on certain neurotransmitters and can interfere in falling asleep for some individuals.

7. Do not use your bed for eating, drinking, studying, watching TV, working/surfing on your lap top. Do not sleep with lights and gadgets on as it can cause sleep interference.

8. Do not think and worry excessively about how was your day, who upset you, why u did this or that and why you shouldn't have done this or that. All these ruminations, worries, anxiety just before going to sleep will certainly affect your sleep. Do not cry or pick up quarrels with others before going to sleep as it will affect your sleep quality.

9. Do not keep getting up and checking the phone, alarm clock or the watch to see what is the time again and again.

10. Do not have a varied sleeping schedule which is very erratic where in one day you sleep at eleven pm the second day at one am and third day at three am. Do not take long hours of nap in the afternoon or evening as it then interferes in falling asleep at night. 

Note: 

If despite your best efforts, you are not able to get good sleep, kindly consult a psychiatrist. The psychiatrist will screen you for a psychiatric disorder where sleep disturbance may be a predominant symptom such as anxiety disorder, stress related disorder, depression, mania, psychosis, etc. The psychiatrist will assess you and provide you treatment for your sleep problems based on whether you have Insomnia, Hypersomnia or Parasomnia related conditions.The psychiatrist will clinically evaluate you, suggest some tests, will teach you relaxation training, sleep hygiene therapy and psychological therapy targeting the cause of your sleep problems and prescribe you medications for the sleep condition you suffer from as per clinical expertise.  The psychiatrist may also refer you to a Neurologist or  a Sleep Physician  as per clinical expertise for conditions such as Sleep Apneas, Nocturnal Epilepsy, Narcolepsy, Restless Leg Syndrome, etc which may need a a comprehensive  evaluation with Sleep Lab based assessments and multidisciplinary interventions.