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. 

Tips For Students: Handling Exam Stress!

A student’s life can be difficult with rising pressure to perform well in this competitive world! For some , the pressure can be internal from their own self to perform better than rest and for some the perceived pressure can be from external sources such as their family expectations, peers and friends, society and the system  to perform academically well! Exams can be an easy ride for some brilliant students who do well with no perceived exam stress, however for a lot of students in the real world preparing for exams and the examination days can be extremely stressful. Many Students get anxious, sad, restless, insomniac, irritable during exams! Exams are a part of the educational system for assessment purpose! One has to prepare well and stay focussed to get good results! These are some simple tips that I have prepared in terms of dos and donts for students while handling exam stress! This is not a fully exhaustive list yet I personally believe that it can be of good help to students!

Dos:

1. Stay positive ! Keep Calm! Believe in yourself! Have positive hope!

2. Sleep well! Even during exams, if you can sleep your basic 6 to 8 hours it will be wonderful. Do not stay awake the whole night cramming , it will certainly reduce your performance. No matter how tensed you maybe, try to sleep for few hours atleast!

3. Prepare a time table, manage your time well, chalk out subjects to be covered over the next few weeks and keep one or two weeks for revision of most essential stuff. Plan and prioritize well. Prepare your own brief revision notes of topics you keep forgetting repeatedly.

4. Have a study area which is away from noise, TV, distractions, etc. If you do not have a separate room and if it gets distracting at home, study at your school or college library or wherever you feel it is comfortable! But remember you have to be honest to yourself and don’t waste time wherever you may study!

5. Play your regular sports and games. Dance if you like! Sing if you like! Go to the gym if you like ! Keep these activities for brief periods during the day to boost your endorphins when you are in your exam preparatory leave, however do not overdo it !

6. Diet can play a good role! Eat simple nutritious meals before exams! Ensure you get good intake of vitamins , serotonin, and minerals in your diet which will help to improve your concentration. Drink a glass of milk daily! Eat green leafy vegetables and fruits! Have almonds, nuts, strawberries and perhaps a bit of dark chocolate as well  ! A cup of tea or coffee may be helpful as well however it is advisable not to overdo it!

7. Talk to your good friends! Try to have friends who are positive, help you prepare better and can be there for you when you feel tensed and you may also help them when they need your help. Call them, talk to your friends, text them when you feel tensed and share your problems with them!

8. Practice yoga daily! Do deep breathing Relaxation exercises! Use relaxing images in your mind such as visualizing greenery,mountains, rivers, flowers, etc! Listen to soothing music!

9. Stay away from harsh , critical , mean, conflicting friends and relatives during exams as they can lower self esteem and can even make you feel sad and anxious by their remarks and behaviours!

10. Pray regularly as per your belief systems! Take good luck wishes from your elders! Stay positive and have faith that All for the best!

Donts:

1. Dont bring in negative thoughts in your mind! Dont compare yourself to others

2. Dont let your past affect you!   Dont waste your time in overthinking and worrying !

3. Avoid Last minute new reading. It causes a lot of stress cramming up stuff last minute if it is not studied earlier!

4. Do not indulge in drinking too much tea, coffee, stimulants as it will cause sleep disturbance and will make you more jittery and restless.

5. Do not overeat before exams. Avoid outside food as far as possible during exams! You certainly don’t want to fall sick on your exam day!

6. Do not try to waste too much time on the computer surfing or watching TV or playing video games excessively. Every minute matters. However if these games refresh your mind or watching an online relaxation video or music helps you relax, plan some time for relaxation as well on your exam days . However keep these breaks strictly monitored in terms of time

7. Do not be late for an exam. Try to reach early itself! Being late can set in anxiety in the mind!

8. Do not pick up quarrels with family members or friends or bring in any unresolved disputes during your exams. Such things can disturb the mind and can interfere with your ability to perform well.

9. Avoid relationship issues and fights with your friends or family  prior or during exams. These can affect your mood and concentration a lot! Remember your exam performance should be your first priority!

10. Do not withdraw completely and switch off from your family, friends, neighbours, etc in your exam preparatory leave! Stay connected! It always helps to have someone to talk to and to share your problems with!

Do not neglect your mental health and let it suffer ! Despite your best efforts to study and prepare well, if you experience severe anxiety, mood swings, difficulty   in concentrating, feelings of hopelessness, negative thoughts, excessive crying spells, fear, panic, not able to sleep well, disturbed sleep, feeling  tensed, palpitations, trembling, choking sensation, inability to remember learnt stuff, uneasiness, disturbing thoughts during  your preparatory period of leave for examinations , kindly consult a psychiatrist as a priority! The psychiatrist will evaluate you clinically, counsel you, provide psychotherapy and may also suggest some medications based on severity of your symptoms and clinical expertise.

Am I stressed ? High Time to visit the Psychiatrist !

This is a question that we all must face at some point in our life as we are living in a world which is so rapidly changing. We are on a daily basis dealing with travel stress, work stress, home stress, relationship issues,educational stress, etc. We tend to do a good job on our own daily and try to fight the stress so that it does not get on to us and we all make our full attempts in coping with it to the best of our capabilities. Yet we are humans and at different points in our lives we may be vulnerable and not be able to cope adequately with it. We may become depressed , anxious, panicky, fearful, insomniac, jittery dealing with it. Sometimes these may be transient and brief, yet it tends to do harm if left ignored. Manyatimes the way stress affects our mental health can cause significant changes in our psyche. It can lead to depression, anxiety disorder, psychotic breakdown, sleep disorder, sexual dysfunction, etc. Stress has also been linked to cardiac illness, hypertension, gastrointestinal disorders, etc. Each one of us can have different stressors and different manifestations of mental health issues. it possible that you may be experiencing some symptoms related to stress or you may be having a full blown psychiatric disorder that you may not be aware of? Disorders like Depression, Generalized Anxiety Disorder, Panic Disorder, Somatoform disorder, BPAD,  Personality Disorders,  Substance related disorder such as Alcoholism, Nicotine dependence, Cannabis dependence, Eating disorder, Sleep disorder, etc can be linked with stress such as stress can play a role in precipitating a psychiatric disorder and also causing exacerbation's and worsening in clinical outcome.  When you are feeling stressed, kindly consult a psychiatrist. The Psychiatrist will clinically assess you and  suggest some investigations perceived appropriate to your symptoms. The Psychiatrist will also suggest you stress management therapy, relaxation training and psychological therapy to cope with the stress. As per the clinical assessment, the psychiatrist will also suggest you certain medications to relieve you of your symptoms based on clinical expertise.

Checklist: I suggest you to kindly go through these symptoms in the checklist that I have prepared. It is not a fully comprehensive one, yet it helps you to read through and if some of these symptoms you can relate to, then it is high time to visit the psychiatrist! Kill the stress before it takes a toll on you! 

1. I am feeling very stressed out lately and I am finding inability to relax, inability to switch off,  feeling anxious, worried, sad, depressed, inattentive, exhausted, irritable, dazed, etc.

2. I am not able to cope well with my job and work pressure and experiencing lots of difficulties.

3. I am not able to cope well  and adjust at my school, college and with my education and feeling very stressed out.

4. I am having significant problems at home withing my family and I am finding it very stressful at home.

5.I am having lots of financial stress and not able to relax.

6. I am having feeling very stressed out in my relationship issues and not able to deal with them effectively on my own.

7. I am feeling stressed because of my general health issues like my my blood pressure, blood sugars, my newly diagnosed medical condition like Diabetes, Hypertension, Cardiac Disease, Cancer, etc.

8. I am not able to sleep well, get disturbed sleep, nightmares, bad dreams.

9. I am gaining lots of weight or losing weight, not able to eat well or eating excessively and having gastrointestinal disturbances because of stress. 

10. I am having marital and sexual problems because of stress.

Technology for a better world in mental health!

The world today that we live in is constantly changing with newer technological advances. Information technology has had a tremendous impact over our lives. It has brought in instant connectivity and is helping build a collaborative and connected world! The principles of technology can be applied to improvising clinical care to patients, educative training programs in health care and communities and research. From the point of view of e learning and education, there are distance education courses in psychology, psychotherapy, e platforms and online trainings. Videoconferencing  help in sharing of knowledge at a global level and one can can attend and participate in webinars and interact from the comfort of one's consulting room! This helps in gaining newer perspectives without having really to travel the distance to attend at the same time additional skills can be learnt! Mental health consultations online are newer concepts which are showing developments at their own pace with mental health professionals providing services online especially to cater to population that do not have adequate mental health resources at their settings. Online consultation, online counselling and psychotherapy are newer concepts emerging. Booking clinical appointments via app based applications are newer concepts emerging. The younger generation being technological savvy have the potential to connect to positive mental health campaigns via the internet which can help in psychoeducating the community about mental health problems, psychiatric disorders, psychological problems, and help towards clarifying misconceptions and work towards reducing stigma towards mental health problems! However, technology has its own critiques and concerns, but the focus has to be for a better world and a positive mental health!

Towards positive mental health in the real world!

Mental Health is an important part of one's life, yet sadly it remains a frequently ignored one! Today's advancing world poses a lot of additional stress of high profile jobs, lack of adequate family support, financial burdens, risings costs, rearing children, juggling between home and work and above all trying to do the best possible job in all situations! I personally believe that mental health is as important a pillar in health along with aesthetics and physical health! One must not only look good, but it is equally important to feel good and do good! Psychiatric disorders and psychological problems are on the rise over the past decade! Many a times, we neglect our mental health due to stigma of an illness, misconceptions, fear about medications, lack of proper knowledge regarding available treatment options, lack of facilities available and procrastination to consult a mental health professional! A stitch in time saves nine! Psychiatric disorders such as depression, anxiety disorders, substance dependence, Bipolar Affective disorder, Personality Disorders, Adjustment and stress related disorders, Psychosis,etc are prevalent in the community. Untreated mental health problems can worsen over time and further lead to problems in education, job, family and social functioning. Mental Stress can frequently precipitate and worsen medical conditions such as diabetes, hypertension,obesity, cardiac illness, etc. Early detection leads to better outcomes. Nowadays with such wonderful advances in psychiatry and psychotherapy, a positive mental health must be a goal for all! Consulting a mental health professional can be a positive step towards a better solution for the emotional and behavioral problems that one is facing! A Psychiatrist will clinically interview you, suggest some psychological assessments and medical assessments if perceived necessary and will provide you guidance regarding your problems in terms of psychotherapy, counselling and psycho-pharmacological interventions available as per clinical expertise. Each one must make their mental health a top priority! If you or your near and dear ones show features of excessive stress, anger outbursts, anxiety, fear, sadness, panic, depression,negative thoughts, difficulty in concentration, impulsivity, addictions, recent change in behavior, difficulty in falling asleep, disturbed sleep or sleeping excessively, eating extremely less or eating excessively associated with stress, significant weight loss or weight gain associated with problems in eating, etc; kindly consult a mental health professional at the earliest!