DEPRESSION - ASSESSMENT AND TREATMENT

Assessment of Depression :-( You can rate yourself on this scale).

Patient can evaluate themselves by Screening and Diagnostic Instrument for Major Depressive Disorder (MDD) with:-
Disease Burden Measured in Disability-Adjusted Life Years (DALYS). :-

 you can score as given below. -

Over the last 2 weeks, how often have you been bothered by any of the following problems?

             1) Not at all                                                                           2) Several days
             3) More than half the day                                                    4) Nearly every day

( you can rate from 1-4on fallowing points on a to i.)

· a) Little interest or pleasure in doing things.
· b) Feeling down, depressed, or hopeless.
· c) Trouble falling or staying asleep, or sleeping too much.
· d) Feeling tired or having little energy.
· e) Poor appetite or overeating.
· f) Feeling bad about yourself, or that you are a failure, or have let yourself or your family down.
· g) Trouble concentrating on things, such as reading the newspaper or watching television.
· h) Moving or speaking so slowly that other people could have noticed, Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.
· i) Thoughts that you would be better off dead, or of hurting yourself in some way.
Diagnosis of MDD to be made if answers to a or b and five or more of a - i are (“more than half the days” score 3 or 4). (count i if present at all.)

TREATMENT OF DEPRESSION, STRESS, GRIEF –

Study conducted by Psychiatrist practicing in Pune on use of COGNITIVE BEHAVIOUR THERAPY (CBT) AND COUNSELLING as only method of treatment verses use of medicine (Anti depressant drugs like Paroxetine & Sertraline) on patient suffering from DEPRESSION, STRESS DISORDER, RELATIONSHIP PROBLEMS, GRIFF, FAILURE, AND LOW MOOD DUE TO OTHER COUSES.
Dr Swapnil Deshmukh – MBBS, MD Psychiatrist – with special interest in Depressive disorder did comparison study of patient suffering from similar problems. As depressive disorder lead to- low mood, weakness, low confidence, ideas of hopelessness, ideas of worthlessness / helplessness, negative thoughts / ruminations, suicidal ideas, sleep problems, decrease interest, poor performance at work, poor / low confidence, fear to face others, fear to drive or travel, fear to face boss or do presentation and many other similar kind of problems. Some patient may also presents with predominant anxiety or pain complaints as complaint of sever palpation, tremors, sweating, and feeling of death or heart attack.
Causes of Depression:- Due to internal factor or External factors. Line of management is almost same on both. Internal factors includes – Changes in Neuro-transmitters (Serotonin, Dopamine, Epi/ nor Epinephrine); brain structural changes, Hormonal changes in body; Seasonal changes; sleep pattern changes.
External factors may be – In reaction to loss / grief.
Results were as fallows-
1) Drug treatment (medication) shows results in 90% of patients.
2) Cognitive behavior therapy takes time to show improvement. Improvement takes in 40% cases.
3) Drugs are faster acting than counseling and other psychotherapies.
4) Sever cases required both treatment simultaneously.
5) Drugs have side effects but newer treatment options are safe and can be continued for long time.
6) Drugs should be taken only after counselting PSYCHIATRIST.
7) Tranquilizers can give fast benefit but may lead to dependence or withdrawal symptoms or rebound increase in symptoms after discontinuation.
8) Tranquilizer should be avoided or should not be continued more than 3 wk.
9) The role of dietary nutrients in Depression –Folic acid ( B9 ), Pyridoxine( B6 100mg/day), Vita B12. Also Zinc, Copper, Magnesium and use of Omega-3 fatty acid can help in better outcome and prevention of depression.
10) Yoga – Relaxation – regular exercise can help patient to keep doses of medication minimum.
11) Long term treatment and preventive treatment is available and helps.
ELECTRO CONVULSIVE THERAPY HELPS IN SEVER CASES AND SUICIDAL PATIENTS but can lead to memory problems on short run.
12) rTMS, Transcranial Magnetic Stimulation is newer development in treatment of depression it is approved by  US FDA in 2008, now it is available in India in few centers like Pune. Cost of therapy is low and effects are seen in 10 days. rTMS is very safe and effective treatment for resistant cases, for patients not tolerating medications due to side effect. Cost per rTMS is around 3450/- Rs ( around 73 US $ ) in Joshi Hospital Pune.

ROLE OF VITAMINES & MINERALS IN PSYCHOLOGICAL ILLNESS

ROLE OF NEUTRITIONAL THERAPY IN PSYCHIATRY
DIETARY REGULATIONS IN PSYCHOLOGICAL PROBLEMS
Psychiatric disorders like Schizophrenia, Depression, anxiety, Obsessive compulsive disorder are common in today’s stress-ful era. In resent research increasing evidence about the effect of trace elements, vitamins, on brain & behavior is appearing as well, for example- Schizophrenics were found to have very low serum iron levels.
Dr Deshmukh revived resent clinical research in world for use of these nutrients in psychiatric illnesses -
1} The role of dietary nutrients in Schizophrenia – newer studies have found that resistant cases of Schizophrenia respond well to high doses of minerals like Zinc, Copper, Magnesium ( Play role at NMDA receptors in brain), Iron ( Low level of serum Iron found in clinical research). Vitamin’s like - Niacinamide, Pyridoxine( B6), Riboflavin, B12, Folate. Study conducted in United Stats also suggests use of Omega-3 fatty acid, Free fatty acid/ Arachidonic acid can lead o significant improvement. These treatments are available in India also but routinely ignored by practicing psychiatrist. Dietary changes can help Schizophrenic patients in better outcome and should be advised.
2} The role of dietary nutrients in Depression – Folic acid ( B9 ), Pyridoxine( B6 100mg/day), Vita B12. Also Zinc, Copper, Magnesium and use of Omega-3 fatty acid can help in better outcome
3} The role of dietary nutrients in Anxiety / panic / phobic disorder:- Via B1, (250mg/ day), Vita B6 , Niacinamide (100mg/day)
4} The role of dietary nutrients in O.C.D. (obsessive compulsive disorder):- Vitamin B-6
5} The role of dietary nutrients in Autism :- Vita B6( pyridoxine 300mg/day), Magnesium (10/kg/day), Omega-3 fatty acid.
6) Mood swings and Irritability commonly seen with deficiencies of Zinc, Copper, Magnesium, Manganese, & Vitamin B12, B-6, Riboflavin, Nicotinic acid, Folate.
7} Conditions like Dementia ( Vita C & E), Tardive Dyskinesia ( Vita B6), Epillepsy/ Seizer ( Niacinamide)
It is essential that treating psychiatrist should know about these simple dietary requirements of patients with these illnesses and advise changes accordingly.

Dr. Deshmukh MBBS, MIPS, MD Psychiatrist

RECENT ADVANCES IN TREATMENT OF SCHIZOPHRENIA / MENTAL ILLNESS

TREATMENT OF SCHIZOPHRENIA / MENTAL ILLNESS IN PUNE :-
Schizophrenia / psychosis are illness due to brain pathology. Neuro- transmitter like Dopamine dis-regulation play major role in etiology. Genetic also plays important role in etiology. Neuro-structural changes can be seen on MRI studies. MRI brain should always be done as 1st line investigation to rule out brain pathology.

(1) Schizophrenia is long term illness that require medication for long duration may be life long. Patient should not hesitate continuing medication for long time as newer molecules are safer, prevent long term cognitive deterioration, prevent further episodes, and benefits of continuing medications are significantly more than risk or side effect of continuation of these medicines. (2) Newer drugs ( Olanzapine, Amisulpride, Quetiapine, Aripiprazol, Risperidone) are more effective in controlling negative symptoms as well as positive symptoms also. Patients should ask treating Psychiatrist about them as risk of tremors, Extrapyramidal symptoms, Tardive Dyskinesia, drowsiness is less common with these drugs. (3) Clozapin is more useful in resistant and poorly responding patients but white blood cell count required to be monitored considering risk of agranulocytosis. (4) More negative symptoms / cognitive problems are present in patient with long term illness. (5) Omega 3 fatty acids are useful in resistant cases but are costly. (6) Counseling & Depot injectable will help in better compliance (Once in month) which in term help patient in better response. (7) Mouth dissolving preparation of medicine are available which are color less/ odor less/ and test less so can be dissolved in food of un-cooperative patient or patient who is not ready to accept medication due to poor understanding about illness. (8) The role of dietary nutrients in Schizophrenia – newer studies have found that resistant cases of Schizophrenia respond well to high doses of minerals like Zinc, Copper, Magnesium ( Play role at NMDA receptors in brain), Iron ( Low level of serum Iron found in clinical research). Vitamin’s like - Niacinamide, Pyridoxine( B6), Riboflavin, B12, Folate. Study conducted in United Stats also suggest use of Omega-3 fatty acid, Free fatty acid/ Arachidonic acid can lead o significant improvement. These treatments are available in India also but routinely ignored by practicing psychiatrist. Dietary changes can help Schizophrenic patients in better outcome and should be advised. (9) Govt.of India has given disability benefits to these patients with Schizophrenia and can get pension/ Travel & Incom tax concession / also continuation of pension of there parents. Relative should ask treating Psychiatrist about Disability certificate. (10) Proper training & rehabilitation can help patient in regaining his lost cognitive , social, occupational, functioning and better treatment outcome on long run. ( 11)  rTMS, Transcranial Magnetic Stimulation is newer development in treatment of Schizophrenia ( approved by US FDA in 2008), now it is available in India in few centers like Pune. Cost of therapy is low and effects are seen in 10 days. rTMS is very safe and effective treatment for resistant cases, for patients not tolerating medications due to side effect. In schizophrenia rTMS is very useful in controlling Hallucinations and negative symptoms/ cognitive deterioration. Cost per rTMS is around 3450/- Rs ( around 73 US $ ) in Joshi Hospital Pune.

swapnilsdesh@gmail.com

OBSESSIVE COMPULSIVE DISORDER ( OCD) - ADVANCED CARE

OBSESSIVE COMPULSIVE DISORDER ( OCD) TREATMENT IN PUNE
Dr Deshmukh MBBS,MD (9923291312) Psychiatrist is well-known leading psychiatrist in Pune. Study conducted by him and his counselor on 63 patients of Obsessive Compulsive Disorder (OCD) with or without psychotic features at his Shreeyash Hospital ( psychiatric treatment & counseling center), Deccan, Pune revealed that (1) Drug management is very essential part of management of OCD. (2) Cognitive behavior therapy in combination with drug treatment is more effective than treating with medicine alone. (3) Clomipramine in combination with SSRI is more useful in poorly responsive or resistant cases of OCD. (4) Regular long term management is usually required. (5) Add on therapy with drugs like Lithium, low dose antipsychotics, Buspirone, BZDs also helps. (6) Exposure & response prevention is very useful treatment in compulsive symptoms. (7) Thought stopping techniques like wrist band / mind diversion can be easily taught to patient.(8) Activity scheduling, family support, counseling helps.(9) Medicine are essential in management treatment of OCD, patient needs to understand that they may have side effect but considering risk & benefit its always recommended that continuing medications for long time/ may be years together gives more benefits than side effect. Also drugs may take around 3 months to start showing its effects but slow escalation of dose use of minimum dose & medicine in combination with therapies helps patient to great extent. (10) The role of dietary nutrients -Vitamin B-6 improves OCD. (11) Newer studies have shown that N- Acetylcysteine – amino acid ( a protein) can be used in reducing compulsive behavior in OCD ( also in Trichotilomania). It’s a well tolerated drug without any side effect. (12) TMS, Transcranial Magnetic Stimulation is newer devlopment in treatment of poorly responding OCD, available in USA, but is very expensive, but safest method without side effects / non medicinal method.

CBT in OCD patients :-) there are three irrational beliefs of OCD. 1. One is worth while if he is thoroughly competent, adequate, & achieving in all the aspects of life. 2. Some things may be dangerous or fearsome,& one should be terribly concerned and keep on dwelling on the possibility of their occurrence. 3. There is a right and precise solution to human problemS, it is catastrophic if this perfect solution is not found.

For further details contact - Dr Swapnil S. Deshmukh (9923291312)

NEW GUIDELINES IN TREATMENT OF ANXIETY, PHOBIA, PANIC ATTACS

TREATMENT OF ANXIETY, PHOBIA, PANIC ATTACKS - DR DESHMUKH MBBS, MD
Study conducted by Psychiatrist practicing in Pune on use of BEHAVIOUR THERAPY, RELAXATION THERAPY, COUNSELLING as only method of treatment verses use of medicine (Anti anxiety drugs like Paroxetine & Sertraline) on patient suffering from ANXIETY DISORDER, PHOBIA, PANIC DISORDER & OTHER NON SPECIFIC FEAR.
Dr Swapnil Deshmukh – MBBS, MD Psychiatrist – with special interest in Anxiety disorder did this comparison study as anxiety disorder can lead to- poor performance at work, poor / low confidence, fear to face others, fear to drive or travel, fear to face boss or do presentation & other similar kind of problems. Some patient also presents with complaints of sever palpation, tremors, sweating & feeling of death or heart attack.
His results were as fallows- 1) Drug treatment (medication) shows results in 90% of patients. 2) Cognitive behavior therapy takes time to show improvement, 40% cases. 3) Drugs are faster acting than counseling / therapies. 4) Sever cases required both treatment simultaneously. 5) Drugs have side effects but newer treatment options are safe & can be continued for long time. 6) Drugs should be taken only after consulting PSYCHIATRIST. 7) Tranquilizers can give fast benefit but may lead to drowsiness, dependence, withdrawal symptoms & rebound increase in symptoms after discontinuation. 8) Tranquilizer should be avoided or should not be continued more than 2 wk. 9) Yoga – Relaxation – regular exercise can help patient to keep doses of medication minimum. 10) Long term treatment and preventive treatment helps. 11) The role of dietary nutrients in Anxiety / panic / phobic disorder:- Via B1, (250mg/ day), Vita B6 , Niacinamide (100mg/day)

For further details you can contact Dr Deshmukh Psychiatrist on 9923291312

swapnilsdesh@gmail.com