Monday, September 26, 2016

TEENAGE - Normal & Abnormal Psychology

Being a teenager is hard. You face life-altering exams at a time when your brain is going through huge changes. While they have a responsibility to manage their own behaviour, by understanding the changes and challenges they face,parents and teachers can guide their practice to help them navigate this as happily and successfully as possible.
neurobiological processes that define adolescence and influence risk-taking are complex, and the role they play is emerging as a key factor in adolescent behavior. These processes must be understood in the context of psychological development and social influences.
It is not uncommon for parents to wonder whether their child is acting like a normal teenager or behaving differently due to mental illness, drug use or behavioural difficulties. Normal teenagers are often moody due to hormonal and physical changes that happen during puberty. However, when mental illness is involved, it may be difficult to differentiate "normal teenage behaviour" from the symptoms of depression, anxiety and other emotional difficulties.
Teenagers may be short-tempered and get angry easily, especially when they begin to naturally separate from the family and feel they do not have enough distance or privacy. The natural process of separation begins in early adolescence; this is when parents see that their child begins to be embarrassed by them and spends increasing amounts of time with friends and very little time with the family.
You may be worried that your teenager spends hours on end on the computer or locked in his or her room chatting on the phone and gets defensive when asked what he or she is doing or who he or she is talking to. This type of behaviour is normal. Teenagers need to naturally separate in order to gain their independence in early adulthood and often react defensively in order to attain this goal. During this time, you should be able to see that even though your teenager may cringe at spending quality time with the family, he or she is still able to enjoy time with friends and engage in healthy social and extracurricular activities outside of the home. If you see that your teen is not engaging in other activities or with friends and is chronically disconnected, angry and sad, this is when the behaviour becomes abnormal and requires intervention.

Some concerning behaviours
Decrease in enjoyment and time spent with friends and family
Significant decrease in school performance
Strong resistance to attending school or absenteeism
Problems with memory, attention or concentration
Big changes in energy levels, eating or sleeping patterns
Physical symptoms (stomach aches, headaches, backaches)
Feelings of hopelessness, sadness, anxiety, crying often
Frequent aggression, disobedience or lashing out verbally
.. Excessive neglect of personal appearance or hygiene
Substance abuse
Dangerous or illegal thrill-seeking behaviour
Is overly suspicious of others
Sees or hears things that others do not exist.

*It’s important to remember that no one sign means that there is a problem. It’s important to examine the: nature, intensity, severity and duration of a problem.

Know who your teenager is
Although your child is growing up and changing rapidly, as his or her parent you are in the best position to know who your child is. You have raised your child with values, beliefs and a set of guidelines to work from; you know when your child is acting out of character and when he or she is having difficulty. Trust your instincts and don’t be afraid to act on them. Even though your teenager may give you attitude when you ask him or her what’s wrong, asking on occasion lets him or her know that you care and that if he or she wants to talk, you are open to it.
Pride and denial can often get in our way of accepting that there is a problem with our child. As parents we have dreams and hopes for our children and we begin to see them come together in the teenage years as the adult personality emerges. Often teens who are intelligent, talented and creative become ill just as they are becoming mature enough to use these skills in a productive way. This can be earth-shattering for parents and makes it very easy to deny that a problem exists.
Ignoring the problem does not make it go away and can contrarily make the problem worse. As with any illness, not getting the appropriate treatment prolongs the symptoms, which will likely get worse with time.
Being open, honest and non-judgmental with your teenager about his or her difficulties will help you to be more in tune with his or her needs and facilitate a trusting relationship between the two of you.
Talking to your teen about your concerns
If you have major concerns about your teen’s behaviour and moods, it is very important to have a conversation with him or her about it. Try to identify specific concerns, i.e., "I’ve noticed that you haven’t really been going out much lately and you don’t answer the phone when your friends call." Or "I can’t help but notice that you haven’t been eating much at dinner and your stomach aches have been getting worse." Your teen will most likely not want to talk about it, but give him or her enough space and time to respond. Let him or her know that you are there to help and that you can work out the difficulties together. Seek help from a family doctor or local Counsilar, who can evaluate your child and offer the appropriate services.
It is never easy to start a conversation with someone about mental illness, but the following tips offer a way to lessen tension during

Speak in a calm voice.
Say what you mean and be prepared to listen.
Try not to interrupt the other person.
Avoid sarcasm, whining, threats and yelling.
Don’t make personal attacks or be demeaning.
Don’t assume your answer is the only answer.
Try not to use words such as "always" or "never."
Deal with the now, not the past.
Don’t try to get the last word.
If things get too heated, take a break and come back to the discussion later.
Make allowances for the other person.
Parents: Remember what it was like to be a teen.
Teen: Remember that parents frequently react strongly because they know the stakes are high.
Acknowledge that you are in this together.
The teenage years can be the most difficult for a parent. During this time, there are many changes that make it difficult to know how and when to intervene

Friday, August 5, 2016


STRESS.... Stress is probably the most common one word describing our lives... Each one of us feel stressed at some point or other. lets know the keyfacts about it-


People feel stressed when they feel like the demands or pressure on them are more than what they can cope with. Everyone feels stressed at times. You may feel under pressure, worried, tense, upset, sad, and angry or maybe a mixture of uncomfortable feelings. These feelings can be entirely normal, but sometimes stress can get too much and can even trigger a mental illness. Sometimes people try to deal with stress by using drugs or alcohol.

It is important to get help if stress is getting too much or you are using drugs or alcohol to try and cope.

Signs of rising stress:

Disturbed sleep
Loss of pleasure in things once enjoyed
Appetite changes
Irritability and impatience
Tiredness, lack of energy
Inability of concentrate, meet deadlines or make decisions
Increasing cynicism or loss of trust
sense of loosing control

Signs that stress is getting too much and that you should get help:
You feel that stress is affecting your health.
You feel so desperate that you think about stopping school, leaving job, running away    or harming yourself.
You feel low, sad, tearful, or that life is not worth living.
You lose your appetite and find it difficult to sleep.
You hear voices telling you what to do, or making you behave strangely.
You have worries, feelings and thoughts that are hard to talk about because you feel people won’t understand you or will think you are ‘weird’.

Stress Management through F.A.C.E.S.{by Dr. Spiegel} is very effective method

[F]ace rather than flee

"If you have a problem, face it rather than run away." Running away from your problems does not make them go away. Working through them in a constructive manner is the only way to put them to bed for good.


There is no situation you can't do something about. "I deal with dying patients all the time," Dr. Speigel began. "I can't keep them from dying... I can't keep any of us from dying. But you can think a lot about how you are going to live in the face of death."

[E]xpress Emotion

"Emotion is not your enemy, it is your friend. Your emotions are there to help you figure out what's important and what isn't. Your brain process more a lot more information than most computers and what keeps it manageable is our emotion system saying this matters and the rest doesn't. So when you think about emotion, use it to identify what matters."

[S]ocial Support

"We are not independant individuals we are social creatures. We can handle stress a lot better when we do it together."

. Make sure you take time to do what you love to do.
. Get to done with something that stressed or bothers you
. If it does not get done then there is a day tomorrow too
. Limit your daily information intake.
. Listen to yourself
. ASK for help
. Take one day at a time.
. Its ok to be not perfect sometimes
Dr Swapnil Deshmukh, MD Psychiatrry (9923291312),  Pune.

Saturday, December 29, 2012





    Times Of India.
    Mental health issues on the rise in city
    14% of the population deals with depression, anxiety and other disorders say psychiatrists

        Around 14 per cent of the population in Pune suffers from mental health issues at a given time, say psychiatrists in the city. And this number, they believe, is higher than the normally acceptable incidence of 10 percent. What is alarming though, is that the situation seems to be spreading like an epidemic.
        “Nowadays, cases of depression are rising significantly. Besides depression, suicidal thoughts, anxiety, schizophrenia and bi-polar mood disorders are some of the serious issues that require clinical attention. This 14 per cent does not include issues such as stress and other disorders which are not so serious, but affect the mental health of an individual,” said Dr Swapnil Deshmukh , Secretary, Pune branch of the Indian Psychiatric Society.
       Dr Deshmukh added that the numbers might be slightly higher in Pune than in other cities given that the population here is predominantly youngsters and older people, who are at a higher risk of falling prey to these illnesses. “Mental illnesses were common among aged. However over the past few years, it has risen significantly amongst youngsters. The main reasons for this are increasing competition, lack of family support, lack of financial and job security and various addictions. The World Health Organization had issued a notice in 2009-2010 stating that mental health problems are very prevalent in India. Moreover, at the rate with which it is increasing, it would make India the country with the maximum number of depression as well as suicide cases even though China has a larger population,” he said.
        On Monday, the Supreme Court (SC) issued a notice to the Central and State governments after a plea by the National Human Rights Commission (NHRC) to seek a country-wide epidemiological survey to identify the magnitude of mental health problems. The SC in 1997 had asked them to monitor three mental health institutions — Ranchi, Agra and Gwalior. The commission extended its scope to the country dividing it into five zones — Northern, Eastern, Southern, Western and Central.
        “We found that with changes in lifestyle, mental health issues are on the rise. However, not much attention is paid to them. We are not geared to meet these challenges as we have no infrastructure and not enough healthcare workers in the sector. We do not even have a proper data base though these challenges have increased substantially. From time to time we issued government guidelines as well as suggestions, but nothing much was done about it,” he said.
    7% Anxiety and depression 3% Bipolar mood disorder 1% Schizophrenia 89% Stress and other issues
    1 in 5 people in India live with mental illness There are 5,000mental health professionals 3:10,000 is the ratio of professionals to patients in Pune. ( TIO)
    Learn what your partner loves

    Biswadeep Ghosh Sep 23, 2011, 12.00am IST

    (Learn what your partner…)

    The wife loves cooking. What is more, she loves discussing recipes. But, living in a nuclear family has its' disadvantages.

    She aspires to talk about food with her hubby, the only presence in her flat. But her man cannot differentiate between cabbage and cauliflower as long as they are not ready for consumption. Shouldn't the husband learn the craft of making food at least to such an extent that he can have a meaningful chat with his wife?

    Logically speaking, yes. But the husband might counter the thought by saying that, if he doesn't know how to cook, his wife knows nothing about cricket. The guy, on the other hand, is so besotted with the game that he dreams of dying with a cricket bat in his hand! Whenever he tries to talk to his wife about the merits of watching the game, she reacts with a disinterested 'I don't know why you guys are so obsessed with this game with a bat and a ball.'
    Consultant psychiatrist Dr Swapnil Deshmukh says, "In a long-term relationship, partners need to adjust to their spouses' likes and dislikes. It is important to try the activity that the partner enjoys. For example, if the husband enjoys watching cricket, and the wife makes an effort to do the same, the couple can connect on a personal level. This makes a lot of difference."

    A relationship may not run into earth-shattering problems if the husband and wife pursue completely different interests. But if each of them end favors to experience the passion of the other, life can be a little more beautiful.

    Relationships in which the husband and wife have diverse interests are very common. Such relationships can work reasonably well also. But, as Sanjana, a working journalist who is a passionate cook, says, "I would have been so much happier if my husband showed some interest in cooking. He loves to eat. But that is it." Sanjana, on the other hand, has learned the game of football ever since she got married. Today, she knows the names of players from Real Madrid and Manchester United like the proverbial back of her hand. But her hubby continues to be indifferent to the goings on the within the kitchen. That, kind of, saddens her.

    Youth more prone, also seek psychiatric help

    Monday, Oct 10, 2011, 12:30 IST | Place: Pune | Agency: DNA

    Alifiya Khan  
    Stigma of mental illness stops 90% of people from seeking professional help.
    Although more than two lakh people in the city suffer from some form of mental illness, a meagre 10% seek psychiatric treatment, say doctors. This means only one in every 10 patients with mental illness have sought help, a shocking figure that points to the resistance among people to seeking treatment as well as low awareness about mental illnesses.
    On the occasion of World Mental Health Day, DNA spoke to leading psychiatrists, who said that despite advances in medical science, people are afraid or have reservations to enter a psychiatrist’s clinic.

    Agreeing that the younger generation is more open to psychiatric treatment,
    Dr Swapnil Deshmukh, consultant at Joshi Hospital, said Pune has a large population of migrant students who are quite regular in seeking help. “Even today we get patients who have tried all means of treatment like going to a general practitioner, neurosurgeon and even witch doctors before they walk into or are referred by someone to our clinics. In this group too, it is the younger population that is more proactive in seeking help and a large percentage of practice involves younger patients suffering from stress, anxiety and depression,” he said.
    “These students stay out of home and that’s why their emotional support network — family and friends — might not be so strong. That’s why we see a lot of these students seeking help from psychiatrists for stress either due to work, studies or relationship issues,” he said.
    He said youngsters do research on the Internet and try to correlate their symptoms with what they read and decide on self-medication. “Unfortunately, it is not so difficult to get drugs, if you so wish, without a prescription. What happens is that in psychiatry there is no readymade formula for medication, unlike other streams where if you have malaria, one type of treatment is given. Our line of treatment depends on various socio-economic, mental and biological factors and this kind of experiment of using the Internet has backfired and I have seen such cases,” he added.



Dealing with resistant OCD. Other modalities
1        1. St. John's Wort and OCD
Alternative medicine such as herbal remedies have been growing in popularity in both Europe and North America. Many people with anxiety disorders such as OCD have tried alternative therapies at one time or another. One of the most popular herbal remedies for anxiety is St. John's Wort. Because antidepressant medications that target the serotonin system, such as Paroxetine and Clomipramine, are effective in treating OCD, it has been suggested that St. John's Wort -- which is said to also have antidepressant qualities -- could be an alternative therapy for reducing OCD symptoms.
2.   Repetitive Transcranial Magnetic Stimulation
r-TMS has got maximum popularity in both Europe and North America as its is safest treatment modality. rTMS, is a relatively non-invasive procedure that has received considerable attention as a possible alternative treatment to reduce OCD symptoms. Repetitive TMS is a relatively non-invasive procedure that involves placing a small device directly on the skull. This sealed device contains a coil of wire that carries electricity. The flow of electricity through the device causes cells in the brain called neurons to become either more or less active. The activity level of neurons has been linked to symptoms of mental illness like OCD. Recent research has shown very good results of this treatment in Depression and OCD. Also is approved by US-FDA.
3.   D-cycloserine and Behavior Therapy
Psychotherapeutic techniques such as exposure and response prevention therapy are highly effective in treating symptoms of OCD. However, these treatments do not always work for everyone, and the challenging nature of behavior therapy and the associated cost cause many people to decline or drop out of treatment. Given this, there has been a lot of interest in identifying ways that behavior therapy can be made both more effective and accessible for more people. One possibility may be to supplement behavior therapy with medication. A medication that has generated a lot of interest with respect to this is the drug D-cycloserine.
4.   Exercise and OCD
Most of us are familiar with the many physical benefits of aerobic exercise, including reduced cholesterol levels and lowered risk of heart disease and diabetes. However, there is growing evidence that physical activity may also help to reduce symptoms of mental illness. Indeed, it is now known that aerobic exercise can be used therapeutically to improve mild to moderate symptoms of depression, as well as reduce overall stress and anxiety levels. Recently, preliminary studies have also examined whether aerobic exercise is helpful in reducing the severity of OCD symptoms. Also Yoga and Pranayam helps in reducing anxiety symptoms.
5.   Deep Brain Stimulation for OCD
Although a number of medications and psychological therapies are available to treat OCD, it has been estimated that between 25 and 40% of people will not respond adequately to these first-line strategies. In the past 20 years, the development of sophisticated brain imaging technologies, such as functional magnetic resonance imaging (FMRI) have led to an explosive growth in our knowledge of the inner workings of the brain. Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment. Deep brain stimulation may offer such a treatment.
Although there are many effective treatments for OCD, some people have what is called treatment resistant OCD. Up to a third of people with OCD have treatment resistant OCD and do not respond to standard treatment protocols. Here are some options to consider when coping with treatment resistant OCD.
1. Explore Reasons Why Your Medication May Not Be Working
Although there are many FDA approved medications available for the treatment of OCD, medications do not seem to work for one-third of people’s OCD symptoms. There are many reasons why this can happen and there are things you can do about it.
2. Consider Augmentation Treatment Strategies
Augmentation therapy treats OCD symptoms with medication. This strategy improves the odds of relieving symptoms by using combinations of drugs, rather than a single drug. Augmentation antidepressant treatment may be helpful for people who do not achieve remission with mono-therapy.
3. Explore Reasons Why Psychotherapy May Not Be Working
Although psychological treatments have come to the forefront in the treatment of OCD, they are not always effective. There are many reasons why psychotherapy for OCD may not be working for you and there are things can do about it.
4. Investigate Intensive Treatment Programs
While there are many effective medical and psychological treatments available for OCD, not all treatments work for everybody. Unfortunately, for some people nothing seems to be effective. To combat this, a number of intensive residential OCD treatment programs have been developed.
5. Consider Taking Part in a Clinical Trial
There are a number of reasons why people with OCD consider taking part in a clinical research trial. For starters, clinical trials often offer cutting edge treatments that are not yet widely available to the public.
6. Explore r-TMS, Psychosurgery and Deep Brain Stimulation for Treatment-Resistant OCD
Although a number of medications and psychological therapies are available for OCD, it has been estimated that between 25 and 40% of people will not respond to treatment. A very small minority of individuals with OCD have symptoms severe enough to consider brain surgery. Surgical procedures for OCD involve inactivating certain brain regions that are responsible for the symptoms associated with OCD. In most cases, approximately 50% to 70% of people who have these procedures see a significant improvement in symptoms. One of these neurosurgical procedures is deep brain stimulation, which appears promising although it is still in the experimental stage and often considered a last resort.
In the last 20 years, the development of sophisticated brain imaging technologies such a functional magnetic resonance imaging (FMRI) have led to an explosive growth in our knowledge of the inner workings of the brain. Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment.
Repetitive Transcranial Magnetic Stimulation & Deep brain stimulation may offer such a treatment.
Deep Brain Stimulation - A Primer
Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the implantation of removable electrodes. rTMS is non-invasive way of modulation. The way in which deep brain stimulation works is still unknown, but it has been suggested that it restores normal activity to areas of the brain that have become dysregulated.
Deep brain stimulation and rTMS has shown considerable promise in the treatment of movement disorders such as Parkinson’s disease, and there is a growing body of evidence that it may be helpful for the treatment of OCD.
Deep brain stimulation and rTMS has a number of advantages over traditional brain surgery for OCD.
·         Deep brain stimulation can be used to treat symptoms with little risk of permanent changes in the brain.
·         The level of stimulation can be adjusted up or down, and the stimulation can be used continuously or intermittently depending on the treatment plan. This allows for greater precision and tailoring of treatment.
·         The surgery is minimally invasive, meaning there is a reduced potential for side effects. It is important to keep in mind, however, that -- like any surgery -- there is risk of complications or side effects, such as bleeding, infection or unanticipated changes in symptoms or personality. For this reason, deep brain stimulation is usually reserved for those people who have not responded to other forms of treatment.
Deep Brain Stimulation and OCD
Deep brain stimulation for the treatment of OCD has been evaluated in a handful of studies. However, because different techniques have been used and diverse brain areas targeted, it has been difficult to compare the results. These preliminary trials hold promise, but it's important to note that this is still an unapproved and experimental treatment for OCD.
Among the most exciting of these studies is an investigation that appeared in the New England Journal of Medicine. Over 10 months, half of the 18 treatment-resistant patients enrolled in the study first received a period of active stimulation of an area of the brain called the subthalamic nucleus, followed by a period of placebo stimulation. The other half of the patients received the placebo stimulation, and then the real stimulation.
Following active stimulation, the majority of patients showed a reduction in OCD symptoms as well as an improvement in their overall ability to return to normal family life, engage in new relationships or go back to work. Only a very small number of patients achieved this while receiving the placebo stimulation.
Although this treatment did not work for everyone, the results of this study are a very positive development in the treatment of OCD. Future studies will have to further examine which brain areas to target as well as determine the pattern of stimulation that works best.