Articles on psychiatric diagnosis

Attention Deficit Hyperactivity Disorder: Important For Your Complete Understanding

Ms. Manavi Khurana, Psychologist
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric conditions of childhood and adolescence affecting 4-12% of children, with a significantly higher percentage of males being diagnosed. ADHD is a persistent problem, manifesting its core symptoms throughout the life cycle, with impairments reflected in a child’s academic performance, peer relationships, family functioning, self-esteem and overall quality of life.Despite its high societal cost, the syndrome is poorly understood. The intent of this article is to educate parents and teachers about the signs and symptoms of ADHD leading to early diagnosis and consequent early intervention.ADHD is a syndrome, reflecting a cluster of symptoms, which are grouped under three broad categories- inattention, hyperactivity and impulsivity. Both the DSM-5 and ICD-10 (manuals for diagnosing mental disorders) share these core clinical criteria. It is important to remember that the symptoms should be maladaptive and inconsistent with the development of the child.ADHD is a condition which is pervasive and persistent: it pervades into a wide variety of situations over a long period of time that disturbs functioning and lowers quality of life. The symptoms should have been present continuously for 6 months by the time the child reaches the age of 7 years.Inattention symptoms include: not paying close attention to details or making careless mistakes in work, failing to sustain attention in activities, not appearing to listen what is being told, failing to follow through instructions, impairment in organising tasks, avoiding or strongly disliking activities requiring sustained mental effort, losing things frequently, and being easily distracted by external stimuli.Hyperactivity is reflected by the following: Fidgeting often with hands or feet or squirming in the seat, often leaving seat in situations where remaining seated in expected, running about often or climbing in situations which are inappropriate, being unduly noisy, and seeming ‘on the go’.Impulsivity symptoms include: Blurting out answers before questions have been completed, failing to wait for one’s turn, interrupting or intruding on others, and talking excessively.More often than not, there is a mixed picture in children, reflecting some parts of all three criteria. Of these core criteria, hyperactivity (because of the distress it causes to the caregiver) is often the quickest to be observed and picked up, and often becomes the reason for psychological referral.Often when children are referred to mental health services, parents/ teachers describe them as being overly naughty and disobedient. The nature of the symptomatology is such that it is easy to misattribute the ADHD syndrome (especially the hyperactivity and impulsivity type) to plain naughtiness, leading to harsh punishment being meted out to the child for no fault of his own.On the other hand, at times true ADHD symptoms are overlooked, because it is a common belief that it is normal for children (especially males) to be naughty during their developing years. Though there is a higher prevalence of the condition among males as compared to females (4:1), recent research has suggested that the rates among girls might be highly underrepresented.This is because of the stereotype of someone with ADHD is a hyperactive little boy, and girls usually don’t fit into that. Their symptoms differ from those of the boys (more of the inattention type, hence less disruptive to the caregivers) which makes it less likely that they will be noticed.The causes of ADHD are manifold. Most of the research evidence points towards genetic factors and disturbances in brain functioning (which explains why the condition is a neuro-developmental one).Environmental factors are more important in maintaining the condition rather than causing it. Parents often blame themselves for their child’s condition and wonder what they could have done to prevent it. Knowing that the cause is biological (and hence out of their control) may help in absolving themselves of the blame. Needless to say, parents, teachers and caregivers go through an enormous amount of distress in handling a child with ADHD. Mostly they unsuccessfully resort to physical punishments and other aversive procedures such as extreme criticism, failing to realise the ineffectiveness of the strategies.With all the negative connotations attached to the diagnostic label of ADHD, one may easily overlook the immense difficulties that children with ADHD have to face each day. Enduring mockery, punishments and criticism from everyone around them brings intense feelings of shame, low self-esteem, sadness, and anger.Children sometimes deliberately display “bad behaviour” in order to mask the real issues they face. For an accurate and complete diagnosis, it is imperative that the child is assessed by a Psychologist.Assessments are usually paper-pencil tests completed across multiple settings- at home, at school and at the clinic. Direct observation, standardized tests and subjective reports are combined to arrive at a diagnosis. An early diagnosis leads to early intervention, which prevents the magnitude of difficulties that the child and caregivers would have to otherwise face. Intervention strategies are multi-modal in nature. The parent, the school and the (various) mental health professionals work in collaboration to manage the child’s condition. It is important to recognise that the child spends a lot of his/ her time in school and hence it also becomes the school’s responsibility to provide the appropriate environment for the child.Children with ADHD often endure a lot of bullying by their peers and are neglected by them. With schools and its teachers holding academic performance as the benchmark of evaluating children, the needs of a child with ADHD are somewhere lost. Parents and teachers need to work closely with the mental health professional in order to gain a better understanding of the child and make an individualistic behavioural management plan for the child keeping in mind his interests, hobbies and personality traits. Cognitive remediation exercises are also taught to the child in order to increase his attention span.Medication is given in a few cases (especially to children with extreme hyperactivity). There is understandably a considerable amount of parental anxiety regarding the side effects and addictive properties of such medications. Research points to the fact that the side effects seem to be low in comparison to the potential benefits of the medication. Monitoring a careful increase in dosage, appropriate timing and precise watch over any side effects should be done by the caregiver and the treating psychiatrist.Parents often wonder whether their children will ever get cured of the condition. It is important to know that because ADHD is a neuro-developmental problem, it may be excellently managed but not cured. This means that there needs to be a continuous effort by the parent, child and the school to work in unison with the treating team in order to deal effectively with the problem. The realisation that the issue is the condition and not the child himself will go a long way in managing target symptoms and helping the child lead his life smoothly.

Psychiatric Drugs: Myths and Facts

Dr. Aditya Gupta, Psychiatrist
There are several myths regarding psychotropic medications in our society. Through this article I will try to break few of them, to aware the public and remove stigma. Each myth will be followed by the associated fact.Medications will change my personality/ make my brain weak - Medications work to correct what is wrong. It doesn’t change who you are nor make you weak.Medications are addictive – with the exception of few, psychotropics cause little if any physical dependency. If taken under medical supervision safely tapering off them is possible.Medications are for weak people, who can’t deal with everyday problems. – psychotropics are not stress reducers, they correct genuine disorders. Far from being a sign of weakness, it takes considerable strength to admit that you have an illness.Psychiatrists give drugs to everyone who comes to them, I only need counseling.–Psychiatrists are the only health professionals who are trained to evaluate all biological, psychological and social factors involved with an illness. They are trained in psychotherapy as well as medication treatment and know which method to apply and when. Have faith in your doctor.Why do I need to see a psychiatrist, can’t my physician/neurologist prescribe for me? –Psychiatrist is the only specialist in mental illness and in medications used to treat it. You wouldn’t expect your orthopaedician to operate your eyes, nor should your physician be expected to know everything about prescribing and monitoring psychotropic medications.Psychotropics are effective but not some magic bullets. Recovery from severe mental illnesses often takes weeks or months, but the results are worth the wait.

Premature Ejaculation Introduction

Dr. Ramesh Maheshwari, Sexologist
Premature Ejaculation has been recognized by modern medicine quite recently. Till 1913, this condition was not mentioned anywhere in medical literature. Dr. K Abraham was perhaps the first to call it ejaculation praecox. Earlier Victorian Physicians were more interested in nocturnal emissions and spermatorrhoea and the bad effect it produced on the mind and body of a person.Definition of premature ejaculation by American Psychiatric Association and DSM-IV is given as ‘persistent or recurrent ejaculation with minimal sexual stimulation that occurs before, during or shortly after penetration and before the person wishes it.This definition has variables like the word ‘minimal’ and a description of timing that cannot be standardized. A man may be perfectly happy if he ejaculates within half a minute whereas another may be unsatisfied even if he ejaculates after half an hour of coital activity. The definition also places emphasis on the man’s subjective feelings totally disregarding the female.In India, our very own Kama-Sutra regards this condition as a normal variation. Here Vatsyayana outlines the ejaculatory response at three levels of duration. In both men and women, the duration of lasting or kala is given as short-timed, medium – timed and long – timed .This is very well described in Kokashastra or Rati Rahasya. Here pandit Kokka gives three variations in men and women as per the duration for which the sexual act lasts. He classifies them as immediate, intermediate and delayed. According to him, this is just a variation and he suggests idea combinations for men and women based on this kala.Why premature ejaculation? What is it ‘premature’ to?It could be so called because due to the early ejaculation there is only partial experience of sexual Pleasure on part of the man which is followed by a refractory period wherein the man cannot get his interest and erection in sex for some period of time which is variable in different men. This results in the woman feeling unsatisfied as she is unable to experience her climax within that much period.Why did this issue of premature ejaculation come up ? Animals do not seem to have premature ejaculation. This question has perhaps originated because of the ‘Pleasure’ component in human sexual activity.  As a result, men and women often complain of experiencing partial pleasures that is perceived only in the genitals and not in the mind. Some believe that sexual contact was in itself the first sin. Hence sex is considered as immoral and it results in considerable guilt and shame which can adversely affect a persons sexual behavior.Multiple factors may be responsible for a man to experience a premature ejaculation. Some common causes cited are:1       Excessive excitement in earlier sexual experiences.2       Sexual  abstinence.3       New partner4       New setting, surrounding5       Extremely responsive and assertive partner6       Early experiences with friends or sex worker wherein the men is pressurized to ejaculate as early as possible7       Anxiety states like,          Will I ejaculate too fast ?          Will I be able to satisfy my partner?8       Marital disharmony with hostility towards partner.Treatment of premature ejaculationVarious research has advocated different approaches for the treatment of premature ejaculation this could be classified as1 Behavioralstart stop methodsqueeze technique2 Pharmacological

Premature Ejaculation: A Deeper Study of Statistics, Causes & Diagnosis

Dr. Yuvraj Arora Monga, General Physician
In my previous article posted, we learnt about premature ejaculation, what is this actual condition and how it is defined. Today we will learn about Statistics, Diagnosis & Type of Premature Ejaculation, Why and how it happens?Statistics of PE:Premature Ejaculation-PE is a common sexual complaint. You are not alone! Estimates vary, but as many as 30-40 % men across the world including India experience problem of PE at some time of life. Approximately 30%-70% of American males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicate a prevalence of 30%, which is fairly spread across all adult age groups.Diagnosis of PE:As per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ), the specific criteria for premature (early) ejaculation are as follows:In almost 75-100% sexual activity, the experience of ejaculation occurring during sexualintercourse within 1 minute after vaginal penetration and before the individual wishes it.The problem above has persisted for at least 6 months.  The symptoms above cause significant mental stress to the person. The dysfunction cannot be better explained by any other nonsexual mental disorder, any medicaldisease, the effects of a drug or medication, etcSeverity of P.E.The severity of premature (early) ejaculation is broadly defined as follows:Even the severe form is not uncommon. Many times men approach the doctors with complaint that they are not able to penetrate the vagina. They ejaculate on minor physical stimulation and it is occurring again and again. Not able to achieve pregnancy is another big concern. If the premature ejaculation is so severe that it happens before commencement of sexual intercourse, conception will not be possible unless artificial insemination is used. Types and Characteristics of P.E.Premature ejaculation can be Chronic (lifelong) or acquired (recent).With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post puberty). Usually it is seen that premature ejaculation starts occurring from the beginning of his sexual activity probably the first sexual intercourse or even the discharge occurs early on masturbation as well.With acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and had successful sexual relationships and only now has developed premature ejaculation in the recent past (few weeks to months). How to approach a person with Chronic (lifelong) or acquired (recent) Premature EjaculationIn patients with Chronic (lifelong) premature ejaculation, the treating doctor or sexual therapist should enquire about the following:ü  Atmospher at Work or schoolü Relationships with friends or brother /sistersü General attitude toward sex by himself and or familyü Previous psychological problemsü Early sexual experiencesü Any bad feelings about sex that relates to 1 or more bad experiences encountered duringgrowing years of lifeü Type of the relationship / sexual engagement (eg, married / non married / live inrelationship)ü Sexual attitude and response of the female partnerü Non sexual aspects of the current relationship ( comfort level & trust factors)Clues from above and similar questions usually point toward possible reasons/factors that may be addressed specifically with therapy by the treating physician or sexual therapist.In patients with acquired (recent) premature ejaculation, the treating doctor or sexual therapist should enquire about the following:         Erectile dysfunction  Performance anxiety ( it is seen very commonly in men i.e., they want to show a good performance in the sexual act with the female partner)ü Psychotropic drug use or alcohol consumptionü Previous & Current relationshipü Nonsexual aspect of the current relationship ( comfort level & trust factors)ü Level of involvement of the sexual partner during sexual actsü Sexual response of partnerü Stamina or fitness level for prolonged intercourseWHAT CAUSES P.E.?Not a single particular cause is responsible for causing premature ejaculation. It can either occur when you indulge in sexual activity with a new partner or if it’s been too long since the previous ejaculation.However, the causes of premature ejaculation can be divided into two broad sub-heads, which are psychological or biological cause:Psychological causes:Premature ejaculation is believed to be a psychological problem and does not represent any known organic / physical disease involving the male reproductive organs or any known defect in the brain or nervous system.Psychological causes behind premature ejaculation may include the development of a certain pattern that is hard to change and is a result of your previous sexual experiences.One of them most common reason is childhood habit of reaching climax / ejaculation quickly because of fear of discovery when masturbating as teenagers or during early sexual experiences with female partner.  This pattern of rapid attainment of sexual release is difficult to change in later stage of life during marriage or long-term relationships.Other reason is situations in which you may have hurried climax / ejaculation in order to hide your problem from your female partner; or feelings of guilt that make you rush through sexual encounters. Other psychological causes include anxiety and relationship issues which can also result from deep anxiety about sex that relates to bad experiences encountered by the patient during development (e.g. incest, sexual assault, conflict with parents, etc.)Biological causes of premature ejaculation:Many scientists have questioned whether premature ejaculation is purely psychological. A number of investigators have found differences in nervous stimulations and hormonal differences in men who experience premature ejaculation compared with individuals who do not. Some believe that some men have hyper-excitability or over-sensitivity of their genitalia, which is again not proven.Abnormal functioning of the ejaculatory systemThyroid problemsInfection or inflammation of the urethra or prostate Nerve damage occurring due to trauma or surgery (a very rare cause) Abnormal levels of hormones and/or neurotransmitters (which are chemicals present in the brain) have been many times said to be responsible for PE likeTestosterone is thought to play a role in the ejaculatory reflex. Higher free and total testosterone levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation Recent article in a Chinese andrology journal showed that semen from men withpremature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of control subjects.Another study found that many men with premature ejaculation have low serum prolactin levelsSomehow these biochemical markers may contribute to premature ejaculation, organic and psychological associations (eg, anxiety) suggest that these biochemical markers play only a partial role. Further research is needed.In part 3 and 4, we will discuss how to approach the men / couple suffering from premature ejaculation to resolve this problem. The therapy includes wide spectrum of approach including counselling, behavioural methods, exercises, techniques and medical remedies both modern as well as alternative medicines.

No Health Without Mental Health - Clinical Case

Dr. Amitabha Mukerji, Psychiatrist
This is the story of a 33 year old woman who was brought into the emergency room by her husband who found her to be undergoing what he described as “another cycle of depression”. She was a mother of two children and a stock analyst. Her husband noted that for the last 10 days she had no sleep and was moved to tears easily. He had also noticed that she had been reacting negatively to almost anything with the slightest provocation. Such “dark” periods had been occurring ever since the husband had known her, but its frequency had increased to six episodes in the past year alone. Each time, a few weeks after taking medicines, the woman would appear better. But during such phases, she would also have a tendency to consume alcohol and sleeping pills which seemed to worsen her symptoms.Recently, the husband was surprised to find his wife taking decisions and committing acts which were not only potentially risky but also contradictory to the woman’s innate nature. She had been actively working on risky ventures while neglecting her children and responsibilities at work, as she thought that her endeavours would make them very rich.Since her college days, the woman had been having phases of sadness interspersed with recurrent spells of sleeplessness, hyper alertness and unusually rapid speech. This had started right after her alcoholic father, whom she was very close to, had committed suicide. Her paternal grand-mother was also known to have suffered from “nervous breakdowns”.In the past, she had consulted a psychiatrist when she experienced a low phase and tried anti-depressant medication, as well as psychotherapy, but the fluctuations in her mood were deteriorating. A part of this could be because the woman was irregular in her visits to the doctor and in following the treatment advice. She would only visit her doctor during the low phases but never during the times of sleeplessness, irritability and restlessness which allowed her doctor limited scope evaluation and a lack of holistic view.During evaluation in the emergency room, the woman’s mood was angry and she was restless. She declared she was fine and wanted to be excused so that she could go home and attend to urgent work. She mentioned that she had the special ability to make predictions regarding the stock market suggesting inflated self-esteem, typically seen during an excited phase. Although she admitted that she was not getting any sleep, she denied that it was a “problem”. Her speech was rapid, pressured and difficult to interrupt. She refused to cooperate for any psychological testing and insisted that the whole thing was a miscommunication. Does this case seem to require a more detailed evaluation?i) Have you seen this kind of person around you?ii) What you think about it? Is it a psychiatric problem which needs treatment?iii) Is it a normal variation of mood and behaviour?iv) Possible diagnosis?

How to Manage Your Erectile Dysfunction Effectively

Dr. Yuvraj Arora Monga, General Physician
There are enough options available which can keep every man sexually active regardless of the cause of erectile dysfunction (ED). However, it is important to get treated by a physician who is willing to give time to understand your problem and identify a suitable and most appropriate therapeutic option.Counselling Sessions:As with an electrical circuit, if there are any breaks in the system it will not function as a unit. Part of the process of psychosexual therapy would be to think about the actual emotional and/or psychological issues behind ED, and to attend to these with weekly counselling sessions. This realisation is an important first step for you to begin and resolve your erection problem. The patient normally implements the therapy advice at home, either alone or with a partner, between therapy sessions. This may help you maintain an erection for once, gradually building confidence.Relieving sexual anxiety:Telling your partner before you make love that you have this anxiety, and the feelings it causes. As a result, your partner will understand, and the two of you can work on it together.You can reduce some worries by being more giving with foreplay, even if your sexual performance isn't what you or your partner wanted, your partner will still be satisfied.Consider regular exercise which brings confidence in your body as your energy is also an important part of overcoming sexual anxiety.Non-Medical TherapiesWatermelon juice (Nature’s Viagra) & Ginseng (Herbal Viagra): L-Citrulline, an amino acid, present in watermelon can bring about significant improvement in blood flow to the penis, showing an improvement in erectile function. Another herb called Ginseng, specifically “red ginseng,” is known as the “herbal Viagra” that can improve sexual performance. Several research studies provide evidence for the effectiveness of these herbs in ED treatment.Kegel exercises: Pelvic exercises, involving the portion of the body between your waist and thighs, are commonly known as kegel exercises. Three months of kegel exercises twice daily can help to significantly improve your erection ability which strengthens the penile muscle. They also promote urinary control.Acupuncture therapy: The acupuncture needles are placed in the wall of the abdomen. By stimulating specific acupoints, the practitioner aims to restore the proper flow of energy in the body resolving ED.Eat  Right: Scientific study at Massachusetts on Male Aging has found that eating a diet rich in fruit, vegetables, fish, lesser red and processed meat, whole and refined grains decreased the likelihood of having ED. Intake of daily multivitamin and fortified foods is the best remedies for treating ED.Walking: Just 30 minutes of walking a day is linked with 41% drop in risk for ED. Moderate exercise can help restore sexual performance in obese middle-aged men with ED.Attention towards vascular health and making body slim: High blood pressure, high blood sugar, high cholesterol, and high triglycerides can all damage arteries in the penis along with heart and brain thereby leading to ED. Maintaining a trim waistline is a good defence for ED, as men with a 42-inch waist are 50% more likely to develop ED in comparison to 32-inch waist people.Avoid excessive alcohol: Chronic heavy drinking of alcohol can cause liver damage, nerve damage, and other conditions, interfering with the normal balance of male sex hormone (androgens) levels ultimately leading to ED.Intake of L-arginine: L-arginine, an amino acid, which is naturally present in the body and helps make nitric oxide, supports a successful erection. Nitric oxide is responsible for making the blood vessels relax, which helps sustain an erection for men.Medical therapy:ED can also be treated with oral medications, drugs insertions or injections into the penis. Oral medications that are normally prescribed to treat the dysfunction work for about 80% of men. They work by boosting the natural signals, which are generated during sexual activity so as to help you sustain an erection. Alprostadil is a type of medicine that causes blood vessels to expand, increasing  blood flow to the penis, thus facilitate an erection. Cialis, Levitra, Staxyn and Viagra work by a similar mechanism to cause erections. There are subtle differences in how long the drug works and how quickly it works.But kindly note drugs like Viagra are not recommended for normal person for recreational use. They should not be used as performance enhancing drugs for they also have their set of side effects and hence, should be taken under medical supervision.A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body.  A pump at the other end of the tube creates a low-pressure vacuum around the erectile tissue, which results in an erection.Ayurvedic Medications:Klaibya in Ayurveda is defined as an inability to attain and keep sufficient rigid (firm) erection which is essential during sexual intercourse for the sexual needs or the needs of his female partner. Also, Vajikarana in Ayurveda means producing a horse's vigor. Some of the herbs used in Vajikarana include:Bulb of Allium sativum (Garlic) Root of Asparagus recemosus (Shatavari)Root of Boerhavia diffusa (Punarnava)Whole part of Cocculus cardifoli (Guduchi)Root of Panax ginseng (Ginseng)Seeds of Myristica fragraus (Nutmeg)Leaf & Root of Withania somnifera (Ashwagandha)Leaf & Seeds of Ginkgo bioloba (Ginkgo)Pitch of Asphaltum bitumen (Shilajit)Dried root of Lepidium Meyenii (Maca)Again please remember, all the above drugs/ remedies  should be taken under medical supervision after consultation from registered medical practitioner after proper diagnosis has been made.

10 Signs That Your Loved One Needs Psychiatric Help

Akshata Bhat, Psychiatrist
Even in this so-called ‘modern age’, there is still a significant stigma attached to consulting a psychiatrist. There is worry that the person will be labeled as ‘psycho’ or ‘mad’. People are reluctant to consult a psychiatrist or seek help due to the taboo that is associated with mental illness. More often than not, the psychiatrist is consulted at the end stage: after exhausting all options. The situation is often out of hand, with both the patient and his family suffering considerably. People prefer to go to faith healers or try alternative medicine. They attribute supernatural forces, spirits, ghosts or curses as the causative factors of mental illness. This commonly leads to a delay in proper diagnosis and treatment. Delay in seeking treatment increases the duration of mental illness and worsens the outcome. For the best prognosis, it is essential that the patient is diagnosed and treated at the earliest.How will you know if someone requires psychiatric intervention? These are some of the signs:Behavioral changes or disturbanceAny behavioral changes or disturbances, especially those happening over a short period of time, are something to be concerned about. These can include decreased self-care or excessive grooming, odd or eccentric behavior, social isolation or over socialization, decreased speech or excessive talking, over familiarity or withdrawn behavior, etc.Changes in sleep patternAny change in the previous sleeping pattern without any obvious causative factor is a cause for concern. This can be excessive sleep, decreased sleep, difficulty in initiating or maintaining sleep, or lack of restorative sleep.Appetite changes:A sudden change in appetite, whether increased or decreased should be looked into thoroughly. Also, unexplained weight gain or weight loss should be investigated in detail.Personality changeAbrupt personality change, whether from quiet to gregarious or from outgoing to reserved should be taken into serious consideration. Anger outburstsUnprovoked outbursts of anger or violent behavior are a red flag. This also includes verbal and physical abuse, which may be unprovoked, on trivial matters or disproportionate to the situation.Preoccupation with certain thingsA newly developed preoccupation with details, rigid or inflexible attitude, and excessive stubbornness all require further examination.SuspiciousnessHaving suspicion that people are against them, talking about them, mocking them or plotting against them (in the presence of evidence to the contrary) is a sign of mental illness.IrritabilityIrritability over trivial issues can be a sign of a much more serious underlying problem.Voicing suicidal ideas or harming selfPersons who voice suicidal ideations or have attempt suicide in the past or those who indulge in self-harm related activities are at a high for suicide. They also have some underlying mental illness which makes them feel so hopeless that they take such a drastic step.Sudden deterioration in social or occupational functioningA sudden deterioration in a previously well functioning individual is a definite cause for concern and has to be assessed thoroughly.It is always better to be safe than sorry. If you notice any of the above signs in someone, seek professional help. Consult a psychiatrist at the earliest.

Tuberculosis: Correct Diagnosis and Treatment Can Save Lives

Dr. Madhukar Pai
Posted on World TB Day, by:Madhukar Pai, MD, PhDDirector, McGill Global Health Programs, Montreal, CanadaTB is an ancient disease that has plagued humans for centuries. Today, India alone accounts for a quarter of all TB cases in the world. Over 2.2 million new TB cases occur every year and TB kills nearly 900 people every day in India. The emergence of severe forms of drug resistant TB has worsened the situation, especially in cities like Mumbai.TB is caused by bacteria that are spread from person to person through the air. Long-term cough and fever are the most important symptoms of TB. When a person with TB coughs, TB bacteria get expelled into the air. The bacteria can then get inhaled by another person who can become newly infected. TB usually affects the lungs,but it can also affect other parts of the body. TB can affect adults and children, and can affect people from all walks of life. Persons with HIV infection and AIDS are particularly prone to getting TB.The positive news is that TB is treatable and curable. However, unlike most common infectious diseases (e.g. malaria or pneumonia) that require a few days of antibiotic treatment, TB requires several antibiotics and 6 months of treatment. Otherwise, TB bacteria will become resistant to antibiotics. Multidrug-resistant (MDR-TB) refers to TB that is resistant to rifampicin and isoniazid, two of the most critical first-line antibiotics used to treat TB.Accurate diagnosis: the first key stepBecause TB is a curable disease, it is very important to accurately diagnose the disease and to do it early, before severe lung damage occurs, and before other people in the community are infected.All individuals with cough for more than 2 weeks must seek care early and get their sputum tested for TB. Sadly, many persons with chronic cough do not seek medical care,and this results in long delays before a diagnosis is made. Sputum testing can involve microscopic examination for the TB bacteria, culture to grow the bacteria in a tube, or newer molecular tests that multiply and detect TB DNA. GeneXpertis the biggest new advance in TB detection. It is a highly accurate, molecular test that has been endorsed by the World Health Organization (WHO). This technology is completely automated and can rapidly detect TB as well as drug-resistant TB within 2 hours (photograph). Over 16 million GeneXpert tests have been done globally.Thanks to the Initiative for Promoting Affordable and Quality TB tests (www.ipaqt.org), led by the Clinton Foundation, it is now widely available in over 100 labs across India at prices that are 50% less than the market price. Through the IPAQT initiative other WHO-approved TB tests such as liquid culture are also available at subsidised rates.Correct and regular treatment can save livesIf TB is diagnosed, the most important thing a patient can do to is to take all of their medications exactly as prescribed by their doctor. No doses should be missed and treatment should not be stopped early, even if the patients feel better. Patients who cannot afford to buy drugs in the private sector must seek treatment in the public sector where drugs are available free of cost.Doctors have an important role to play in ensuring that their TB patients are treated correctly. Doctors must follow recommended treatment guidelines, monitor patients’ response to treatment, and make sure therapy is completed. Doctors should also avoid starting anti-TB drug treatment without doing any laboratory testing to confirm the disease. If TB is confirmed, they should start treatment promptly and follow Standards for TB Care in India.For regular, drug-sensitive TB, a standard 4-drug treatment must be started, and the total duration of treatment must not be less than 6 months. Drug-resistance usually happens when patients do not complete their full course of treatment; when doctors prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs.If drug-resistance is suspected, it should be confirmed using laboratory tests such as GeneXpert and liquid culture. For drug-resistant TB, second-line drug treatment must be started, and the total duration of treatment must be at least 2 years. Treatment for MDR-TB can be very expensive in the private sector, and such patients can access free treatment in specialized public hospitals that can treat MDR-TB patients.With correct diagnosis and complete treatment, TB can be cured and loss of life averted.Importantly, this will also help control the spread of this deadly infection.

What Is Cerebral Palsy? Symptoms, Diagnosis and Treatment

Dr. Vykunta Raju K. N, Neurologist
What is Cerebral Palsy (CP)?Cerebral Palsy is primarily a disorder affecting the movements and actions performed by various muscles of the body (motor disorder). Though described as non progressive the disability (due to the damage sustained at a time during early childhood) can progress.How common is CP?Most place the prevalence around 2 per1000 children. In India, no absolute figures are available, but estimated children affected (based on hospital records) are over 2.5 millions.How do you recognize C.P.?§ The hall mark of the condition is motor dysfunction, i.e. there is abnormal muscle tone, abnormal posture and movement§ As the child grows, the movement disorder can appear worse because every effort to move is confronted by the force of gravity§ The clinical expression of the child depends on the extent and area of brain damage, growth of the child, coexisting developmental problemsWhy is it important to know about CP?§ Ignorance about the problem often causes more problems for a person with C.P. than the condition itself.§ Actually a child with C.P. is not hopeless§ Half the children with C.P. have average or above average I.Q.§ With timely help and proper guidance a vast majority can lead active, self supporting and long livesEarly diagnosis of CPWarning symptoms§ Lack of alertness§ Increased abnormal movements, Fits§ Feeding problems, drooling§ Poor quality of sleepAbnormal signs§ Reduced head size or fall in its growth§ Delayed social smile§ Poor head control present at 3 months of age§ Delayed appearance of developmental milestones§ Constant fisting after 2 months of age§ Increased tone, scissoring or assumption of equinus position of feet§ Eye problems: roving eyes, no visual following, persistent squint§ Lack of response to soundConditions that mimic CP§ Birth defects-neural tube defects, vertebral instability etc.§ Slowly progressive degenerative brain disorders e.g. metabolic disorders - amino aciduri as like glutaric acidemia type I, peroxisomal disorders, mitochondrial disorders§ Neuromuscular disorders e.g. muscular dystrophies.In all cases where the diagnosis is in doubt, further follow-up and diagnostic evaluation may be required.Role of investigationsDiagnosis of CP is essentially clinicalü Laboratory tests are not necessary to confirm diagnosisü Brain imaging studies including Ultrasound scan of brain, CT and MRI may be useful in elucidating the cause of cerebral palsy and suggesting a long term outcome.ü Ultrasounds can head is easily available in most health centers and is useful to detect bleeding and periventricular leucomalacia in preterm babies.ü CT and MRI - to detect / diagnose other diseases that may be confused with CP e.g. slow degenerations, birth defects etc.Eye and hearing assessmentü  Always screen systematically for visual and auditory problems even if they may not be clinically apparentMANAGEMENTBenefits of early interventionü  Anatomical - Maintains soft tissue extensibility, optimises musculoskeletal growth and developmentü  Physiological - Early visual and sensory inputs optimize movement, posture and balanceü  Developmental - Reinforces positive developmental patternsü  Reduces cost of treatment, minimizes complications and mitigates need for adaptive equipmentWho does the CP management team consist of?Multidisciplinary approachThe CP management team consists of a Child neurologist, developmental pediatrician, physiotherapist, a child psychologist, orthopedic surgeon, speech therapist, occupational therapist and a social worker. The neurologist coordinates the functioning of the team and is primarily involved in diagnosis, assessing development and disability. Control of fits if any and determining the need for any interventions-medicines, surgery or otherwise.How is CP managed?The management of CP revolves around the management of associated conditions (like fits, mental subnormality, visual and hearing loss) prevent the progression of disability and rehabilitation.Counseling: A physician should have an elementary idea of all the modalities required for holistic management.Physiotherapy and motor trainingPhysiotherapy should be directed towards:ü  Specific training of actions such as sitting, standing, walking and steppingü  Exercises designed to increase muscle strengthü  Prevention of contracturesü  Control of movementTraining in activities of daily livingManagement of feeding difficultiesü  Usea shallow spoon, soft foods.ü  Place the food on the middle of tongueü  Give small pieces of solid foodü  If needs help to keep mouth closed when chewing, apply pressure to jaw to keep it closedü  Drooling can be minimized by improving swallowing, drugs not very effectiveEarly developmental stimulationBasic principles areü  Follow  general principles of normal developmentü  Attempt to break the primitive reflexes as they interfere with attainment of normal milestonesEducational problemsü  Children with mild CP do well in mainstream schoolsü  Most children with moderate to severe cerebral palsy need to be educated in special schools.Eye problemsü  Check for refractive error, advice eye exercisesCommunication problemsü  Encourage child to speak. Guidance from speech therapist can help improve speech patternsFITSü  Management is same as for other children with fitsü  However,a larger proportion of children with CP may have refractory fits or require drug therapy for prolonged periods. Avoid phenobarbitone.Counseling of the familyThe doctor should emphasize that CP is:ü  Not a mental illnessü  Not necessarily associated with mental retardationü  Not contagiousü  Not inherited (except in rare cases)ü  Not curable but treatment aims at minimizing disability to improve their quality of life.Aim of the schools is not to admit them and segregate them from their family and peer groups but to provide an insight and train the parents and school teachers about the special needs of these children and their strength and weakness.Social awarenessü  All CP children do not have low IQ and least 1/3rd have average 1Qü  They are not a burden on the society and can contribute activelyLegislature – passed on 22nd December,1995 – disability bill for equal opportunities.ü  Equal opportunities, protection ofrights and full participation. As per this act the government and local authorities shall ensure that every child with disability has access to free and adequate education till the age of 18, integrate students with disabilities into normal schools, set up special school, for those in need of special educationü  Employment – posts are identified for disabled personsü  Non-discriminationü  The government shall within economic limits, undertake rehabilitation programs for persons with disabilities