schizophrenia…the basics.

The purpose of this post is to address the basics of schizophrenia, and it is meant for all my readers medicos, non-medicos, psychiatrists and non- psychiatrists.

  1. Schizophrenia is a serious and long-term mental disorder affecting approximately one out a hundred individuals. (1%)
  2. It was first described by Emil Kraepelin about 130 years from now.
  3. The term was coined by Eugen Bleuler, has Greek origin, schizo (split) and phrene(mind) to describe the fragmented thinking of people with the disorder. His term was not meant to convey the idea of split or multiple personalities, a common misunderstanding by the public at large.

schizophernia affects multiple aspects ,including mood,thoughts,cognition,behavior,working capacity.

for the diagnosis of illness the symptoms should be present for atleast 6 month.

patients suffering from schizophrenia most commonly are preoccupied with the belief that other people are conspiring against them,are trying to harm them by one way or the other.They hold this belief very firmly and it is as true for them as day and night are for any of us,thus they get agitated when me challenge their belief.

patients might have other common symptoms like hearing of voices,when actually their is nobody talking around them.

apart from these a common symptom is that ones spouse is cheating on one.

social withdrawal, Hostility , extreme reaction to criticism. Deterioration of personal hygiene. Flat, expressionless gaze. Inability to cry or express joy or inappropriate laughter or crying. Oversleeping or insomnia are other common features…

these symptoms help us to identify a person suffering from schizophrenia.

many a time during clinical practice, we come across patients and relatives requesting for neuroimaging to confirm the diagnosis of psychiatric illness,but the thing is neuroimaging is not contraindicated, but might not even be very helpful, as there are not many specific findings suggestive of schizophrenia found on neuroimaging(CT scan, MRI). Therefore the only way to come to a conclusion for the diagnosis of Schizophrenia is on the basis of the clinical features.

once we are fairly satisfied of the diagnosis,we treat the patient.

for the treatment there are various drugs ,stimulant procedure and psychotherapies,which we choose depending on many factors including the patient profile,availability ,affordability ,efficacy and potency of treatment.

Yes, schizophrenia is a chronic illness like hypertension or diabetes but with less clear evidence of the etiology, therefore treatment mostly has to be continued for a long time if not lifelong.

questions we frequently encounter when dealing with patients suffering from schizophrenia and their relatives are:

  1. can one inherit schizophrenia?

answer: yes there is a genetic contribution to almost all forms of schizophrenia, the chances of a monozygotic(identical) twin to have schizophrenia if the other twin is suffering from it are 50% which 4 to 5 times of dizygotic twins.

2.can a person with schizophrenia, ever be cured??

answer: research and literature suggest that approximately, 20 to 30 percent of all schizophrenia are able to lead somewhat normal lives.

3.how long should the treatment be taken?

answer: It depends upon the response a patient shows on treatment, the literature suggests, approximately 70% of patients treated with any antipsychotic achieve remission.

4. Can a person suffering from schizophrenia get married and have children?

answer: well, this is also very subjective and depends on the condition of the patient,it cannot be generalized every patient is different.

But, marriage is not at all a suggestible treatment of schizophrenia.

these are few of the many questions patients ask us regularly and few of the ones that i can recall.

World Schizophrenia Day is celebrated on May 24 every year. It aims to bring awareness about schizophrenia and reduce stigma towards people affected by this mental disorder.

Since 1986, Schizophrenia Awareness Week (SAW) is held in May every year. This year, Schizophrenia Awareness Week is marked from the 20 to 27 May 2018. This coincides with the week of World Schizophrenia Awareness Day. The theme for this year’s SAW is ‘Do What You Can Do’,asking people to join in taking action to beat stigma and promote inclusion.

Please note that research is going on to find more specific theories of the etiology(cause) of schizophrenia and the treatment.

Image result for world schizophrenia day 2018

John Nash was one of the greatest thinkers in mathematics of the 20th Century. And, thanks to his biography: A Beautiful Mind, and the award-winning film of the same name he was also one of the best-known patients with schizophrenia of the same period.

https://www.livingwithschizophreniauk.org/john-nash/

Dr.john-nash

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love…

Well well well,somethings in life are very difficult to express and understand.love is one of those things.

the meaning of love according to Viktor Frankl,is the only way in which one can grasp another being in the innermost core of his personality.

nobody can become fully aware of the essence of someone else unless he loves him…

by loving a person one sees the essential traits in the person and also the various potentialities he or she has.

it is a medium by which one can find the meaning of life…

i rememeber the first time we met,it was our college canteen ,the old one.

he was sitting there amongst all other seniors ,unlike others he seemed not interested,he was tall lanky ,dark not the best looking person,but he had a charm about himself at the sametime.

i instantly got attracted to him(not romantically),and wanted to talk.

he seemed uninterested,until he saw my shoes .i was wearing sneakers under my salwar suit.he found it really cool.while the other seniors did not seem very pleased.

we met again and again and again .he became my mentor,my friend, guided me in my studies and was there for me in my tough times like a rock.he was carefree unlike me,he was bold unlike me,he was outgoing unlike me,yet he never jugded me.neither did i.people did not speak very well of him.

but , i made up my mind to learn from my own experiences,he seemed innocent and cautious at the same time.

extremely determined,hardworking and competitive,he challenged me always to realise my potentials.it was a bond that had opened me up.i had my fears ,he had his.I had my limitations,he had his,we did not judge.

was that love,yes it was.

we were lucky for our friends, for our families to have accepted us wholeheartedly,otherwise, would the love ever fade.no it would not.

today he is a part of my journey to find my meaning of life,i have always wanted to be with a partner who helps me grow,i have questioned it many times.when i look back to the years ,yes he has ,he has healed me allot.

i have accepted him with his flaws, he has accepted me with mine.

i respect his space, he respects mine.

i know in my head, no matter what happens he will be by my side.Now it is my turn to help him, help him grow, I have my own ways, he has immense potentials, every one of us has, it just needs a little nurturing and a tiny amount of LOVE.

i am not very fond of public display of affection, but I know he will smile (may even cry)

on reading this one.

 

 

the essence of my existence…

my search for the meaning of life

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Well, it has been a while since I have written.I was actually absorbing things before delivering.

what has made me write this??..

today I completed reading a book which is a life changer precisely and going through it has been a therapeutic experience on its own, it is like meditation, so I wanted to share the wisdom I have gained after reading it.

secondly, today is valentines day, yes, of course, it is not as important to us as it used to be earlier, still, some amount of limelight we can throw on it for old times sake and for the great memories it has given us.

what is so great about this book??

firstly, it is written by Dr. Viktor E. Frankl who was an Austrian (Jewish) psychiatrist as well as a neurologist.

But, more importantly, he survived the dreaded Holocaust.

Secondly, the book is simple yet very intense, each sentence holds a meaning one has to read between the lines, the lines which themselves are very meaningful.Dr. Frankl has very intricately and with clarity illustrated his extraordinary journey of survival, survival in the most brutal situations possible (though he has tried to tone down the level of brutality).

The moment one starts reading it, one is gripped by the hope he instills into the reader.

yes getting carried away while describing the book is easy and unavoidable for someone like me, cause at this instant I am spellbound by it.

but, not making it a book review, I would quote a few lines about life and love inspired by the book and other sources.

life ,of what little wisdom i have,isa gift,a gift that is wrapped up in various layers,each layer when removed brings in an irreversible change in us,each layer when removed has a meaning.But,the process of changing the wrapper is difficult,full of joys ,stressors ,achievements.The meaning of life ,differs from man to man and from time to time.every person is unique,absolutely unique,his abilities,his opportunities,his struggles are unique,so is his meaning of life.

EACH man is questioned by life at some point or the other ,their meaning of life,their purpose of existence.

searching for the same and trying to answer it helps one to look at the bigger picture and ultimately gives one enough strenght and hope to cope with a given situation.this helps a person to actualise his full potentials.

I remember reading a quote of Mahatma Gandhi where he says, when you are having difficulty taking a decision, think whether your action will help the poorest person you have seen?

will that was his meaning of life, that was his altruistic way of thinking.

the problem we are facing today is meaninglessness,there is no meaning in our conversations, no meaning in our attitudes and no meaning in our existence, the society today has become achievement oriented if someone is achieving something he or she is supposed to be happy.but, I think after reading the book is that life has a much bigger purpose,a bigger meaning.one should live each day as if it is a new life altogether and one can correct or relive one life again, better than one did earlier.My meaning for life currently and since the time i have known has been serving, serving people who need it, it has become my motivating drive, explains many things that i do.

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hope i have been able to put my point of view forward,I am still learning to write .bookreview

letter to kuro

dear kuro,

we still can’t believe that it has been one year since you left us.

I still shut the gate as tight as possible , when I enter your home.

I still expect to see you jumping with joy when i enter your door.

I still look around to see you sleeping somewhere indifferent to every other activity.

We still hesitate in saying “chalo”.

Mummy still closes the door swiftly as she leaves home.

We miss u babu kuro.we miss you like hell.

i was in my eleventh grade ,when siddhu adamantly brought u home,

i couldnt come to recieve you at the airport,as i had tuition classes to attend.

U came from bangalore ,siddhu said along with your brother.

siddhu chose you out of the two ,as u had a darker skin color .

I was there at home to receive u along with Subbu and Sinha auntie.

all of us were so excited to see you.

I cannot describe in words ,how adorable you were as a puppy,the cutest i had ever seen , u were just 40 days old .(it pained to think u were separated from ur family ,at such a tender age).

and the first thing u did as soon as u landed on the floor was to pee.

and you had us all in splits(except maa,who until now had evidently expressed her distress “hum abhi bhi keh rahe hain isko wapas kar aao “)

Siddhu was the happiest ,cute little boy he was back then.

I remember your first night at our home.mummy had bought a basket for you ,which is now being used for laundry,she had put an old quilt of mine and you were placed in the same.(u were expected to sleep and stay in there baba ).

But , as soon as all dozed off you manouverd and came out.I as usual was the last to sleep, was watching over you the whole night and many other nights that followed.

you remember your strict trainer??

the tall police trainer? of course, you do?how scared you used to get, I was the one who would save you from him.there were so many times I would not open the door for him.

I was so protective of you.

oh!I clearly remember all those girlfriends of yours, the black lab, the yellow lab, of course, spuggy our favorite,we suspected the yellow one had your babies,but her mom denied.Anyways spuggy was our favorite.We have named another one spuggy now.

Remember the fight you got into with that adult great dane .It was like Nawazuddin Siddiqui getting into a fight with the great Khali.You behaved hilariously that day.

ofcourse that incident when a small squirrel entered our home and u ran upto it,we got scared u would harm it .instead you carried it tenderly in your mouth and left it in the garden.such a gentle dog you were.

Panchalotiya sir used to call you the old wise man.

mama called you cousin dog kuro.

Nanu called you koru.

Some even called you purab.
there are soooo many other incidences kuro.I wish i could tell you.

I wish i could be with you in your illness.

I regret not being able to mourn your demise properly, as i was getting engaged the next day.

maa and papa are fine, though they are still struggling with the void that was created.but they are doing fine.Maali kaka has shifted, i haven’t seen him since last 365 days.

I hope he is fine.

we all still love you babu kuro.and will always do.I wish you a very happy life wherever you are today.You will always be in our thoughts.

and i am a vegetarian because of.you changed our outlook towards animals.

love to the power infinity

srivastavas and friends

(special mention to Sinha uncle and family,avinash Nayal, Ragini Varshney ,Raja uncle, CHoubey unlce ,maali kaka,watchman kaka,mani ben and all those who have given our Kuro love, we are all very thankful)

ROOM NO.501 (contd.)

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10th of September 2017 ,marks the 15th time the world health organisation is endorsing the idea of SUICIDE prevention.

suicide in Latin means “self murder”.

It ranges from thinking that life is not worth living to actually completing the act.

It is one of the very few Psychiatric emergencies we come across.

like time,suicide has a past ,a present and a future.

past implies to the previous mental illnesses (studies suggest suicide is almost always the result of a mental illness).

present implies to the act of committing it .

and with future i imply ,the devastating legacy it leaves for those who have lost a loved one to it.We refer to them as the SURVIVORS of suicide.

room no. 501 has left its paint on my mind,

it reminds me of allot ,

it reminds of both good and extremely bad times.

the beginning was the toughest ,it was a ‘house full’ of lonely nights , hopeless evenings and mundane Sunday mornings.

then with help it became easier, and coming out of the phase changed me immensely.

i came out as a more confident , less anxious , more forgiving ,less judging and a more positive being.

after the phase i understood my patients’ agony better ,may be it was purposed to happen ,so that i would come out stronger.

I now connect better with my patients,I listen more intently, observe more keenly and take more interest.

 

Just about last year i received a call from my mother ,in between my exams that one our known expired ,on inquiring  she said it was a completed suicide.

this was the first time I came across someone who ,not related to my work background ,

had done so.It was perturbing.when other people in our circle discussed about it,

I understood suicide’ position in our society.

  1. most commonly people said “what was so bad in the persons life that she has to resort to such a huge step.”

to that i would usually say that it is very rare that suicide occurs as a result of a single factor,usually there are many.and it is very difficult to explain.

2.others would try to ignore suicide and just concentrate on the death part.it is a big taboo to talk about it.

to that i would usually surrender (my bad).

understanding the risk factors can help us all to curb the rising rates .

  1. age :over 45 yrs.
  2. divorced/widowed.
  3. unemployed.
  4. conflictual interpersonal relationships
  5. chaotic family backgrounds
  6. chronic illnesses.
  7. substance abuses
  8. hopelessness
  9. previous suicide attempt(the most important determinant).
  10. social isolation.

there are many others and it should be noted that anybody ,anytime of their lives can become suicidal ,and anyone ,anytime of their lives should be taken seriously if they report so.

action to be taken is i would say report to a doctor immediately ,preferably a person who is trained in the field of mental illness.

following is the link to my previous article on the similar topic.

ROOM NO.501

reach out.take help.your life is precious.all problems have a solution.your suffering can be lessened .it is an illness like any other physical illness that demands attention and treatment.

losses

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They were married for 30 odd years now,

4 children ,2 abortions,demise of parents and elder siblings ,

yes they has sailed through all ,Together,

for all their lives ,she was the parent in their relationship and he the child

(http://www.hopestreetcentre.org.uk/therapy-sandbach-cheshire/understanding-parent-adult-child-model),

She was the pacifier ,he the impulsive one.

But,tables were turning now,

It seemed she needed help now.

She couldn’t drape a saree ,she FORGOT how to.

She FORGOT she had eaten ,she FORGOT she slept ,

She FORGOT where they lived,She FORGOT how old she was.

She FORGOT their date of marriage,she FORGOT she had FORGOTTEN.

It all began the day she put salt instead of sugar in his favourite dessert.

When she was brought,the DEMENTIA had already taken its toll.

she was admitted to look for reversible causes ,still there was hope.

But everyday during the rounds her symptoms were the same.

She could not recall her address,not the names of her children.

On asking she would just smile ,hiding the embarrassment.

While the new parent (her husband)would move his hands over her hair,

scared he was even more now,he would feed her now,dress her .But when she was not looking he would cry ,he would cry like a baby who has been separated from an elder,

he would cry like never before,cause he was grieving the loss of his companion,his partner,his family,his friend ,his love ,his wife.   #dementia #family #love

dementia ,an overview

#dementia#mentalhealth

AFTERWORD: dementia is the progressive impairment in higher brain functions specifically cognition,the consciousness unlike delirium remains clear.

It is not the same as mental retardation as the deficits in dementia ,represent a decline from previous functioning.

It occurs in approximately 5% of population above the age of 65 years.Of all causes Alzheimer’s disease is the most common,followed by vascular dementia which has an underlying etiology related to cardiovascular diseases.

It is diagnosed on the basis of clinical features and history narrated by close relatives.

Now treatment is done on the basis of the etiology  ,for irreversible causes like Alzheimer’s cholinesterase  inhibitors are used.

The question is whether it is preventable ,recent studies suggest it is.

http://jamanetwork.com/journals/jamaneurology/fullarticle/798129

as the above article(link)suggests diet modification,exercise and lifestyle modification play a positive role in preventing dementia.

also it is suggested that learning new things , after turning 30 may be helpful .

#preventingdementia

 

A living funeral

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The new year came and went,

he told no one but he knew that this would be his last ,

when a colleague died suddenly of a heart attack,

Morrie went to his funeral,

came home depressed.

“what a waste” he said.”all those people saying such beautiful things and irv never got to hear any of it”.

had a better idea;he called a few friends ,fixed a date and organised his ,’living funeral’

This is inspired from the book called “Tuesdays with Morrie” by the author (Mitch Albom) which was gifted to me by my professor and head Dr Panchal.

 

the idea of a living funeral appealed to me to a large extent,

the idea is analogous to farewells we conduct ,

to many ideas at the social networking sites like,testimonials(orkut) and the recent saraaha (or whatever).

what draws my attention more is that why do we need funerals,what i ponder upon is that man being the social animal is always  in search of an approval or rejection from others(positive or negative game) which is always preferred to indifference.

I feel therefore,we need to learn to be appreciative .

to express feelings,emotions,desires,opinions whenever given an opportunity.

to express love and gratitude before all the energy gets wasted.

you will get time to watch that video tomorrow as well But,u will not be able to appreciate your mothers food tomorrow,

you will get time to play candy crush tomorrow But, not be able to see the joy on your fathers face when u tell him you are proud of him.

you will be able to click that selfie anytime you want ,but, u will miss your husbands grin tomorrow when he is frustrated with his work.

you will be able to scroll Facebook tomorrow but ,you will definitely miss the opportunity of telling your sibling how you appreciate their BEING after they leave for college.

you will miss your friends

and definitely you will not be able to pat your doggie once he dies …

and death is but the ultimate separation,

So before we become ‘brimmed’ with regret  let us talk to each other ,appreciate each other .dedicate poems to each other,sing and dance for each other,

because we have very less time… 

 

 

 

Its a dirty world…

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For her everything was dirty,

her life revolved around dirt and getting rid of it,

for her cleaning was an occupation,an addiction,a fate and not a hobby,

she would start it as the first thing in the morning and conclude only when she slept,

she had forgotten she had a family,

a husband ,two children.

at times she would have relaxed months,relaxed years.

But,whenever there was a change in the environment ,her cleaning would make new records.

years had passed all together ,she had not traveled ,she did not learn anything new,

she was trapped in her OBSESSION of CONTAMINATION.

she never knew there was a solution,

she never knew there were others like her,

she never knew it was an illness,

she never knew it was not her mistake,

she never knew she could be free…

for her the world remained a dirty dirty place …

http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.154.7.911

#OCD#contamination#obsessive#compulsive#disorder#hope#psychiatry

keep calm ,don’t panic!!!

She called ,i was driving.

She called back , i picked up.

Before i could talk,she was crying.

i knew she was on treatment ,

i asked her what was wrong,

but she would not stop crying,

now i started getting scared,

what was she upto,was she alright?

what was she thinking?,

where must she be ???

i asked her again,please tell me what is it?

she said she could not breathe,

i did not understand

she said she had a chest pain ,

i was getting close.

she said she is going to die,

Ah!impending doom i thought.

i asked her if she was alone,

she did not answer,

she said everything has finished,

i said no it has not,tell me where are u.

she said she was at home.

phew i thought ,is auntie at home i asked.

yes she is ,but i don’t want to trouble her.

i said ok .just take your tablet clonazepam.

she said she did not want to.

i was confused ,what else could i do?

we were 700kms apart and i knew how stubborn she was.

she would suffer but not take the medicine,

that is the way she was.

never had i seen her like this,not even during the worst times .

she kept crying ,everything is gone,i’m dying

i’m having a panic attack she said.

she was getting better now.

i asked how she wanted me to help her .

she said u just listen. OK i thought.

she did not say anything after that ,i could hear only her incessant cries.

within 10 mins she said she felt better ,and would call me later.

i called my other friend in the same city immediately as soon as she hung up.

i asked to not tell her i called.

Because like everybody my dear friend felt vulnerable.

she felt oh i cannot be weak .Oh !no no no no.

I say can something be done ??

She got well in a month or so,we have not talked about that later on.

I asked her to tell others that treatment is available for mental illness ,

she said she would for sure.

the other thing that kept me pondering was ,what if the patient does not want to take medicines,

is there something else we can do?

or are we crippled?

many questions ,not many answers…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330525/

 

 

ROOM NO.501

I would stand there (in our balcony) for hours ,IMG-20141104-WA0018

time would just not move,

for sometime i would look at the dark sky

they were cloudy nights,many of them,

I stood there for hours

other times i would look at the hospital ,the surgical ward,not much movement at that hour.Still i would stare in a hope to see somebody.

Then i would look down ,where our vehicles were parked,But the watchman would also be sleeping, lucky man i thought.

Also i had many other thoughts,including a frequent one of the consequence of jumping off the building.i would think what will happen if i jump ,will i die or will i sustain injuries,oh! my already overworked husband (then boyfriend),will have another case to solve.I thought of the watchman who would loose his sleep ,

oh !poor man i thought,i thought of our warden my HOD himself, he would have to be disturbed at that hour of the night,no no i thought,

I thought of my roommates and good friends ,what would they think , she was weak could not even sustain a branch that is as comfortable as psychiatry.

I thought of my mother and trembled with agony , how could i even think of something like this, poor woman my maa.

I thought of my father ,bas i could not think more.

I felt drops on my face i felt the pain,i felt i was crying oh yes i was,i thought of the reason i absolutely could not,

I took a deep breath and looked at my watch(cellphone) it was  already 3:00 a.m.

I had to wake up at 7. I immediately called the first contact i saw,that was of my husband i knew he was awake,he picked up my phone as cheerfully as always ,asked me why was i still up ,i was just crying,his cheer turned to worry and immediately asked if i was alone at home and asked me to come down ,i told him not to worry he insisted to see me, i told him ok ill come to your ward ,i went there at 3, helped him with the dressings he asked what was wrong i could not explain,as i was myself in awe.till we finished the work it was already 4:30 he dropped me home,i slept i suppose.

The other day i was up by 7:30 am though i had planned to take an off ,but couldn’t help but wake up.I the rounds that day and many other days i would not understand any bit,as i was drowsy .I made mistakes while working ,mistakes that i could not.Got scolded by my superiors,they seemed concerned.They asked me what was wrong ,i said i am not getting enough sleep and the matter closed.

One day while talking to a patient in the O.P.D i started crying the patient looked at me and said madam is all well?i said yes it is, how dare it not.

Nights were the worst ,specially Tuesdays and Fridays ,as my roommate would be away (emergency duty) .

I did not think of talking to anyone as i was scared all will judge,they would say psychiatry has affected me ,which i was sure had not.I thought they would say i am doing so to gain attention and to cover up for my mistakes.I was very scared.

I had never been a social person,but never had i felt so lonely before.

On the 24th of november 2014 i finally decided to talk to the person who i believed would not judge ,that was my professor . I talked to him he listened,i cried he listened ,asked me if i wanted to start medications i asked him for some other alternative he gave me a book .

Feeling good by David burns

and for the first time in months i felt good.

i dont know what went wrong then but something was wrong ,it definitely was.