July 6, 2019 - DR. Bhatwadekar

By PM@vtech2u.com on July 6, 2019

WATCH FOR THE 3Cs – Dr. Vani Kulhalli

A person with mental health challenges needs constant support of key family members. A study called the ‘International Pilot Study Of Schizophrenia’ was done by the World Health Organisation. It was found that patients in India had better recovery than patients from Western countries and this difference was due the high quality of support they got from family members. So, a lot depends on the contribution of caregivers. We, mental health professionals look upon patient’s friends and family as important members of the treating team and caregivers are a great resource for us. Then, what makes a great CAREGIVER?

The 3Cs

Several personal qualities have been studied as essential to the caregiving role. These include empathy, love, compassion, competence, caring attitude, financial stability and so on. In my experience, the most important among them are- CONNECTION, COMMUNICATION and self- CARE. Any person who has found himself/ herself in the caregiving role can cultivate these qualities to help their loved one.

CONNECTION

The connection that a caregiver feels is mainly of compassion. Caregivers feel a deep concern for the patient and are invested in their well- being. It is also true that sometimes one becomes a care-giver because there is no one else to take the responsibility. At such a time, one has to learn EMPATHY. Empathy means to visualize the patient’s situation and try to understand the effects that it has. When you have empathy, you will maintain your own point of view which may be different from that of the patient. As they say ‘we can disagree and yet stay together’. Caregiving does not mean that patient and the carer remain with each other all the time, to the exclusion of everything else. The caregiver supports by becoming available to the extent that is healthy for the patient and that does not lead to dependency. The connection between the patient and caregiver has to allow for freedom and individuality. Neither the patient nor the caregiver exerts control over the other.

COMMUNICATION

Caregivers are the ‘first responders’. Whenever a person feels turmoil, it is the caregiver who soothes them. Caregivers have to therefore be good at communication. Good communication means to ‘speak less and listen more’. The caregiver uses both verbal and non- verbal means to give comfort. Caregivers must avoid ‘çounseling’, ‘motivating’ or ‘logical reasoning’. Patient’s condition is usually due to brain responses that are beyond control. So trying to talk the patient out of their symptoms or their behaviors causes more stress to them. Best is to be available to the patient when they want to express and listen calmly to what is being said. You don’t have to agree to everything they say but there is no need to try to change the patient’s beliefs- that is the professional’s job. Often non-verbal means like being nearby to the patient, looking at the patient softly, holding hand, patting the shoulder or holding them close- all done without uttering a word, help the patient to feel secure and better.

Another important communication role is to coordinate with the rest of the treating team. As caregivers are in close contact with the patient, they can share their observations. It helps us to correctly understand the behavior, effects and side effects of medicines. It is a useful habit to write down observations and carry this to the consultation. Caregivers also have to remind the patient about treatment instructions that they may be not following properly. They will need to learn to be tactful and assertive when some of the instructions are not to the liking of the patient.

SELF CARE

Being a caregiver is a very stressful situation. Research has shown that due to the demands of this role, sometimes caregivers themselves go through a lot of problems. The problems vary from boredom, anger, lack of a sense of well-being to the development of chronic or serious health problems. Taking care of a person with mental illness is not a short term task but a long term commitment. The problems are sometimes complicated and resources are limited. It taxes the abilities of even the strongest of people. The best course of action is to work on remaining strong enough to be able to handle all the challenges. Some people see their problems as arising out of the patient’s mental condition. This makes them feel that continuously trying to improve the patient’s condition is the only way. This is not true. While the patient’s condition is being addressed, the caregiver has to make separate efforts to restore themselves. These efforts are called ‘self -care’ activities. Some time and resources are required to do self- care activities. Also self- care activities are effective only when done regularly. Caregivers should not feel guilty about taking out the time or spending some money to take care of themselves.

Activities for self- care

Time out and diversion

Caregivers must take regular, daily breaks from being with the patient. They should pursue their hobbies and social activities to the extent possible. This is possible by sharing responsibilities.

Diet, sleep and exercise

A balanced diet with plenty of fluids, vitamins and minerals is as important for the caregiver as it is for the patient. Ensure proper hours of restful sleep as that refreshes the system. It is also important to avoid using cigarettes, alcohol, sleeping pills and such substances.

Daily exercise- whether it is yoga, brisk walking or dance is essential
Health monitoring and health care As per the age, caregivers need to get regular check- ups for their own health problems. If advised some medicines or treatments, they should meticulously follow them and maintain health
Stress Management

Caregivers have to face many issues other than taking care of the patient. So there is a lot to be handled at the same time. Some form of purposeful stress management will need to be learnt. Maintaining healthful habits, diet, hobbies and regular schedule helps to manage stress. In addition, you can seek counseling and treatment for yourself from the treating Psychiatrist. There are also support groups of caregivers where people can support each other by sharing coping strategies. Meditation and mindfulness are helpful for many people.

Living a full life

Sometimes mental health issues completely envelop the caregiver and drown out every other aspect of life. This is not recommended. Mental illness is a huge challenge but let it be only a part of your life; do not allow it to take over your whole life. Caregivers should pay attention to living life to the fullest, as much as possible. This means to continue your work, hobbies and friendships with good planning and to the extent that it is possible.

Attitude management

Caregivers go through guilt, fear or shame. They feel a sense of defeat when mental illness is diagnosed in their loved ones. But the fact is that mental illness is not caused by any one factor and no person is to be blamed for causing it. One has to cultivate hope and confidence. A scientifically informed approach and ‘can-do’ attitude is required.

In conclusion the Caregivers are the bedrock of the patient’s recovery. In the caregiving role one has to pay attention to developing the 3Cs for success.

By PM@vtech2u.com on July 6, 2019

General Analysis, recurring blogs, satori

The Journey of Therapy – Satori Pansare

How many therapists does it take to change a lightbulb?

Only one but the lightbulb has to want to change!

Starting point

To acknowledge the fact that some things need changing or that there is a problem, is really the starting point from where therapy can begin. While therapy can work wonders, therapists aren’t magicians. Therapy is a two-way street. Efforts are required from both ends to create those wonders people talk about. As a client then, the first step really is just to come to terms with the idea of change. Change is uncomfortable but accepting that it is going to be uncomfortable really makes the discomfort easier to handle. In a case wherein the client is reluctant or is forcefully brought in by a relative, there is very little a therapist can do to help.

Key ingredients

Once you have reached the point of acceptance and are willing to take on the challenge of changing, you will find yourself sitting across from your therapist trying to unravel many jumbled thoughts and feelings. While merely unloading all of the weight you have been carrying around (knowingly or unknowingly) can provide a sense of relief, it doesn’t change circumstances. For things to change and become better, active participation and patience are required.

It is most likely that what you are going through is not something that has occurred overnight. Hence, for any sort of change to reflect, it will take time as first there might be need for some undoing before you can learn new, healthy ways of coping. And when things do start changing for the better, be sure to recognise and celebrate. Every small change is a stepping stone towards your growth.

Finding answers

No two people are the same. Each client walks in with a unique background and set of experiences. Hence, you and your therapist will work together to find out what works best for you and what will help you grow in your circumstances. It is natural to have questions and doubts along the way but it is important to remember that there are no readymade answers. The role of a therapist is not that of an advisor. Rather, the role of a therapist is more of that of a facilitator and a sounding board.

Direction and destination

Therapy might feel like merely talking to another person but that is not the case. Your therapist is a trained professional who uses evidence based techniques to nudge you towards growth. What really sets therapy apart from a casual conversation is therapy goals.

And while some clients may come into therapy knowing exactly where they want to end up, others may have no clue at all. Either way once it is established what the issue at hand is, the therapist and client mutually decide goals and draw a road map to what it might take to reach their destination. Therapy goals also allow both the therapist and client to measure and evaluate progress over time.

Therapy is a journey. A journey where your therapist is holding the torch for you to be able to see the road ahead. Some days you might cover a lot of distance. Some days it might be difficult to take a few steps ahead. Some days you might have to go back and revisit places in the past. Some days you may choose to spend more time and take in the place where you are. Trust the process, for with every session the path becomes clearer and you are taking a step closer to where you want to be.

By PM@vtech2u.com on July 6, 2019

Cardio Monitoring

Circadian rhythms – Dr. Sujay Prabhugaonkar

COVID times

“We’re all shift workers’ ‘ – Dr Satchitananda Panda.

Our sleep is periodically disrupted when we pull an all nighter for studies or when we travel different time zones or when we nurse a sick relative or when nursing a newborn child or when a working mother wakes up early morning to prepare meals for her family and sets off to work.

But during COVID times our sleep was regularly disrupted for days on end. This set up a prolonged jet lag which led to sleep deficit. Not to mention other aspects that added to this like digital jet lag (jet lag due to devices).

Problem amplification

I remember regularly seeing patients who would come for problems related to sleep and disturbed routine.

One student I remember would stay up late to chat with friends and get up late just before his online classes. This resulted in nausea during the morning which would lead to him eating very little during daytime. But during early evenings he would get very hungry and would binge eat, specially sweets. This resulted in his obesity and tiredness and lethargy during daytime. He found it difficult to concentrate on his lectures.

Our biological clock

During lockdown routine has been disrupted. This has given rise to clocks going out of sync. I mean our biological clocks or in other words our Circadian Rhythm. Other examples of clocks going out of sync are during jet lag when the person travels towards a different time zones and during shift work.

How the rhythm is regulated

We have a suprachiasmatic nucleus in our brain which responds to light. At 12am when there’s completely dark, melatonin is secreted which tells us it’s time to sleep. This melatonin secretion stops by 7am. If we don’t sleep during that time, sleep debt occurs which leads to sleep deprivation.

When we wake up in the morning cortisol secretion starts and peaks at 8am. This cortisol arouses us and wakes us out of sleep. This cortisol also increases glucose levels in our blood. Thus glucose levels are highest early in the morning. This is the right time to do workout so that we can convert excess glucose into energy and we can reap the maximum benefits of exercise.

Disrupted rhythms

But, although circadian rhythm is a part of our nature, which develops at the age of 3 to 6 months in infants, it is not a constant thing. We can reset our clocks. Bright light exposure in the evening makes our brain feel it’s still daytime and we can be active till late hours. Conversely, dull lights in our cabins during work hours make our brains feel it’s night and we yawn. But these frequent disruptions in circadian rhythms can cause many health problems. Problems range from insomnia and sleep deprivation to obesity, diabetes, hypertension etc. Even our longevity gets affected. Thus, it’s good to stay in bright lights during daytime and keep pitch dark at night without taking our phone to bed so that the melatonin secretion continues.

Zeitgeber or time giver

Our circadian rhythms are turned on by specific cues which regulate body rhythms. Newly married couple initially takes time to adjust to each other’s sleep rhythms but eventually they’re set for the long term. That is why those who lose their spouses or those who get separated have disrupted rhythms and the grieving person has difficulty sleeping and can go into depression. Thus traumatic life events can give rise to mood disorders due to this mechanism.

Mental health

Disturbance in circadian rhythms give rise to mental health problems too. Those who have depression, have irregular sleep wake cycles and abnormal cortisol levels. The treatment of mild depression can be done by light therapy or sleep deprivation (by reducing REM sleep). Thus, during episodes of mild depression, just by entraining the circadian rhythm, depression can be cured.

Also disrupted circadian rhythm can be a trigger for Bipolar disorder, especially the manic phase of bipolar disorder in which there is decreased need for sleep. Thus one of the treatments for bipolar disorder is Interpersonal and Social Rhythm Therapy (IPSRT) which is meant to regulate individual’s social rhythms such as meal times, personal relationships, exercise and social demands.

Conclusion

Thus, we have to set our internal clocks in order and synchronise it to a day night 24 hour cycle, which can help us in living a healthy and fulfilling life. It will not only help in overcoming lifestyle diseases like hypertension, diabetes etc but can help in psychological disorders like depression, bipolar disorder etc as well as increase longevity and would go a long way to prevent major medical illnesses.