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Mental disorders have existed since time immemorial. There are descriptions of patients suffering from schizophrenia since the days of Rigveda. The oldest texts on psychiatry include Charaka Samhita, the Ayurvedic text. The present day figures about mental disorders are alarming. Globally, depression affects 264 million people. Bipolar disorders affect 45 million people. Schizophrenia affects 20 million people. About 50 million people in the world have dementia. About 40 percent of patients visiting a general practitioner have some or the other mental health issues which need to be addressed. About 800000 people commit suicide every year all over the world. The need for awareness about mental disorders has been a perpetual need since ages. Mental disorders can severely affect the quality of life and hence deserve attention.
According to an article in The Lancet Psychiatry, Vol. 7, Issue 2, February 01 2020 (Pages 141-168), in 2017, 197.3 million people in India suffered from mental disorders. 45.7 million suffered from depressive disorders and 44.9 million from anxiety disorders. One in seven Indians were affected by mental disorders of varying severity. According to the statistics presented by the National Crime Records Bureau, more than 1.39 lakh Indians died by suicide in the year 2019, 67 per cent of which were young adults (18-45 years). 71 per cent of those who died by suicide suffered from mental illness, 64 per cent had family problems. There is an 8.5 per cent increase in young suicides compared to last year. There is a constant growing need for addressing the issue of mental health in India.
Both. Problems related to stresses of modern lifestyle have definitely increased. Increased population, fierce competition, technological boom, social media, changing value systems, economic crises, the recent pandemic- What not. All of these are adding to our stress. However, we need to remember that better diagnostic tools are available, more and more scientific research is adding details to our knowledge every day, newer treatments are available; so many more problems are diagnosable and treatable today than were earlier. Mental health awareness campaigns have yielded positive outcomes.
Despite the growing awareness there is still stigma pertaining to mental disorders and their treatment. People still go by their own prejudices and stereotypes related to mental disorders. Ignorance and misinformation are the foundation of stigma. The commonest belief is that mental illness means madness that never gets better. People suffering from mental disorders are very often labelled as insane. Popular images of a ‘mental patient’ and a ‘shrink’ portrayed in novels and movies still haunt people’s minds. There is a dearth of proper scientific knowledge about mental disorders and their treatment even among educated people. Somehow, there is a mixture of curiosity, praise and skepticism around the world of mental disorders. Awareness is an ongoing, never- ending process which opens people’s eyes and refreshes their minds.
A psychiatrist is a medical professional who has done MBBS and then a postgraduate degree or diploma in Psychiatry. So a psychiatrist is able to prescribe medicines for treating mental disorders. A psychologist is a person with an arts degree such as MA and can do counselling and/ or administer psychological tests. A counsellor is a person who does counselling- could be coming from a background of psychology or social work or could be someone who has done some course in counselling.
Fact- Some psychiatric disorders have some symptoms which are not socially acceptable and appear odd and unusual as compared to normal people. For example, a person with schizophrenia who mutters to himself/ herself or laughs to himself/ herself, or a child with ADHD who is constantly restless, or a person with mania who talks excessively and is irritable etc. These are disorders with biochemical disturbances in the nervous system which the person is not able to control and is not even aware of them.
Fact- Let us know once for all that THE MIND IS LOCATED IN THE BRAIN. The brain consists of about 100 billion brain cells or neurons. Each neuron can connect to tens of thousands of other neurons. The junctions between neurons are called synapses. The transmission of impulses in the brain takes place electrochemically. There are different neurotransmitter chemicals such as dopamine, serotonin, acetylcholine, GABA etc that have been identified in the brain. Dysregulation of different neurotransmitters has been shown to occur in different mental disorders. More and more research is throwing light on specific neurotransmitter disturbances in disorders such as schizophrenia, depression, anxiety, bipolar disorders, ADHD, addictions etc.
Fact- Till 1952 there was no specific medicine in Psychiatry. People with major mental illnesses would invariably land up into mental asylums where the scenario would be pathetic. Patients would be tied with iron chains, beaten up and all sorts of things. When chlorpromazine was discovered in 1952, it was a major revolution and it is said that their chains got broken, they improved and many of them could be managed without hospitalisation. Then came other drugs, antianxiety, antidepressants and so on. The overall picture of mental disorders has remarkably improved with medication. There were different forms of other therapies like psychotherapy, behaviour therapy and their combinations which were developed. All these modalities of treatment contributed significantly to recovery from mental disorders.
Fact- Many mental disorders have chemical neurotransmitter disturbances as a prominent root cause. It is important to treat these disturbances with medication. When the biochemical state of the nervous system is restored to normal, the person becomes receptive to counselling. For example, a person with schizophrenia who is violent or a person with depression who is suicidal, or a child with ADHD who is suffering because of inattention- impulsivity and hyperactivity needs to be stabilised first. In fact, it can be dangerous to try counselling alone in some mental disorders such as schizophrenia as it can cause a flare up in symptoms.
Fact-Psychiatry is a branch of Medicine and follows the same process of diagnosis and treatment as other branches of Medicine. Like any other branch of Medicine, the most important tool in diagnosis is good history- taking. This involves taking an interview with the patient and the family. A very important tool in diagnosis of a mental disorder is assessing the MENTAL STATUS of the person. A good clinician carries out a mental status examination while talking to the patient and collecting the history. It appears that the doctor is just ‘chatting’ with the patient. But it is done with a purpose of diagnosis. The diagnosis is aided by physical examination and physical and psychological tests if required.
Fact- A psychiatrist examines a patient’s mental status which includes examining the person’s consciousness, attitude, behaviour, mood, thought, perception, orientation, memory, intelligence, insight and judgment.
Fact- Hypnosis is a form of treatment useful for certain patients only and not all psychiatrists are trained for the same. It is not possible to put anyone into hypnosis against the person’s will and consent. There is no question of manipulating anyone into any form of treatment.
Fact- Loss of sleep is a symptom of many psychiatric conditions. A psychiatrist does not treat a symptom but treats the cause. There are several drugs available for treating different mental disorders. They are not sleeping pills but act on specific neurotransmitter chemicals in the brain. Some of them have sedation as a side effect that wears off after some time and the desirable effects take over. The so- called sleeping pills alone are not useful in treating mental disorders.
Fact- There are some conditions that are called disorders e.g. schizophrenia, bipolar disorder, ADHD which require long term maintenance with medicines- just as some physical conditions like hypertension and diabetes do. This is not called dependence but maintenance.
Fact- All medicines have potential side effects. There are two kinds of side effects- unpleasant and dangerous. Generally the dictum is – start low, go slow and monitor for desired effects and side effects. Psychotropic medicines take weeks to show desired action. One often experiences unpleasant side effects initially- e.g. sedation, dryness of mouth, hyperacidity, sometimes restlessness etc. These effects wear off and then the desired effects appear.
Fact- There are some serious mental disorders in which a person can become dangerous to self or others which can be an emergency. In this situation it is not advisable to wait for medicines to act which takes weeks. An emergency treatment called Electro- convulsive therapy (ECT) is used to treat such cases. Modern ECT involves giving general anaesthesia and a muscle relaxant to the patient, followed by passing a small electrical current for a brief period of time through the brain. The person is asleep during the procedure.
Fact- This is disastrous! It is often resorted to as a ‘treatment’ by families, for serious mental disorders like schizophrenia. Marriage is a potential source of stress for an individual even if it is associated with happiness. It involves taking responsibility, adjusting with another person and his or her family. Very often, a mentally ill person is not in the right frame of mind with respect to marriage and is unable to take the stress of marriage. Marriage can, at times, worsen the symptoms of a mental disorder because of stress. A person with a serious mental disorder should be married only after proper symptom control and psychosocial rehabilitation.
Congratulations! This is a very positive goal. And, something you can achieve if you pay attention to a few important things. Please remember that psychiatric treatment is a two- way process wherein both the treating psychiatrist and the patient participate together. Much depends on your willingness to participate in this process with trust. If you approach the psychiatrist with a receptive attitude the process of treatment becomes smooth. Please go through all the Q & A below.
The best thing to do is to book an appointment well in advance. If it is an emergency, please explain the urgency to the receptionist. There are genuine emergencies like a suicidal or acutely disturbed patient and non- genuine 'emergencies' like "I am on a holiday for my friend's wedding so I want an appointment today"!
Generally, an attempt is made to accommodate everyone as soon as possible. If there are any cancellations by other patients, this becomes easier.
In case you need to cancel an appointment please note that it is important to inform well in advance, or, at least as early as possible if you are not going to make it for some reason so that the time slot reserved for you can be given to some other person who is waiting in the queue. Just as you need a desperately early appointment someone else also might need one.
Telephonic consultation is jumping the queue without being in it! It cannot be a substitute for direct consultation. Can you think of disturbing a surgeon over the telephone who is performing a surgery in an operation theatre? A psychiatrist in consultation with a patient is in exactly the same situation as a surgeon operating. He needs to focus well on the case at hand and cannot afford to lose the link of conversation even if the call is just for one minute.
If you want to ask a small piece of advice such as "Some medicine is not available, is there a substitute name?" or, "Should I take the medicine after meal or before meal?" or, you have queries regarding some side effects of medicines you are experiencing, please ask the receptionist your question. She will note down your question and ask the doctor in between two consultations and get back to you with the answer. Please be very specific with your questions. Please do not insist on having a telephonic discussion with the doctor. It disrupts clinical work. Just imagine that you waited for your turn to get into the doctor's cabin, you have a twenty-minute- slot with the doctor, you are sitting in front of the doctor and the doctor is busy answering phone calls one after the other and paying no attention to you.
There is an emergency helpline called Nidaan on which the doctor is available on call for real emergencies. Please take the details from the receptionist. If it is not an emergency, you can also send a WhatsApp message (either text or audio) on the clinic mobile number. You will get a reply within 24 hours. However, please avoid continuous chatting with the doctor over WhatsApp. The more precise you are in asking your questions, the better it is.
It is important to take the next appointment just after a consultation so that this situation is avoided. In case of a video consultation, please send a message a week before the completion of the actual expected date of appointment so that it becomes easy to schedule one. If due to some reason, you are unable to take an appointment or are not able to make it on the day of appointment and are about to run out of your prescription, AS AN EXCEPTION, you can request the doctor to send you a prescription for 10 days till the next date of appointment.
As a rule, NO. It is understandable that one can be late due to reasons such as traffic. However, let us look at it this way. How many times have we missed a train or a bus or a flight because of traffic? Can we treat a doctor's appointment as precisely as catching a train or a bus or a flight? When a patient reaches late, the time slot allotted to that patient gets wasted. Plus, the doctor has to spend additional time with the patient. Therefore, it is best to stick to the allotted time of appointment.
Sometimes some patients take a longer time than expected. It is a situation which cannot be avoided. That patient also could also be you and someone else has to wait!
No. It is advisable to write points before the consultation so that nothing gets missed. In case you forget anything please send a WhatsApp text or audio message on the clinic mobile number. If it is too long a narration you may send an email to the doctor with prior permission.
You can do so on WhatsApp on the clinic mobile number or email. The receptionist will guide you in this regard.
Please feel free to say this to the doctor. There is nothing right or wrong about what you express about your difficulties. The doctor will not judge you if you describe some strange thoughts or feelings that you have experienced. It is possible that you have never shared your feelings or thoughts with anyone before because you found them odd. You can begin with a narration of your current presenting complaints and then move on to the past history. The doctor will, of course, guide you through this communication. Carrying some notes with you as guiding pointers is helpful. This is particularly important in case you have a long history with details to be presented in a chronological manner. It is possible that the initial history might be taken by one of the counsellors and then presented to the doctor.
It is important to carry all your relevant medical history, earlier prescriptions if any, along with all the reports. It is mandatory to carry your latest prescription for a follow up visit.
As a rule, the doctor maintains hundred per cent confidentiality. However, in case of a severely suicidal patient it is mandatory that the doctor reveals the details to the close relatives of the patient.
Please understand that the receptionist has to do many tasks at a time such as giving appointments, attending to the patients in the waiting room, answering phone calls, attending to the doctor's calls etc. There can be some patients pressuring her to send them inside, some asking her a query about a prescription, someone over the telephone bargaining about an appointment etc. This can be very stressful. The receptionist is a very important link between the patient and the doctor. She maintains the flow of the clinic efficiently. She can be of great help if patients cooperate with her and treat her with respect. Fighting with the receptionist or manipulating her would only add to her stress, thereby reducing her efficiency, and is strictly prohibited. It is, therefore, important to trust her as a part of the clinic team.
Sadness is a normal human emotion. All of us feel sad sometimes. But it is a temporary feeling that comes and goes. If it is just a temporary wave of sadness which you are experiencing it is unlikely that you are depressed. However, if you are persistently and frequently feel sad, if this sadness is very severe and intense, and if it adversely affects the quality of your life e.g. enjoyment in life, work, relationships at home and outside; it is likely that you are suffering from a disorder called depression and need to be assessed by a psychiatrist.
Our brain contains some neurotransmitter chemicals which regulate our mood. Serotonin is an important neurotransmitter in this regard. At times, there is a dysregulation of serotonin that gets triggered in the brain without any apparent external reason. This causes a persistent disturbance in mood and the person feels depressed. Of course, such dysregulation can occur as a reaction to a loss or trauma. But it can happen on its own in individuals who are prone.
If you are depressed, it just means that you are not well. All you need is treatment of your depression, and you will be back to your normal self. Strong and weak are not labels one should use to judge oneself. It Is just that some people are more prone to certain kinds of disorders, whether physical or mental.
Loss of sleep is a symptom of depression and not a cause; just as in case of a person with malaria, fever is a symptom and not the cause. It is pointless to treat a symptom without treating the cause. There are several other symptoms of depression. One does not treat each symptom individually but treats the basic biochemical disturbance which is at the root of all of them. When the basic disturbance starts improving, sleep is usually the first symptom to start improving.
When one is depressed, one can feel hopeless. Hopelessness is a very prominent symptom of depression. “Nothing is right and nothing ever will be right” is very often an expression used by people having depression. If this person receives treatment for depression, slowly the biochemical disturbance in the brain starts improving, one starts feeling better, the world starts appearing better, life starts appearing brighter and the hopelessness disappears. So please receive treatment, wait and observe the positive change that follows. There is light at the end of every tunnel!
It is as ridiculous as asking someone to snap out of fever or diarrhoea. Depression is a biochemical disorder of the nervous system. In that sense it is very much ‘physical’. If you are depressed, you are not imagining it or inviting it by thinking about it. So you cannot ‘just drop’ it or ‘snap’ out of it. Pushing yourself into doing normal activities will only worsen the stress and guilt.
You will need medicines to treat the biochemical factors causing depression. Counselling is an additional feature of treatment which facilitates recovery. It helps improve negative thoughts, negative self- image and promote positive behaviour. But counselling alone will not help.
No. They do not cause dependence. But one needs to take them under long – term supervision for maintenance. They are to be tapered off, too, underthe psychiatrist’s supervision. If they are prematurely withdrawn or stopped abruptly without doctor’s supervision, there is a high chance of recurrence of depression, which can become chronic.
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