Showing posts with label psychiatry. Show all posts
Showing posts with label psychiatry. Show all posts

Sunday, January 14, 2024

Links to educational resources

Please find the links to all of my recommendations for students on educational resources (click on the links below to open in a new window).


Professional resources:

Lectures for medical students on major topics in Psychiatry (click on link to podcast under each topic)

Patient education videos on common psychiatric conditions

Advice to aspiring students on whether to join the medical profession: video and article


Writeups on mental health issues: 

Article on stress

Article on dementia

Two articles on ADHD: one and two

Article on homosexuality


Books written by me on mental health issues:

Lake Amidst The Seas: An account of resilience in the face of mental adversities








Aham: Short stories of the Mind

[With explanatory notes on the mental issues covered in the stories]


Aham Paperback: Publisher's Store,  Amazon,  Flipkart






Further reading: 

My book recommendations for all medical students

My book recommendations for students of Psychiatry



Further viewing: 

My film recommendations for all medical students

My film recommendations for students of Psychiatry






Saturday, April 29, 2023

Is it okay to be GAY?!

Is being gay a social problem?

Gayness has existed since times immemorial; it’s only since Indian people started asserting everything about their personalities openly that we are waking up to the situation.  Bewildered by their own ignorance, parents, grandparents, aunts and uncles, contrary to eons of cultural conditioning, are having to face the harsh reality that one of their sons, granddaughters, nephews or nieces is gay.  The situation is so glum that for many elders in India, the concept of homosexuality is an impossibility that they struggle to comprehend. 

If you look around, I am certain you can find an uncle or an aunt or a distant relative or a friend who has remained a ‘bachelor/spinster for life’, only because they were unable to declare their actual sexuality to the world for fear of ostracization by their family/community.  Either this, or they submit to the whims of their families and enter into fruitless and joyless matrimony, which if it lasts, is nothing short of torture. 

I am reminded of a recently married male patient who was advised to see me because he was not ‘participating’ in the marriage.  His mother expressed great hope in our therapy process and thought that he would be cured of his marital diffidence, whereas the bride’s side were vehement in their criticism of his family for conniving to get their ‘abnormal’ son married.  The girl even tried to touch him during therapy to demonstrate how he would recoil from her.  At home, the mother apparently stood guard outside the couple’s bedroom so that her son would not escape conjugal union with his spouse!  

What would you do in cases such as these?  How would you address a problem that was created to hide another problem?  How will you tell them that straight marriage is not the one-stop solution to all problems under the sun; that individuals will not be cured of their gayness if they are married off?

While all denominations of the LGBTQI spectrum face the ire of the ‘regulars’ to varying extents, it is the male-male relations that seem to receive the most flak from all quarters in our country.  I am not suggesting female-female relations are accepted without problems – they are not – but somehow men falling for men is considered to be more shocking and unacceptable. 

This is probably due to the expectations surrounding the male progeny; that he should be macho, in control of all situations, well educated, gainfully employed till retirement age, married to a woman who he can keep under his thumb, and able to procreate and raise children according to his family’s expectations.  Any deviation from this norm invites harsh criticism from all quarters, with an expectation of course-correction to fall back in line and ‘settle down’. 


Is homosexuality a disease?

Zoologists have observed homosexual proclivities in animal species as diverse as baboons, giraffes, dolphins, anglerfish, mallard ducks and cats, among others. The Homo sapiens species is no different.

Indeed, the more relevant question to be pondered upon is how is it possible for the entire humanity to be divided right down the middle into male and female genders? 

Birth, influence of genes/environment, physical gender, psychological gender and sexual feelings are complex factors influencing the ultimate gender/sexual expression of an individual.  This is reflected in the ever-increasing numbers of alphabets that are added to the acronym LGBTQ+ that indicates the gay community.  Therefore, reducing gender/sexuality to a binary is a reductive exercise and betrays a lack of understanding of these complexities. 

But ignorance and bigotry make for a deadly duo.  This is why gay people around the world have had to bear with insults, taunts, ostracization, victimization, discrimination, and the worst, conversion therapies.  Anybody who makes a claim that gayness can be cured like any disease is lying, and is probably operating under the influence of the deadly duo. 

Being gay is neither a disorder nor a crime.  Homosexuality has been removed from psychiatric diagnostic manuals such as the ICD-11 (devised by the World Health Organization) and the DSM-5 (devised by the American Psychiatric Association) since a long time. 

Whether it is a crime or not depends on where you are living.  There are still certain countries where the state and the majority of the population are afflicted by the deadly duo and homosexuality is considered a criminal offence.  It is not because gay people do not exist in such societies; it is just that they live a cloistered life, away from public expression.  I have seen this in students who come from a far eastern theocratic country where being gay is outlawed. 

Homosexuality is not a disease, but homophobia is!  Homosexuality is neither a lifestyle choice as surmised by upholders of traditional cultural values nor does it occur due to poor upbringing, as some parents of gay children fear it to be.  On the other hand, homophobia is a by-product of eons of erroneous cultural and religious conditioning.  Further, it can be indicative of the underlying insecurity and a 'fear of the unknown' on part of the ‘straight’ people who seem to operate under the influence of a slew of psychodynamic defence mechanisms and project these fears onto the gay community.

Ultimately though, it is all about the ego.  Families of gay people live in fear of stigma and ostracization.  Deeply affected by the diagnosis, they either live in denial of their son/daughter’s homosexuality and try to get them married, or if they do acknowledge the condition, they try to drag them along to dubious therapies in the vain hope of a ‘cure’.

This non-acceptance of homosexuality and the resulting distress caused by the attitude of their family, relatives and friends can result in gay people experiencing cognitive dissonance – a phenomenon characterized by a discord between how one feels from within and how one has to behave in the outside world.  Combine this with the guilt resulting from cultural and religious bigotry, and you will get some idea as to the pitiable state of mind that gay people have to endure for having been born that way in the wrong place and at the wrong time.    


What do the religions say?

It is most unfortunate that the LGBTQI discourse has been hijacked to some extent by 'wokeists' and pseudoliberals who never let go of an opportunity to pit it against Sanatana Dharma’s tenets, conveniently forgetting the patent homophobia that exists in prescriptive and converting religions.  

If anything, Sanatana Dharma has always been LGBTQI-friendly.  The only Hindu person who claims to have a cure for samlaingikata (that is homosexuality in Hindi), is a prominent yoga guru and Ayurvedic products manufacturer – no prizes for guessing who.  I am an admirer of his work in general, but I disagree with this claim, and I hope he desists from making such misleading claims in the future.   

Leave that aside, and you will find that our itihasas and puranas are replete with stories of LGBTQI characters who are part of the mainstream discourse and play a crucial role in the stories therein.  Mahabharata’s Shikhandini who later became Shikhandi is only one such example.  The enchanting damsel, Mohini, who tricked the Asuras into forgoing their share of the immortal nectar, Amrita, was Vishnu in a female avatar.  The Ardhanarishwara form of Lord Shiva shows Him as a union of the male and female forms.  Aiyappa, the celibate Hill-God of Kerala was born of the union of this very Mohini and Shiva.

These stores underscore the fact that everything in this universe is energy.  So, even gender should be seen as such; varying expressions of the same energy, depicted in different cultures as Purusha-Prakriti and Yin-Yang.

Further, in the Valmiki Ramayana, Lord Rama’s devotee and companion Hanuman is said to have seen rakshasa women kissing and embracing each other during his Lankan sojourn.  At another place, the Ramayana tells the tale of a king named Dilip, who had two wives, but died without leaving an heir. The story says that Lord Shiva appeared in the dreams of the widowed queens and told them that if they made love to each other, they would have a child.  The queens obeyed Lord Shiva and one of them got pregnant and gave birth to a child who grew up to be King Bhagiratha, best known for having brought Ganga from heaven to earth.

So, why did our culture that was so libertarian that it expressed sexuality on temple walls and in sex treatises become so close-minded and bigoted?

Most likely, it is due to the imposition of puritanism by western invaders/land occupiers that any matter relating to sex was severely curtailed, the crowning glory being the imposition of Article 377 by the British, which the Indian government foolishly continued even after the British themselves had legalized gay relations in their own country. 

As the scholar of Abrahamic studies, Sumit Paul, says: ‘Thousands of years of slavery and the restrictive Semitic civilisational influence transformed the collective mentality of Indians and changed their psycho-sexual behavioural ethos.  We began to condemn our own cultural heritage and history.’

It took a few enterprising NGOs to take the matter to the Supreme Court to have the article struck down.  Still, that’s only one part of the struggle; till date there are no equal civil rights to marry, or to register children/properties for gay couples (this matter is sub judice in the Supreme Court, as of April 2023). 

Spiritually, we are moving from one body to another; sometimes male, sometimes female, sometimes other genders.  So, a man might have been a woman in a previous birth, and may be reborn as a transgender in the next.  So why confine yourself to this birth alone?  If you look at it from the universal and spiritual perspective, it hardly matters whether you are male, female or other. 

As per spiritual healers and masters, your soul decides which body to inhabit prior to its earthly sojourn.  You are a spirit wearing the garb of a human body, put here to do certain actions with your free will so as to facilitate your karmic journey through this birth and the next with the ultimate aim of attaining moksha.  So, focus on that, and give up your fixation with ephemeral bodily features. 


What should parents/families do?

As I have written under sex education, have an open conversation with your child at the appropriate time about their sexual preference.  Alternative sexuality is a normal variation of sex expression, just as being left-handed or grey-eyed is.  There is more to your child than just his/her sexuality; look at developing their overall personality, academic interests and any other passion.  Do not reduce their life to fretting over the fact that they may not get married or have children.  There is more to life’s purpose than these events.  Remember that not everybody is cut out to get married or have children.

Whether we like it or not, whether governments of the day dither or not, whether radical religions oppose it or not, and even if self-appointed custodians of Indian culture send missives to the President asking for equal civil rights not to be granted to the gay community, gayness always was and always will be.  It will be accepted as being part of the mainstream in the future, if not now. 

As we emerge from the heteronormative prerogative of brushing aside anything queer under the carpet, we need to figure out how to uplift 'hijras'/'eunuchs' from a marginalized lifestyle that involves begging from and harassing people at traffic signals towards a more mainstream life of gainful employment through equal opportunities.  And yes, for that matter, toilets and restrooms would also have to be redesigned to be more inclusive of the LGBTQI community.  

I envisage a future wherein intimate relations would be an optional undertaking rather than mandatory, with the individuals having a wide range of sexual/gender diversity to select their partners from. 



Resources/references:

  • LGBT banner picture: https://en.wikipedia.org/wiki/LGBT
  • https://www.deccanherald.com/opinion/panorama/time-to-destigmatise-homosexuality-1152092.html
  • https://en.wikipedia.org/wiki/Homosexuality_in_India#:~:text=On%207%20September%202018%2C%20a,making%20homosexuality%20legal%20in%20India.
  • Shikhandi: And Other Tales They Don't Tell You, Devdutt Pattanaik, Zubaan and Penguin Books India, 2014

Thursday, September 15, 2022

Bright: A silent short film on Mania

Mania is part of Bipolar Disorder (Manic Depressive Psychosis in the olden days).  It is an episodic condition characterized by excessive happiness/irritability and increased energy/activities.  In addition, there could also be agitation, distractibility, racing thoughts, excessive speech, reduced sleep, grandiose ideas, and risk-taking behaviour such as rash driving, overspending or sexually promiscuous behaviour.  It can alternate with depressive periods, although this is not always necessary; a single episode of Mania still qualifies as Bipolar Disorder.  

Persons undergoing a manic episode may be able to describe the euphoric feeling of ‘feeling on top of the world’, with no need to rest or sleep.  They feel highly energetic, and often this energy is directed towards purposeless activities that can rile up people they live with.  They can sing, dance, make jokes, and quote poems with rhyming words, or on the other hand, cry for no reason, and become very angry over trivial issues, and even assault others.  In severe cases, psychotic features such as grandiose delusions may set in, which results in the person believing that he/she is rich beyond means, or has some special abilities, or that they are very important individuals, such as presidents or celebrities. 

With all this going on, the feature that makes Mania the most challenging condition to manage is that the person is unaware that he/she is mentally ill and needs treatment.  But when treatment is given, the symptoms become more manageable, and with the recovery of insight, preventive treatment can be continued on a long-term basis.

Credits
Featuring: Aadya Pawar
Writing/Direction/Editing: Deepak Pawar

[Currently only showing in Festival Circuits]

In this short educative video on Mania, I have attempted to show some of the above features as accurately as possible.  I have experimented with images/sounds that best depict the misplaced joyousness and inner turmoil of the person experiencing Mania.  The speed is deliberately enhanced and the music is set at a frenetic pace to convey the feelings of restless energy in the person.  The expressions/emotions displayed by the actress are similar to those that I have observed in patients with Mania over the years. 

If you feel dizzy, irritable, excited or exhausted while watching this video, that’s just down to the condition itself; the ideas is to give you a feel of mental state of the person experiencing a manic episode.  

As with other short films on Depression and Anxiety, I invite your constructive comments/suggestions and ratings/reviews at Bright on IMDb.

Please also see my patient education video on Bipolar Disorder.

For a more professional information on Mania and Bipolar Disorder (under Mood Disorders), please go through the lectures.


Resources:

Background music: Book Me 2 Flirt-Max McFerren; Busy City-TrackTribe; This is Not Drum and Bass-True Cuckoo
Mania quote: https://www.youthdynamics.org/18-quotes-illustrating-life-with-bipolar-disorder/
Bipolar disorder statistics: https://www.business-standard.com/content/press-releases-ani/one-out-of-150-suffer-from-bipolar-disorder-in-india-70-percent-left-untreated-though-it-is-treatable-122090700775_1.html

Saturday, July 16, 2022

Breathless: A silent short film on Anxiety

Anxiety is a common emotion; everyone experiences it.  It is natural to feel anxious when you are called upon to perform in public, meet new people, visit a hospital, meet a deadline, etc.  

So, when does it become a problem? 

As therapists, we look at the quantity and quality of anxiety.  In other words, anxiety becomes a problem when the duration of symptoms exceeds far beyond what is expected, or when the quality of life is affected.  For example, if anxiety persists even after the provocative task is completed, or even after the stressful issue has been resolved, then it can be a problem. 

Further, if the anxiety worsens so much that a person is paralyzed with stress/fear, and is unable to complete the task, or go about his/her daily routine, then too, anxiety can be unproductive.  It then progresses from common anxiety to an anxiety disorder. 

Anxiety disorder manifests in many ways: panic attacks, generalized anxiety, fear of objects/situations (phobias – commonly agoraphobia & social phobia), stress following a traumatic event (post-traumatic stress disorder - PTSD), repetitive thought & actions (obsessive-compulsive disorder - OCD), etc. 

In this short silent educative film, the following conditions have been depicted:


Credits
Featuring: Aadya Pawar
Writing/Direction/Editing: Deepak Pawar

[Currently only showing in Festival Circuits]

Panic attacks: Brief spells of intense dread with physical symptoms such as breathlessness, palpitations and tremors, and psychological symptoms such as feelings of losing control/dying and sensation of body/surroundings altering in shape/form/colour. It is annoyingly repetitive and can occur even without provocation.  That is, even when the person is not doing anything stressful, when he/she is at home, or in peaceful surroundings.  It may occur on its own or in combination with any of the other anxiety disorders. 

Agoraphobia: Fear of becoming stuck in an inescapable situation, such as in crowds, buses, lifts, etc.  The individual may become homebound in severe cases; that is, he/she may not leave the place of safety – usually their home – at all.

There can also be other specific phobias: social phobia – inability to meet people/perform in public; fear of spiders (arachnophobia), snakes (ophidiophobia), injections (needle phobia), etc.

PTSD: Feelings of intense reliving experiences after a traumatic event; even though this is a stress-related disorder, anxiety and depressive feelings occur quite commonly in this condition, and the person may become homebound as he/she avoids getting into a similar situation.

OCD: Unwanted, repetitive thoughts/images/urges that cause distress (e.g., hand contamination), which is relieved by doing a compensatory act (e.g., handwashing).  This can be a highly disabling condition and affects the quality of life of both the sufferer and the carer.   

In this film, I have intermittently added imagery pertaining to anxiety-provoking objects/occurrences (traffic, spiders, snakes, natural disasters, flight turbulence, injections, accidents) to illustrate the variety of stimuli that can cause anxiety.  The film ends with a series of noises that can be most annoying to the human ear, and can therefore precipitate or worsen anxiety.

The purpose of this film is not to scare you, but to accurately depict the above conditions, so as to facilitate understanding of the nature of anxiety and its many triggers and manifestations.  I hope this helps medical/psychiatric students, patients, carers, and interested lay viewers to better understand anxiety disorders and seek timely professional help, where necessary.

As ever, I invite your constructive feedback and comments.  Please rate/review Breathless on IMDb.

Please read these earlier articles to know more about OCD, and stress.

For a more professional lecture on stress and anxiety disorders, please see the video link in this post.

Film festival selections for Breathless: 

1. Lift-Off Global Network First-Time Filmmakers Sessions:





Resources/references:
'Worry' quote: psychcentral.com


Thursday, September 2, 2021

I'm always overthinking... Have I got OCD...?!

Obsessive Compulsive Disorder, or OCD, is an anxiety disorder that is characterised by obsessions (intrusive and recurrent thoughts, images or urges) and compulsions (repetitive actions such as counting, touching, washing, rearranging and hoarding).  

Even though the recurrent thoughts are recognised as being silly or impossible, it is difficult for patients to resist having them.  This results in increasing tension, which can only be relieved by carrying out compensatory compulsive acts listed above. Thus begins a never-ending spiral of negative thoughts, stress and irrational actions.  

Even though OCD is a neurotic condition, it can be recurring, chronic and debilitating.  It can occur on its own, or in combination with panic disorder, depression, drug & alcohol abuse (often as a symptom relieving habit), Tourette syndrome or autistic spectrum disorders.  

For carers of people with OCD, it can be a horrendous condition to come to terms with; they may, for instance, struggle to understand the patient's need to wash hands repeatedly. 

Timely and ongoing intervention is necessary, and this may entail medication therapy as well as psychotherapy in the form of modifying the patient's thinking/behaviour and response to stress.  Cognitive-behaviour therapy and exposure & response therapy, respectively, help in achieving these.  Relaxation therapy to reduce the somatic symptoms of anxiety may also be added on.  

Patient's partner/spouse may undergo training from the therapist for home management of the symptoms.  For example, he/she can help the patient look for alternatives to or even prevent repeated hand washing.

Learn more about this condition and its treatment in this video in three languages:

English: https://youtu.be/YSrct6U237s

Hindi: https://youtu.be/arkbbsvrGL8

Kannada: https://youtu.be/8o-P5zO8gh4

Read more on stress and panic attacks in earlier articles. 

Find out more about the medications used in the treatment of OCD. 

The link to a short film on OCD and other anxiety disorders can be found here.

For a more formal discussion, please see lectures on anxiety disorders and other topics.



Resources: 

Background music: Fresh Fallen Snow by Chris Haugen

Thursday, July 8, 2021

Does my child have ADHD?!

Attention Deficit Hyperactivity Disorder, or ADHD, is one of those disorders that can exasperate a parent of a child with this condition.  

Here I talk about the disorder in three languages:

English: https://youtu.be/YMuc_PFgiP0

Hindi: https://youtu.be/2m2GSMDJIVg

Kannada: https://youtu.be/hd6Xg7NkiNc

Do not forget to read more about ADHD from my earlier article.




More writings on ADHD:

On boloji.com (click on external link): https://dgvpawar.blogspot.com/2014/12/article-on-adhd-energetic-tots.html

And for fun: https://dgvpawar.blogspot.com/2014/08/chhota-bheem-doraemon-and-oggy-indian.html




Resources:

Music: Waterfall, Aakash Gandhi

Thursday, June 24, 2021

How can I quit SMOKING?!

The torture was beyond human power to bear.
(Sigmund Freud on his attempt to quit smoking)

Smoking and consumption of tobacco products are common in spite of the several media messages and pictorial warnings as to the harm caused by tobacco.  Why is this so?

What begins as a peer influenced, 'harmless', 'occasional' behaviour, stays with the person indefinitely, and before he/she realises it, becomes an insurmountable addiction.

People who have tried to quit smoking can vouch for the fact that it is a hopeless situation to remain without the daily nicotine fix - the cravings and withdrawal effects can be unbearable.  Ask Freud! 


When nicotine enters the bloodstream it activates what is known as the dopamine reward mechanism as shown here:

Dopamine is the 'feel good' brain chemical that activates the reward circuitry in the brain as follows: 

And so on it goes, until it becomes a vicious circle.

This makes tobacco/nicotine one of the most addictive substances in the world - the reason why quitting smoking is such an onerous task, fraught with relapses after periods of abstinence. 

However, breaking this reward circuit by associating less harmful substances (such as caffeine) with the pleasurable feeling, may work in some cases.  

Or, one could also try associating nicotine with unpleasant consequences such as odourous breath or health issues such as coughing/breathlessness. 

Yoga, pranayama and meditation, if done under guidance, can help break this vicious circle by helping one focus on larger issues rather than resort to smoking as a coping mechanism.

I talk about smoking addiction, complications due to long-term smoking, and treatment of smoking addiction in these videos in three languages:

English: https://youtu.be/OQmymTjteyg

Hindi: https://youtu.be/eCks5TGFfuk

Kannada: https://youtu.be/mhLfLL1xvl8

Please read more about smoking and what works in the treatment of its addiction in my earlier articles (click on the links from these pages to external site):

Harmful effects of tobacco; 10 ways to quit smoking and why e-cigarettes are no better.  

Also read a similar article on alcohol addiction.



Resources:

Music: Bed and Breakfast, The 126ers

Pictures:

  • https://researchoutreach.org/wp-content/uploads/2019/06/shutterstock_1119286277.jpg
  • https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Dopamine_pathways.svg/1200px-Dopamine_pathways.svg.png
  • http://b.vimeocdn.com/ts/435/029/435029196_640.jpg
  • https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/20244/width1356x668/h5pht2cy-1360802054.jpg
  • https://upload.wikimedia.org/wikipedia/commons/thumb/9/94/Nicoderm.JPG/330px-Nicoderm.JPG
  • https://www.publicdomainpictures.net/pictures/70000/velka/electronic-cigarettes-1387647695FRV.jpg


Thursday, February 18, 2021

My spouse’s mood changes all the time... Is she/he BIPOLAR..?!

Bipolar affective disorder (BPAD - previously called Manic Depressive Psychosis) is a complex mood disorder characterized by the lows of depression and the highs of mania, and everything in between.  

More prevalent in the higher socioeconomic population, it is a chronic, potentially lifelong illness that needs constant care and attention.  People with BPAD are prone to mood swings, although not the circumstantial dysphoria and irritability that people usually make the mistake of attributing to the illness (as in labelling someone 'bipolar').  That is to say, the mood changes occur subtly over several days, and not dramatically within minutes. 


BPAD, to me, underscores the fact that everything in the universe is in a state of balance: too much or too little of anything is unsustainable.  

So it is with the human body and mind.  Too much of blood sugar is termed diabetic, and too little, hypoglycemic.  Too much of sadness is depressive, and too much of happiness is manic.  

BPAD often affects creative people, and patients even attribute some of their creative outbursts to the early phases of mania when thoughts are racing through the mind, and there is a restless need to create.  

Everyone experiences highs and lows of mood, but the extremes of BPAD affect quality of life and relationships, and therefore require intervention.  Indeed, if a patient develops mania, it is the family that seeks professional help because the patient lacks insight into the seriousness of his/her mental condition. 

I talk about the signs and symptoms, risks associated, and the treatment of BPAD in this video in three languages:




Also read my review of the book on BPAD, Em and the Big Hoom.




Resources:

Background music: 7th Dimension, 

Pictures: https://c1.staticflickr.com/9/8451/7996124566_5b4d08ecaf_z.jpg



Monday, November 23, 2020

My father is always forgetting... has he got DEMENTIA?

Dementia is a neurocognitive condition that affects people over 60 years of age.  It is characterized by short-term memory loss, confusion, sleep reversal, and odd behaviour. 



Find a brief introduction to this complex condition in this video in three languages:

English: https://youtu.be/SS8upBPfsfk

Hindi: https://youtu.be/WesEr0KHM78

Kannada: https://youtu.be/QXCEdKxcnew

Find out more about dementia in an earlier article of mine that was published in Deccan Herald.  Also read about the effects of meditation on ageing.  A recommended book on end-of-life care is Being Mortal.


Resources:
Background music: Cosmology by Evocativ
Pictures: 
https://loonylabs.files.wordpress.com/2015/10/dementia.jpg?w=550&h=422
https://upload.wikimedia.org/wikipedia/commons/thumb/a/ad/Alois_Alzheimer_003.jpg/220px-Alois_Alzheimer_003.jpg

Sunday, July 26, 2020

Alcohol: How much is enough?

In the puranic texts, it is known as soma rasa, sura, madira.  

Yes, we are talking about that liquid whose quantity consumed is second only to water: alcohol.

According to the strength of ethanol content, it is also known as alcopops, beer, cider, lager, wine, sherry, and spirits which are very high in strength and include whisky, rum, vodka, gin and brandy.  




Drinking alcohol is common across communities and cultures across the world.  It is just something that has fascinated mankind with its intoxicating properties that can numb the mind temporarily from the harsh realities of life.  

Studies have also shown that drinking culture is associated with high rates of alcohol dependence.  It is also associated with co-dependence with other substances such as smoking and drugs.  

There are serious consequences of too much indulgence with alcohol and the ramifications are many: social, vocational, medical and psychiatric.  

Treating alcohol dependence is an onerous task, and there are frequent relapses into old patterns of drinking habit, which makes it a frustrating problem to deal with.

So one needs to consider:

How much can one drink?
When does it become a problem?
Are there any indicators of problematic drinking?
How can one measure their alcohol intake?

Find the answers to these questions in this short video in three languages:




Also, read and watch video about smoking/nicotine addiction.




Resources:
Background music [English & Hindi videos]: Paradise [Kannada video: Dreaming in 432Hz by Unicorn Heads]
Picture:
https://upload.wikimedia.org/wikipedia/commons/thumb/5/5f/Chivas_image_for_wikipedia.jpg/1200px-Chivas_image_for_wikipedia.jpg
Units of alcohol, with gratitude to:
https://www.caldersidemedicalpractice.co.uk/wp-content/uploads/2018/05/alcohol-units.jpg
https://www.onesmallstep.org.uk/application/files/8315/7141/4290/how_many.gif

Tuesday, May 26, 2020

My son/daughter has Schizophrenia! What should I do?

What is Schizophrenia?
What is the treatment?
How long should the treatment continue?
What is the role of the family in treating Schizophrenia?
Can the patient get married?


I answer these questions in this short educative video on Schizophrenia, in three languages:





Resources:
Music: 'Birds in Flight', Dan Lebowitz
Thumbnail picture: https://62e528761d0685343e1c-f3d1b99a743ffa4142d9d7f1978d9686.ssl.cf2.rackcdn.com/files/89075/area14mp/image-20150720-12546-bslji2.jpg

Sunday, May 24, 2020

Lectures in Psychiatry

Audio recording with slides of my lectures to undergraduate medical students.  Relevant to medical students/interns of any country/university posted in Psychiatry.


 1. Lecture: Introduction to Psychiatry, Classification & Etiology




Includes detailed explanation of the following slides:

  • What is Psychiatry?
  • Role of psychiatrist
  • Psychiatry not to be confused with... (difference between Psychiatry & Psychology)
  • Mental health teams (components of multidisciplinary psychiatric teams)
  • Branches of Psychiatry
  • Definition of mental health
  • Consequences of mental illness
  • Classification (of psychiatric disorders)
  • Systems of classification
  • ICD-10 Chapter V
  • DSM-5 multiaxial classification
  • Differences between ICD-10 & DSM-5
  • Etiology (of psychiatric disorders)
  • Psychiatric assessment (steps involved)
  • Etiological formulation (based on biopsychosocial model)
  • Formulation: etiology of bipolar affective disorder (an example)
  • Extra slide: Management: investigations + treatment (based on biopsychosocial model)


2. Lecture: Interview techniques, History taking in Psychiatry & Mental State Examination




Includes detailed explanation of the following slides:

  • Interview techniques 2/2 (setting the scene, assessment & questioning style)
  • History 3/3 (steps of history taking with examples/significance)
  • Mental state examination 2/2 (steps of MSE with examples/significance)
  • Diagnosis & Formulation (biopsychosocial approach)


3. Lecture: Psychopathology




Includes detailed explanation of the following slides:

  • Psychopathology (introduction, pioneers)
  • Appearance & behaviour 1/2 (attitude, rapport, tics, tremors, chorea, athetosis, dystonia, stereotypies, mannerisms, compulsive acts)
  • Appearance & behaviour 2/2 (mitmachen, mitgehen, gegenhaltan, negativism, ambitendency, catalepsy, echopraxia, stupor)
  • Speech (poverty of speech, pressure of speech, perseveration, circumstantiality, tangengiality, echolalia, coprolalia, mutism, dysarthria/dysphonia/dysphasia)
  • Affect & mood (labile, flattened, congruous/incongruous affect; euthymic, dysthymic, hyperthymic, cyclothymic, depressed, hypomanic, manic, anxious mood)
  • Thoughts (retarded thinking, thought block, perseveration, circumstantiality, desultory thinking, flight of ideas, knight’s move thinking, vorbeireden, verbigeration, neologisms, obsessions/phobias, overvalued ideas/delusions, suicidal ideas)
  • Perception (illusions, hallucinations, depersonalisation, derealisation)
  • Cognition (consciousness, attention & concentration, disorientation, amnesia, apraxia, agnosia)
  • Insight (partial/full/absent)


4. Lecture: Stress, Adjustment disorders & Anxiety disorders




Includes detailed explanation of the following slides:

  • Stress & adjustment disorders (acute stress reaction, adjustment disorder, post-traumatic stress disorder/PTSD: clinical features, associations)
  • Anxiety (normal/abnormal)
  • Yerkes-Dodson curve (relationship between arousal & performance)
  • General symptoms (physical & psychological symptoms of anxiety)
  • Panic disorder (clinical features, associations)
  • Generalised anxiety disorder (clinical features, associations)
  • Phobias (agoraphobia, social phobia, specific phobias: clinical features, associations)
  • OCD/Obsessive-compulsive disorder (nature & examples of obsessions & compulsions; clinical features, associations of OCD)
  • Management (biopsychosocial approach)
5. Lecture: Grief & bereavement reactions, Mood disorders, Suicide & parasuicide (DSH)




Includes detailed explanation of the following slides:

  • Overview of contents
  • Grief & bereavement reactions (stages of grief, clinical features & management of abnormal bereavement reaction)
  • Depression: core features
  • Depression: biological/somatic symptoms
  • Depression: psychological/cognitive symptoms
  • Depression: psychotic symptoms
  • Mania: core features
  • Mania: biological/somatic symptoms
  • Mania: psychological/cognitive symptoms
  • Mania: psychotic symptoms
  • Psychopathological differences: mania & schizophrenia (table)
  • Clinical distinction between hypomania & mania (flowchart)
  • Mood disorder diagnostic algorithm (flowchart)
  • Bipolar affective disorder (types 1 & 2, mixed affective state)
  • Management (biopsychosocial approach for depression/mania/BPAD)
  • Suicide & parasuicide/DSH (suicide/DSH risk assessment & management)

 6. Lecture: Schizophrenia and other psychoses


Includes detailed explanation of the following slides:

A) Schizophrenia:
  •      History
  •      Epidemiology
  •      Etiology (genetic, neurochemical & neuropathological theories)
  •      Clinical features
  •      Classification
  •      Diagnosis (first rank symptoms, ICD 10 & DSM 5)
  •      Management

B) Other psychotic disorders
C) Extra slides: MCQ with answers

References/resources:
An Atlas of Schizophrenia, Stefan M., Travis M. & Murray R.M., The Parthenon Publishing Group, London, 2002
https://upload.wikimedia.org/wikipedia/commons/9/95/Van_Gogh_Self_Portrait_with_Straw_Hat_1887-Detroit.jpg
https://upload.wikimedia.org/wikipedia/commons/a/a9/John_Forbes_Nash%2C_Jr._by_Peter_Badge.jpg
https://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Emil_Kraepelin_1926.jpg/220px-Emil_Kraepelin_1926.jpg
https://upload.wikimedia.org/wikipedia/commons/c/c4/Eugen_bleuler.jpg
https://en.wikipedia.org/wiki/Unitary_psychosis#/media/File:Griesinger.jpg
https://images.app.goo.gl/D1AaGLjCRtkSgvbS8
https://upload.wikimedia.org/wikipedia/ru/thumb/f/f3/Kurt_Schneider.jpg/230px-Kurt_Schneider.jpg


 7. Lecture: Psychosexual disorders & Paraphilias



Includes detailed explanation of the following slides:
  • Normal sexual stages
  • Sexual stage disorders
  • Paraphilias 1/2: voyeurism, exhibitionism, frotteurism, fetishism, transvestism, masochism, sadism
  • Paraphilias 2/2: pedophilia, gender dysphoria
  • (With additional explanation about masturbation & homosexuality)


 8. Lecture: Disorders of Sleep


Includes detailed explanation of the following slides: 1. Disorders of sleep (insomnia & hypersomnia) 2. Stages of sleep 3. Circadian rhythm disorders 4. Parasomnias 5. Management of sleep disorders (including sleep hygiene)

References/resources:
https://sleepdisorders.sleepfoundation.org/chapter-1-normal-sleep/stages-of-human-sleep/ 
http://facweb.furman.edu/~einstein/general/sleepdemo/sleep.htm



9. Lecture: Psychopharmacology, ECT & Psychotherapies



Includes detailed explanation of the following slides:

1. Psychopharmacology (10 slides):
  • biopsychosocial management 
  • pharmacokinetics & pharmacodynamics, 
  • main groups of drug with examples, 
  • indications, 
  • treatment outcome, 
  • general & specific adverse effects, 
  • usage in special patient groups
2. Electroconvulsive therapy (ECT)

3. Psychotherapies (5 slides):
  • general attributes & counselling skills,
  • supportive psychotherapy,
  • behavioural therapy & cognitive-behaviour therapy (CBT),
  • psychodynamic psychotherapy & other types of therapy

References/resources:
  • Fundamentals of Clinical Psychopharmacology, Anderson I.M. & Reid I.C., 2nd Edition (2004), British Association of Psychopharmacology, Taylor & Frances (UK)
  • The Maudsley Prescribing Guildelines, Taylor D., Paton C. & Kerwin R., 9th Edition (2007), The South London And Maudsley NHS Foundation Trust, Informa Healthcare (UK)
  • Shorter Oxford Textbook of Psychiatry, Gelder M., Mayour R. & Cowen P., 4th Edition (2001) Oxford University Press (UK)
  • https://upload.wikimedia.org/wikipedia/commons/thumb/e/e6/MECTA_spECTrum_ECT.jpg/1200px-MECTA_spECTrum_ECT.jpg
  • https://www.dovepress.com/cr_data/article_fulltext/s160000/160093/img/NDT-160093-F01.jpg


10. Lecture: Psychiatry Summary Slides

Comprehensive overview of major topics in Psychiatry for Medical Undergraduate Students, as per DSM-5.  

https://youtu.be/_mtrKYymVHg

Includes the following:

  • Psychological theories
  • Biopsychosocial model of etiology
  • Assessments & classification
  • Biopsychosocial model of management
  • Stress & anxiety disorders
  • Mood disorders & suicide
  • Somatic & dissociative disorders
  • Psychotic disorders
  • Personality disorders
  • Substance use disorders
  • Sleep-wake disorders
  • Psychosexual disorders
  • Neurodevelopmental & impulse control disorders
  • Eating disorders
  • Neurocognitive disorders



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