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Healthcare Delivery

Introduction to Psychiatric Conditions

By Dr Kiran Manduva

Mental health is an often ignored aspect of overall health. It is a truism that there is no health without mental health. In fact, mental health is so crucial to one’s overall well being that a physically disabled or otherwise afflicted person can still be a happy and productive member of society if his mental health is taken care of. There are many examples of such people who ‘ve beaten tremendous odds in life to come up and make their mark on society. That is simply not possible without a robust psychological state of being. Thus, despite health being a holistic entity, if I had to choose, I will place psychological health a notch above physical health.

Instead of going into technical details and statistics, I will try to present a bird’s eye view of the problem at hand. At the risk of sounding simplistic, I will divide the psychological disorders into six groups, for the purposes of the present article. These are

  1. Major psychiatric disorders including schizophrenia, bipolar disorder, severe depression etc.
  2.  Minor psychological conditions including anxiety, minor depressions, stress-related conditions,
  3. Personality disorders, marital discord.
  4. Substance abuse including tobacco chewing and smoking, alcohol addiction, cannabis abuse etc.
  5. Neuro-developmental disorders like Mental retardation, autism, ADHD, SLD
  6. Dementias especially Alzheimer’s disease.

The above is an informal classification presented here for the sole purpose of simplifying the subject matter for the laypeople so that a better understanding of the issue can be achieved. This is not meant to an exhaustive list and some of the rarer conditions are not covered in the classification. These categories are not watertight and many conditions span the different groups based on their severity and other variables. Often, a person can suffer from multiple conditions from different groups because psychological disorders are not discrete entities, as categorised below. Rather, psychological disturbance can manifest itself in multiple ways and quite often in more than one form, simultaneously, in the same person.

Below, I shall dwell upon each of these groups of disorders in brief- how they arise, how they impact the person and how they can be treated.

The disorders in the first category, the major psychiatric disorders, like schizophrenia, bipolar disorder, severe depression etc can loosely be termed ’psychoses’, in which, the person develops delusions and hallucinations, which cause him to lose touch with reality. These disorders usually have a heavy genetic component and also depend on the maternal health (especially fevers etc) when the patient was ‘in utero’. These can normally be treated only with medication with adequate psychological, social and occupational support for reintegration into the society. In many cases, the patient may need to be on the medications for a fairly long period of time.

The second category, the minor psychological conditions like anxiety, depression and stress related conditions arise mainly due to two reasons. One – as a genetic accompaniment to major psychiatric disorders that someone else is suffering from in the larger family. Two – due to various interpersonal issues, family disharmony and social conditions like school and work related stresses, poverty, unemployment etc. Many of these patients need a variable period of treatment with psychological medicines that ameliorate the neurotic symptoms. These conditions can also be treated with better coping skills, self empowerment, breathing exercises, Yoga etc. Once the person is better, the medicines can be slowly tapered off and allow the natural defences of the person to deal with the issue.

The third category is that of personality disorders and its consequences. These are people who have a particular pattern of seeing themselves or relating to others, and many times, these might result in interpersonal disharmony and suffering to either the patient himself or to the others. A frequent cause of marital discord is the existence of some traits of any personality disorder in one or both the partners. Many violent crimes, including domestic violence, child sexual abuse and other criminal violence can also be due to personality disorders in the perpetrator. This often needs a comprehensive approach including medication, counselling and the intervention of other agencies like child care services and law enforcement services including the police

The fourth category is that of substance abuse. There is a steep hike in the number of people addicted to various substances like nicotine (smoking tobacco), alcohol and cannabis. The youth of the society are more prone to it due to their innate impulsive and rebellious nature of their behaviour. This can result in significant damage to ones long term health and productivity, apart from causing family disharmony. This needs treatment with medication, counselling and in many cases a relatively long period of treatment in a rehab centre.

The fifth category is that of neurodevelopmental disorders that afflict children right from their very early age. This is due to the altered brain structure and includes conditions like mental retardation, autism, attention deficit hyperactivity disorder, specific learning disability. These children have a different trajectory of development of milestones, behavioural and academic problems. They need lot of intensive psychological intervention.

The sixth category is that of dementias, the most common being Alzheimers dementia. This is a disorder of the elderly brain degenerating and is more prevalent in the community as the proportion of the elderly increases in the society. It is a problem that is only going to increase in the country and needs lot of family support, medication and institutional old age care.

It is imperative that any person suffering from any kind of emotional or behavioral problem approach a mental health professional without delay or stopping oneself due to the stigma normally attached to psychological conditions. With proper treatment, many are able to lead a near-normal and productive social and occupational life. The public health strategies for different conditions need to be tailored to the particular subgroup of disorders and is an uphill task for the country to ensure the availability and effective delivery of health care services to all the needy.

About the author

Dr Kiran Manduva did his MBBS in 2001 and studied Psychiatry from NIMHANS in 2005. He is interested in deaddiction, psychotherapy for victims of sexual abuse and neuroscience. He is especially interested in novel public health approaches to make psychiatric care accessible to all.

Categories
Healthcare Delivery

How Vitamin D Deficiency could be silently killing you

In 2014 my wife decided to hire a trainer to help her with her fitness. I was curious how this would work and hence I also decided to go with the same trainer. I spoke to the trainer from the Chennai airport where I was on that day on a business trip and then processed to hire her.

I am no stranger to workouts and I had been leveraging trainers before in the various gyms that I had visited. But this was different. As my training started the first thing I remember was that there was intense pain in my muscles and joints. Despite pain killers, the pain would not go away. The trainer kept telling me that it was a matter of time and things would improve. She even brought in another trainer, who helped me with some stretching exercises and twisting. But when things got worse I had to consult my family physician. One look at me, he said, well my friend when was the last time you checked your Vitamin D levels? That started a quest for settling my Vitamin D levels which continues till this day.

Vitamin D Deficiency Symptoms
D vitamin is known since it is produced by the exposure to sunlight light. It is an important element that a human body requires. Deficiency is a critical problem. The below mentioned are a number of the common signs of lack of D vitamin. Vitamin and mineral basic’s consumption is critical for a human body to work. There is a lot of information what’re the sources of these nutrients and concerning the significance of the nutrients.  

In 2010, the venerable Institute of Medicine (IOM) issued a report based on a lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently, a level below 20 was considered a vitamin D deficiency. (Source:
https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893 )

Below are the charts I have kept for my Vitamin D Levels. As you can see I started with a deficiency around 11 and now have managed to keep myself above the 20 mark for the last 5 years.

Key Symptoms

Weakness and Pain: The weakness of bones and muscles is the first sign that there might be a problem. Rickets in children and Osteomyelitis in adults are among the largest of deficiency of D vitamin deficiency symptoms. Weak bones are vitamin d.’s feature However they generally occur at an early age or older age.

Obesity: individuals who’re obese are more common in showing that the signs of lack of D vitamin. Now, this could be one of the reasons for the obesity epidemic in India.

Feeling Low: Difficult to explain but lack of sunlight is known to cause subclinical depression. This often leads to mood swings, lethargy among others

Other Symptoms: Some other signs are knock-kneed appearance, low blood calcium level, high blood pressure level, reasons why that the vitamin d deficiency occurs are given below.

Reasons for Deficiency

The numerous reasons why that the vitamin d deficiency occurs are given below.

  1. Less exposure to direct sunlight
  2. Extensive use of sunblocks and sunscreen
  3. Lack of absorbing of D vitamin.
  4. Hereditary factors

The given are a number of the readily recognize able signs of vitamin D deficiency symptoms. So what do you do?? In my opinion these should be your next steps.

  1. Visit a doctor- Please do not self medicate, please do visit a doctor
  2. Check your Vitamin D Levels regularly from a NABL certified Lab
  3. Plan for at least 30 minutes of outdoor activity daily specially in the morning- Walks, Jogs or just stretching in the park is a good idea.
  4. Keep a record of your levels

I trust this article is helpful in understanding your symptoms and seeking the right help. As always we are open to your questions and we will do our best to answer them.

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Healthcare Delivery

Why hbA1c levels are the key to your diabetes management?

The average life of the Red Bood Cell (RBC), is around 120 days. With an estimated half-life of 2-3 months, it is a good indication of the overall health of the individual. Glucose molecules in the blood combined with hemoglobin, and through this glycation form a ketoamine that is stable and can be used as a measure of the glucose in the blood. Since 1970’s hbA1c measures have been recommended as a standard of care for diabetes management.

Why is this a better measure than the traditional fasting and Post-Prandial measures(PP)?

  1. Firstly measuring hbA1c gives us the story for 90 days. So it not a point in time investigation rather its a holistic view of the system.
  2. It is human tendency to cheat if we know that a blood sugar test is looming. I have seen my mother do that many times and there are dietary adjustments made just before the test that can give us a false negative.
  3. Thirdly the test does not require any fasting or dietary restrictions, hence the compliance is better.

For more scientific details on this method, please do read this article on the research already conducted.

While these are great reasons to conduct the test, the key to the test is to go to an accredited lab. Always insist on choosing a NABL (National Accreditation Board for Testing and Calibration Laboratories) accredited lab. I have often heard of samples getting mixed up between patients. This is mostly true of the many labs providing online services or online firms serving as aggregators.

Finally, talk to your doctor on why you should consider mapping this level. I have been doing my tests over a period of time and last few months results are below. These tests have given my physician a good indication as to why we need more aggressive intervention in my case.

Anyways do let me know if you have any questions on diabetes management and I would be happy to answer them for you.

Categories
Healthcare Delivery

Patients views may be the key to reducing medical errors says new study

Patients’ views are not often included in records of diagnostic errors, but new data released on November 5 suggest that patient and family narratives may contain key information that should formally be included in the system.
To learn more about how patient experience and patient-physician interactions might affect the risk for diagnostic error, Traber Davis Giardina, PhD, MSW, and colleagues analyzed reports submitted from January 2010 to February 2016 to the nonprofit Empowered Patient Coalition.

Categories
Healthcare Delivery

Management and Treatment of PostPartum Hemorrhage

Postpartum Hemorrhage or PPH is a serious concern and the main cause of maternal mortality and morbidity across the world. PPH is the excessive bleeding after childbirth. In a normal or vaginal delivery if there is a blood loss of more than 500ml and in case of a C-Section if there is a blood loss of more than 1000ml then PPH is said to have occurred. If bleeding occurs within the first 24 hours of delivery it is called Primary PPH; whereas any excessive bleeding that occurs between 24 hours and 6 weeks after delivery is termed as Secondary PPH. Postpartum hemorrhage accounts to about 30% of maternal deaths.