UNDERSTANDING A DIAGNOSIS OF BIPOLAR DISORDER?

 A common diagnosis in psychiatry is bipolar  disorder. Though Dr. Hagop S. Akiskal may  have propounded a 7 type classification of  bipolar disorder which is very famous but it is an  equally well-known fact that the most common  classification practiced is of Bipolar 1 and  Bipolar 2.

 Now what it is being Bipolar?

 Bipolarity in its common meaning means  exhibiting 2 different poles in same person and  that is exactly what happens. A person  diagnosed as bipolar disorder certainly falls into  depression for months and then lifts into mania  or hypomania. Many people exhibit swings of  mood from being into sad state to joyous. Are  they always bipolar?

 A simple answer is no. There is a specific set of  symptoms which should be exhibited for certain  duration of time to be called bipolar.

 Now let us discuss both commonly used of  bipolar disorder types.

 BIPOLAR 1

 Bipolar 1 is diagnosed when a patient shows a  clear picture of separate episodes of mania and  depression separated invariably by a period of  normalcy which should be ideally for 2 months.

 A typical maniac episode characterizes by- 
 1. A persistent irritable or euphoric mood.            Plus 3 for euphoric and 4 for irritable of    following  symptoms 
 2. Decreased need for sleep
 3. Grandiosity- characterized by delusion of      power, wealth or position. 
 4. Increased activity 
 5. Hyper sexuality 
 6. Pressure of speech-Speech which is fast    than normal to the extent of being  incomprehensible. 
 7. Decreased appetite 
 8. Planning 
 9.Overfamiliarity 
 10. Recklessness, overconfidence and  dis    tractability.

 Symptoms should be present for more than 7  days.

 A typical depressive episode characterizes by-

 Major symptoms

 1.       Persistent sad mood

 2.       Decrease in energy levels

 3.       Loss of interest in once pleasurable  activities.

 Minor Symptoms

 1.       Decreased or increased sleep

 2.       Decreased or increased appetite

 3.       Decreased level of concentration

 4.       Decreased level of confidence

 5.       Loss of libido

 6.       Guilt

 7.       Weight loss

 8.       Social withdrawal

 9.       Suicidal tendencies

 A milder form is diagnosed when 2 major plus 2  minor symptoms are present and a severe form  when at-least 3 major plus 4 minor symptoms  are present.

 Duration of at-least 15 days is required except in  case of rapid very severe type with major socio-  occupational disruption.

 Both mania and depression can have secondary  psychotic symptoms.

 BIPOLAR 2

 Bipolar 2 is diagnosed when a patient shows a  clear picture of separate episodes of hypomania  and depression separated invariably by a period  of normalcy which should be ideally for 2  months.

 A typical hypo-maniac episode characterizes by-

 1.       A persistent irritable or euphoric mood.

                               Plus

 3 for euphoric and 4 for irritable of following  symptoms

 2.       Decreased need for sleep

 3.       Grandiosity- Grandiosity is not at  delusional level.

 4.       Increased activity

 5.       Hyper sexuality

 6.       Push of speech instead of pressure is  present

 7.       Decreased appetite

 8.       Planning

 9.       Overfamiliarity

 10.   Recklessness, overconfidence and  distractibility.

 Symptoms should be present for not more than  4 days or not so severe to be disruptive socio-  occupationally non psychotic or require  hospitalization.

 A typical depressive episode characterizes by-

 Major symptoms

 1.       Persistent sad mood

 2.       Decrease in energy levels

 3.       Loss of interest in once pleasurable  activities.

 Minor Symptoms

 1.       Decreased or increased sleep

 2.       Decreased or increased appetite

 3.       Decreased level of concentration

 4.       Decreased level of confidence

 5.       Loss of libido

 6.       Guilt

 7.       Weight loss

 8.       Social withdrawal

 9.       Suicidal tendencies

 A milder form is diagnosed when 2 major plus 2  minor symptoms are present and a severe form  when at-least 3 major plus 4 minor symptoms  are present.

  Duration of at-least 15 days is required except  in case of rapid very severe type with major  socio-occupational disruption.

 Depression can have secondary psychotic  symptoms.

 Apart from the above mentioned differences  there are several other differences

 1.       Bipolar 1 usually starts with maniac  episode and bipolar 2 with depressive.

 2.       There are more chances of suicide in  bipolar 2 than 1.

 3.       Lamotrigine is more effective in bipolar 2.

 Apart from these types there is a mixed type  too, rapid cyclers and ultra-rapid cyclers but  these are present in very less amount of cases.

 With best wishes for healthy and long life
 Dr Hitesh Sharma 

 MBBS, MD (Psychiatry)

HOW TO CONTROL YOUR ANXIETY?

Have you ever thought that when you sit for exams, tests or some task which requires you to perform so that you can be judged, your heart starts beating fast, you become nervous and invariably your performance declines. This happens to everybody but for some it is so disabling that it messes up your entire performance to a considerable degree. People wonder what their performance would have had been had this phenomenon not been a part of their experience.

First of all as a psychiatrist I would like to explain this phenomenon and then I would like to give certain tips which would be of immense help to you.

  This phenomenon in psychiatry is called performance anxiety. By performance anxiety I mean any nervousness, increase in heart rate, sweating, tremors, dryness of mouth, weakness which occurs just before giving any test etc.

This may be as impairing in children as in adults and could be the main reason behind your child's failure in examinations.
Tips to reduce performance anxiety can be divided into drugs based and non-drug based.
To start with i would like to list non drug based measures. Main non drug based measures include-
1) Deep breathing exercises-these are the easiest and cheapest way to overcome your anxiety.
2) JPMR-these are progressive muscle relaxation exercises which very effective way to control your disabling anxiety symptoms. But the drawback is that you need to learn them from a qualified psychiatrist or psychologist and they are time consuming.
3) Distraction techniques-the main principle which governs this type of therapy is that your thoughts lead to these symptoms. So distracting from your anxiety provoking thoughts will cause these anxiety symptoms to subside.
Main drawbacks of non-drug based measures include:-
-it is time consuming.
-exact technique needs to be mastered to have maximum effect.        
-it needs space.
-it is not useful in case of severe anxiety.
-it is difficult to teach to children.
-instant benefit is limited.
To people who have these limitations drug based methods are best which include
1) Beta blockers such Propranolol which can be taken before exam or test.
2) Benzodiazepines such as Alprazolam. It is for short term control of anxiety.
3) SSRI'S such as Escitalopram. It is for long term control of anxiety.
Main drawbacks of drug based measures include:-
-A consultation from a psychiatrist must before administration of drugs.
-It is costlier than non-drug based methods.
So it is advisable to get a proper health and psychiatric evaluation before instituting any treatment.

With best wishes for healthy and long life
Dr Hitesh Sharma 

MBBS, MD (Psychiatry)

IS YOUR CHILD HAVING POOR ACADEMIC PERFORMANCE?

  Every parent teacher and guardian wants their child to excel in studies and have a bright academic career ahead. To realize this dream they try to provide their ward with best facilities and environment so that they can get the best out of their child and thus lead them to a bright future. Starting from best schools to extra time to best resources, whatever may be required is fulfilled for the child.

Then, why it is so that certain children excel and other fare poorly on academic fronts. There may be a plethora of reasons for your child to fare poorly on scholastic front. Every worried parent has a right to find the reason for the child’s dismal performance so that they may correct the cause of this problem if possible and guarantee a bright career for their offspring. In the following blog I am going to discuss certain causes of poor academic performance and their remedies if possible.  

     1.      Academic performance may be not be actually poor but may be perceived by parents as poor. This happens when the parent’s expectations are very high. All of us should know that not every child is genius. The real meaning of poor academic performance is academic performance far less than average for that age. Reassurance is best remedy for the parents otherwise they will unnecessary wait their energy and resources. A proper psychological counseling will be of immense help.

     2.      Academic performance may actually be poor. How to come to conclusion that the academic performance is poor? Visible below par academic performance to a neutral person who is neither a parent nor teacher can decide this. 

Causes of true poor academic performance

        1.      Social

        2.      Family related

        3.      Medical

        4.      Psychiatric

        5.      Environmental

-Social causes of poor academic performance include bulling at school, over comparison with toppers, neglect of child in peers. This leads to inferiority complex and an impact on school grades. The guardian should look into this matter and arrange for proper solution in discussion with school authorities and teachers

- Causes of poor scholastic performance originating in family include neglect from parents, abuses, fights between parents and non-cordial atmosphere in family. These reasons can be behind the child below par performance in school.

-medical causes include malnutrition, chronic diseases like asthma, cancer, congenital heart defects. Proper medical treatment and regular medical check-up is the only solution to these problems being identified and treated to rise in academic performance.

-psychiatric problems like autism mental retardation and dyslexia may lead to poor academic performance. There are special ways to get maximum out of children with these problems. For details you must consult your psychiatrist. Other psychiatric problems like depression, OCD and schizophrenia should be identified and treated to make your child perform better.

-environmental problems include crowded house and schools noise, air or water pollution. Changing child’s environment also helps.

Wishing you a healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)

For asking a query or phone/video consultation with me visit--https://www.icliniq.com/hitesh

WHAT IS DEPRESSION?

We all feel sad some or the other time but this does not mean that we are suffering from depression. So what is depression? 

Depression is a mood disorder characterized by persistent and pervasive low mood usually lasting for more than two weeks. 

Other symptoms of depression are-

Major symptoms- these are apart from depressed mood

      1.      Lack of interest in once pleasurable activities.

      2.      Decreased energy

Minor symptoms-

      1.      Decreased sleep

      2.      Decreased appetite

      3.      Lack of confidence

      4.      Lack of concentration

      5.      Suicidal ideas

      6.      Decreased activity

      7.      Guilt

Depression can be with or without psychotic symptoms.

Depression is mild if it has 2 from major and 2 from minor, moderate if there are 2 from major and 3 from minor criteria and severe if there are 3 from major and at-least 4 from minor criteria present.

Depression has a life time prevalence of around 10%.

Risk factors for depression

Women are affected two times more than men.

Depression commonly occurs in middle 40’s.

Genetic factors- family history

Stress

Causes of depression

       1.      Certain neuro-chemicals like serotonin, norepinephrine, dopamine and acetylcholine.

       2.      Hormonal alterations like thyroid, growth hormone and prolactin.

       3.      Minute abnormalities in brain

Average length of depression episode can be from 6-9 months

There are various scales to measure the severity of depression. These are

        A.      Hamilton

        B.      Beck

        C.      MADRS

        D.     Zung

Treatment of depression

Treatment by medicines

          A.      SSRI’S fluoxetine, sertraline, fluvoxamine, paroxetine, escitalopram and citalopram

          B.      SNRI’S venlafaxine, duloxetine, milnacipran and desvenlafaxine.

          C.      NDRI- Bupropion 

          D.     Mirtazapine, trazadone, raboxetine, tianaptine,

          E.      TCA’S- Amitriptyline, imipramine, amoxapine

          F.       MAOI inhibitors

Medicines for augmentation of anti-depressants are

          A.      Lithium

          B.      Anti-psychotics

          C.      Modafenil

          D.     Thyroxine

          E.      Pindolol

          F.       buspirone

Treatment resistant cases can be treated with electro convulsive therapy. Average no of ECT required for depression is around 6-8 in number.

Wishing for your healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)

For asking a query or phone/video consultation with me visit-https://www.icliniq.com/hitesh

“GENERALIZED ANXIETY DISORDER” ANXIETY MUCH MORE THAN NORMAL

What is Generalized Anxiety Disorder? 

It is a type of an anxiety disorder in which the person feels anxiety for most of the time of day. The anxiety is difficult to control and associated with symptoms like difficulty sleeping, muscle tension, restlessness and irritability. The anxiety is of such grade that it significantly disturbs important areas of life. These symptoms should be present for at-least 6 months to be classified as GAD.

GAD has a typical onset in 20’s and its prevalence is close to 5% in general population. Women are affected more with a ratio of 2:1.

Cause of Generalized Anxiety Disorder GAD

       1.    Abnormalities in serotonin levels

       2.    Abnormalities in benzodiazepines

       3.    Minute abnormalities in structure of brain

The distinction between GAD and normal Anxiety is excessive to the nature that it is difficult to control.

Symptoms of Generalized Anxiety Disorder GAD 

Apart from muscle tension and sleep disturbance these symptoms may or may not be present are:

       1.    Tremors

       2.    Palpitations

       3.    Dry mouth

       4.    Sweating

       5.    Restlessness

       6.    Chills

       7.    Nausea

       8.    Rapid breathing

       9.    Chocking sensation

      10. Dizziness

      11. Abdominal discomfort

      12. Chest discomfort

Most of patients of this disorder visit cardiologists, gastroenterologists, internists, general practitioners and pulmonologists instead of psychiatrists. Only 33% manage to consult a psychiatrist.

Treatment of Generalized Anxiety DisorderGAD

 Medicinal treatment includes

      a)    SSRI’SThe most effective SSRI is paroxetine

      b)   Buspirone

      c)    SNRI’S -Venlafaxine

      d)   TCA’S such as imipramine are effective

      e)    Propranolol

      f)     Benzodiazepine- should be avoided as they can cause dependence in long term use. They should only be prescribed for immediate symptomatic relief.

Medicinal treatment of GAD is usually for 12 months but if relapse has occurred it can be life-long for complete relief.

Non medicinal treatment includes

      a)    Cognitive approach

      b)   Behavioral approach

  Wishing you a healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)
For asking a query or phone/video consultation with me visit- https://www.icliniq.com/hitesh

NICOTINE ADDICTION (SMOKING ADDICTION)

 Tobacco or nicotine is one of the most commonly abused substances in the world. The addiction potential of nicotine is such that it is the most difficult substance to abstain from, once dependence develops.

What is Nicotine dependence or addiction?

Presence of three of following criteria in span of one year is required for the diagnosis of nicotine dependence

       1.      Craving

       2.      Tolerance

       3.      Withdrawals

       4.      Use despite harm

       5.      Neglect of alternate pleasurable activities

       6.      Loss of control

Withdrawals of nicotine are characterized by

        a)      Tension

        b)      Irritability

        c)      Drowsiness

        d)      Increased appetite

        e)       Weight gain

        f)      Decreased heart rate and blood pressure
        g)   Difficulty concentrating

Nicotine withdrawals start within 2 hours peak in 48 hours and remain for months

Types of nicotine usage

        a)      Smoking

        b)      Chewing

        c)      Sniffing

50% of world’s total population has used tobacco in one form or other in their lifetime. Around 75% of habitual smokers have tried to quit smoking once in their lifetime.

Cessation of smoking has following health benefits

      1.      Decreased risk of heart attack and stroke

      2.      Decrease risk of lung diseases

      3.      Decreased risk of cancers

      4.      Decrease risk of newborn disorders like low birth weight if mother smokes in pregnancy.

Treatment of nicotine dependence is one of the most challenging tasks in addiction psychiatry. Due to its highly addictive nature quitting smoking is very much uphill task.

Various pharmacological methods used to quit smoking are as follows-

         1.      Nicotine replacement therapies- these include

a)      Nicotine inhalers

b)      Nicotine lozenges

c)      Nicotine patches
d)      Nicotine gums

e)      Nicotine nasal spray

         2.      Non nicotine medications include

a)      Bupropion

b)      Nortriptyline

c)      Clonidine

d)      Benzodiazepines

e)      Varenicline

The most efficacious medication found to help quit smoking is varenicline and the worst is nicotine gums.

Wishing you a healthy life ahead

Dr Hitesh Sharma

MBBS, MD (Psychiatry)
For asking a query or phone/video consultation with me visit-https://www.icliniq.com/hitesh