Author: Manasvi Specialists

ADHD

ADHD

Psychiatry

ADHD (Attention Deficit Hyperactive Disorder )

ADHD

Attention deficit hyperactivity disorder is the most common emotional, cognitive and behavioural disorder treated in youth. . It is associated with higher degree of psychiatric morbidity in adulthood. It affects 4% to 7% of children worldwide. New research indicates that it can persist into adulthood.

What are the symptoms of ADHD?

A. Symptoms of inattention like

  1. Often fails to give attention to details or makes careless mistakes in school work , work or other activities
  2. Often has difficulty sustaining attention in tasks or play activities
  3. Often does not seem to listen to when spoken to directly
  4. Often does not follow through on instructions
  5. Fails to finish schoolwork chores or duties in the work place
  6. Often has difficulty in organizing tasks or activities
  7. Often avoids , dislikes or is reluctant to engage in tasks that require sustained mental effort
  8. Often loses things  ( pencils, toys, books etc)
  9. Is often easily distracted by extraneous stimuli
  10. Is often forgetful in daily activities

B. Symptoms of hyperactivity or impulsivity

  1. Often fidgety with hands or feet or squirms in seat
  2. Often leaves seat in classroom or in other situations in which remaining seated is expected
  3. Often runs about or climbs excessively in situations in which it is inappropriate

Often has difficulty in playing or engaging in leisure activities quietly

Is often on the go or often acts like as if driven by a motor

Often talks excessively

Impulsivity

  1. Often blurts out answers even before the question is completed
  2. Often has difficulty awaiting turn
  3. Often interrupts or intrudes on others

Some of the above symptoms should be present before the age of 7 yrs

Symptoms can be present in home and or in school

Impairment in social, academic or occupational functioning

What are the causes of ADHD?

The cause for ADHD is multifactorial

  1. Physical conditions; pregnancy and delivery complications, cigarette and alcohol exposure in the womb, lead exposure, medications, neurological conditions can be associated with ADHD
  2. Family conflict, adverse family environment, decreased family cohesion can predispose to ADHD
  3. ADHD is highly genetic and can run in the family

Do ADHD symptoms reduce with age?

The earlier literature suggests that the hyperactivity component can reduce with age. New research suggests that the attention deficit part can persist into adulthood leading to impairment in socio occupational function. New research suggests a new terminology called adult ADHD.

Children with ADHD are more prone to suffer from conduct disorder, increased chances of substance use and having attention deficits in adulthood. Hence it is always advisable to seek help from a professional when symptoms of ADHD are noticed.

What is the treatment for ADHD?

ADHD can be treated with medications and Behaviour therapy.

For mild to moderate cases behaviour therapy can be considered. It is to be noticed that behaviour therapy is a long process and the parents should have a lot of motivation and patience to implement the therapy.

For moderate to severe ADHD many medications like stimulants like methyl phenydate are available which can help your child. It is advisable to have a detailed discussion with your doctor about the side effect profile of theses medication and then to take an informed decision.

Medical Specialists

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Dementia Carers Information

Dementia Carers Information

Psychiatry

Dementia Carers Information

Understanding Alzheimer’s Disease (AD)

Sometimes, you may feel that you don’t know how to care for the Person with AD. You’re not alone. This is a common feeling among AD Caregivers because each day may bring different challenges. Learning about AD can help you understand and cope with these challenges. Below, we Discuss the stages of AD and tell you how to learn more about the illness.

Stages of AD and What They Mean

Alzheimer’s disease consists of three main stages:

  1.  Mild (Early-stage),
  2. Moderate
  3. Severe (late-stage).

Understanding the stage can help you plan ahead.

Mild Alzheimer’s disease: In mild AD, the first stage, people often have Some memory loss and small changes in their personality. They may have trouble remembering recent events or the names of familiar people or things. They may no longer be able to solve simple math problems or write a Cheque. People with mild AD also slowly lose the ability to plan and Organize. For example, they may have trouble making a grocery list and Finding items in the store. They may have problems finding their way in Familiar surroundings. Contrary to popular belief they will remember Remote events and forget recent events.

Moderate Alzheimer’s disease: This is the middle stage of AD. Memory loss and confusion become more obvious. People have more trouble Organizing, planning, and following instructions. They may need help getting Dressed and may start having problems with incontinence (Can’t control Their bladder and/or bowels). People with moderate-stage AD may have trouble recognizing family members and friends. They may not know where they are or what day or year it is. They also may lack judgment and begin to wander, so people with moderate AD should not be left alone. They may become restless and begin repeating movements late in the day. Also, they may have trouble sleeping. Personality changes can become more Serious. People with moderate AD may make threats, accuse others of stealing, curse, kick, hit, bite, scream, or grab things.

Severe Alzheimer’s disease: This is the last stage of Alzheimer’s and ends in the death of the person. Severe AD is sometimes called late-stage AD. In this stage, people often need help with all their daily needs. They may not be able to walk Or sit up without help. They may not be able to talk and often cannot recognize family members. They may have trouble swallowing and refuse to eat.

Caring for a Person with AD

Understanding How AD Changes People

Challenges and Coping Strategies

Alzheimer’s disease is an illness of the brain. It causes large numbers of nerve cells In the brain to die. This affects a person’s ability to remember things and think Clearly. People with AD become forgetful and easily confused. They may have a hard Time concentrating and behave in odd ways. These problems get worse as the illness gets worse, making your job as caregiver harder.

Kindly note that the carers should learn to differentiate the disease from the person and not blame the person due to lack of understanding of the disease. Remember we do not blame the person if he has fever.

Challenges carers face while taking care of a person with AD.

  1. Changes in communication skills 
  2. Changes in personality and behavior
  3. Changes in intimacy and sexuality

1. Challenge: changes in communication skills:

Communication is hard for people with AD because they have trouble remembering things. They may struggle to find words or forget what they want to say. You may feel impatient and wish they could just say what they want, but they can’t.

Here are some communication problems caused by AD:

Trouble finding the right word when speaking

  1. Problems understanding what words mean
  2. Problems paying attention during long conversations
  3. Loss of train-of- thought when talking
  4. Trouble remembering the steps in common activities, such as cooking a meal, paying bills, getting dressed, or doing laundry
  5. Problems blocking out background noises from the radio, TV, telephone calls, or conversations in the room
  6. Frustration if communication isn’t working
  7. Being very sensitive to touch, tone, and loudness of voices

Also , AD causes some people to get confused about language.

How to cope with changes in communication skills

The first step is to understand that the disease causes changes in these skills. The second step is to try some tips that may make communication easier. For example, keep the following suggestions in mind as you go about day-to-day care.

To connect with a person who has AD:

  1. Make eye contact to get his or her attention, and call the person by name.
  2. Be aware of your tone and how loud your voice is, how you look at the person, and your “body language”. Body language is the message you send just by the way you
  3. Hold your body. For example, if you stand with your arms folded very tightly, you may send a message that you are tense or angry.
  4. Encourage a two-way conversation for as long as possible. This helps the person with AD feel better about himself or herself.
  5. Use other methods besides speaking to help the person, such as gentle touching to guide him or her.
  6. Try distracting someone with AD if communication creates problems. For example, offer a fun activity such as a snack or a walk around the neighborhood.
  7. Give them time to communicate try not to complete the sentence for them every time.

To encourage the person with AD to communicate with you:

  1. Show a warm, loving, matter-of-fact manner.
  2. Hold the persons hand while you talk.
  3. Be open to the person’s concerns, even if he or she is hard to understand.
  4. Let him or her make some decisions and stay involved.
  5. Be patient with angry outbursts. Remember, it’s the illness “talking.”
  6. If you become frustrated, take a “timeout” for yourself.

To speak effectively with a person who has AD:

  1. Offer simple, step-by-step instructions.
  2. Repeat instructions and allow more time for a response. Try not to interrupt.
  3. Don’t talk about the person as if he or she isn’t there.
  4. Don’t talk to the person using “baby talk “or a “baby voice.”

Here are some examples of what you can say:

  1. “Let’s try this way,” instead of pointing out mistakes.
  2. “Please do this;” instead of “Don’t do this.”
  3. “Thanks for helping,” even if the results aren’t perfect.

You also can:

  1. Ask questions that require a yes or no answer. For example, you could say, “Are you tired?” Instead of “How do you feel?”
  2. Limit the number of choices. For example, you could say, “Would you like rice or chapathi for dinner?” Instead of “What would you like for dinner?”
  3. Use different words if he or she doesn’t understand what you say the first time. For example, if you ask the person whether he or she is hungry and you don’t get a response, you could say, “Dinner is ready now. Let ‘s eats.”
  4. Try not to say “Don’t you remember?” Or “I told you.”

Helping a Person Who Is Aware of Memory Loss

AD is being diagnosed at earlier stages. This means that many people are aware of how the disease is affecting their memory. Here are tips on how to help someone who knows that he or she has memory problems:

  1. Take time to listen. The person may want to talk about the changes he or she is noticing.
  2. Be as sensitive as you can. Don’t just correct the person every time he she forgets something or says something odd. Try to understand that it’s a struggle for the person to communicate.
  3. Be patient when someone with AD has trouble finding the right words or putting feelings into words.
  4. Help the person find words to express thoughts and feelings.

Be careful not to put words in the persons mouth or “fill in the blanks” too quickly.

  1. As people lose the ability to talk clearly, they may rely on other ways to communicate their thoughts and feelings.

For example, their facial expressions may show sadness, anger, or frustration. Grasping at their undergarments may tell you they need to use the bathroom.

2. Challenge: changes in personality and behavior

Because AD causes brain cells to die, the brain works less well over time. This changes how a person acts. You will notice that he or she will have good days and bad days.

Here are some common personality changes you may see:

  1. Getting upset, worried, and angry more easily
  2. Depressed or not interested in things
  3. Hiding things or believing other people are hiding things
  4. Imagining things that aren’t there
  5. Pacing a lot of the time
  6. Showing unusual sexual behavior
  7. Hitting you or other people
  8. Misunderstanding what he or she sees or hears

Also, you may notice that the person stops caring about how he or she looks, stops bathing, and wants to wear the same clothes every day.

Other factors that may affect how people with AD behave

In addition to changes in the brain, the following things may affect how people with AD behave.

How they feel:

  1. Sadness, fear, or a feeling of being overwhelmed
  2. Stress caused by something or someone
  3. Confusion after a change in routine, including travel
  4. Anxiety about going to a certain place

Health—related problems:

  1. Illness or pain
  2. New medications
  3. Lack of sleep
  4. Infections, constipation, hunger, or thirst
  5. Poor eyesight or hearing
  6. Alcohol abuse
  7. Too much caffeine

Problems in their surroundings:

  1. Being in a place he or she doesn’t know well.
  2. Too much noise, such as TV, radio, or many people talking at once. Noise can cause confusion or frustration.
  3. Stepping from one type of flooring to another. The change in texture or the way the floor looks may make the person think he or she needs to take a step down.
  4. Misunderstanding signs
  5. Mirrors. Someone with AD may think that a mirror image is another person in the room.

How to cope with personality and behavior changes

Here are some ways to cope with changes in personality and behavior:

  1. Keep things simple .Ask or say one thing at a time.
  2. Have a daily routine, so the person knows when certain things will happen.
  3. Reassure the person that he or she is safe and you are there to help.
  4. Focus on his or her feelings rather than words. For example, say, “You seem worried.”
  5. Don’t argue or try to reason with the person.
  6. Try not to show your anger or frustration. Step back. Take deep breaths, and count to 10. If safe, leave the room for a few minutes.
  7. Use humor when you can.
  8. Give people who pace a lot a safe place to walk. Provide comfortable, sturdy shoes. Give them light snacks to eat as they walk, so they don’t lose too much weight, and make sure they have enough to drink.

Use distractions:

  1. Try using music, singing, or dancing to distract the person. One caregiver found that giving her husband chewing gum stopped his cursing.
  2. Ask for help. For instance, say, “let’s clean the vegetables”; “It’s time to go for our walk”; or “I really need help folding the clothes.”

Other ideas:

  1. Talk to the psychiatrist about any serious behavior or emotional problems, such as hitting, biting, depression, or hallucinations.

How to cope with sleep problems

Evenings are hard for many people with AD. Some may become restless or irritable around dinner time. This restlessness is called “sun downing.” It may even be hard to get person to go to bed and stay there.

Here are some tips that may help:

  1. Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness.
  2. Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day.
  3. Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it.
  4. Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help.
  5. Limit caffeine.
  6. Use night lights in the bedroom, hall and bathroom.

How to cope with hallucinations and delusions

As the disease progresses, the person with AD may have hallucinations. During a hallucination, a person sees, hears, smells, tastes, or feels something that isn’t there. For example, the person may see his or her dead mother in the room. He or she also may have delusions. Delusions are false beliefs that the person thinks are real. For example, the person may think his or her spouse is in love with someone else.

Here are some things you can do:

  1. Consult a psychiatrist about the hallucinations or delusions.
  2. Discuss with the psychiatrist any illnesses the person has and medicines he or she is taking. Sometimes an illness or medicine may cause hallucinations or delusions.
  3. Try not to argue about what the person with AD sees or hears. Comfort the person if he or she is afraid.
  4. Distract the person. Sometimes moving to another room or going outside for a walk helps.
  5. Turn off the TV when violent or upsetting programs are on. Someone with AD may think these events are really going on in the room.
  6. Make sure the person is safe and can’t reach anything that could be used to hurt anyone or him or herself.

How to cope with paranoia

Paranoia is a type of delusion in which a person may believe–without a good reason –that others are mean, lying, unfair, or “out to get him or her.” He or she may become suspicious, fearful, or jealous of people. In a person with AD, paranoia often is linked to memory loss. It can become worse as memory loss gets worse. For example, the person may become paranoid if he or she forgets:

  1. Where he or she put something. The person may believe that someone is taking his Or her things.
  2. Someone with AD might not trust you if he or she thinks you are a stranger.
  3. The person may believe that strangers will be harmful.
  4. Directions you just gave. The person may think you are trying to trick him or her.

Paranoia may be the person’s way of expressing loss. The person may blame or accuse others, because no other explanation seems to make sense.

Here are some tips for dealing with paranoia:

  1. Try not to react if the person blames you for something.
  2. Don’t argue with him or her.
  3. Let the person know that he or she is safe.
  4. Use gentle touching or hugging to show the person you care.
  5. Explain to others that the person is acting this way because he or she has AD.
  6. Search for missing things to distract the person; then talk about what you found. For example, talk about a photograph.
  7. Have extra sets of keys or eyeglasses in case they are lost.

How to cope with agitation and aggression

Agitation means that a person is restless and worried. He or she doesn’t seem to be able to Settle down. Agitated people may pace a lot, not be able to sleep, or act aggressively toward others. They may verbally lash out or try to hit or hurt someone. Most of the time, these behaviors happen for a reason. When they happen, try to find the cause.

For example, the person may have:

  1. Pain, depression, or stress—and not know how to explain it
  2. Too little rest or sleep
  3. Constipation
  4. Soiled underwear or diaper

Here are some other causes of agitation and aggression:

  1. Sudden change in a well-known place, routine, or person
  2. A feeling of loss—for example, the person with AD may miss the freedom to drive or the chance to care for children
  3. Too much noise or confusion or too many people in the room
  4. Being pushed by others to do something—for example, to bathe, or remember events or people—when AD has made the activity very hard or impossible
  5. Feeling lonely and not having enough contact with other people
  6. Interaction of medicines

Here are suggestions to help you cope with agitation and aggression:

  1. Look for the early signs of agitation or aggression. If you see the signs, you can deal with the cause before the problem behaviors start.
  2. Try not to ignore the problem. Doing nothing can make things worse. Try to find the causes of the behavior. If you deal with the causes, the behavior may stop.
  3. Slow down and try to relax if you think your own worries may be affecting the person with AD. Try to find a way to take a break from care giving.
  4. Allow the person to keep as much control in his or her life as possible.
  5. Try to distract the person with a favorite snack, object, or activity.

You also can:

  1. Reassure him or her. Speak calmly. Listen to the person’s concerns and frustrations. Try to show that you understand if the person is angry or fearful.
  2. Keep well-loved objects and photographs around the house. This can make the person feel more secure.
  3. Reduce noise, clutter, or the number of people in the room.
  4. Try gentle touching, soothing music, reading, or walks.
  5. Build quiet times into the day, along with activities.
  6. Limit the amount of caffeine, sugar, and “junk food” the person drinks and eats.

Here are things the doctor can do:

  1. Give the person a medical exam to find any problems that may cause the behavior. These problems might include pain, depression, or the effects of certain medicines.
  2. Check the person’s vision and hearing each year.

Here are some important things to do when the person is aggressive:

  1. Protect yourself and your family members from aggressive behavior. If you have to, stay at a safe distance from the person until the behavior stops.
  2. As much as possible, protect the person from hurting himself or herself.
  3. Ask the psychiatrist if medicine may be needed to prevent or reduce agitation or aggression.

How to cope with wandering

Many people with AD wander away from their home or caregiver. As the caregiver, you need to know how to limit wandering and prevent the person from becoming lost. This will help keep the person safe and give you greater peace of mind.

Try to follow these tips before the person with AD wanders:

  1. Make sure the person carries some kind of ID. If the person gets lost and can’t communicate clearly, an ID will let others know about his or her illness. It also shows where the person lives.
  2. Let neighbors and the local police know that the person with AD tends to wander.
  3. Keep a recent photograph or video recording of the person to help police if the person becomes lost.
  4. Keep doors locked. Consider a keyed deadbolt, or add another lock placed up high or down low on the door. If the person can open a lock, you may need to get a new latch or lock.
  5. Install an “announcing system” that chimes when the door opens.

How to cope with rummaging and hiding things

Someone with AD may start rummaging or searching through cabinets, drawers, closets, the refrigerator, and other places where things are stored. He or she also may hide Items around the house. This behavior can be annoying or even dangerous for the Caregiver or family members. If you get angry, try to remember that this behavior is part of the disease. In some cases, there might be a logical reason for this behavior. For instance, the person may be looking for something specific, although he or she may not be able To tell you what it is. He or she may be hungry or bored. Try to understand what is causing the behavior so you can fit your response to the cause.

Here are some other steps to take:

  1. Lock up dangerous or toxic products, or place them out of the person’s sight and reach.
  2. Remove spoiled food from the refrigerator and cabinets. Someone with AD may look for snacks, but lack the judgment or sense of taste to stay away from spoiled foods.
  3. Remove valuable items that could be misplaced or hidden by the person, like important papers, checkbooks, jewelry, and keys.
  4. People with AD often hide, lose, or throw away mail. If this is a serious problem, consider getting a post office box
  5. Keep the person with AD from going into unused rooms. This limits his or her rummaging through and hiding things.
  6. Search the house to learn where the person often hides things. Once you find these places, check them often, out of sight of the person.
  7. Keep all dustbins covered or out of sight. People with AD may not remember the purpose of the container or may rummage through it.
  8. Check dustbin containers before you empty them, in case something has been hidden there or thrown away by accident.

You also can create a special place where the person with AD can rummage freely or Sort things. This could be a chest of drawers, a bag objects, or a basket of clothing to fold or unfold. Give him or her a personal box, chest, or cupboard to store special objects. You may have to remind the person where to find his or her personal storage place.

3. Challenge: changes in intimacy and sexuality

Intimacy is the special bond we share with a person we love and respect. It involves the way we talk and act toward one another. This bond can exist between spouses or partners, family members, and friends . AD often changes the intimacy between people.

Sexuality is one type of intimacy. It is an important way that spouses or partners express their feelings physically for one another.

AD can cause changes in intimacy and sexuality in both the person with AD and the caregiver. The person with AD may be stressed by the changes in his or her memory and behaviors. Fear, worry, depression, anger, and low self-esteem (how much the person likes himself or herself) are common. The person may become dependent and cling to you. He or she may not remember your life together and feelings toward one another. Sometimes the person may even fall in love with another person.

You, the caregiver, may pull away from the person in both an emotional and physical sense. You may feel upset by the demands constant forgetfulness, repeated questions, and other bothersome behaviors.

Most caregivers learn how to cope with these challenges, but it takes time. Some learn to live with the illness and find new meaning in their relationships with people who have AD.

How to cope with changes in intimacy

Remember that most people with AD need to feel that someone loves and cares about them. They also need time with other people as well as you. Your efforts to take care of these needs help the person with AD to feel happy and safe.

It’s important to reassure the person that:

  1. You love him or her.
  2. You will keep him or her safe.
  3. Others also care about him or her.

When changes in intimacy happen, the following tips may help you cope with your own needs:

  1. Talk with a psychiatrist about these changes. It may feel awkward to talk about such personal issues, but it can help.
  2. Talk about your concerns in a support group.( if you have one nearby)
  3. Think more about the positive parts of the relationship.
  4. Get more information. some books, articles, and DVDs/videos can help you understand
  5. how AD affects intimacy
  6. How to cope with changes in sexuality

The well spouse/partner or the person with AD may lose interest in having sex. This Change can make you feel lonely or frustrated. Here are some possible reasons for changes in sexual interest.

The well spouse/partner may feel that:

  1. It’s not okay to have sex with someone who has AD.
  2. The person with AD seems like a stranger.
  3. The person with AD seems to forget that the spouse/partner is there or how to make love.

People with AD may have:

  1. Side effects from medications that affect his or her sexual interest
  2. Memory loss, changes in the brain, or depression that affects his or her interest in sex.

Here are some suggestions for coping with changes in sexuality:

  1. Explore new ways of spending time together.
  2. Focus on other ways to show affection. Some caregivers find that snuggling or holding hands reduces their need for a sexual relationship.
  3. Focus on other ways to show affection.
  4. Try other nonsexual forms of touching, such as giving a massage, hugging, and dancing.

Helping Family Members and Others Understand AD

Deciding when and how to tell family members and friends

When you learn that someone you love has AD, you may wonder when and how to tell your family and friends. You may be worried about how others will react to or treat the person. You also may wonder if there is a right way to talk about it. While there is no single right way to tell others, some approaches to think about.

Think about the following questions:

  1. Are others already wondering what is going on?
  2. Do you want to keep this information to yourself?
  3. Are you embarrassed?
  4. Do you want to tell others so that you can get support from family members and friends?
  5. Are you afraid that you will burden others?
  6. Does keeping this information secret take too much of your energy?
  7. Are you afraid others won’t understand?

Realize that family and friends often sense that something is wrong before they are told. AD is hard to keep secret.

When the time seems right, it is best for you to be honest with family, friends, and others. Use this as a chance to educate them about AD.

For example, you can:

  1. Tell them about the disease and its effects.
  2. Share books and information to help them understand what you and the person with AD are going through.
  3. Tell them how to get more information.
  4. Tell them what they can do to help. Let them know you need breaks.

Help family and friends understand how to interact with the person who has AD. You can:

  1. Help them realize what the person still can do and how much he she still can understand.
  2. Give them suggestions about how to start talking with the person.
  3. Help them avoid correcting the person with AD, if he or she makes a mistake or forgets something.
  4. Help them plan fun activities with the person, such as going to family reunions; church, temple, or mosque gatherings; other community activities; or visiting old friends.

Communicate with others when you’re in public settings. Some caregivers carry a card that explains why the person with AD might say or do odd things . For example, the card could read, “My family member has Alzheimer’s disease. He or she might say or do things that are unexpected. Thank you for your understanding.”

The card allows you to let others know about the person’s AD without the person hearing you. It also means that you don’t have to keep explaining things.

Helping children understand AD

When a family member has AD, it affects everyone in the family, including children and grandchildren. It’s important to talk to them about what is happening. How much and what kind of information you share depends on the child’s age. It also depends on his or her relationship to the person with AD.

Give children information about AD that they can understand.

Here are some other suggestions to help children understand what is happening:

  1. Answer their questions simply and honestly. For example, you might tell a young child, “Grandma has an illness that makes it hard for her to remember things.”
  2. Know that their feelings of sadness and anger are normal.
  3. Comfort them. Tell them they didn’t cause the disease. Young children may think they did something to hurt their grandparent.

If the child lives in the same house as someone with AD:

  1. Don’t expect a young child to help take care of or “babysit” the person with AD.
  2. Make sure the child has time for his or her own interests and needs, such as playing with friends, going to school activities, or doing homework.
  3. Make sure you spend time with your child, so he or she doesn’t feel that all your attention is on the person with AD.
  4. Help the child understand your feelings. Be honest about your feelings when you talk with a child, but don’t overwhelm him or her.

Many younger children will look to you to see how to act around the person with AD. Show children they can still take with the person, and help them enjoy things each day. Doing fun things together can help both the child and the person with AD.

Here are some things they might do:

  1. Do simple arts and crafts.
  2. Play music.
  3. Sing.
  4. Look through photo albums.
  5. Read stories out loud.

Some children may not talk about their negative feelings, but you may see changes in how they act. Problems at school, with friends, or at home can be a sign that they are upset. You may want to ask a school counselor or teacher to help your child understand what is happening and learn how to cope. Be sure to check with your child often to see how he or she is feeling.

A teenager might find it very hard to accept how the person with AD has changed. He or she may find the changes upsetting or embarrassing and not want to be around the person. It’s a good idea to talk with teenagers about their concerns and feelings. Don’t force them to spend time with the person who has AD. This could make things worse.

If the stress of living with someone who has AD becomes too great for child, think about placing the person with AD into a respite care facility. Then, both you and your child can get a much-needed break.

Medical Specialists

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Alzheimer's and Dementia

Alzheimer's and Dementia

Psychiatry

Alzheimer's and Dementia

DEMENTIA

What is dementia?

Dementia is a disease which causes change in the behaviour, memory, intellect and personality of the person. The decline is gradually and the rate of decline depends upon the underlying cause.

It usually occurs after the age of 65 yrs and the older you get the chances of getting dementia increases.

Some people can get dementia even before the age of 65yrs.

What are the causes of dementia?

The following types of dementia account for 90% of all cases

  1. Alzheimer’s disease
  2. Diffuse lewy body dementia
  3. Frontotemporal dementia
  4. Vascular dementia

The cause of Alzheimer’s disease is not known but we know that it can be associated with Down’s syndrome. We know that it causes damage to the brain leading to the symptoms of dementia. It is the most common cause of dementia.

Vascular dementia also causes damage to the brain by causing small blocks in the blood vessels supplying the brain called infarcts. The more the infarcts the more the degree of damage to the brain.

Diffuse lewy body dementia is neurodegenerative disease in which the person can suffer from Parkinson’s disease symptoms.

What are the symptoms of dementias?

Depending upon the cause of dementia and the site of brain involved symptoms of dementia can vary. The person gradually loses the functions of the brain leading to memory loss, initially for immediate and recent memory and gradually remote memory. They forget instructions given, misplace keys, lose their way, fail to identify people and can also lose the ability to wear clothes and take care of their personal care. There can be change in their personality and they can get irritable and angry easily, abusive, sleep can be disturbed, they can become talkative and disruptive. Some people can suffer with psychiatry problems like visual hallucinations, depression and auditory hallucinations.

How is dementia treated?

When a person first presents with symptoms the doctor will examine the person and advice a battery of tests both blood tests and CT/MRI of the brain. This is to find out the cause for dementia and look for any reversible causes of dementia.

The aim of the treatment is maintain the quality of life and dignity of the person. Hence the approaches are with medication and counseling the carers about the illness and how to manage such patients.

Medications like donapezil may be prescribed to slow down the rate of deterioration of the brain.

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Depression

Depression

Psychiatry

Depression

Depression is a major psychiatric disorder and one the most common psychiatric disorders encountered in clinical practice. It is more common in women than men. Lifetime incidence of major depressive disorder is 20% in women and about 12% in men. In other words one in five women will suffer from depression some time in their lifetime.

What are the symptoms of depression?

There are definite criteria to diagnose if a person is suffering from depression.

Some of the symptoms are

  1. Feeling sad for most of the time
  2. No interest in previously pleasurable activities
  3. Impaired concentration
  4. Disturbed sleep
  5. Decreased or increased appetite
  6. Loss or gain in weight
  7. Hopelessness, worthlessness, helplessness ( negative thoughts)
  8. Guilt feelings
  9. Easy fatigability
  10. Suicidal ideations or attempt
  11. At times anxiety symptom
  12. Being aloof
  13. Impaired socio- occupational functioning
  14. Multiple physical complaints
  15. Decreased sexual functioning

The psychiatrist will make a diagnosis of depression based on the duration and number of symptoms the patient has. You need not have all the symptoms to make a diagnosis of depression. The duration of symptoms should be at least 2 weeks.

B. What are the causes for depression?

Depression is caused by number of factors

  1. Genetics: Depression runs in families. Children of parents with depression have a higher chance of getting depression than normal population.
  2. Chemicals: Depression can be caused by dysfunctions in certain chemicals called neurotransmitters in the brain. The common neurotransmitters are serotonin, dopamine and nor epinephrine. Other chemicals can also be involved.
  3. People suffering from physical problems like hypothyroidism are more prone to depression. Patients with chronic illness are also more prone to depression. Beta blockers, alcohol and other illicit substances.
  4. Stress: major life events like death, loss of employment, debts, financial problems, divorce, break ups etc can increase the chances of depression in susceptible people.

To be noted that you do not have to have any stress in order to suffer from depression, a significant number of patients suffer from depression even without any stress. In other words even a person having all his external needs met can suffer from depression.

C. What is the treatment for depression?

Depression can be treated with medications and /or Cognitive behaviour therapy.

  1. Medications: Medications are a very effective way of treating depression. They are numerous groups of anti depressants which can be used. The medications act on the neurotransmitters serotonin and nor epinephrine. The commonest group of medications used for depression now a day is called serotonin specific re uptake inhibitors (SSRI).
  2. Cognitive behaviour therapy: CBT is used along with medications for the treatment of depression. In cases of mild depression it can be used as the sole modality of treatment.

D. Will patients with depression become completely alright?

In general depression has a good prognosis which means a significant number of patients will become completely alright if treated correctly.

E. How long do you have to take medications for depression?

Psychiatrists prescribe medications for at least 6 months for depression before considering reducing the dosage of medications gradually. During this period it is important to see your psychiatrist regularly to monitor for relapse in symptoms and side effects.

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Schizophrenia

Schizophrenia

Psychiatry

Schizophrenia

What is schizophrenia?

A disorder of the mind that affects how you think, feel and behave. Its symptoms are often called either ‘positive’ or ‘negative’. It is an illness which can be gradually progressive and can affect any gender, race, caste, socioeconomic status and any geographic location.

Signs and symptoms of schizophrenia

Early symptoms (prodrome )

It presents itself gradually and the initial symptoms could be behavioural changes which the near and dear ones of the person notices, like being withdrawn, spending a lot of time indoor, impaired attention and concentration, sleep disturbances, impaired socio occupational functioning and depressed mood.

You find it harder to concentrate – it’s more and more difficult to:

  1. finish an article in the newspaper or watch a TV programme to the end
  2. keep up with your studies at college
  3. keep your mind on your job at work.

Your thoughts wander. You drift from idea to idea – but there’s no clear connection between them. After a minute or two you can’t remember what you were originally trying to think about. Some people describe their thoughts as being ‘hazy’ when this is happening. When your thoughts are disconnected in this way, it can be hard for other people to understand you.

‘Positive’ symptoms

These are unusual experiences which should not be there.

Hallucinations

A hallucination happens when you hear, smell, feel or see something – but it isn’t caused by anything (or anybody) around you.. The commonest one is hearing voices.

They are false perceptions in the absence of a stimulus.

What do voices sound like?

They sound very real. They usually seem to be coming from outside you, although other people can’t hear them. You may hear them coming from different places, or they may seem to come from a particular place or thing. Voices can talk to you directly or talk to each other about you – it can be like over-hearing a conversation. They are often rude, critical, abusive or just plain irritating.

How do people react to them?

You may try to ignore them, talk back to them – or even shout back at them if they are particularly loud or irritating. You may feel that you have to do what they tell you, even if you know you shouldn’t. You may wonder if they are they coming from hidden microphones, from loudspeakers, or the spirit world.

Where do they come from?

Voices are not imaginary – you really do hear them – but they are created by the mind. Scans have shown that the part of the brain that ‘lights up’ when you hear voices is the same area that is active when you talk, or form words in your mind. The brain seems to mistake some of your thoughts, or ‘inner speech’, for voices coming from outside you.

The voices may comment on the person’s action continuously. (running commentary)

Two or more voices talking about the person usually derogatory in nature ( 3rd person auditory hallucinations)

Voice may talk directly to the person( 2nd person auditory hallucination) or give them commands which may be followed by the person .

It can sometimes feel like when you are trying to make a phone call in a very crowded and noisy place. The person can feel scared by these experiences and become withdrawn.

Other hallucination

You may see things that aren’t there, or may smell or taste things that aren’t there. Some people have uncomfortable or painful feelings in their body, or feelings of being touched or hit.

Delusions

A delusion happens when you believe something – and are completely sure of it – while other people think you have misunderstood what is happening. It’s as though you see things in a completely different way from everyone else. You have no doubts, but other people see your belief as mistaken, unrealistic or strange. If you do try to talk about your ideas with someone, your reasons don’t make sense to them, or you can’t explain – you ‘just know’. It’s an idea, or set of ideas, that can’t be explained as part of your culture, background or religion.

Delusion is a false belief, firm , fixed, unshakable and which is not cultural accepted .

example of delusions

‘Paranoid’ delusions

These are ideas that make you feel persecuted or harassed. They may be:

  1. unusual – it feels as though the government is spying on you. You may think that others are influencing you with special powers or technology.
  2. Feeling of being spied upon by using cameras
  3. Belief that your partner is unfaithful. (delusion of infidality)
  4. Feeling persecuted.
  5. Feeling that your thoughts are being known by others
  6. Feeling that your thoughts are being broadcast on the TV, radio and newspaper.
  7. Feeling that thoughts are being inserted and withdrawn from your brain
  8. Feeling that you have special powers, excessive wealth etc
  9. Feeling that people are plotting against and trying to harm them
  10. Feeling that they are controlled by others and external agencies

You feel that:

  1. your thoughts have suddenly disappeared – as though someone has taken them out of your mind;
  2. your thoughts feel as though they are not yours – it’s as though someone else has put them into your mind;
  3. your body is being taken over, or that you are being controlled like a puppet or a 

Some people explain these experiences by thinking it’s the radio, television or laser beams, or that a device has been implanted in them. Other people blame witchcraft, angry spirits, God or the Devil.

Ideas of reference

you start to see special meanings in ordinary, day-to-day events. It feels as though things are specially connected to you – that radio or TV programmes are about you, or that someone is telling you things in odd ways, for example, through the colours of cars passing in the street.

‘Negative’ symptoms

  1. You start to lose your normal thoughts, feelings and motivations.
  2. You lose interest in life. Your energy, emotions and ‘get-up-and-go’ just drain away. It’s hard to feel excited or enthusiastic about anything.
  3. You can’t concentrate.
  4. You don’t bother to get up or go out of the house.
  5. You stop washing or tidying, or keeping your clothes clean.
  6. You feel uncomfortable with people.

People can find it hard to understand that negative symptoms are really symptoms – not just laziness. This can make it difficult for both you and your family. Your family feel that you just need to pull yourself together. You can’t explain that … you just can’t. Negative symptoms are less dramatic than positive symptoms, but can be really hard to live with.

Does everyone with schizophrenia have all these symptoms?

No you need not have all the symptoms. You can hear voices and have negative symptoms, but may not have delusional ideas. Some people with delusional ideas seem to have very few negative symptoms.

Psychiatrists use a definite set of criteria as given in the ICD-10 (international classification of diseases) or DSM -4 ( diagnostic and statistical manual) to diagnose schizophrenia.

Loss of “insight”

It feels as though everyone else is wrong, that they just can’t understand the things that you can. You feel that the problem is with the rest of the world, not with you. You do not believe that you have an illness. Hence it can lead to non compliance with medication and not visiting the doctor.

How common is schizophrenia?

It affects around 1 in every 100 people over the course of their life. It affects about 1% of the world population.

Who gets it?

It affects men and women equally. It affects any gender, race, caste, socioeconomic status and any geographic location.Women are affected later than men. These symptoms usually start in the early twenties .

What causes schizophrenia?

We don’t yet know for sure. It is probably a combination of several different things, which will be different for different people.

Stress-vulnerability-coping model best describes why people get schizophrenia.

Genes

Although only 1 in 100 people get schizophrenia, about 1 in 10 people with schizophrenia have a parent with the illness.

Twins

An identical twin has exactly the same genetic make-up as his or her brother or sister, down to the smallest piece of DNA. If one identical twin has schizophrenia, their twin has about a 50:50 chance of having it too.

Non-identical twins have a different genetic make-up to each other. If one of them has schizophrenia, the risk to the other twin is just slightly more than for any other brother or sister. These findings are much the same even if twins are adopted and brought up in different families.

 Relatives with schizophrenia Chance of developing schizophrenia
 None 1 in 100
 1 parent 1 in 10
 1 identical twin (same genetic make up) 1 in 2
 1 non-identical twin (different genetic make up) 1 in 8

Certain chemicals called neurotransmittors in the brain are effected which causes the symptoms of schizophrenia. Dopamine and serotonin are the most common neurotransmittors implicated in the causation of schizophrenia.

Brain damage

Brain scans show that there are differences in the brains of some people with schizophrenia – but not in others. Where this is the case, it may be that parts of the brain have not grown normally because of:

  1. a problem during birth that stops the baby’s brain from getting enough oxygen
  2. a virus infection during the early months of pregnancy.

Drugs and alcohol

Sometimes, street drugs seem to bring on schizophrenia.

Amphetamines can give you psychotic symptoms, but they usually stop when you stop taking the amphetamines. We don’t yet know whether these drugs, on their own, can trigger off a long-term illness, but they may do if you are vulnerable.

It can be easy to use drugs or alcohol to cope with symptoms, but this usually makes things worse.

Cannabis

  1. The heavy use of cannabis seems to double the risk of developing schizophrenia. New research has shown that the stronger forms of cannabis, may increase this risk.
  2. It’s more likely if you start using cannabis in your early teens.
  3. If you have smoked it frequently (more than 50 times) during your teens, the effect is even stronger – you are 6 times more likely to develop schizophrenia.

Stress

Stress can precipitate an episode or worsen the symptoms of schizophrenia.

Family problems

Family problems does not cause schizophrenia but it can worsen the symptoms of schizophrenia. Hence therapy will be needed to prevent relapse.

Do people with schizophrenia become violent ?

A few people with schizophrenia do become violent – they usually hurt themselves but sometimes hurt other people. This can be caused by feelings of persecution or voices telling them to do it – often a combination of the two. It is much more likely if the person has used drugs or alcohol.

What is the treatment for schizophrenia ?

Schizophrenia is treated with medications and psychological treatments. Medications are the first line of treatment for symptoms of schizophrenia.

If you have the symptoms of schizophrenia for the first time, you should start medication as soon as possible.

You will have to consult a psychiatrist and he will put on one of the various medications called antipsychotics.

What are the medications for schizophrenia?

Psychiatrists will use one of the numerous medications avaiable for the treatment of schizophrenia. These medications are collectively called antipsychotics. Some of the antipsychotics are risperidone, olanzapine, clozapine,quitiapine, aripiprzole etc. For more details kindly look up the antipsychotic section of the website.

Why take medication?

Medication reduces the effects of the symptoms on your life. Medication should:

  1. reduce delusions and hallucinations gradually, over a period of a few weeks;
  2. help your thoughts to be clearer;
  3. increase your motivation and ability to look after yourself you

You will initially be adviced to see the psychiatrist once in 2 weeks ( sometimes 1 week) to monitor the effects and side effects of the medication . Medications will be increased on an average once in 2 weeks if the improvement is not optimal.

How well does medication work?

Majority of the patients who take medications in the correct dosage and adequate duration of time will see a reduction in the symptoms. Side effects of medications must be monitored at treated to improve the quality of life of the patient.

How long will I have to take medication for?

  1. Most psychiatrists will suggest that you take medication for a long time.
  2. If you want to reduce or stop your medication, discuss this with your doctor.
  3. Reduce your medication gradually. If you do this, you can notice any symptoms returning before you become really unwell again.

What happens when I stop taking medication?

The symptoms will usually come back – not immediately, but usually within 3 – 6 months.

Getting back to normal

Schizophrenia can make everyday life hard to deal with. This may or may not be due to the symptoms. Sometimes you may just get out of the habit of doing things for yourself. It can be difficult to get back to doing ordinary things like washing, answering the door, shopping, making a phone call or chatting with a friend. Hence it is advisable to maintain a regular daily schedule in spite of the illness and medication side effects.

Psychological (or talking) treatments

Cognitive Behavioural Therapy (CBT)

This can be done by clinical psychologists, psychiatrists or nurse therapists. It helps you to:

  1. concentrate on the problems that you find most difficult. These could be thoughts, hallucinations or feelings that you are being persecuted.
  2. look at how you tend to think about them – your ‘thinking habits’.
  3. look at how you react to them – your ‘behaving habits’.
  4. look at how your thinking or behaving habits affect you.
  5. work out if any of these thinking or behaving habits are unrealistic or unhelpful.
  6. work out more helpful ways of thinking about these things or reacting to them.
  7. try out new ways of thinking and behaving.
  8. see if these work. If they do, to help you use them regularly. If they don’t, to find better ones that do work for you.

This kind of therapy can help you to feel better about yourself and to learn new ways of solving problems. We now know that CBT can also help you to control troublesome hallucinations or delusional ideas. Most people have between 8 and 20 sessions, each lasting about 1 hour. To help the symptoms of schizophrenia, you may need to carry on with ‘booster’ courses from time to time.

Try to avoid things that make you worse, such as:

  1. stressful situations
  2. using street drugs or alcohol.
  3. disagreements with family, friends or neighbours.

Learn relaxation techniques.

Make sure you regularly do something you enjoy.

What are the other ways to reduce symptoms?

Along with medications the following can be tried to reduce symptoms

  1. spend time with other people
  2. keep busy
  3. listen to a personal stereo (TV and radio also work but may annoy your family or neighbours).
  4. remind yourself that your voices can’t harm you
  5. remind yourself that your voices don’t have any power over you and can’t force you to do anything you don’t want to.

Look after your body. People with schizophrenia have poorer health than others, so it’s worth looking after yourself:

  1. try to eat a balanced diet, with lots of fresh vegetables and fruit
  2. try not to smoke – cigarettes harm your lungs, your heart, your circulation and your stomach
  3. take some regular exercise, even if it’s only 20 minutes out walking every day. Regular vigorous exercise (double your pulse rate for 20 minutes 3 times a week) can help improve your mood.

Doesn’t schizophrenia make people dangerous?

People who suffer from schizophrenia are usually not dangerous. Any violent behaviour is usually sparked off by street drugs or alcohol. This is similar to the situation with people who don’t suffer from schizophrenia.

Although there is a higher risk of violent behaviour if you have schizophrenia, it is very small compared to the effects of drugs and alcohol in our society. People with schizophrenia are far more likely to be harmed by other people than other people are to be harmed by them.

Do patients with schizophrenia get better ?

One third of patients suffering from schizophrenia improve completely, 1/3 approximately have a few residual symptoms and are able to function resonable well but 1/3 of the patients have a gradual decline in their functioning with residual symptoms and they need assistance in life.

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Bipolar affective disorder

Bipolar affective disorder

Psychiatry

Bipolar affective disorder (BPAD)

Bipolar affective disorder is a mood disorder in which the patient suffers from both depressive episodes and manic/hypomanic episodes. It was called manic depressive psychosis in the past. Patients suffer from intense mood swings in this disorder.

What are the symptoms of BPAD?

The patients have both depressive and manic symptoms

Symptoms suggestive of mania are

  1. Felling happy ( elated or euphoric)
  2. Increased self esteem
  3. Decreased need for sleep- feels rested even after sleeping for only 3 hrs
  4. Talks excessively and it is difficult to stop the patient from talking
  5. Gets multiple ideas and thoughts ( racing thoughts )
  6. Jumps from one topic to another while speaking
  7. Easily distractible and concentration is impaired
  8. Spends more money than usual/ spending sprees
  9. Increased sexual drive
  10. Is over active and over familiar with people
  11. Has great ideas and plans which are not practical
  12. They can hear voices which no one else can hear
  13. Can have grandiose delusions like claiming to be god or a very prominent person in the society
  14. Can be irritable
  15. Does not complete tasks given and jumps from one task to another.
    The duration of the symptoms should be at least one week.
    The symptoms of depression are as document under the depression section.

What causes BPAD?

The exact cause of BPAD is still not known but some of the factors are

  1. Genetic factors : Bipolar illness is known to run in families
  2. Dysfunction in certain chemicals in the brain called neurotransmitters can lead to BPAD. Some of the neurotransmitters implicated are nor epinephrine and serotonin.
  3. Life events and stress can precipitate an episode of the illness in vulnerable individuals

What is the course of BPAD?

Patients usually experience their first episode in their early 20s. Manic episode typically begins suddenly with a rapid escalation of symptoms over a few days; hence it is advisable to see a psychiatrist at the earliest. The manic episode normally responds well to treatment and the patient generally has periods when he has no symptoms of the illness. However some patients may continue to have persistent symptoms without coming back to pre morbid levels.

What is the treatment for BPAD?

The main stay of treatment for BPAD is medications.

If a patient has a manic episode and also if he has psychotic symptoms he is treated with antipsychotic medications like olanzapine, quitipine, risperidon etc.

If a patient has depressive symptoms he is treated with antidepressants like serotonin specific reuptake inhibitors like sertraline, fluoxetine, escitalopram etc.

Patients are also given a group of medication called mood stabilizers like lithium, sodium valproate, carbamezapine, lamotrigine etc. Mood stabilizers help in treating the mood swings much like how a voltage stabilizer works, if the mood goes high it gets it down, if it goes low it gets it up.

Mood stabilizers can also prevent future episodes in some patients or reduce the intensity of the episode or increase the gap between episodes.

In addition to medications your psychiatrist will help you identify early warning symptoms of an episode so that help can be sought at the earliest.

Remember the earlier the patient is taken to a doctor the better and faster is the response to medication.

How long are medications given for BPAD?

Mood stabilizers are normally given for at least 2 years after one episode and up to five years with multiple episodes.

Remember an untreated episode of mania can last up to 6 months on an average and an untreated episode of depression on an average for 12 months.

What is a rapid cycler ?

A person who has BPAD who gets 4 or more episodes of the illness in a year is called a rapid cycler.

How can carers help?

It is of paramount importance that the carer of a person who is suffering from BPAD learns about the illness and its manifestation. They should be aware of the early warning signs and seek help at the earliest. They should also keep a watch on the patients spending during an episode and be aware of his credit card expenditure. If possible methods to stop access to money and credit cards should be decided with the patient when he is doing well and plan executed if needed.

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