Author Archives: Dr. Jyoti Kapoor

PRE MENSTRUAL SYNDROME AND ITS PSYCHOLOGICAL EFFECTS

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The life cycle of a living organism is primarily guided by the internal hormonal milieu but it is mostly manifested in women due to the cyclicity with which their entire life, from menarche to pregnancy to menopause goes through. The monthly menstrual cycle is a neuro endocrine processes and the physiological as well as psychological changes during the various phases of menstrual cycle range from imperceptible to highly disruptive.

The pre menstrual syndrome is diagnosed when certain physiological and psychological changes Occur In A Predictable Pattern In 1-2 Weeks Period Before Start Of Menstruation.

pms 1

Physical Signs and Symptoms of Pre Menstrual Syndrome

  • Weight gain related to fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Exacerbation of acne
  • headaches
  • Disturbed bowel movement (constipation/diarrhoea)
  • Muscle aches
  • Fatigue

Psychological Symptoms of Pre Menstrual Syndrome

  • Stress or anxiety
  • Crying spells
  • Depressed mood
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration

What is of Pre Menstrual Syndrome?

Premenstrual Dysphoric Disorder is largely a state of emotional instability and sadness that occurs prior to menstruation. The risk factors include history of mood disorder, emotionally unstable personality, family history of depression or mood disorder and severe or chronic stress. Altered responses of neuro endocrine systems to gonadal hormone’s fluctuations during the menstrual cycle, as well as an increased sensitivity to changes in gonadal hormones may contribute to menstrual related symptoms in vulnerable women.

If symptoms of PMS are intense or disrupt normal functioning, professional help should be sought.

Follow the points given below if you are suffering from Pre Menstrual Syndrome

  • Make a symptom chart along with the dates of menstruation.
  • Note any exacerbating or relieving factors.
  • Observe seasonal variation.

Treatment for Pre Menstrual Syndrome

  • Management depends on predominant symptoms.
  • Life style modifications are effective for mild symptoms.
  • Exercise and balanced diet helps maintain energy levels and reduce gastric symptoms.
  • Regular stress relieving activities ensure better mood state.
  • Cognitive Behaviour Therapy is helpful in mild to moderate mood symptoms.
  • Antidepressants may be needed in moderate to severe cases of mood disorders.

DRUG ABUSE TREATMENT

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Today the youth of India is dependent on alcohol and drugs. According to the official data from the ministry of social justice and empowerment, India has an estimated 3.4 million drug abuse victims and 11 million alcoholics in the country.The implications of alcohol and drug use are huge on the health sector. It is estimated that 7 individuals commit suicide due to this problem every day.

Management of alcohol and drug abuse problems begins at identifying them as an illness rather than a choice. The stigma associated with mental health issues prevents people from seeking help and individuals tend to go on abusing substances because they are unaware that treatment is available.

drug abuse treatment 1

Treatment Components:

  • Detoxification:

Most substances of abuse cause physical dependence which means that upon stopping the substance, the individual develops withdrawal symptoms. These symptoms cause acute discomfort and therefore, the abuser tends to go back to using the substance to get relief from symptoms. The first step therefore is to identify and mitigate physical withdrawal symptoms by prescription medicines. Psychiatric treatment for withdrawal is done under supervision and is safe and effective in preventing individuals from relapsing to substance abuse.

  • De-addiction:

The next step is relapse prevention. Patients tend to use alcohol or drugs due to various reasons. Exploring the factors which can lead to relapse is important to individualize rehabilitation plans. Various factors cause addiction behavior-

  • Environment
  • Genetic/Hereditary factors
  • Primary Psychiatric illnesses
  • Personality Factors
  • Treatment Planning:

This is done by taking into consideration two important aspects:

  • Psychiatric Evaluation: It’s aimed at identifying stage of substance use and dependence, withdrawal symptoms and underlying personality along with the psychiatric factors. Once evaluated, treatment program is individualized and planned.
  • Psychological intervention: This is done with the help of counseling and by inclusion in the self help groups.

Counseling: It is aimed at enhancing motivation to stop harmful use of substances, exploring options to replace harmful use behavior, and finding creative and productive ways of handling craving and withdrawal.

Self Help and Support Groups: Group counselling and support groups like Alcohol Anonymous aid in rehabilitation and normalizing behavior.

Life style interventions are imperative in long term recovery from this malady.

  • Preventing Relapse:

Relapse is a reality in substance use disorders but it does not mean that de-addiction cannot be achieved. Patient should be assured that the treatment process continues despite relapse and therefore he/she should stay in touch with the specialist for management.


COPING WITH ALCOHOL AND DRUG ADDICTION

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Substance abuse disorders are classified in medical science as an illness but the society still looks at them as a characterological trait which the sufferer is solely responsible for. Even though the socio cultural factors play a significant role in substance use behavior, genetic and biological influences can’t be discounted. Epidemiological studies of twins and families have demonstrated a genetic contribution of 30-60% in developing addiction. Coping with substance use disorders thus requires understanding and education of both biological and psycho social factors.

 

drug&alcohol 1

Coping Strategies for Patients of Substance Abuse

Deal with Denial- Most patients believe that they can give up the habit when they choose to and need no help. Substance abuse is a complex condition and treatment requires adequate guidance and support especially during withdrawal phase. Patients need to be educated that biological withdrawals can be quite threatening, especially in case of alcohol dependence and need proper medical attention.
drug&alcohol 1

Get rid of Guilt- Not being able to stop taking a harmful substance is a medical problem and proper treatment can be helpful. Feeling guilty and not taking help because of guilt is a major reason for treatment noncompliance and obstructs recovery.
Take Responsibility- Even though substance abuse is mediated by biological and psycho social factors, one needs to take responsibility for recovery. Patient can get better if he/she accepts that abuse behavior can be controlled if one chose to and decides to make that choice. Medicines and therapy require cooperation from the patient and are not the sole responsibility of the treating psychiatrist or family members.
Accept psychological conflicts that fuel substance abuse behavior- Whether it is anxiety, tension or depression or a social problem, if one feels like taking the substance to relieve the stress resulting from these issues, one needs to accept and sort them. Rehabilitation is aimed at identifying all such factors that cause relapse to substance abuse behavior.
Psychiatric disorders increase vulnerability for substance abuse disorders. Take help before self-medicating with alcohol, nicotine or drugs.


STIGMA- ASSOCIATED WITH AIDS

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hiv-aids-stigmaStigma is a social construct which means  a mark of disgrace. If human brain identifies a thing or an event as having negative impact, it has a tendency to withdraw from it. This biological response takes on a behavioural connotation in terms to negative attitude towards a certain entity/group or place. AIDS has been identified as such a negative entity because of the associated fear of an untreatable illness with huge morbidity and economic cost. The social attitude towards those suffering from AIDS is thus a result of an underlying social phobia of contracting an un treatable illness. There are also a number of myths associated with mode of transmission of HIV which, despite a lot of positive media intervention continues to persist due to negative and often false messages spreading on social media.

Dealing with Stigma as an individual disease-

  1. Social Support- Patients who are HIV positive are themselves going through a major traumatic experience. Fear of discrimination and isolation makes them stay quiet about their problems and they are unable to seek help and support. Social support from friends, family and colleagues is important in helping them deal with associated stigma.
  2. Individual support- psychological intervention is recommended right before the HIV test is undertaken in terms of pre test counselling. People with positive HIV test results should be as a rule, referred to a psychological counsellor or therapist in order to identify and deal with associated stress and negative psychological impact of the disease.

Dealing with stigma as a social disease-

  1. Negative social media campaign needs to be addressed. HIV does not spread by eating bananas or pine apples with HIV positive blood injected in food. Rumours need to be countered with spreading correct information about disease transmission.
  2. The stigma associated with socially condemned practices like individual sexual preferences and drug addiction need to be separately addressed. AIDS is the result of a particular viral infection and not the result of a certain practice.
  3. AIDS does not spread by social contact, nor does it affect the intellect or ability of person to function in their vocation unless the disease process affects the brain. Discrimination at work place needs to be addressed as part of the educational campaign at work place.
  4. Educational institutions including schools now have awareness programs to spread correct information about AIDS.
  5. The AIDS related Anxiety Disorder has escalated in past few years and needs to be treated like any other hypochondriasis. The health professionals need to be sensitized so that repetitive unnecessary tests can be avoided and the psychiatric problem is treated.

HIV infection can be largely contained now with available antiviral medication. Patients with suspected infection need to be guided and supported so that they can take help.


MOOD DISORDER

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Mood Disorders are characterized by disturbance in an individual’s mood which is significant and pervasive and effects his/her personal, social and or occupational life. A normal mood highlights the general personality of a person and his or her reaction to every day situation , however if a person has a mood disorder, their reactions are different and can be termed as an overreaction. The mood disorders are categorized into Depressive Disorders & Bipolar Disorders depending upon the quality of mood & fluctuations in its quality. The key feature of longitudinal course of mood disorder is a tendency towards cyclicity or recurrence.

MoodDisordersManagement of Mood Disorders:

  • Identification: Despite wide spread prevalence of mood disorders, only one third of individuals are properly diagnosed. This is also because, most people with mood disorder present with somantic or physical complaints like unexplained pain, weakness, fatigue, sleep disturbance, appetite disturbance, etc. It’s imperative to understand that persistence of a mood state like sadness for too long is pathological and needs evaluation.
  • Diagnosis: Psychiatric evaluation of mood disorders is primarily clinical and is based upon validated international criteria listed in DSM-V or ICD-10. Depressive disorder is diagnosed when depressed mood or loss of interest is persistent for more than 2 weeks with or without other symptoms like sleep disturbance, appetite disturbance, agitation, restlessness, negative thoughts, feeling of worthlessness, suicidal ideation, etc. Bipolar disorder is diagnosed when there are distinct episodes of mania or hypomania when a person is excitable, energetic, over talkative with or without other symptoms of excessive excitation like irritability interspersed with episodes of feeling sad, low or dull (depression).

Treatment for Mood Disorders:

Depending upon the history, intensity and frequency of episodes, treatment of mood disorder is planned.

  • Mild depressive states which are reactive or associated with adjustment issue can be treated with psychotherapy like cognitive behavior therapy (CBT).
  • Moderate to severe depressive disorders required pharmacotherapy with or without psychotherapeutic intervention.
  • Bipolar Affective disorders are primarily biological disorder and mood stabilizing medicines are main stay of treatment.
  • Psychotropic medicines available today are safe and effective in management of mood disorder and under expert guidance are well tolerated.

Important Notification

Due to recent ban on use of Rs 500/- and Rs 1000/-denomination currency, we request you to pay by either of the following means- 1. Currency notes other than Rs 500/- and Rs 1000/- 2. Mobile wallets- PayTm- 9990818967 PayUMoney- 9990818967 MobiKwik-9990718967 3. NEFT transaction to following account- Dr Jyoti Kapoor A/c No. 09291140082855 HDFC, sector 45, gurgaon IFSC : HDFC0002645 We don't have debit/ credit card facility. Regards मन:स्थली Dr Jyoti's Psychiatry Clinic Gurgaon

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