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“Nirvana” is a Sanskrit word meaning- Place of Perfect Peace and Happiness, a State where a person’s individual Desires and Suffering Disappears.
‘Nirvana Psychiatric Clinic’, run by one of the top Psychiatrists in Raipur Dr. Vikalp Wasnik, MD Psychiatry from Central Institute of Psychiatry, Ranchi, and Dr. Shalini Bijali, DPM, DNB Psychiatry, is one-of-a-kind healthcare provider for all your Psychiatric and Mental wellbeing needs. Our team of experts stand strong with the essential pillars of Healthcare System, that is, Accessibility, Availability and Confidentiality where we are dedicated to making sure patients and their Families have access to Informational and Educational resources at every step of the care journey.
We stand out among Mental Healthcare Providers by the virtue of “Empathy”.
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Know More About Your Mental Health
Depression
- Persistent sad, anxious, irritable or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of irritability, frustration, or restlessness
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy, fatigue, or feeling “slowed down”
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early morning awakening, or oversleeping
- Changes in appetite or unplanned weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
- Suicide attempts or thoughts of death or suicide
Individuals with Bipolar disorder (formerly called manic depression or manic-depressive illness) also experience depressive episodes, in which they feel sad, indifferent, or hopeless, combined with a very low activity level. But a person with bipolar disorder also experiences manic episodes, or unusually elevated moods in which the individual might feel very happy, irritable, or “up,” with a marked increase in activity level.
Main causes for depression can be broadly classified as Internal / Biological causes and External causes. Internal/Biological causes includes:
- Genes (familial)
- Neurotransmitter abnormalities in the brain, like reduced serotonin and dopamine
- Harmonal changes like thyroid abnormalities or pregnancy/ menstrual related
- Other systemic disorders like Diabetes, heart diseases, arthritis, kidney diseases, epilepsy etc
- Personality traits like thinking patterns, coping skills, defence mechanisms used while dealing with the stressors
- Death or loss of somebody/ something
- Physical, emotional or sexual abuse
- Major life changing events
- Chronic stressors
- Personal conflicts or disputes (specially when individual already have underlying biological cause)
- Substance Abuse- Tobacco, Alcohol, cannabis, Opioids etc
- Some medications like steroids, isotretinoin, Oral contraceptive pills are known to cause depressive like symptoms
If someone has mild depression, or it has only just started, one option is to wait and see whether the symptoms go away again without treatment. This “watchful waiting” approach doesn’t mean that the symptoms are ignored and nothing is done, though. It is important to stay in touch with the doctor and have regular appointments to discuss how you’re feeling and how you can cope with the situation. If the symptoms get worse or last several weeks, further treatment may be needed. It is also important for people to be able to talk with others. Partners, friends and family play a very important role here. Support and information centers can offer help and guidance too. Sometimes it can help to talk to people who have gone through similar experiences, for example in a support group. Particularly in moderate or severe depression, it is usually very important to get immediate treatment because the symptoms are very distressing and can last quite a while. This is also true if someone has chronic depression or is thinking of harming or killing themselves (committing suicide). There are various treatment options for depression. They include psychological treatments, medication and general measures such as relaxation techniques. Different treatment options are often combined.
A distinction is made between different phases of treatment, referred to as “acute,” “continuation” and “maintenance” treatment (relapse prevention). Acute treatment usually lasts six to eight weeks. The aim is to
- relieve symptoms enough to enable the person to cope in everyday life again, and
- make the symptoms go away sooner, preventing the depressionfrom further affecting their lives.
- further relieve the symptoms, until they go away, and
- sustain the progress made through treatment.
Psychological treatment usually involves talking about things in depth and doing detailed analysis of thoughts and behavior. The kind of psychological treatment that is most commonly used for depression is known as cognitive behavioral therapy (often called “CBT” for short). Cognitive behavioral therapy
In depression, negative thought patterns such as self-doubt and feelings of guilt often make the problem worse. Cognitive behavioral therapy aims to break these patterns bit by bit, so that people feel better about themselves. Cognitive behavioral therapy combines two treatment approaches: Cognitive therapy: Cognitive therapy is based on the idea that problems are often caused less by things and situations themselves, but rather by the importance that people attach to them. So changing the way people see things can be an important step.
Behavioral therapy: Behavioral therapy is based on the assumption that behavior is learned and can also be unlearned. The goal of behavioral therapy is to identify destructive patterns of behavior, then work at them and change them.
The goal of cognitive behavioral therapy is to become more aware of your own thoughts, attitudes and expectations. This makes it possible to identify false and distressing beliefs, and then change them. Other therapies include: Psychoanalytic approaches
Dialectical Behavioural Therapy Supportive Psychotherapy
Electroconvulsive therapy is usually carried out in a hospital, under general anaesthesia. Electrodes are placed on the patient’s head and a short burst of electric current is passed through the brain, inducing a seizure. The patient can’t feel anything because the procedure is carried out under general anesthesia. Electroconvulsive therapy is safe and effective technique. It usuallyonly considered as a treatment option for people with severe depression if other treatments haven’t helped or in patients who are trying to harm themselves when the urgent treating of depressive symptoms is needed.
Anxiety Disorders
Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But most of us get over with it using healthy coping skills and anxiety subsides after the trigger has been removed. Anxiety disorders on the other hand involve more than temporary worry or fear. For a person with an anxiety disorder, anxiety is persistent and pervasive without any imminent cause. The anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships.
- Generalised Anxiety Disorder
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Social anxiety disorder
- Specific phobias
- Generalized Anxiety Disorder (GAD) is an exaggerated anxiety and tension that persists for months, sometimes even for years. GAD causes people to anticipate catastrophe and worry excessively about many things, from overarching concerns such as health, money or work to more routine concerns such as car repairs or appointments. When anxiety becomes so severe, normal life and relationships become impaired. Worries can be accompanied by physical symptoms, such as
- Fatigue
- Headaches, muscle tension and aches,
- difficulty swallowing,
- trembling, twitching,
- irritability,
- sweating, and hot flashes.
- Difficulty in breathing
- Difficulty in sleep
- Restlessness
- Inability to focus
Panic disorder is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom or a fear of losing control. Panic attacks can occur at any time, even during sleep.
Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others. In its most severe form, social phobia may be so broad that a person experiences symptoms almost anytime they are around other people.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. After traumatic events, such as death, an earthquake, war, car accidents, floods or fires, it is not uncommon for people to experience feelings of heightened fear, worry, sadness or anger. If the emotions persist, however, or become severe, or the person gets triggered into reliving the event in their daily life, this can affect the person’s ability to function and may be a sign of PTSD.
- Cognitive Behavioral Therapy (CBT)
- Psychotherapy
- Stress-Management Techniques
- Relaxation techniques
- Antidepressants and Anti-Anxiety Medications
Stress
Stress is a normal physical response to events that make one feel threatened or that upset one’s balance in some way. When the body senses danger—real or imagined—the body’s defenses kick into high gear in a rapid, automatic process known as the ‘fight-or-flight’ reaction, or the stress response. The nervous system responds by releasing a flood of stress hormones, including adrenaline and cortisol, that rouse the body for emergency action.
Stress is not necessarily always negative. Although stress of any type does take a toll over time. Sometimes it can be beneficial in the short term. Stress occurs due to the activation of the sympathetic nervous system, which leads to the fight-or-flight response. The sympathetic nervous system helps people respond to things that scare them by:
- sending blood to the muscles
- increasing breathing rate and heart rate
- releasing glucose into the bloodstream, which provides energy
Physical effects of chronic stress:
- higher chance of experiencing a heart attack, stroke, or high blood pressure.
- Excessive release of cortisol due to chronic stress can cause fatigue, weakness, obesity
- Continuous exposure to cortisol, suppresses immune function resulting in increased chances of infections and disease
- Under chronic stress, your muscles may be in a constant state of tension, which can cause problems like chronic neck or jaw pain.
- Stress can exacerbate pre-existing respiratory issues like Asthma.
- Chronic stress also affects reproductive system leading to reduced libido, Erectile dysfunction or impotency. Chronic stress can reduce chances of fertility in both men and women.
- Mood changes
- Irritability
- Trouble sleeping
- Ideas of helplessness
- Anxiety
- Depression
- Difficulty in concentrating
- Disorganised thoughts
- Feeling out of control
- Dissociative episodes
- Post traumatic disorder
- Low self esteem
- Personality disorders
Youth of all ages, but especially younger children, may find it difficult to recognize and verbalize when they are experiencing stress. For children, stress can manifest itself through changes in behavior. Common changes can include irritability, withdrawal from formerly pleasurable activities, routine expression of worries, excessive complaints about school, frequent crying, display of surprising fearful reactions, separation anxiety, sleeping too much or too little, or eating too much or too little. With teens, while spending more time with and confiding in peers is a normal part of growing up, significantly avoiding parents, abandoning long-time friendships for a new set of peers, or expressing excessive hostility toward family members may indicate that the teen is experiencing significant stress.
Minimizing the chronic stress of daily life as much as possible is important for overall health. Here are some evidence-based ways to relieve stress.
- Get more physical activity
- Follow a healthy diet
- Practice relaxation techniques like yoga, pranayama, meditation
- Practice self-care habits
- Take adequate sleep
- Reduce intake of harmful substances like nicotine, alcohol etc
- Take part in social gathering, community activities. Spend time with friends and family
- Nurture hobbies which keeps you relaxed
- Create healthy boundaries and learn to say no whenever necessary
- Practice healthy coping skills like problem solving, assertion, humor
- Minimize screen time and social media usage. Regulate the content you consume.
- Practice mindfulness in everyday life.
OCD
Obsessive-compulsive disorder (OCD) is a common and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (“obsessions”) and/or behaviors (“compulsions”) that he or she feels the urge to repeat over and over. These thoughts and repetitive acts are very distressful to the patient and family members and they usually cause dysfunction in social and occupational life.
Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:
- Fear of germs or contamination
- Aggressive thoughts towards others or self
- Having things symmetrical or in a perfect order
- Forbidden or perverse sexual thoughts, images, or impulses
- RELIGIOUS OBSESSIONS- Concerned with sacrilege and blasphemy, Excess concern with right/wrong, morality
- Fear of doing something embarrassing
- Intrusive (non-violent) images
- Intrusive nonsense sounds, words, or music
- Lucky/unlucky numbers
- Colors with special significance Superstitious fears
- Concern with illness or disease
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in order to reduce obsessive thoughts. By carrying out compulsive acts patients anxiety is temporarily relieved. But anxiety reappears after sometimes with obsessive thoughts. Common compulsions include:
- Excessive cleaning and/or handwashing
- Ordering and arranging things in a particular, precise way
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
- Compulsive counting
- REPEATING RITUALS like Re-reading or re-writing. Need to repeat routine activities(e.g. in/out door, up/down from chair)
- Repetitive Need to touch, tap, or rub
- Sexual compulsions like compulsive masturbation.
Not all rituals or habits are compulsions/ OCD. Everyone double checks things sometimes. But a person with OCD generally:
- Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
- Spends at least 1 hour a day on these thoughts or behaviors
- Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
- Experiences significant problems in their daily life due to these thoughts or behaviors
- These repetitive acts or thoughts are very destressing and followed by guilt due to inability to stop.
It usually starts at 16-20 years of age however it can occur at any age including as early as 2 years of age in children.Children experience some of the same obsessions and compulsions as adults. One third of adults with OCD developed their symptoms when they were children. Children may have worries about germs, getting sick, dying, bad things happening, or doing something wrong. There are many different rituals such as washing and cleaning, repeating actions until they are just right, starting things over again, doing things evenly, erasing, rewriting, asking the same question over and over again, confessing or apologizing, saying lucky words or numbers, checking, touching, tapping, counting, praying, ordering, arranging and hoarding.
OCD is typically treated with medications and psychotherapy. Best results are achieved by combining both. Patients who show no/little improvement with these, can be benefited with newer techniques like rTMS (recurrent Trans-cranial magnetic Stimulation).
- Medicines may take 8 to 12 weeks to start working. Be patient.
- Talk with your health care provider to make sure you understand the risks and benefits of the medications you’re taking.
- Do not stop taking a medication without talking to your health care provider first. Suddenly stopping a medication may lead to “rebound” or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
- Report any concerns about side effects to your health care provider right away. You may need a change in the dose or a different medication.
Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP)—spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing)—is effective in reducing compulsive behaviors in OCD
Bipolar Disorder
Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. It involves clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
BPAD occurs in episodes, which may last from weeks to months. These episodes can be depressive episodes or manic episodes(mania). There could be a complete recovery in between these episodes, sometimes patient may remain symptom free for years in between episodes. But research shows as the disease progresses, these episodes can become severe or the time between successive episodes may reduce, if left untreated.
- A decreased need for sleep with little apparent fatigue
- A sudden increase in goal-oriented activities(such as a project that needs to be done to the exclusion of other activities)
- Persistent and often purposeless movement
- Restlessness and an inability to remain still
- Rapid thoughts
- Increased talking, lack of connection between thoughts/ jumping from one topic to another
- Increased energy
- Intrusive thoughts
- Reckless behavior such as gambling or spending money recklessly.
- Elevated cheerful mood
- Extreme excitability
- Sudden shifts to extreme irritability, hostility, or even anger
- Inappropriate humor and brash behavior
- Hypersexuality and sexually provocative behaviors
- Reckless and extravagant spending (including the lavishing of gifts on friends, casual acquaintances, and even strangers)
- An increased focus on religious activity.
Medications
Certain medications can help manage symptoms of bipolar disorder. Some people may need to try several different medications and work with their health care provider before finding medications that work best. The most common types of medications that doctors prescribe include mood stabilizers and atypical antipsychotics.Medications that target sleep or anxiety are sometimes added to mood stabilizers as part of a treatment plan. People taking medication should:- Talk with their health care provider to understand the risks and benefits of the medication.
- Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
- Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
- Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.
Other Treatment Options
Some people may find other treatments helpful in managing their bipolar symptoms, including:- Electro Convulsive Therapy (ECT) is a brain stimulation procedure that can help relieve severe symptoms of bipolar disorder. ECT is usually only considered if an individual’s illness has not improved after other treatments such as medication or psychotherapy, or in cases that require rapid response, such as with suicide risk or catatonia (a state of unresponsiveness).
- Transcranial Magnetic Stimulation (TMS) is a type of brain stimulation that uses magnetic waves, rather than the electrical stimulus of ECT, to relieve depression over a series of treatment sessions. Although not as powerful as ECT, TMS does not require general anesthesia and presents little risk of memory or adverse cognitive effects.
Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.
- Get treatment and stick with it. Treatment is the best way to start feeling better.
- Keep medical and therapy appointments and talk with your health care provider about treatment options.
- Take medication as directed.
- Structure activities. Keep a routine for eating, sleeping, and exercising.
- Try regular, vigorous exercise like jogging, swimming, or bicycling, which can help with depression and anxiety, promote better sleep, and is healthy for your heart and brain.
- Keep a life chart to help recognize your mood swings.
- Ask for help when trying to stick with your treatment.
Psychosis/ Schizophrenia
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities causing impairment in personal, family, social, educational, occupational, and other important areas of life. People with schizophrenia often also experience persistent difficulties with their cognitive or thinking skills, such as memory, attention, and problem-solving.
Schizophrenia symptoms can differ from person to person, but they generally fall into three main categories: psychotic, negative, and cognitive. Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. People with psychotic symptoms may lose a shared sense of reality with others and experience the world in a distorted way. For some people, these symptoms come and go. For others, the symptoms become stable over time. Psychotic symptoms include:
- Hallucinations: When a person sees, hears, smells, tastes, or feels things that are not actually there. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
- Delusions: When a person has strong beliefs that are not true and may seem irrational to others. For example, individuals experiencing delusions may believe that people on the radio and television are sending special messages that require a certain response, or they may believe that they are in danger or that others are trying to hurt them.
- Thought disorder: When a person has ways of thinking that are unusual or illogical. People with thought disorder may have trouble organizing their thoughts and speech. Sometimes a person will stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning.
- Movement disorder: When a person exhibits abnormal body movements. People with movement disorder may repeat certain motions over and over.
- Having trouble planning and sticking with activities, such as grocery shopping
- Having trouble anticipating and feeling pleasure in everyday life
- Talking in a dull voice and showing limited facial expression
- Avoiding social interaction or interacting in socially awkward ways
- Having very low energy and spending a lot of time in passive activities. In extreme cases, a person might stop moving or talking for a while, which is a rare condition called catatonia.
- Having trouble processing information to make decisions
- Having trouble using information immediately after learning it
- Having trouble focusing or paying attention
Schizophrenia symptoms can differ from person to person, but they generally fall into three main categories: psychotic, negative, and cognitive. Psychotic symptoms include changes in the way a person thinks, acts, and experiences the world. People with psychotic symptoms may lose a shared sense of reality with others and experience the world in a distorted way. For some people, these symptoms come and go. For others, the symptoms become stable over time. Psychotic symptoms include:
- Hallucinations: When a person sees, hears, smells, tastes, or feels things that are not actually there. Hearing voices is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
- Delusions: When a person has strong beliefs that are not true and may seem irrational to others. For example, individuals experiencing delusions may believe that people on the radio and television are sending special messages that require a certain response, or they may believe that they are in danger or that others are trying to hurt them.
- Thought disorder: When a person has ways of thinking that are unusual or illogical. People with thought disorder may have trouble organizing their thoughts and speech. Sometimes a person will stop talking in the middle of a thought, jump from topic to topic, or make up words that have no meaning.
- Movement disorder: When a person exhibits abnormal body movements. People with movement disorder may repeat certain motions over and over.
- Having trouble planning and sticking with activities, such as grocery shopping
- Having trouble anticipating and feeling pleasure in everyday life
- Talking in a dull voice and showing limited facial expression
- Avoiding social interaction or interacting in socially awkward ways
- Having very low energy and spending a lot of time in passive activities. In extreme cases, a person might stop moving or talking for a while, which is a rare condition called catatonia.
- Having trouble processing information to make decisions
- Having trouble using information immediately after learning it
- Having trouble focusing or paying attention
Most people with schizophrenia are not violent. Overall, people with schizophrenia are more likely than those without the illness to be harmed by others. For people with schizophrenia, the risk of self-harm and of violence to others is greatest when the illness is untreated. It is important to help people who are showing symptoms to get treatment as quickly as possible.
Current treatments for schizophrenia focus on reducing psychotic and negative symptoms and helping individuals, improve day-to-day functioning, and achieve personal life goals, such as completing education, pursuing a career, and having fulfilling relationships.
It’s important to recognize the symptoms of schizophrenia and seek help as early as possible. People with schizophrenia are usually diagnosed between the ages of 16 and 30, after the first episode of Psychosis. Studies show as the duration of untreated schizophrenia/psychosis increases complete recovery becomes less likely. Hence starting treatment as soon as possible following the first episode of psychosis is an important step toward recovery.
Schizophrenia has a heterogeneous range of end states.Some cases especially untreated for a longer period progress in to chronic schizophrenia and becomes debilitated. Some cases requirerepeated hospitalization with on and off symptoms,and in few cases, a single illness episode is followed by complete remission. Roughly half of schizophrenia patients recovered or significantly improved over the long term, suggesting that functional remission is possible. Several factors predict the course of schizophrenia, including demographic, clinical, and treatment characteristics, as well as socioeconomic variables. Studies about the outcomes after 10 years from diagnosis suggests that about 25% of people with schizophrenia will recover completely from the first episode and go on to have no further problems in their life. A further 25% will be substantially improved with treatment and will go on to recover almost all of their former level of functioning with very few relapse events. Another 25% of people will improve somewhat but will still need considerable levels of support to function normally and to get them through relapse events which will occur at several intervals in their life. This leaves the final 25% for whom the outlook is not so good. Of these, 15% will lead a chronic course with little or no improvement and involving repeated hospital stays over a prolonged part of their adult life, whilst the final 10% will die either due to physical condition or by suicide. However, with the availability of better knowledge about the disease and newer drugs recovery rates of schizophrenia are improving.
It can be difficult to know how to help someone who is experiencing psychosis. Here are some things you can do:
- Help them get treatment and encourage them to stay in treatment.
- Make sure they are taking their medicines regularly. Some patients may even need supervised medication.
- Remember that their beliefs or hallucinations seem very real to them.
- Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior.
- Discuss with treating doctor regarding any doubts about the disease/treatment than believing myths.
- Look for support groups and family education programs
Inability to Sleep
Insomnia may be the primary problem, or it may be associated with other conditions. Common causes of chronic insomnia include:
- Poor sleep habits.Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
- Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
- Travel or work schedule.Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
- Eating too much late in the evening.Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
- Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well like Mania, Psychosis, Schizophrenia, delirium.
- Medications. Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
- Medical conditions. Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
- Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
- Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
Everyone needs different amounts of sleep. On average:
- adults need 7 to 9 hours
- children need 9 to 13 hours
- toddlers and babies need 12 to 17 hours
- You probably do not get enough sleep if you’re constantly tired during the day.
Sleep is as important to your health as a healthy diet and regular physical activity. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well. Complications of insomnia may include:
- Poor attention, Concentration
- Impaired memory
- Lower performance on the job or at school
- Slowed reaction time while driving and a higher risk of accidents
- Impaired judgement/ decision making
- Mental health disorders, such as depression, an anxiety disorder or substance abuse
- Felling irritable or inability to regulated emotions
- Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease
Insomnia usually gets better by changing sleep habits. By maintain adequate sleep hygiene. DO’s
- Go to bed and wake up at the same time every day
- Relax at least 1 hour before bed, for example, take a bath or read a book
- Make sure your bedroom is dark and quiet and cool
- Exercise regularly during the day
- Make sure your mattress, pillows and covers are comfortable, can make use of some essential oil to get relaxed
- Use your bed only for sleeping
- Wind up your day with some daily habits like writing journal and saying goodnight
- Do not smoke or drink alcohol, tea or coffee at least 6 hours before going to bed
- Do not eat a big meal late at night
- Do not exercise at least 4 hours before bed
- Do not watch television or use devices, like smartphones, right before going to bed, because the bright light makes you more awake
- Do not nap during the day for more than 20-30 mins
- Do not use your bed for other purposes like eating, studying or playing
Seek help if:
- There is problem in onset of sleep/ frequent awakening at night/ inability to go back to sleep after night awakening.
- When these symptoms occur repeatedly at least three nights a week and persists for more than three months
- Waking up earlier than your regular time
- Waking up tired
- Feeling tired and sleepy throughout the day
- Inability to sleep at night is associated with overthinking, worries, negative thoughts.
- These problems persist even after following all the do’s and don’ts of sleep hygiene habits.
- Inability to sleep is impairing day time functioning
- Inability to sleep is associated with any other mental health problems.
Your doctor is the better judge of whether you required a sleeping pills/tablets and what type/ dose of medication you need, after assessing your sleep problems and your mental and physical condition. Prescribed sleeping pills (sedative -hypnotics) are mostly safe when taken under doctor’s guidance. Avoid taking these medications over the counter without any medical guidance. Prescribed sleeping medication can be beneficial when taken for a shorter period of time. And they have to be gradually tapered down and stopped to avoid withdrawal symptoms.
Yes, there are other prescription medications that can be used to treat insomnia/inability to sleep like Melatonin: This is the natural hormone secreted in our body which regulates sleep and wakeful cycle. This can be used in some individual to treat insomnia. Other anti-cholinergic and anti-histamines which has sedation as their side effect can be made use to treat insomnia. Progressive muscle relaxation therapy, sleep meditation and imagery, paradoxical intention, controlled sleep deprivation these are some psychological treatment methods used to treat inability to sleep
Sexual Disorders
- Problem in Desire: lack of sexual desire or interest in sex, both in men and women.
- Problem in Arousal: inability to become physically aroused or excited during sexual activity. Inability to achieve or maintain an erection (hard penis) suitable for intercourse (erectile dysfunction).
- Problem in Orgasm: delay or absence of orgasm (climax). Absent or delayed ejaculation despite enough sexual stimulation (retarded ejaculation). Inability to control the timing of ejaculation (early, or premature, ejaculation). Inability to achieve orgasm.
- Pain disorders: pain during intercourse, both in men and women.
- Inadequate vaginal lubrication before and during intercourse.
- Inability to relax the vaginal muscles enough to allow intercourse.
There are a number of causes of sexual dysfunction . They are grouped into two categories: physical causes and psychological causes.
Physical Causes
There are many physical causes of sexual dysfunction. For example, the following diseases and conditions can lead to problems with sexual function:- Diabetes
- Cardiovascular disease (heart disease and blood vessel disease)
- High blood pressure
- High cholesterol
- Alcoholism
- Smoking Cigarette
- Drug abuse
- Hormonal imbalances
- Neurological disorders
- Chronic diseases, such as kidney failure
- Nerve damage
- Urological infections or cancer
- Some Prescription medications
Memory Disorders
Dementia is a term used to describe a group of symptoms affecting memory, thinking and social abilities that interfere with your daily life. Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer’s is the most common cause of dementia. Usually occurs at old age and the risk of dementia increases with increasing age.
It’s normal to forget things once in a while as we age, but serious memory problems make it hard to do everyday things like driving, using the phone, and finding your way home. Apart from memory Dementia involves impairment in other cognitive functions like, language, praxis, new learning ability. Signs that it might be time to talk to a doctor include: Asking the same questions over and over again
Getting lost in places a person knows well
Forgetting that they have eaten food or taken medicines and asking for food again
Having trouble following recipes or directions
Difficulty communicating or finding words
Difficulty with planning and organizing
Not able to carry out basic tasks which they were well versed with like dressing, writing, bathing
Repeatedly forgetting family member’s or relative’s name, or calling them with different names.
Becoming more confused about time, people, and places, even inside the house.
Forgetting important recent events or festivals.
Not taking care of oneself —eating poorly, not bathing, or behaving unsafely
Some times dementia may also be associated with psychological changes like remaining dull and sad or extremely irritable, disturbed sleep, crying spells, Depression, anxiety, remaining withdrawn, Inappropriate behavior, Personality changes, being fearful (Paranoia), agitation, hallucinations.
Dementia is caused by damage to or loss of nerve cells and their connections in the brain. Depending on the area of the brain that’s damaged, dementia can affect people differently and cause different symptoms. And depending on what causes this neuronal damage dementia can be of different types and can be either reversible or irreversible. Irreversible causes/types of dementia are:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia.
- Huntington’s disease
- Traumatic brain injury (TBI)
- Creutzfeldt-Jakob disease
- Parkinson’s disease
- Infections and immune disorders
- Metabolic problems and endocrine abnormalities
- Nutritional deficiencies
- Medication side effects
- Brain tumors
- Normal-pressure hydrocephalus
- Stop smoking, alcohol intake
- Manage cardiovascular risk factors like taking proper treatment for hypertension and diabetes and maintaining normal blood pressure and blood glucose
- having a healthy diet- reduce junk food and complete your daily requirement of vitamins and micronutrients.
- Be Physically active
- Participating in community activities- having a active social life and interactions reduces the risk of cognitive decline.
- Maintain hobbies/activities which are stimulating to brain.
Child and Adolescent Psychiatry
Although it is sometimes assumed that childhood and adolescence are times of carefree bliss, as many as 20% of children and adolescents have a diagnosable mental disorder that causes impairment. With increasing age, more children develop one or more disorders.
Almost all the psychiatric disorders which are seen in adults can be seen in children like
- Anxiety disorders
- Stress related disorders
- Depression and Bipolar mood disorders
- Obsessive compulsive disorders
- Psychosis/ Schizophrenia
- Dissociation disorder
- Autism Spectrum disorders
- Attention Deficit Hyperactive Disorder (ADHD)
- Specific Learning Disorders / Dyslexia
- Tic / Tourette Disorder
- Intellectual disability
- Language and speech disorders
- Enuresis (Bed wetting)
- Eating disorders like pica, Avoidant/Restrictive food intake disorders
- Disruptive disorders like Oppositional Defiant Disorder and Conduct disorder
- Impulse Control Disorders
- Intermittent Explosive disorders
- Sleep related disorder
- Child abuse and neglect
Warning signs that your child may have a mental health disorder include:
- Persistent sadness that lasts two weeks or more
- Withdrawing from or avoiding social interactions
- Hurting oneself or talking about hurting oneself
- Talking about death or suicide
- Outbursts or extreme irritability
- Out-of-control behavior that can be harmful
- Drastic changes in mood, behavior or personality
- Changes in eating habits
- Loss of weight
- Difficulty sleeping
- Frequent headaches or stomachaches
- Difficulty concentrating
- Changes in academic performance
- Avoiding or missing school
- Changes in play behaviour
If you see above mentioned changes in your child or concerned about your child’s mental health, consult your child’s health care provider or a psychiatrist. Describe the behaviors that concern you. Talk to your child’s teacher, close friends, relatives or other caregivers to see if they’ve noticed changes in your child’s behavior. Share this information with your child’s health care provider/psychiatrist.
Common treatment options include:
- Psychotherapy:Psychotherapy is also known as talk therapy. Psychotherapy is a way to address mental health concerns by talking with a psychologist/psychiatrist or other mental health professional. With young children, psychotherapy may include play time or games, as well as talk about what happens while playing. During psychotherapy, children and adolescents learn how to talk about thoughts and feelings, how to respond to them, and how to learn new coping skills.
- Behavioural Therapy: Behavioural therapy mainly aims at reducing maladaptive or harmful behaviour and encouraging healthy behaviour by using techniques of positive and negative reinforcement, Parents are involved in the therapy and taught how to practice these techniques at home.
- Medication:Though psychotherapy and behavioural therapy forms the main part of the treatment of most of the mental illnesses in children certain psychiatric disorders requires the use of medications for full recovery/management. Your psychiatrists are the best judge of what medications can be given (which are FDA approved) in children and up to what dosage. Your psychiatrist will explain risks, side effects and benefits of drug treatments.
Epilepsy
A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. Epilepsy may occur as a result of a genetic disorder or an acquired brain injury, such as a trauma or stroke. During a seizure, a person experiences abnormal behaviour, symptoms and sensations, sometimes including loss of consciousness. There are few symptoms between seizures. Epilepsy can start at any age, but usually starts either in childhood or in people over 60.It’s often lifelong, but can sometimes get slowly better over time.
In most cases, it’s not clear why this happens. It’s possible it could be partly caused by your genes affecting how your brain works, as around 1 in 3 people with epilepsy have a family member with it. Occasionally, epilepsy can be caused by damage to the brain, such as damage from:
- Stroke
- Brain tumour
- Severe head injury
- Drug abuse/Alcohol misuse
- Brain infection
- Lack of oxygen during birth
- Metabolic imbalance
Seizures can affect people in different ways, depending on which part of the brain is involved. Possible symptoms include:
- Staring
- Jerking movements of the arms and legs
- Stiffening of the body
- Loss of consciousness
- Breathing problems or breathing stops
- Loss of bowel or bladder control
- Falling suddenly for no apparent reason, especially when associated with loss of consciousness
- Not responding to noise or words for brief periods
- Appearing confused or in a haze
- Nodding the head rhythmically, when associated with loss of awareness or even loss of consciousness
- Periods of rapid eye blinking and staring,lip smacking
- strange sensations, such as a “rising” feeling in the tummy, unusual smells or tastes, and a tingling feeling in your arms or legs
Things“to do” if someone is having a seizure
- DO Move any objects, such as furniture, away from them so that they don’t hurt themselves. Only move the person is they are in a dangerous place, for example in the road
- DO Put something soft (such as a jumper) under their head to stop it hitting the ground
- DO Check the time to see how long the seizure goes on for. If the seizure lasts more than 5 minutes call an ambulance.
- DO Try to stop other people crowding around. Think of your casualty’s dignity – they wouldn’t want to awake to see lots of faces staring at them. Try to minimise any embarrassment. If they have wet themselves deal with this as privately as possible (for example, put a coat over them).
- DO call an ambulance if you have any concerns or they have injured themselves during the seizure. Most people’s seizures will stop on their own and the person will not need any medical help.
- DO take notes on what you observe during the seizure. This will be very useful to them and their medical team afterwards.
- DO Stay with them until they recover and can safely return to what they had been doing before. Some people recover quickly but others may take longer to feel back to normal again.
- DO Check that their breathing goes back to normalafter the seizure. Put them in the Recovery Position if they don’t wake up.
Things “NOT to do” whilst someone is having a seizure
- DO NOT restrain (try to hold down) the person.
- DO NOT place anything between the person’s teeth during a seizure (including your fingers).
- DO NOT move the person unless they are in danger or near something hazardous.
- DO NOT try to make the person stop convulsing. They have no control over the seizure and are not aware of what is happening at the time.
- DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.
- DO NOT start CPR unless the seizure has clearly stopped and the person is not breathing or has no pulse.
- DO NOT leave them. Stay with them so they have someone there when the seizure stops.
- DO NOT attract unnecessary attention to them whilst they are having their seizure – unless you can get someone who knows them to come and be with them for support.
Specific treatment for a seizure will be determined by your doctor based on:
- Your age, overall health, and medical history
- Extent of the condition
- Type of seizure
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
- Medications There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication, and the adherence with the use of the medication.
The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone. The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very high- fat, low- carbohydrate diet causes the body to make ketones. Ketones are made by the body from the breakdown of fat. They are made for energy when the body does not get enough carbohydrates for energy. If your child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is important to the success of the diet. High-fat foods:
- Butter
- Heavy cream
- Oil
- Mayonnaise
- Cream cheese
- Bacon
- Cheese
De-Addiction
De-Addiction related problems are complex, and often chronic, brain diseases. These are characterised by drug craving, seeking, and use which can persist in the face of devastating life consequences.
The physical signs of abuse or addiction depends on the person and the drug being abused. Each drug has short-term and long-term physical effects on the people which is very dangerous for their future lives. Cocaine increases heart rate and blood pressure, whereas Opioids may slow the heart rate and reduce respiration.
If a person is compulsively seeking and using drugs despite negative consequences (loss of job, debt, family problems, or physical problems brought on by drug abuse), then he/she is addicted.
Treatment may vary for every person. It depends on the type of drugs being used. With behavioural therapies, Drug Addiction can be effectively treated and addiction to some drugs such as heroin, nicotine, or alcohol, medications.
Headache
- Depression.
- Bipolar Disorder.
- Anxiety Disorder.
- Consuming alcohol, nicotine etc.
Somatic Disorder is diagnosed when a person focuses on his/her physical symptoms significantly, such as pain, weakness or shortness of breath which result in major distress or problems functioning.
- Genetic reasons, such as Pain Sensitivity.
- Difficulty in dealing with stress.
- Negative affectivity.
- Decreased emotional awareness etc.
- Neurologic problems.
- Sexual symptoms.
- Pain.
- Gastrointestinal complaints etc.
Motivational Enhancement
Motivational Enhancement Therapy is a therapeutic approach that aims to help the individuals identify and resolve reversibility regarding alcohol and other drug use.
- Avoid arguments.
- Accept resistance.
- Express empathy.
- Acknowledge discrepancy.
- Support self-efficacy.
- Building motivation to change.
- Strengthening commitment to change.
- Follow through and consolidation of motivation.
- You can feel better.
- You can regain self-confidence.
- You will be stress-free etc.
Counselling and Therapy
Counselling, the process between an individual and the counsellor, helps the individual to overcome the difficulties. It helps to change the maladaptive or unhealthy emotional, behavioural or cognitive aspects.
‘Counselling’ & ‘Therapy’ are often used to mean the same explanation. In Counselling, the counsellors focus on the specific problems. On the other hand, Therapy focuses on your problem deeply.
Counselling is only for those people (students, working professionals, couples, parents) who are very mentally disturbed. Most of the time, people who can think, feel and behave appropriately, but sometimes, they may require help to enhance, develop, improve his/her condition.
- Anxiety, Depression, Stress.
- Relationship Issues.
- Academic Problems.
- Loneliness etc.
Couple Therapy
Couple Therapy is a form of psychotherapy which is helpful for you and your partner. Through this, we help to improve your relationship. If you are facing any difficulty in your relationship, you can seek Couple Therapy to rebuild your relationship.
- Straight or Gay Relationships.
- Relationships with a significant age gap.
- Young teen or college relationships.
- Interracial Relationships etc.
- Emotionally Focused Therapy.
- Psychodynamic Couple Therapy.
- Behavioral Therapy.
- Cognitive Behavioral Therapy etc.
- Identifying Feelings.
- Exploring The Past.
- Focusing on Solutions.
- Teaching Skills etc.
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'Nirvana Psychiatric Clinic' is providing you with the Best individualised Psychiatric Treatments in Raipur designed to help you, under the supervision of two excellent Psychiatrists, Dr. Vikalp Wasnik and Dr. Shalini Bijali.
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