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Ayur-rekha - Health Line.
Greetings.
Welcome to Ayur-rekha.
We observe Oct 10 as Mental Health Day.
Diseases seen in many people like Bipolar Disorder
and such psychiatric disorders are under discussion
in Ayur-rekha today.
Today, a well known psychiatrist from Kozhikode
who is Clinical Director of Mental Health Action Trust
Dr. T. Manoj Kumar, is with us.
Doctor, welcome to Ayur-rekha.
Thank you.
What is Bipolar disease?
Bipolar disorder, or Bipolar mood disorder
or Bipolar affective disorder -
this was earlier known as Manic Depressive Psychosis.
This is a severe mental illness.
There are mental illnesses which are severe and which are not severe.
Among the severe ones are schizophrenia and so on.
This is one of those serious mental illnesses,
Bipolar mood disorder or Bipolar affective disorder.
This is a mental illness which comes and goes.
It can manifest in two ways.
In the state of depression
or in the state of mania.
If you take into account all mental illnesses
and even physical illnesses,
this is an illness which causes a lot of loss for society.
According to World Health Organisation - WHO -
even if you take into account all illnesses in the world,
the 6th ranking illness in terms of loss to society
is this Bipolar mood disorder.
Even if you consider diseases like cancer and so on,
in terms of loss to society -
lost productivity, people being unable to work,
when all such losses are calculated,
it is the 6th ranking illness in terms of morbidity.
In our country, as well as abroad, this illness
affects a lot of people, especially youngsters.
What are the symptoms of this illness?
As mentioned earlier, there is one phase of mania or hypomania,
and another phase of depression, which come alternately.
An illiterate patient had told me once,
"it is like voltage increasing and voltage decreasing" -
that is how he described his own illness.
In the phase of mania, there will be more energy, more thoughts,
less sleep is needed, there will be euphoria, anger,
they will do things which they don't do normally.
They will take risks, will spend more money.
They will get into problems.
Mania is such a state which causes all these
disruptions, a very problematic phase.
Hypomania is a milder form of this mania.
Depression is more familiar to us.
Energy is less, sleep is lacking,
no appetite, we become apathetic about doing any work,
there is sadness in the mind,
suicidal thoughts may occur,
feelings of guilt without any reason,
lack of expectations,
these are the symptoms of the depression phase.
All patients with depression need not get mania.
It is only when the same patient shows both phases
that we call it bipolar disorder.
Nowadays we don't see bipolar disorder as a single disorder.
We call it bipolar spectrum disorder.
In that spectrum, there can be various
different stages of the illness.
Doctor, we have a call,
Hello,
Is it doctor?
From where are you calling?
Hello?... Hello.
From where are you calling?
From Payyoli.
All right. Speak to the doctor.
Greetings.
Doctor?
Tell me.
My name is Sajith, I am 30 years old.
For the last ten years I am taking anti-depressants.
Are there any side-effects due to taking them?
The doctor says I should continue.
Yes. In general, such anti-depressants have very few
serious side-effects.
The doctor says I should continue to take them.
It would be good to continue to do that as the doctor says.
I just wanted to know if there are any side-effects for it...
There will be no more side-effects other than what
you have been experiencing till today.
If it is taken continuously, whether anything in the long term.....
If there was anything, it would already have come now.
Usually, gaining weight is a side-effect.
If that has not happened till now, in future also
nothing significant is expected to happen.
No, I am not gaining weight.
My opinion is that you can continue the medicine without any hesitation.
I do not know more details about you, but from what you have said,
I feel that you can safely continue the medication.
OK doctor, thanks.
Thank you for calling Ayur-rekha.
There is another call,
Hello ... Hello,
Who is speaking?
My name is Chandu Nair ...
Yes, speak to the doctor.
Tell me.
Good afternoon doctor.
Good afternoon. Tell me.
My name is Chandu Nair.
Hello.
I saw this program in Asianet News,
this is for myself only,
I was abroad for 24 years or so.
For the last few years I am back here,
and staying with my family.
My problem is excessive anger.
Excessive?
Anger. When my family members say something, I get very angry.
And immediately I cool down also.
Even for small things.
Whether it is my son or someone else,
my reaction is very fast.
When something negative is told,
I react immediately, I am unable to control it.
And later you regret it, right?
Yes, later I feel I should not have spoken like that.
Other than this, you don't have any other symptoms, right?
Other than this, I am perfectly OK.
Earlier I was in service, then I went abroad for 10-20 years....
So this has not affected your life significantly.
You have lived a successful life. Right?
Yes.
So, this cannot be regarded as a disease.
What we are discussing here, bipolar disorder,
that is unlikely to be your problem.
This is like a part of our personality, a small defect,
which we would like to change ourselves.
For this, there is anger management,
a type of psychological help.
So, wherever you are at the moment,
you could consult a good clinical psychologist,
or counsellor, and you could learn about anger management.
Especially for people who are not too young,
people who have life experience, you can do it.
This sudden losing of temper - when I speak something positively,
when they respond in a negative manner...
First accept what I say, and then respond.
I tried to educate them like this. But no.
We cannot expect others to change.
We can only change ourselves.
Exactly.
To deal with this, to overcome this,
what you need is psychological help.
OK.
It is called anger management.
OK. Just because I saw this program, I called, in case any advice...
We cannot give detailed advice in such a short interaction.
Some sessions would be needed.
A series of sessions with a psychologist would be needed.
All right, thank you for calling Ayur-rekha.
Doctor, what are the circumstances under which bipolar disorder manifests?
It is like other illnesses.
Mental illnesses are due to changes in the brain.
Mental illness is just like any other disease in our body.
The only thing is that it affects the brain.
An important finding is that
for 70% of people in the bipolar spectrum,
the reasons are hereditary.
70% of the reasons are heritable.
The rest - our surroundings, circumstances of upbringing,
the stress we experience,
when all these come together, the disease manifests.
In short, if bipolar disorder is seen in our family,
that increases the chances that we also suffer from it.
For example, we say that for first degree relatives -
children, siblings, parents -
someone with the illness in such a family member
indicates that our chances of the illness increases ten-fold,
as compared to someone who does not have such family history.
So, in short, if the family has this,
the chances are higher that coming generations
in the family also have the illness.
That is what we have to be careful about.
OK. How do we recognise that there is an illness?
Generally, if we take the stage of mania,
the patient may not recognise that he/she has the illness.
For them, it may be a pleasant experience.
Euphoria, more energy, thinking expands.
For many, it may be a pleasant experience.
So, often, in this manic phase, the people around,
the family members, would recognise the change.
That is also a big problem.
Because when we feel that we don't have any illness,
we will not be ready for treatment.
So, even if family members say so, patients
may not be ready for treatment.
That is mania.
Depression can be recognised by the patient also.
Mental pain, a feeling that things are not right,
lethargy, inability to be happy,
seeing everything negatively, like watching
everything through a dark lens, seeing darkness everywhere.
When such thoughts assail us, we will ourselves recognise,
even if someone else does not understand.
These are the preliminary signs of the illness.
The importance of this is, once these are seen,
recognising that this is the illness,
especially if there is a family history of such illness,
and getting treatment as soon as possible would be best.
These are early warning signs.
Doctor, we have a call.
Hello ... Hello,
From where are you calling?
Yes, tell us, we are listening. From where are you calling?
The patient is 42 years old.
He does not take the medicine.
Is it bipolar disorder?
Hello, it is not clear...
Yes, tell us, we are listening.
42 years old. He will not take the medicine.
How long has he been unwell?
Now it has been two years.
What did the doctors say as the diagnosis?
They said it is bipolar.
I see.
That is what I mentioned just now.
The people who have the illness often
will not recognise that they have the illness.
And they may refuse medicines.
That is a big problem.
Are you not able to talk to him and make him have the medicine?
Can't you force him to have it?
He will not have medicine.
Once the doctor treated, but..
If you can talk him into taking the medicine....
Sometimes, if the patient becomes violent, or...
Yes, he becomes violent.
Then there are some injections which can be given,
which need to be given only once in two weeks.
For those who refuse medication, doctors can give
such long-acting injections.
Once in two weeks.
There are such injections.
Or, for a short period, getting admitted somewhere
getting treated, then coming out and continuing the treatment.
These are some options.
All right, thank you for calling Ayur-rekha.
Doctor, what are the side-effects of the medicine?
When someone called earlier I mentioned
that matter of anti-depressants.
But other medicines are different from those.
There are three types of medicines which are mainly used.
As mentioned before, manic and depressive episodes alternate -
there is one medicine to prevent this.
Earlier, those medicines which were used for epilepsy as anti-convulsants,
and a medicine lithium carbonate - these are used
to prevent episodes - for prophylaxis.
Unfortunately all these have side-effects.
But a good doctor will take the side-effects into account
and reduce the dose accordingly, managing in that way.
There may be some side-effects which are unavoidable,
for some others there may be no problems at all.
Then there are medicines called anti-psychotics.
When the mania is on the upswing, these reduce the severity of the illness.
The earlier medicines are to prevent episodes.
When an episode is going on, to reduce the severity,
anti-psychotics and anti-depressants are used.
These anti-psychotics have their own side effects.
But as mentioned before, a good doctor will anticipate the side effects,
adjust the dosage accordingly, and manage like that.
We ourselves see around 3000 needy patients.
Most of them have this bipolar disorder.
But we are able to manage a good percentage of them
using these medicines.
Side-effects of medicines is a problem -
we cannot deny that -
but a bigger problem, as mentioned by the previous caller
is the refusal to take the medicines.
Doctor, we have a call.
Hello ... Hello.
Welcome to Ayur-rekha.
From where are you calling?
From Palakkad.
All right, you can speak to the doctor.
Greetings.
I'm calling for my wife.
60 years old.
It has been 5-8 years, maybe more...
The problem is, once in a year,
sleep becomes less.
Then, she will get up at night
and chant some shlokas.
That is how it begins.
And then later, after a few days
speaking loudly, shouting.
Talking unrelated things without any reason and so on.
She is taking treatment now.
The medicines are, one, Qutan,
Yes, Quetiapine, and ...
Litha...
Yes, as we mentioned earlier, lithium.
She is taking these two.
The doctor is Dr. Praveen
At Thrissur?
When I heard this bipolar disease discussion
when I checked on the 'Net, I thought it was similar,
so I called.
Yes.
After taking the medicines, she speaks normally.
after a day or two of taking medicines.
After some days, it completely goes away.
For her, she does not know.
The doctor said that the dose can be reduced gradually.
Very good.
When the illness is more, we give 300, qutan
and then we give other medicines also.
Licab has to be taken continuously.
The qutan dose now, latest situation, 100 mg.
Very good.
This is likely to be bipolar disorder.
The treatment method is also correct.
As mentioned before, one of the medicines
licab, lithium....
I think the call is cut. Let us continue.
Lithium as a preventive. And as the gentleman said,
in bipolar disorder, the manic phase
is what happens once a year.
At those times, the anti-psychotic
Quetiapine is increased.
And the other medicine continues as a preventive.
That is the correct treatment.
Other than medicine, how far is meditation useful?
Other than these medicines?
Meditation, yoga and so on?
As a treatment, not much of a role.
That is, to remove the state of illness, medicines are required.
But in prevention - to handle stress and problems in life
as a part of healthy living,
counselling, yoga, meditation, exercise -
exercise is very important -
all these things are important.
Shock treatment - how and what is it?
Unfortunately it has become controversial,
this is a very effective method of treatment.
Nowadays, for very few patients,
only when there is no other way,
do we use this electro-convulsive or shock therapy.
Usually for very severe depression.
Sometimes, due to the illness,
the patient may not eat food, or drink water at all.
When the patient may die of lack of food,
at that stage, we have to do something quickly.
In such situations, this shock therapy is very effective.
Doctor, we have a call.
Hello....
Hello, greetings.
Greetings.
Speak to the doctor.
My name is Mohanan, 60 years old, calling from Coimbatore.
I have a sort of fear all the time in my mind.
When I see TV, I feel like switching it off.
While doing something, feel like going on a journey.
Going on a trip, feel like going back.
For how long do you have this?
It has started around two weeks back.
Has this happened earlier?
Earlier... some 3-4-5 years ago it was there.
I used to take the Stresnil tablets.
Which one?
Stresnil.
Do any other family members of yours have any type of mental illness?
No one has.
All right. Most probably...
it is not correct to give a diagnosis
after talking to you for just two minutes,
but this seems to be a stage of depression.
Anyway it has only been two weeks.
If it does not go away by itself,
there are some medicines of the anti-depressant type,
very safe medicines, which if you take for a few months,
you will come back to normal.
It is likely that you have a mild depression,
what you are experiencing now.
It is a condition which has good treatment options.
All right, thank you for calling Ayur-rekha.
Other than shock therapy, are there other therapies?
In that manner, there are no other therapies,
among physical treatments. Shock therapy, then medicines
as I have mentioned before to a caller, injections.
These are the treatments.
The rest, like I mentioned before,
psychotherapy, counselling, help in preventing
relapse of the disease and in general
help in coping with life, and in understanding the illness,
we call it psycho-education.
The other methods of treatment have these roles in the illness.
But for severe cases, medicines are the indicated treatment.
Ayur-rekha's time is up now.
Thank you for answering our viewers' queries.
Thank you.