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| Sunday, 12 October 2003 |
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Features |  |
| News Business Features Editorial
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Mental Health Day fell on Oct. 10 : Panic disorder
Panic attacks are a common reaction to extreme stress. Not everyone who has a panic attack has panic disorder. To be diagnosed as having the illness, a person must have had at least four panic attacks in a four-week period. The attacks must include a combination of symptoms such as sweating, shortness of breath, heart palpitations, chest discomfort, unsteady feeling, choking or smothering sensations, tingling, nausea or abdominal distress, feelings of unreality, fear of losing control, dying or going insane. The pain these symptoms bring is sometimes so acute that it drives the panic disorder sufferer to a hospital emergency room; doctors unfamiliar with the illness may judge that the patient is in no danger and send him or her home. Often, the undiagnosed panic disorder sufferer starts avoiding situations or places - like elevators or buses - where panic attacks have occurred, sometimes even becoming reclusive. Panic disorder afflicts twice as many women as it does men. It knows no racial, economic or geographic boundaries. Because victims often hide their illness and because health care professionals often do not recognize it, it is difficult to gauge how widespread panic disorder is. Recent studies in America suggest that panic disorder's roots are both physical and psychological. Researchers have found the illness runs in families - a fact which supports the idea that the condition may pass genetically from generation to generation. Correct diagnosis Panic disorder is often mistaken for other medical or psychiatric problems, such as heart disease, thyroid problems, respiratory problems or hypochondriasis. To correctly diagnose the disorder, the physician or psychiatric physician will first ensure the patient has had a thorough physical examination, and will piece together a complete knowledge of the patient's background, history of drug and alcohol use (or abuse) and medical history, to gain the complete understanding needed to begin treatment. Treatment Today, psychiatrists treating panic disorder have a number of medicines and therapies they can use to help their patients. Typically, treatment involves education about the illness, medication if warranted, psychotherapy and behavioural treatment techniques such as relaxation training. With appropriate psychiatric treatment, nine out of ten sufferers will recover and return to normal life. ***** Schizophrenia Schizophrenia is a name given to a large group of disorders, usually of psychotic proportion, manifested by characteristic disturbances of thought, mood, and behaviour. Thought disturbances are marked by alternations of concept formation that may lead to misinterpretation of reality and sometimes to delusions and hallucinations. Mood changes include ambivalence, constriction, inappropriateness and loss of empathy with others. Behaviour may be withdrawn, regressive and bizarre. Currently recognised types of schizophrenia are: Acute schizophrenic episode: A condition characterised by the acute onset of schizophrenic symptoms, often associated with confusion, perplexity, ideas of rejection, emotional turmoil, excitement, depression, fear, or dreamlike dissociation. This term is NOT applicable to acute episodes of other types of schizophrenia described here. Catatonic type: A schizophrenic disorder manifested in either or both of two ways; (i) by excessive and sometimes violent motor activity and excitement, or (ii) by generalised inhibition manifested as stupor, mutism, or negativism. Childhood Schizophrenia: Schizophrenia appearing before puberty. It is frequently manifested by autism and withdrawn behaviour; failure to develop an identity separate from the mother's' and general unevenness, gross immaturity and inadequacy in development. Hebephrenic type: A schizophrenic disorder characterised by disorganised thinking, shallow and inappropriate effect, inappropriate giggling, silly and regressive behaviour and mannerisms, and frequent hypochondriacal complaints. Delusions and hallucinations are usually bizarre and not well organised. Latent type: A condition manifested by clear symptoms of schizophrenia but no history of psychotic schizophrenic episodes. Sometimes designated as incipient, prepsychotic, pseudoneurotic, pseudo-psychopathic, or borderline schizophrenia. Paranoid type: A schizophrenic disorder characterised primarily by the presence of persecutory or grandiose delusions, often associated with hallucinations. Process schizophrenia: Unofficial term for schizophrenia attributed more to organic factors than to environmental ones; typically begins gradually, continues chronically and progresses (either rapidly or slowly) to an irreversible psychosis. ****** When one's behaviour becomes a problem... by Dr. R. A. R. Perera About ten per cent of psychological references are labelled as 'personality and behavioural disorders'. The World Health Organisation defines a person with personality disorder as someone with deeply ingrained, maladaptive patterns of behaviour generally recognizable by the time of adolescence or earlier and continuing through most of adult life. What is considered a personality disorder by one observer may be considered normal by another. It may be difficult to distinguish stress-related reactions and unacceptable behaviour from personality disorder. In patients with problem personalities, evidence of serious, repeated or long-standing problems will be found for example: . Problem at school, work, with the police or marriage Such people also show irresponsibility, lack of concern for others, inability to profit from past experience and an inability to form and maintain close warm relationships. The individual naturally 'plays down' this history but inconsistencies at the interview, followed up by direct questioning and tactful confrontation, will usually reveal the problem. A family history of personality disorder, absence of, or rejection by parental figures in early life, and limited opportunities for early close relationships and for identification with satisfactory models are common associations. Violent problem personalities report punitive, rejecting, alcoholic or persistent anti social parents, excessive physical punishment and problem-solving by violence. Childhood fire setting and cruelty to animals is significant and repeated violence as an adult and associated jealousy makes future violence more likely. Such persons may be brought in to a psychologist because of . A chance association of physical and mental illness. . Consequences of their behaviour, such as injury or intoxication . Psychological complaints, tension, boredom, depression, feelings of rejection and loneliness. These may be complicated by maladaptive impulsive behaviour, for example self-poisoning and self-mutilation. Acute stress reactions and short-lived conduct disorders may resemble as a personality disorder, especially when the patient is emotional. Organic brain disease, mental handicap or alcohol intoxication can present as behaviour difficulties when compounded by lack of satisfactory history and difficulties in communication. Sometimes a psychosis or a neurosis may present as a personality disorder. Priorities set by patient, such as finance, housing, police or marital problems, may need to be dealt with as a first step. Triggers to outbursts of disturbed behaviour should be sought at an early stage. Overwhelmed by a strong emotional reaction, the patient takes refuge in problem behaviour. The patient must be made aware of the link between the trigger and the impulse for maladaptive behaviour. Avoidance or control of triggering situations should be promoted. Repeated detailed 'thinking through' of the consequences of actions should approach impulsiveness. Reminders of past and present achievements and respect shown by others in words and actions can reduce depressive feelings. Self-mutilation, such as repeated wrist slashing, requires exclusion of psychosis and attempted suicide. Self-mutilation is reinforced by effective reduction of tension following cutting and the inevitable medical and personal attention shown by the family. Dealing with these problems due to choice or impossible behaviour requires services of volunteer or state social services participation on long term basis. ********** October is cancer month : Fibre intake prevents colon cancer by Dr. D.P. Atukorale Fibre is the complete mixture of substances derived from cell wall of plants. our digestive enzymes cannot digest this fibre and when we eat vegetables, fruits, legumes, whole grains nuts and seeds we are taking fibre. Fibre is absent in meat, fish and animal products. There are two categories of fibre, soluble and insoluble fibre. Soluble fibre is more important than insoluble fibre. Soluble Fibre Mucilage, pectin and gums form soluble fibre found inside and around plant cells. Soluble fibre dissolves in water unlike insoluble fibre which does not dissolve in water. Soluble fibre is present in pectin of apples, berries and oranges (which causes jams, jellies and marmalades to gel). Soluble fibre is also found in legumes, beans, vegetable gelatin of seaweed origin, vegetables and fruits like citreous fruits, rice bran, pulses such as dhal, bananas and apples. Insoluble Fibre Cellulose, hemicellulose and lignin are found throughout plant kingdom and this insoluble fibre does not dissolve in water. Wheat bran is high in insoluble fibre. Vegetables such as cabbages, "Gotukola", "Thampala" and "Saarana" are rich in insoluble fibre. Fibre is not digested as it moves through our stomach and intestines and the beneficial effect of insoluble fibre results in its ability to hold water as it passes through the intestines and the fibre provides a mass to the faeces thus creating a large soft stool which moves through the intestine easily and quickly and takes with it many substances which could trigger disease process. Soluble fibre present in oat bran, pectin of fruits, gaur and gums in legumes have been found to reduce blood cholesterol (by preventing the absorption of cholesterol secreted with bile juice into the intestine) as well as cholesterol consumed in the diet: Fibre is also found useful to control blood sugar levels by promoting slow and gradual delivery of dietary carbohydrates instead of short rises and falls. Endurance athletes find a program meal of food rich in soluble fibre such as lentils (dhal) to be preferable to sugar. Dietary fibre helps in weight reduction as high fibre foods increase the feeling of fullness and reduces hunger and it is always advisable to consume dietary fibre in moderation and according to WHO an adult should take 25-40g of dietary fibre per day. Dietary Fibre and Colon Cancer Colon cancer (which is quite common in the Westerners and which is not common among Asians especially those who take vegetarian or near-vegetarian diets) has been linked to lack of fibre in the diet. Although two studies published one year ago in New England Journal of Medicine showed that consumption of high fibre diets do not prevent colon cancer in people with diverticular disease, the fact remains that colon cancer is not common among vegetarians. Fibre is one of the most important factors thought to prevent colorectal cancer. When fibre enters the large bowel, fibre increases the stool weight, reduces transit time, dilutes colonic contents and stimulates bacterial anaerobic fermentation. This process reduces the contact between the intestinal contents and the mucosa (thin inner surface of the intestine) and leads to fermentation of short chain fatty acids, acetate, propionate and butyrate which reduces pH (ie increases the acidity) and converts primary to secondary bile acids.Butyrate is a major source of energy to distal colon and it reduces cellular proliferation and induces apoptosis, factor that is associated with transformation of colonic epithelium to carcinoma. ************* Visual impairment
The eye is one of the most delicate structures of the whole human body and is easily damaged by blows or penetrating injuries or eye disorders. Some of the commonest eye disorders are as follows: Red Eyes: Some red eyes are painful, others are not. Some causes of red eye can affect the vision, therefore self-medication with eye drops and eye ointments is dangerous at any cost. Conjunctivitis: Commonly referred to as "Sore Eyes" is a reaction of the thin membrane covering the front of the eye. It usually occurs in both eyes. If apparently one sided other causes, eg. glaucoma, should be considered. The white of the eye becomes red, and irritable with distended blood vessels, burning and tears one may have difficulty in looking at light (Photophobia). Discharge from the affected eye may stick the eyelids together. The cause may be "VIRAL" (Adenovirus type), "BACTERIAL" (the discharge is thick and yellow in colour) or 'ALLERGIC'. The disease is usually self-limiting in case of viral infection, but anti-biotic drops are being used to prevent secondary infection with bacteria. Acute glaucoma - This is a disease of middle aged or later life. Usually one sided; the patient experiences blurred vision and Haloes around lights specially at night. The cause is blockage of the normal drainage of liquid inside the eyeball, hence increasing the internal pressure of the eye. There are many types of glaucoma, but untreated, all are liable to lead to blindness. Acute glaucoma is an emerging and must be treated in a hospital without delay. Fortunately, surgical and medical treatment including the administration of special eye drops, have considerably improved the outlook for most cases. Most people have a habit of using eye drops whenever they get red eye without consulting a doctor for diagnosis. In glaucoma self-medication is so dangerous. Foreign bodies in the Eye Those vulnerable to this are specially those who ride on a motor bike or walk on the roads exposing themselves to dust particles. Insects and other tiny objects can also get into your eye. This is also one of the common causes of Red Eye. It is advisable to wear a protective gear such as specs or goggles when you ride on a bike or when you are working in a dusty area. *************** Guidelines on ethical conduct for medical/dental practitioners The Ethical Committee of the Sri Lanka Medical Council (SLMC) has compiled a list of useful do's and don'ts as guidelines for its members. As these rules are directly related to the health of the general public, this page will carry relevant extracts from the publication. Obligations of medical practitioners * Make the care of patients their first concern * Treat every patient politely and considerately * Respect patients' dignity and privacy * Listen to patients and respect their views *Give information to patients in a way they can understand * Respect the rights of patients to be fully involved in decisions about their care * Keep professional knowledge and skills up to date * Recognize the limits of their professional competence * Be honest and trustworthy *Respect and protect confidential information * Make sure that personal beliefs do not prejudice patients' care * Act quickly to protect patients from risk if there is good reason to believe that they or a colleague may not be fit to practise * Avoid abusing their position as a doctor * Work with colleagues in the ways that best serve patients' interests. In all these matters, they must never discriminate unfairly against their patients or colleagues, and they must always be prepared to justify their actions to them. "A doctor's signature is required by statute on certificates for a variety of purposes, on the presumption that the truth of any statement which a doctor may certify can be accepted without question. Doctors are therefore expected to exercise care in issuing certificates and similar documents, and should not certify statements which they have not taken appropriate steps to verify. Any doctor who in a professional capacity signs any certificate or similar document containing statements which are untrue, misleading or otherwise improper, may be liable to disciplinary proceedings." Adapted from the booklet "Good Medical Practice" published by the General Medical Council, UK in October 1995. |
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The following article from the CCHM Journal for Mental Health discusses
two common problems that reveal the fine line between mental health and
mental ill health.
