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| Sunday, 28 March 2004 |
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| News Business Features Editorial
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Compiled by Carol Aloysius Mind healing-beyond traditional boundaries
Q: Your interest in psychiatry has led you to research on a wide range of issues relating to mind over matter. Comment. A: It was because of my interest in issues of mind over matter that I went into psychiatry as soon as I went to the UK after qualifying as a doctor in Sri Lanka. I have been working in this field since 1965 ending up as a consultant psychiatrist for the NHS since 1996. During the time of my training , I was exposed to Group Dynamic processes which I found fascinating in terms of a person's mental health as well as how society evolves through time during major psycho-social changes . Q: Give us some examples. A: Take the post independence years of our own country. For the first twenty five years changes were at a slow pace. But in the latter 25 years there have been major psycho-socio conflicts due largely to ethnic and religious differences as well as the changing economic landscape . Q: How does the latter lead to psycho - socio conflicts? A: Like the West, Sri Lanka too is caught up in the rat race for survival. We live in a fast paced society and many of us imitate the West whether in eating habits or in the way we live. Hence it is inevitable that the mental problems of Western society such as stress and other mental diseases related to modern living. e.g. depression, anxiety, will also become part and parcel of our lives. Q: What is the usual approach to dealing with such problems? A: Conventional psychiatry is all about treating mental conditions with drugs. As the saying goes, "There's a pill for every ill'! This is acceptable if the condition has only psychological abnormalities - i.e. changes in the brain chemistry like severe depression and schizophrenia. However, although medicine is also important for less severe mental illnesses like anxiety, obsessional psychosomatic disorders, in the long term they require psychological intervention. Q: What kind of interventions are you referring to? A: They vary from counselling to in-depth psychotherapy. Q: What does psycho-therapy involve? A: Psychotherapy is a broad term which encompasses informal support to less formal counselling such as active listening and support without judgement, to the more formal structured methods. This includes Behaviour therapy, Cognitive Behaviour therapy and in-depth psycho analysis as when a patient lies on a couch and is subjected to free association by the psychiatrist. Psychological therapies are delivered in the one to one format as well as smaller and medium sized groups. The one to one approach is very useful for individuals who have suffered severe psycho-social trauma in the past . However this can lead to dependency on the therapist. It is also an expensive procedure. Q: What is the alternative? A: Group therapy. This is cost effective and if convened properly would lead to less dependency on the therapist. Patients are also able to get long term benefits of mutual support from one another. Therapeutic processes help groups to adapt to wider social groups as well instead of limiting them to only the immediate social circle. Q: Which approach do you use? A: I use the group process method which incidentally has been used from the time of the ancient Greeks to take decisions in groups. Although there was evidence of these informal processes in the early 20th century in Britian and US particularly in dealing with children and health problems, they were formalised especially in Britain after 1945 following the world war. This was because there were so many people who needed psychiatric help as they had been traumatised by the war. Two organisations were set up for this purpose, the Tavistock Clinic started by Dr Bion and the Group Analytical Society formed by Dr Foulkes. I have been a member of the latter group since 1997. Q: What are the special benefits that Group therapy offers to a patient? Can it be used on any patient with a mental problem? A: This approach is used essentially to help persons with long term psychological problems in a group convened by one or two trained therapists. The benefits that are experienced can't be put into words because there are subtle changes that take place in the individual which last a life time. The Group process also addresses something that the one to one approach does not-namely, personal stigma. Having group sessions is one way to overcome stigma against mental patients. Q: Do you feel that this non conventional approach is particularly relevant to patients with mental problems in Sri Lanka today? A: This is an area that is very important in dealing with persons who have been traumatised by the ethnic war as in Sri Lanka. It is important because while on one hand Sri Lanka is trying to achieve peace, on the other hand we have a large number of persons victimised by the war, while still others are struggling to endure major social and economic changes in the country. Q: What role does the community play in caring for mentally ill patients? A: In the UK for the past 20 years , large hospitals are being closed and Community Care is being promoted as an alternative to caring for patients. The tendency is now to treat mentally ill people more humanely. But before we de-institutionalise patient care and reintegrate patients into society, we have to first allay the fears and anxieties of the rest of society. For this we need an attitudinal change. If not the victims will be re-victimised again. Q: How can you be contacted by organisations and individuals dealing with issues relating to mental health? A: My website is www.netgroup.org.uk. *********** Nutritional benefits of eggs Only few foods are as nutrient dense as eggs. eggs are a source of high quality protein and nutrients and accounts for only 1.3 per cent of the total calories of ones daily food. There is more to eggs than just good nutrition. They also contain constituents that help in the treatment of a wide range of human health problems, from wounds and rashes to cancer and cardiovascular disease, says Dr. A. Nandakumar. Studies have revealed that egg contains three substances such as lumiflavin, lumichrome and sulphoraphane that are capable of resisting the multiplication of cancer including viruses and also prevent normal cells turning into cancerous cells. These compounds are also natural antioxidants. The carotenoid pigments present in the egg yolk are natural antioxidants that eliminate free radicals as well as anti-carcinogenic agents, natural pigments and precursor to Vitamin A. They also reduce the serum LDL (bad) cholesterol levels and thereby prevent cardiovascular disease (CVD). The yolk phospholipid, lecithin, congested with Vitamin B12, when given to rats, premature babies and persons suffering from Alzheimer's disease, resulted in better nervous tissue development and mental ability. The toxicity of diamidine and other drugs used against protozoal diseases was significantly reduced when encapsulated in egg yolk lecithin, Lecithin of egg yolk is more stable and has higher entrapment efficiency than soy lecithin. The lysozyme (G 1-globulin), G2 & G3 globulins, ovomacroglobulin, antibody IgY and other natural anti microbials and other immunostimulants in the egg prolong the life of AIDS patients, due to high nutritional value, as well as their immunostimulating and anti microbial properties. Egg albumin is used as an antidote to counteract some toxins and irritants consumed accidentally. It protects the stomach and intestine from ulcer formation. Due to its water holding and binding properties, it counteracts the enteritis caused by toxic substance and microbes. Egg white is a good natural remedy for gastritis, enteritis, diarrhoea, dysentery and dehydration. Yolk lipoprotein and other biological value proteins in the egg act as excellent growth promoters in children and animals. Chicken egg is abundant in antibodies like IgY, which is cheaper and better than mammalian immunoglobulin IgG. This IgY can be used in treatment of human rotavirus, E coli, Streptococcus, Pseudomonas, Staphylococcus and salmonella infection. Egg white (especially chalaza) is good for cuts, burns, insect bites and rashes. By pasting the shell membrane over the affected skin, reduces the inflammation and infection and promotes healing. The egg yolk and chalaza (thin membrane between the shell and the egg white) are rich sources of sialic acid, mainly Neu-5-AC, patented as SLEX in some countries. It has powerful antimicrobial, anti viral properties. Hence used in treatment of H. Pylori and other microbial infections. The taurine present in the egg prevents the atherosclerotic plaque formation in arteries and thereby prevent CVD. Conjugated linoleic acid present in the egg yolk reduces the risk of certain heart and cancer problems. Yolk lipid is one of the richest source of the monounsaturated fatty acid (MUFA), oleic acid having about 42% of yolk lipids. Nutritionists have concluded that MUFA is better than PUFA (polyunsaturated fatty acids) for human health. Vitamin E, organic Selenium and other anti oxidants in the eggs prevent oxidization, aging, formation of plaque in the arteries, atherosclerosis and CVD. The high level of homocysteine in the blood is an independent risk factor for CVD. It acts as a powerful molecular abrasive, scrapping the mucosa of the blood vessels, leading to the deposition of plaques and CVD. Betaine a, methyl donor present in egg, red wine and other food products reduce plasma homocysteine, CVD and stroke. In Ayurveda and Sidda recognize eggs as anti inflammatory, healing, binding, antimicrobial and immunogenic properties. Eggs are also used for vaccine production. Eggs provide a cheap but good medium for immunoglobulin and vaccine production. *********** A complete examination of the cardiovascular system is not complete without an ECG : Exercise electrocardiography (stress testing) by Dr. D. P. Atukorale The small electrical signals that pass through the heart and which trigger the heart beat can be picked up by electrodes placed on the skin. These signals can be amplified and recorded on paper. This technique is known as electrocardiography and the paper trace is called an electrocardiogram (E.C.G.). Thus an E.C.G. is an electrical map of the heart.
A complete examination of the cardiovascular system is not complete without an E.C.G. The E.C.G. is the most useful test to diagnose myocardial infarction (heart attack) and other types of ischaemic heart disease (I.H.D.). E.C.G. is also a very useful test to detect abnormal rhythms and palpitations and many other cardiac ailments such as pericarditis (inflammation of the coverings of the heart) and myocarditis (inflammation of heart muscle). Exercise E.C.G. The exercise E.C.G. is not much different from an ordinary E.C.G. except that the patient is active rather than resting. The activity takes the form of walking on a moving belt called treadmill or cycling. The moving belt gradually increases its speed and tilts upwards to simulate walking uphill. In majority of patients with angina (chest pain due to insufficiency of oxygen to the heart muscle), the resting E.C.G. is normal whereas if the E.C.G. is recorded while the patient is walking or cycling the E.C.G. is abnormal. Therefore the exercise E.C.G. has become a routine method of assessment of patients with chest pain. In Masters test which can be done in a doctors surgery, the patient climbs up and down two steps, each 9 inches high over a one and a half minute period, the number of steps and the amount of the exercise depending on the patients age, sex and weight. In the bicycle ergometry, the bicycle used is a stationary one of which only one wheel moves, the resistance of which can be increased or decreased by a system of gears. The workload is measured by the speed and the resistance. As mentioned earlier, in both government and private hospitals of Sri Lanka, the exercise E.C.G. is recorded using a tread mill. Here you walk on a moving belt initially at slow speed on the flat and then at increasing speed and a slope until you are stopped by the doctor or cardiac technician when you complain of angina. The procedure may be stopped before you get angina if the doctor or technician observes E.C.G. abnormalities in the E.C.G. monitor. Your blood pressure, heart rate and rhythm are recorded during each stage of the exercise E.C.G. by the doctor.The most common protocol used in Sri Lanka is called Bruce Protocol. Here patient starts by walking one minute at a speed less than 2 miles per hour followed by 3 minutes at 2.5 m.p.h with a gradient of 12 per cent and so on till you achieve the required increase in the heart rate. The patient should be instructed not to take a heavy meal or caffeinated beverages for 3 hours before the test, and wear comfortable shoes and loose-fitting clothes. Unusual physical exercises should be avoided prior to the testing. The patient should be examined by the doctor immediately before the exercise and blood pressure (B.P.) should be recorded. The exercise is not done if the B.P. is high. A resting E.C.G. is done and if this shows changes suggestive of a recent heart attack or changes suggestive of impending attack, the exercise E.C.G. is not done. The treadmill walking should be demonstrated by the cardiac technician prior to getting the patient on to the treadmill. The patient should be made to relax and reassurance given before starting the test.If the patient develops dyspnoea (difficulty in breathing) or giddiness or angina or abnormal changes in the E.C.G. monitor, the exercise is stopped and the readings taken. The exercise E.C.G. is a very safe and a simple test. It is very safe if you select the correct type of patient and if it is done by an experienced cardiac technician in the presence of an experienced doctor. The patient undergoing an exercise E.C.G. has the right to request the hospital to provide him or her with the services of a medical officer during the procedure. An extremely rare complication of exercise E.C.G. is the development of a heart attack during the test. In the Colombo Institute of Cardiology, over 30,000 exercise E.C.G.s have been done during the last 30 years without any mortality as it is always done by very experienced cardiac technicians in the presence of experienced medical officers. Uses of Exercise E.C.G. The most frequent indication for exercise E.C.G. is to establish the diagnosis of ischaemic heart disease (I.H.D.) in patients who complain of chest pain and have a normal E.C.G. Angina like chest pain is not uncommon among middle-aged females who have no I.H.D. and exercise E.C.G. is an easy method to exclude I.H.D. Exercise E.C.G. is very useful to assess patients who are recovering from heart attacks so that the physician can evaluate their fitness to resume their normal duties. Exercise E.C.G. is done prior to angiography in patients with angina and who may need by-pass surgery or angioplasty. If the exercise E.C.G. is negative i.e. no fresh abnormalities appear in the E.C.G. on exercise, coronary angiography is usually not performed. But if the exercise is positive i.e. the patient develops abnormal changes suggestive of ischaemia in the exercise E.C.G. angiography is usually performed to select patients who might need coronary surgery or angioplasty.The exercise E.C.G. is very helpful in diagnosing certain abnormalities of heart rhythm in patients who complain of palpitations on exertion. Another use of exercise E.C.G. is to evaluate people in special occupations such as pilots, firemen, police officers, bus and track drivers in the more developed countries. The exercise E.C.G. is also very useful in eliciting response to therapy and to the programme of rehabilitation and exercise after a heart attack. It helps the physician to monitor the progress of patient and to see if his exercise tolerance is satisfactorily increasing. Sometimes the exercise E.C.G. can be positive in patients who have no I.H.D. (false positive) and the test can be negative in people suffering from I.H.D. (false negative). So the test can be misleading in some people. One has to resort to performing coronary angiography in such patients if the clinical history is suggestive of I.H.D. after subjecting such patients to a stress echo in order to increase the accuracy of the test if facilities for stress echo are available. |
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| Editorial | Security Produced by Lake House |
Dr. N. Yoganathan, a Consultant Psychiatrist in UK has specialised in
child Psychiatry, Old age Psychiatry, drug and alcohol abuse, forensic
psychiatry, rehabilitation and psychotherapy. He discusses with CAROL
ALOYSIUS a novel approach to healing the mind that transcends conventional
methods.
Nowadays E.C.G. recording is very simple. The leads are placed on the
arms and legs and six positions on the chest wall in front of the heart.
