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| Sunday, 21 November 2004 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius. Mental Health problems of adolescents Mental Health problems among adolescents and even young children is on the rise in Sri Lanka. Dr. Gamini Prematilaka Consultant Psychiatrist explains why in an interview with Carol Aloysius.
A: Yes, According to a recent study Mental health problems among rural adolescents in Sri Lanka were as common as reported elsewhere in the world. 17-22 per cent of adolescents in developed countries suffer from emotional and behavioural problems. Q: Are they different from adult problems? A: Some serious psychiatric illnesses which are relatively uncommon in children and adolescents like Schizophrenia and Bipolar affective disorders are similar to adults in the symptom pattern. Phobias are common in children and adolescents, especially social phobia which is very common among adolescents. Depressive illness is also not uncommon in adolescents but their presentation may be different from that of adults. Q: What are the most common symptoms? A: Loss of concentration, irritability, social withdrawal, anxiety, depression, antisocial behaviour, Bodily symptoms like sleep problems, loss of appetite, headache, chest pain, weakness. Q: What are the common problems? A: Social phobia, Obsessive Compulsive Disorder, Depression, Schizophrenia, Anxiety, Attempted suicide, Substance abuse, Delinquency, and Somatoform disorders (Hysteria): present with physical symptoms that are unexplained. Q: What are the symptoms of anxiety? A: Sense of fearful anticipation, irritability, sensitivity to noise, feeling of restlessness, impaired concentration, disturbed sleep, palpitation, dry mouth, sweating, diarrhoea, frequency of micturition, headache, backache, pain in the neck, dizziness, faintness, palpitations, discomfort in the chest and panic attacks, Symptoms of a panic attack are: Palpitation, shortness of breath, chest discomfort or pain, sweating, trembling, dizziness or faintness, numbness, flushing, nausea, fear of impending death, loss of control or madness. Q: What is social phobia? A: In social phobia the patients main fear is that they will act in such away as to humiliate or embarrass themselves in front of others. They fear and avoid various situations in which they would be required to interact with others or to perform a task in front of other people. Typical social phobias are of speaking specially to superiors or members of opposite sex, eating or writing in public, using public lavatories and attending social gatherings or interviews. A common fear in these people is that the others will detect and ridicule their anxiety in social situations. Here the anxiety is related to specific situations and if forced or surprised into the phobic situation the individual experiences severe anxiety accompanied by various bodily symptoms like sweating, blushing, dry mouth, palpitations tremors, chest pain etc. Q: What is OCD? A: Obsessive compulsive disorder includes Obsessions and Compulsions: Obsessions are recurrent and persistent thoughts, impulses or images that are experienced at some time as intrusive and inappropriate and that cause marked anxiety or distress. The person attempts to ignore or suppress such obsessions or to neutralise them with some other thoughts or action. Compulsions are repetitive behaviours (hand washing, checking, ordering etc.) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession. These are aimed at preventing or reducing the distress or some dreaded event or situation. Q: How do you recognise depression in adolescents? A: Depressive disorders are not uncommon in adolescents and children. They may not complain of a sad mood as such but may present with symptoms like loss of interest and enjoyment, reduced energy, disturbed sleep, loss of appetite, loss of weight, loss of concentration, loss of memory, pessimistic view of future, loss of self esteem irritability, pain in different parts, anxiety etc. Rarely, they may have suicidal ideas. Q: What are the common symptoms of Schizophrenia? A: Though uncommon the first episode of Schizophrenia appears in adolescence sometimes. They may have symptoms like irrational behaviour and speech, over activity, aggressive behaviour, withdrawal, talking to self, smiling to self, abnormal fears and suspicions, seeing or hearing things what others cannot see or hear, bodily symptoms like poor sleep, loss of weight, headache etc. Q: What substances abused by adolescents cause mental illness? A: Tobacco smoking is one of the commonest thing. But more serious is Cannabis smoking because it can cause behaviour disorders in some patients similar to illnesses like schizophrenia and depression and even suicidal attempts. Cannabis is sometimes consumed orally as an Ayurvedic drug called Madana modakaya. Most people start consuming alcohol at this stage but rarely they are addicted. Also Heroin addiction is not uncommon. Causative factors may be pressure from the peer groups or result of experimenting. Q: What are the causes? A: Poverty and overcrowding; Unskilled parental care (e.g. Inconsistency, extremes of discipline or neglect); Parental illness or social problems particularly maternal depression; Marital discord, family breakdown; Poor schooling, School or studies related stresses; Adolescent changes, adjustments, conflicts with parents; Repeated institutionalisation (being in and out of several children's homes). Q: Can the present educational system contribute to the stress of the children and adolescents? A: Yes, the attitudes and expectations of the parents and the children in the field of education today can affect the mental health of the adolescents very seriously. Due to tuition and other extra classes children today have no time to relax and play. This is very important for them to get rid of day to day stress. They have no time to take proper meals and this may lead to malnutrition. Over competitiveness and unfair expectations from the parents may lead to tension, anxiety and depression in children and adolescents and this may even lead to suicide. The present education system, is more examination oriented and thus concerned only with the intellectual development, while the emotional development of children is overlooked causing poor mental health, making them vulnerable to emotional and social problems. Q: Can love affairs be blamed for suicides specially in adolescents? A: This is an important social issue in a developing country like Sri Lanka where there is a mix up of the eastern and western cultures. We have copied a lot of things from the western culture and we allow our children to attend free tuition classes or to the factories in the free trade zones where there are enough opportunities for the girls and boys to mix. At the same time the media both print and electronic as well as the films, novels and music admire and encourage Love. Even the Valentine day is celebrated in style with the support of the media. Thus it is natural for adolescents to develop love affairs according to the norm of western culture. But most parents oppose this and usually react at the wrong time in the wrong way. This is a leading cause for depression and attempted suicides. Q: How can those with mental disorders be treated? A: Methods of treatment used commonly are, Counselling, Family therapy, Behaviour therapy and Drug treatment. Most of these illnesses can be treated in the OPD. Anybody suffering from a mental disorder can go to the Out Patients Department in the General or Base Hospital close to them and they will be referred to the Psychiatric clinics. Also there are Psychiatric clinics conducted by Medical officers (Mental Health) in a lot of district hospitals all over the country and the patients may be directed to them too. If necessary the local psychiatrists may be consulted privately. Q: Finally and most importantly, how can you prevent mental problems in young people taking a serious turns? A: By screening school children and treating those with or emotional problems. Educating parents, teachers and health workers to identify people with problems and refering them to suitable agencies. Establishing counselling centres in the schools, universities, health centers and workplaces and educating to-be-parents about proper parenting skills will also help prevent such problems. ******************* New hope for women with stress incontinence It is a problem most women do not like to discuss.
It is not an unfamiliar scenario. A woman so worried about being embarrassed with uncontrollable urinary leakage when she coughs, laughs, or sneezes that she is afraid to go out in public. She may also experience the same during physical activity, walking, travelling, sitting or bending or during sexual intercourse. Besides, the intermitted leakage of urine causes irritation, inflammation and discomfort or pain in her genitals together with constant itching, giving rise to major health problems. This uncontrollable leakage of urine during any activity which increases the abdominal pressure is called urine stress incontinence and is a common problem amongst women, particularly after childbirth or menopause. The factors causing urine stress incontinence are many - often the primary cause is the damage to the pelvic floor musculature, nerves and connective tissue due to childbirth. The group of muscles and connective tissue which supports pelvic organs such as the bladder, uterus (womb) and upper vagina and the rectum, which form a diaphragm at the bottom of the pelvis is called pelvic floor. Vaginal childbirth could damage the pelvic floor muscles which allow the pelvic organs (bladder, womb and rectum) descent through the weakened vaginal walls. Another main factor causing the weakening of the pelvic floor is menopause. The sex hormones secreted by a woman's ovaries are essential for the maintenance of pelvic floor muscle tone. The reduction or loss of secretion of these hormones during the onset of menopause initiates a gradual process of weakening the pelvic floor. Often the damage suffered by the pelvic floor at childbirth is subsequently aggravated by menopause. In addition, some females have intrinsically weak pelvic floor musculature, and, in such people, urine stress incontinence and pelvic organ descent manifest at a much younger age, even without the trauma of childbirth. Prior gynaecological or rectal surgery has also been shown to cause damage to the pelvic floor resulting in urine stress incontinence or organ descent. Pelvic organ descent through a weakened pelvic floor is called a prolapse, and there are several types: isolated bladder prolapse, womb prolapse or rectal prolapse via the vagina, but commonly there is a combination of all three. A bladder prolapse (or cystocoele) when descending changes its original anatomical position, and this can then be a major contributory factor towards causing involuntary leakage. But not all cases of involuntary leakage are due to a bladder descent. Sometimes urinary leakage occurs independently, without a perceptible bladder prolapse problem. Over the last several decades many corrective surgeries for the condition of urine stress incontinence have been described. But collectively taken, the results have not been particularly good, especially in the long term. Some even found their urinary leakage was worsening following the surgery. There was obviously better research and techniques required to improve the success rates in continence surgery. With the advent of a new research area into female urinary problems together with prolapses, the sub-speciality of uro-gynaecology was created. The development of investigative techniques which are collectively called uro-dynamic studies (or cysto-metrography) have helped us to identify each person's problem, thereby allowing treatment to be individualised. This individualisation of care has greatly increased the success of therapy, and reduced the incidence of unfortunate worsening of symptoms following surgery. At the very forefront of surgery for female urine stress incontinence, there is a method that was developed approximately 12 years ago in Europe by Ulmstern. It was called Tension-free Vaginal Tape (TVT) and involves a sling like tape being placed surgically under the mid-urethral region, with the precise amount of tension. This tape, made of polypropylene (prolene) with a certain amount of elasticity, will prevent uncontrollable urine leakage in situations where intra-abdominal pressure increases, allowing for normal voluntary bladder evacuation. This surgery, when compared with previous stress-incontinence surgeries, is much less traumatic to the patient and the results are immediately apparent. The procedure could be carried out with regional (spinal) anaesthesia or even local anaesthesia so the patient may go home the day after the surgery. The long term success rate is also very high compared to previous surgeries while complications are at a minimum. This surgery has revolutioned therapy for the immensely troublesome condition of urine stress incontinence in women, and it has now replaced other techniques as the only acceptable surgical method for this condition. This method has also revolutionised treatment for the social and hygienic distress experienced by urine stress incontinence. It has given permanent relief to most women with this condition all over the developed world. ******************* Diet, physical activity and health The World Health Assembly has adopted a Global Strategy on diet, physical activity and health. This has been described as a landmark achievement in global health Dr. T. W. Wickramanayake, Professor Emeritus, Universities of Ruhuna and Peradeniya explains what the WHO global strategy is all about... The strategy addresses the main outcomes of the heavy and increasing burden of non-communicable diseases which now account for about 60 per cent of global deaths and almost half of the global burden of diseases. These major risk factors are unhealthy diet and physical inactivity. Dietary and activity risks are among the 10 leading causes of death, viz, high blood pressure, elevated blood cholesterol, low intake of fruits and vegetables, elevated blood cholesterol, high body mass index, under nutrition and physical inactivity. The policy recommendations outlined by the global Strategy include: Policies concerning the environment include: . Formulation of national dietary and physical activity guidelines. . Promotion of food products consistent with a healthy diet, including the provision of market incentives, to promote the development, production, marketing of food products that contribute to a healthy diet. . Introduction of fiscal policies to influence food choices. . Consideration of agricultural policies and their effects on national diets. . School policies that improve healthy literacy, promote healthy diet and provide physical education and facilities. Policies that address foods, drinks and modes of transport . Modify foods to limit fat, especially saturated fat and trans-fatty acids, salt and sugar. . Introduction and provision of incentives for new products with better nutritional value. . Modify marketing practices of foods that contribute to an unhealthy diet. . Encourage environmental planning that allows increased walking, cycling and other physical activities. Policies aimed at individual change . Provision of accurate information through education and public awareness campaigns and adult literacy programme. . Provision of accurate nutrition labelling and monitoring nutrition and health claims on foods. . Practical advice by health professionals to patients and families on the benefits of healthy diets and increased levels of physical activity, combined with support to help patients initiate and maintain healthy behaviours. . Provision of clear, simplified messages with regard to healthy diet and physical activity (reduce salt, sugar, and fat, increase fruit and vegetables, etc.) These policies require the involvement of sectors and stakeholders beyond the health domain. Proven effective interventions are those that cover the following three levels: the host (individual), the agent (food and drink consumed) and the environment (changes in national policies, legislation and the creation of an enabling environment for healthy diet and physical activity). These recommendations offer us a blueprint for action. Hopefully, the government will develop notional plan and implement the recommendations to pave the way for a healthier nation. |
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| Produced by Lake House |
Q: Is it correct that mental health problems in the adolescence
as well as in children are increasing?
But its psychological effects can be devastating. DR. SUDHEERA UDUWELA,
Consultant Obstetrician, Gynaecologist and Uro Gynaecologist of the Apollo
Hospital discusses how urine stress incontinence can be effectively
managed by a relatively new surgical procedure.
