WHAT IS MANIA

Mania or first episode mania to be precise is a psychiatric disorder in which a person has persistent and abnormal elevated or irritable mood lasting more than a week or less if the disruption is such that patient needs hospitalization. 
To seal the diagnosis of mania the patient should have at-least 3 of following symptoms if mood is elevated or 4 if mood is irritable

1.     Pressure of speech or increased talkativeness

2.      Disinhibit ion or lack of social inhibitions

3.      Decreased need for sleep

4.      Increased self-esteem or grandiosity

5.      Distractibility

6.      Reckless behavior like reckless spending or reckless driving

7.      Increased sexual energy
8.   Increased activity
9.   Flight of ideas

The disorder of mania can be without or with psychotic symptoms such as delusions and hallucinations

Causes of mania-

No definitive evidence has been found but a disturbance in neurotransmitters like dopamine and serotonin; hormones like thyroid, growth hormone are implicated.

Risk factors for mania-

a)      Genetic factors

b)      Family history

c)      Stressful environment

d)      Stressful life events

e)      Certain personalities

Mania should be differentiated from hypo-mania in which there is no hospitalization, socio-occupational dysfunction and no psychotic symptoms with symptoms lasting less than 4 days.

Course and prognosis

Average duration of maniac episode can be anywhere between 2-4 months. It is a self-limiting illness but chances of relapse are high.

Treatment of mania

Why should mania be treated if it is a self-limiting illness?

      a)      It should be treated because severe socio-occupational dysfunction caused by it and threat to patient and others lives.

      b)      Prevent relapses.

When does a patient need hospitalization?

      1.      Threat to patient’s and other lives and property due to excessive violence.

      2.      Not talking care

      3.      Not willing to take medicines

      4.      Not enough family support

Scales which can be applied for progress of success of treatment include young mania rating scale.

Drugs used in treatment of mania are

      1.      Mood stabilizers such as  lithium, valproate,carbamazepine

      2.      Anti-psychotics

      3.      Benzodiazepines

Usual duration for treatment of mania is 1 year.

Wishing you a long and healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry) 
For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh

DISORDER OF COMPULSIVE BUYING

        What is compulsive buying? 

It is also called oniomania, shopping addiction or compulsive shopping. This disorder characterized by unscrupulous buying usually with use of several of a lot of credit cards and landing in serious financial difficulty which usually leads to bankruptcy. There is as such no diagnostic category of compulsive buying in both two recognised manuals of ICD 10 and DSM-4.

The proposed criteria for this disorder equate it with impulse control disorder in which there is mounting tension to do the wrong work with anticipatory relief from anxiety.

The patient's time is frequently occupied with buying or urge to buy. This urges are irresistible. The buying is of the amount which cannot be afforded. The items bought are usually not needed. There is marked distress, time consumption and socio occupational dysfunction. The diagnosis is made when there is no other associated physical or mental disorder.

This disorder occurs in about 2% of general population and it commonly affects women. Age of onset is late teens but can also occur in 20’s or 30’s.

The buyer usually tries to control the behavior but in vain. Early diagnosis is useful to prevent further damage.

Treatment of compulsive buying-

Treatment of this disorder is difficult.

        a)      Non medicinal treatment includes supportive therapy and self-help groups like Debtors anonymous.

        b)      Medicinal treatment includes- antidepressants particularly SSRI, anxiolytics, anti-mania drugs, anti-psychotics.

Average debt on a patient estimated is around 25000 dollars

Wishing you a healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry) 
For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh  

POST TRAUMATIC STRESS DISORDER

What is PTSD? 

Post-traumatic stress disorder or PTSD is an anxiety disorder associated with development of certain set of anxiety symptoms after a catastrophic stress. These symptoms remain after at least 1 month of onset to differentiate it from acute stress reaction another anxiety disorder occurring after similar catastrophic stress but remaining for less than 1 month. Symptoms of PTSD can occur with a delay of 1 week to 30 years.

Also referred to as combat neurosis or gulf war syndrome, the prevalence is about 8 percent with women being twice as susceptible as men.

Risk factors for PTSD

        1.      Catastrophic stressor such as wars, natural calamities, tortures and rapes.

        2.      Presence of childhood traumatic experiences  

        3.      Inadequate family support 

        4.      Alcohol

        5.      Genetic vulnerability

        6.      Neuro-chemical changes
        7.       Personality disorders
        8.       Female sex

Symptoms of PTSD

       1.      Recurrent distressing intrusive thoughts, dreams, images or perceptions.

       2.      Feeling as if traumatic event is recurring or flashbacks.    

       3.      Actively avoiding avoid activities, thought, and places related with event.

       4.      Impairment of socio-occupational functioning due to this.

       5.      Characteristics of hyper-arousal including increased startle responses, difficulty in sleep, anger outbursts, decreased concentration, and  hyper vigilance.
              6.       Severe physiological and psychological distress to cues.

Course of PTSD

About 33% improve, 33% remain same and rest 33% worsen if left untreated. Children and elderly have worst prognosis.

Treatment of PTSD

A psychiatric help is must for treatment of PTSD if a victim has been identified with suspicion of having PTSD.

Medicinal treatment include

         a)      SSRI’S such as paroxetine

         b)      TCA’S- imipramine and clomipramine

         c)      Buspirone

         d)      MAOI’S

         e)      Trazadone

         f)       Anti-convulsants- valproate and carbamazepine

         g)      Clonidine

         h)      Propranolol

Non medicinal treatment include

        a)      Systematic desensitization

        b)      EMDR

        c)      Behavior therapy

        d)      Cognitive therapy

Wishing you a very long and healthy life ahead

Dr Hitesh Sharma

MBBS, MD (Psychiatry)
For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh

OPIOID ADDICTION

  What is opioid? Opioid are substances which act through opioid receptors and are similar to opium (morphine).

Types of opioids

There are broadly three types of opioids-

      1.      Morphine and derivatives of morphine- morphine, codeine and diacetylmorphine  

      2.      Semisynthetic opioids-buprenorphine and oxycodone

      3.      Synthetic opioids- fentanyl, pethidine and methadone

Some street names are- opium, smack, brown sugar and heroin.

 What is opioid addiction?

Opioids are highly addictive substances which produce high degree of dependence. The more a substance is potent and pure the higher degree of dependence. Dependence could be defined as general for all substances and are as follows

     1.      Craving

     2.      Tolerance

     3.      Withdrawal

     4.      Use despite harm

     5.      Loss of control

     6.      Neglect of alternate pleasurable activities

The fulfillment of any of three above criteria within one year seals diagnosis of dependence.

There are certain features associated with withdrawals of opioids only like

     1.      Goose flesh

     2.      Diarrhea

     3.      Body-ache

     4.      Yawning

     5.      Lacrimation

     6.      Watering of nose

Complicated withdrawal include seizures, delirium, psychosis

Treatment of opioid dependence

Treatment of opioid dependence follows two basic approaches

    A.      Complete abstinence

    B.      Substitution therapy

Candidates for complete abstinence are

                         i.     Low potency opioid users

                        ii.    Short duration of use

                        iii.   Few relapses

                        iv.  Strong willed

                       v.    Non intravenous drug users

Candidates for opioid substitution therapy are

                        i.     High potency opioid users

                       ii.     Long duration of use

                      iii.    Multiple relapses

                      iv.   Weak willed

                      v.    Intravenous drug users

       For complete abstinence following approaches are advised

a)      Symptomatic approach in this symptomatic treatment is given which includes clonidine, ibuprofen and diazepam and slowing tapering them to stop their use. Finally the patient is put on opioid antagonist naltrexone or nalmefene. This technique has low rate of success.

b)      Therapy with opioid agonists or partial agonists- these include using tramadol, buprenorphine and other opioids in detoxification phase. The drugs are gradually decreased and stopped. Then the patient is put on naltrexone or nalmefene which is continued till 6-8 months and stopped.

     For opioid substitution following approaches are followed

a)      Buprenorphine

b)      Methadone

The main goal of opioid substitution is harm reduction.

Joining self-help groups such as narcotic anonymous will be of great help to maintain success achieved

Wishing you a long and healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)
For asking a query or phone/video consultation with me visit-https://www.icliniq.com/hitesh  

PANIC DISORDER

What is panic disorder? 

A severe attack of anxiety which reaches peak instantly and settles down within 15-30 minutes is called panic attack. It invariably is accompanied by a feeling of impending doom. Panic attack can occur in all physical as well as mental conditions but to be classified as panic disorder it should be independent of those conditions.

Panic disorder is present in approximately 3% of population. It is 3 times more common in women than in men.

Causes of panic attacks

Certain neurochemicals like serotonin are implicated in this disorder

Panic inducing substances are known to occur in these people

Brain imaging may show certain minute abnormalities.

Risk factors for panic disorder is family history

Mitral valve prolapse might mimic panic attack

For panic attack to be classified as panic disorder the frequency of panic attack should be once/ week for 4 weeks.

Types of panic disorder

     1.      Panic disorder without agoraphobia

     2.      Panic disorder with agoraphobia

Agoraphobia is defined as fear of occurrence of panic disorder in places from where immediate escape is not possible like open fields, cinema halls etc. If accompanied by some person the patient feels safe.

Symptoms of panic attack include-

     1.      Dryness of mouth

     2.      Palpitations

     3.      Sweating

     4.      Coldness of skin

     5.      Tremors

     6.      Chest discomfort

     7.      Headache

     8.      Feeling of impending doom

Treatment of panic disorder

Differentiating panic attack caused by other medical and psychiatric conditions from true panic disorder.

Pharmacological treatment includes

SSRI’S particularly Paroxetine is the mainstay of treatment of panic disorder.

TCA’S can also be used

Benzodiazepines are for the initial symptomatic control of panic attack till the SSRI’S or other drugs act. Long term use of these for panic disorder should be avoided as they cause dependence

MAOI’S are to be used with caution.

SNRI’S

Lithium

Carbamazepine

Valproate

Buspirone

Verapamil

Non pharmacological treatment includes cognitive behavioraltherapy.

Wishing you a long and healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)
For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh

ANOREXIA NERVOSA: AN INCREASING PROBLEM IN YOUTH.

    Anorexia nervosa is a Greek term for loss of appetite. There are three aspects of anorexia nervosa.

    1.    Self-induced starvation to significant degree.    

    2.  Presence of medical signs of starvation.
   3. Morbid fear of fatness.

Above three features present for three months seal the diagnosis.

There is body image misperception in these youth. To achieve their goal they might reduce their food intake and may or may not indulge in purging behavior.

It is reported in around 3.5% of adolescents mostly occurring in teens with girls being 15 times more affected than boys. In professions such as models and ballet dances, its prevalence is greatest.

Causes of anorexia nervosa

Definite cause is not known to but a disturbance in endogenous opioid production and neurotransmitter imbalance is known to play role. Extra emphasis on thinness in society is also implicated.

Medical complications associated with anorexia nervosa

     1.    Cardiac- loss of heart muscle mass, arrhythmia, bradycardia or sudden death.

     2.    Reproductive- amenorrhea, sterlity.

     3.    Skin- edema

     4.    Blood- decrease in WBC

     5.    Dental- caries

     6.   Skeletal- osteoporosis

     7.     Metabolic- electrolyte abnormalities
    8.  Cachexia- loss of muscle mass and fat. 
    9.  Digestive- bloating, constipation and abdominal pain.
       10.   Neuropsychiatric- Depression, Seizures. 

Course of illness

An untreated illness has waxing and waning course and outcome ranging from complete recovery to death.

Treatment of anorexia nervosa

Patients who are weighing 20% less than the expected weight are recommended hospitalization for around 1 month but who are below 30% require prolonged hospitalization to around 6 months.

During hospitalizations patient is weighed daily. Medical complications are corrected and patient is force fed according to calories calculated. Drugs such as fluoxetine and amitriptyline are beneficial. Cyproheptadine is another useful drug for regaining weight.

Cognitive behavioral therapy may be useful in many cases.

Wishing you a very healthy and long life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)

For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh

IDENTIFYING DYSLEXIA IN CHILDREN

  What is dyslexia?

 Dyslexia is a kind of learning difficulty in which the reading is below par for the age, education and intelligence of the child leading to poor academic performance.

Word recognition is poor, slow and inaccurate with poor comprehension.

Approximately 5% of children suffer from dyslexia, boys four times than girls.

Risk factors for dyslexia

      1.      Fetal alcohol syndrome

      2.      Cerebral palsy

      3.      Epilepsy

      4.      Malnutrition

      5.      Brain lesions

      6.      IUGR

      7.      Complicated pregnancy

      8.      Preterm infants

      9.      Family history

Symptoms to identify dyslexia

      1.      Poor spelling are obvious and abundant in the text of the child

      2.      Omissions, addition, and distorted words appear in the reading performance of the child.

      3.      Speed of reading is slow with minimal comprehension.

      4.      Right left confusion is present.

      5.      Starts reading from middle or end of sentence.

      6.      Transpose letters/ write letters as mirror image in written text.

      7.      Child is usually good in math poor in subject involving languages.

      8.      Phonetic errors are ample

      9.      Poor handwriting. It can be almost incomprehensible.

Treatment of dyslexia

There is no definitive cure for dyslexia. A special strategy has to be followed so that these children don’t lag behind other children.

1.      Identifying dyslexia early. On suspicion the parents should take children to psychiatrist who can identify the problem.

2.      Psychologists may apply dyslexia battery.

3.      Once a child has been identified with dyslexia a special education called individual education program me may be helpful. Reading instruction program me and word study will also be helpful

4.      Certification of dyslexia will help in getting privileges for dyslexic children.

Early identification of dyslexia and management will save child and parents will unnecessary harassment, frustration and failure. Ultimately the child will be able to achieve more than what he/she would have done if left unguided.

Wishing you a healthy and long life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)

For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh

CANNABIS (MARIJUANA) DEPENDENCE

Marijuana is the highest abused substance in the world. The causes of high number of patients with marijuana dependence, is the easy availability and low cost of the drug.

Cannabis is now being classified with alcohol and nicotine as a gateway drug. A gateway drug is the first drug which an addict usually gets into addiction.

Various forms of cannabis are weed or grass or bhang or Mary Jane, ganja, charas, hashish and hashish oil. The active component is THC in increasing concentrations.  Cannabis is usually smoked rolled in cigarettes.

Dependence of cannabis can be judged by certain common criteria used for alcoholdependence. However marijuana is ranked the least addictive drug of all the dependence forming drugs.

When a person leaves cannabis he/she experiences withdrawals. Withdrawals characteristic to cannabis includes insomnia, decreased appetite and loss of concentration.

Risk factors associated with cannabis dependence are-

       1.      Younger age of onset

       2.      Family history of cannabis dependence

       3.      Long time use

       4.      Heavy use

       5.      Use of more potent forms

Among complications of marijuana use development of psychosis is very common.

A motivation syndrome- long term use of cannabis can lead to a state called a motivation syndrome. This syndrome is characterized by amotivation, avoilition, apathy, asocialia, alogia lack of effect.

Treatment of cannabis dependence-

Pharmacological intervention

Shifting users from cannabis to benzodiazepines and then tapering them is the main stay of cannabis detoxification. New drugs like cannabinoid receptor antagonist rimonabant have yet to prove efficacy.

Non pharmacological intervention

Cognitive behavioral therapy is of some use.

Relapse prevention and motivation enhancement therapies hold their ground and are important and effective.

Self-help groups like marijuana anonymous as compared to alcohol anonymous are yet to prove their worth.

Wishing you a long and healthy life

Dr Hitesh Sharma

MBBS, MD (Psychiatry)

For asking a query or phone/video consultation with me visit-  https://www.icliniq.com/hitesh