The concept of health includes both physical and mental well-being. Mind and body are two sides of the same coin, and hence their disturbances are interrelated. The “Mind” is not purely a spiritual entity, but also forms part of the brain as a structure. So, like any body part it can have issues of illness. We always relate doctors, medicines and diseases with physical ailments. Unfortunately, mental disorders are visualised purely from non-medical and non-scientific aspects leading to misconceptions.

A Psychiatrist deals with emotional disturbances, including disturbances in thought and behaviour. Illness results in changes in these areas which are not necessarily features of “madness”. Madness is a loose term used by people and creates stigma for people with genuine emotional difficulties.

Members of public have a common misperception that all mentally ill patients are violent or behave in a funny way. Exaggerated depiction of violence and comic behaviour by visual media adds to this misconception that all mental illnesses lead to total loss of self-control.

Of all the people suffering from mental disorders, a very small percentage exhibit disordered behaviour. The suffering of the majority is not visible to the outside world.

Ignorance, misconception, fear and social stigma are the main reasons. Strong visual images or personal experience with an occasional disturbed patient may leave a lasting impression on our minds.

At a personal level, we believe that we should be in total control of our mind all the time. A misconception that a mental illness always leads to loss of self-control because of a “weak mind” makes us take a “not me” stand.

Acceptance increases when we believe that mental disorders are like any other physical illness, and can happen to anybody.

It is estimated that 1 out of 4 person in population will require treatment for severe or common Mental disorder or stress related psychosomatic disorder during their life time.  of the population experiences some or the other form of psychological distress during their lifetime. World Health Organization (WHO) estimates that Depression will be the number one illness in terms of impact by 2030.

In spite of such a high prevalence, the number of people actually receiving proper care is very small due to various reasons. This creates a false impression in the public that mental illnesses are rare.

A Psychiatrist is a medically qualified doctor with postgraduate training in Psychiatry. He / she can diagnose mental disorders and use both psychological and medical interventions to treat these.

A Psychologist is a nonmedical professional with postgraduate training in Psychology. They conduct psychological testing and can use psychotherapeutic techniques (excluding medicines) to help people.

A Psychiatric social worker is trained in evaluation and management of social aspects of mental health.

A Counsellor is a professional who gives focussed advice. Counselling can be done by all of the above mentioned professionals.

Other members of the team of Mental Health Professionals [MHP] are Psychiatric Nurse, Occupational Therapist and Special Educators.

A Neurologist (Neuro physician or Neurosurgeon) is a medical expert who deals with disorders of the brain due to physical causes (strokes, tumors, infections, etc.).

Psychiatric Assessment

Physical health is evaluated by the doctor by a clinical history and examination. Investigations are asked for, if necessary.

In mental illnesses multiple internal and external factors have influence on brain chemistry resulting into imbalances in brain functioning. These are not visible on brain scans. However, if the cause for symptoms is suspected to be gross brain pathology (stroke or tumor), then a CT or MRI scan can be useful.

These are standardized tests consisting of questions, pictures, images, puzzles, and skill evaluation. These are conducted by a qualified clinical psychologist. These are helpful in certain conditions.

It is necessary to evaluate the person in totality. Knowledge of the prior functioning of the individual, life history and the stresses contributing to the illness is vital. Family history is necessary to understand the social and inheritable aspects of the problem. Also important is the role of interpersonal conflicts and the personality structure of the individual.

Confidentiality is a professional ethic followed by all Psychiatrists. So, one should share as much information as possible without hesitation. It may be necessary to share some information with other doctors or psychologists from the management perspective.

Lot of relevant information can be obtained from people close to the patient. A highly distressed, confused, or violent patient is in no position to give accurate history. It is also important for family members to understand the illness, take appropriate decisions and supervise the treatment for best outcome.

You are correct! Each culture has a different approach, and hence the style of functioning is not comparable.

Some people still associate a Psychiatrist with the use of a “Couch”. This used to be a practice for “Psychoanalysis” which was a form of therapy. Psychoanalysis has a limited role in modern Psychiatry.

This is a challenge, and the best option is to discuss this with a Psychiatrist first who can guide you with respect to various options available in your setup.

This may involve help from a friend, family doctor, social agency, or some competent authority. Use of medication, home visit by a doctor, or direct hospitalization through emergency services are some options.

A severely depressed patient may be unmotivated to visit a Psychiatrist. Such patients will need to be handled tactfully. A recovered patient, or a neutral senior can help in this situation.

One should act as soon as possible in case of an uncooperative person or a patient who is non adherent to treatment so as to avoid unpleasant steps subsequently. As per the provosiso of Mental Health Act02017 a patient who is Harmful to sel and others can only be admitted as supported admission for 72 hours with the consent of care givers all other admissions are under category of independent admissions in which the patient should have the capacity to take treatment dicisions.

Short term hospitalization is considered for any psychiatric emergency for rapid control of symptoms. At times it is impossible to treat the patient at home due to various reasons and hence supervised care by skilled staff in a hospital setup is necessary. Treatment like ECT/BPT / Detox/ Ketamine Infusion etc need medical facilities.

Long term hospitalization or institutional care is considered for severe, chronic, non remitting conditions, or in cases where adequate support system does not exist to manage the patient at home.

Causes of Psychiatric Illness

The person affected by mental illness may appear physically well but the symptoms change the person’s nature making him talk & behave differently. Due to the changes in a person’s identity, black magic/ possession by evil spirits became the belief of communities. Scientific advancements have helped us understand that mental illnesses are due to an interplay of biological (genes & brain),psychological and social factors and they affect the three realms of Emotion, Thinking & Behaviour.

We can easily understand the cause of medical illnesses like tuberculosis or malaria. Since we could not understand what goes wrong in mental illnesses, lot of superstitions & religious beliefs provided the explanation. There is no visible or measurable abnormality in mental illness unlike other medical illnesses which added to the mystery of cause of such illnesses. In similar fashion, people look for reasons in “Pitrudosh”, and “Karma” instead of accepting the illness and working on treatment.

Many of us have a tendency to attribute our difficulties and shortcomings to the supernatural and the mystical resulting in superstition. The same happens with mental illnesses.

In major mental illnesses, the impairment is so severe that one cannot work objectively on such advice. One has to accept medical and psychological treatment with an open mind. You cannot exercise with a broken leg!

These are likely to be symptoms of an unwell person. Some such episodes may be temporarily aborted by “Tantrik” rituals.

Usually, such symptoms are due to unresolved conflicts. Hence, these are repetitive unless treated with medicines and psychotherapy.

In some people, the biological and genetic factors predominate, leading to the occurrence of a mental illness even in the absence of identifiable stressors. Presence of a direct relation to stress is not necessary for illness to occur.

Mental illnesses develop due to multiple reasons. Hereditary factor is one of them. Genes confer a vulnerability to mental illness. The vulnerability may or may not result in illness depending on several other external factors. Thus, development of mental illness is not dependent only on family history.

Each one of us would respond differently to a given stressor. A mental disorder is defined by a cluster of symptoms lasting for a long duration of time (weeks) which incapacitates our ability to work and interact socially. Treatment attempts to restore normalcy which in turn helps to fight stress.Treatment gets priority irrespective of the cause. If a bone is broken, we don’t debate on the cause in order to fix it!

Just as medical illnesses can afflict anybody, mental illnesses can affect any person irrespective of age, sex, education, financial status or social support. High intelligence does not confer protection against mental illnesses. Even a doctor who is knowledgeable about mental illnesses is not immune to them.

It is hypothesized that stress can produce long lasting changes in the biology of the brain, so that even when the problems are long gone, the changes persist. So, one may utilize all the resources & cope during the stressful period but experience symptoms later due to the effects of cumulative stress and exhausted reserves.

How each one of us responds to an incident depends on our mental makeup, coping skills & coping styles, past experiences, and our support system. When we are suffering from Depression there is an inability to think positively or think in a manner which would help us solve the issue. Negative thinking and thinking about the past is due to the ill state of mind as a result of neurochemical changes. One cannot simply wish it away.

The mind and the body are intricately related. Unresolved conflicts and psychological distress can often lead to physical or somatic complaints. Common examples are a headache or frequent stomach upsets for which no cause can be found despite investigations. In addition, psychological factors are often known initiate,sustain and impact the course of illnesses such as Diabetes, Hypertension, and Bronchial Asthma etc.

Symptoms of Psychiatric Illness

Stress, anxiety & depression can cause disorders that have physical complaints or difficulties. On investigating these disorders, no physical cause is found. These disorders can be effectively managed by a psychiatrist.

Alcohol consumption over a period of time can lead to social, financial & occupational problems.People often continue alcohol for the fear of sleeplessness and tremors on stopping. It is a diagnosable psychiatric problem for which effective treatment is available.

Tobacco in any form is, also, a substance use disorder associated with psychological & physical health issues.

Depression is a common psychiatric disorder characterized by persistent low mood; reduction in confidence, interest & energy levels; negative thoughts about one’s self and her environment; and at times suicidal behaviour. It is found in all social classes and all age groups.

Depression can be effectively treated with antidepressant medication, psychotherapy, and Electroconvulsive therapy.

Counselling can address issues that may be responsible for Depression.

This seems to a psychiatric problem called Mania. The opposite of Depression, Mania is characterised by excessive cheerfulness, excessive activity & reckless behaviours. It can be treated with psychiatric interventions

He will need to be assessed to rule out Schizophrenia. Schizophrenia is characterized by persistent false beliefs (Delusions), hearing voices or seeing images (hallucinations), odd behaviours, and social & occupational deterioration. It is a chronic problem and has to be regularly treated with medicines. This disorder is found in approximately 1 in every 100 persons.

Excessive worrying without a reason is called anxiety. Repetitive anxiety causing thoughts about specific situations or objects which lead to avoidance behaviour are called as phobias. This problem requires a combination of medicines & psychotherapy.

This is a commonly occurring problem called Panic Disorder.These are acute anxiety attacks with all sorts of bodily symptoms. The features mentioned above can easily be confused with a cardiac problem. Like other anxiety disorders mentioned above it requires medication & psychotherapy.

Some amount of forgetting is age related. When it is excessive and associated with impairment in daily routine activities, it is referred to as Dementia. Dementia is often associated with soiling or confused behaviour, aggression, depression or psychosis. Treatment is supportive, and aimed at controlling behaviour, improving mood and slowing the progression of the disorder.

Intelligence need not be impaired in person with epilepsy. When the seizures are well controlled they can lead almost completely normal life. However, they may need to follow certain restrictions so that further seizures do not occur.

Fit- or seizure-like episodes can occur as a reaction to stress. Psychotherapy & Stress management can help in long term relief from such episodes.

Poor academic performance needs to be thoroughly evaluated. Commonest causes in cases like the one mentioned above will be:

Attention Deficit Hyperactivity Disorder – which is characterized by poor concentration, short attention span, easily forgetting things, incomplete work, poor understanding of rules & concepts, forgetfulness, etc. Such children are hyperactive, cannot sit at one place, are often clumsy, and impulsive.

Specific Learning Disabilities – characterized by poor performance (below the age & Standard requirement) in reading, writing & Mathematics.

Bed wetting, or Nocturnal Enuresis, is diagnosed when a child continues to pass urine at night (occasionally in the daytime also) beyond the age at which he or she is expected to become continent. In Indian children, urinary incontinence beyond 5 years is a problem which needs to be addressed medically. Nocturnal Enuresis is called primary if a child has never achieved complete bladder control, and secondary if there has been a period of normalcy in between. This problem can be treated effectively with behaviour therapy & medicines.

Yes, this could be a condition called Obsessive Compulsive Disorder (OCD). These patients can have repeated thoughts about getting infected, or contaminated. They often doubt everything that they do, and are unsure of themselves. Some patients can have irrational sexual or religious thoughts. Such patients require treatment in the form of medicines and psychotherapy.

Sexual problems can result from psychological conflicts. They can also be symptoms of major psychiatric illnesses like Depression. Awareness about normal sexuality prevents many misconceptions and dysfunctions.

Depression and Psychosis in women, after childbirth, is a common postpartum problem, known as Postpartum Psychosis. Stress associated with delivery and child care, and associated hormonal changes along with a genetic predisposition are responsible for this condition. Prior mental illness can also get precipitated in the postpartum period. Risk of suicide or harm to the baby are very high, and so it should be treated on an emergency basis.

A suicide attempt is not a cowardly act, but a manifestation of underlying Depression in this case. Being brave or strong willed does not make one immune to suicidal ideas or attempts. Any such idea expressed by the patient should always be reported to the Doctor so that appropriate measures can be taken.

Treatment of Psychiatric Disorders

Medication is essential part of treatment of many psychiatric disorders. Medications restore the balance of chemicals present in the brain and help to achieve normalcy (eg. Antidiabetic medications help control sugar levels in Diabetes Mellitus). These are symptoms beyond the control of the patient and hence medication gets priority.

Many techniques mentioned above, especially Yoga & exercise promote health in general for all, and are more of healthy life style patterns. These are not treatments for specific problems. Medications & psychotherapy of different types are needed for specific illnesses.

Probably, last time she was suffering from acute but minor episode of psychological ill health but it may not be of the same intensity this time. In fact, research shows that with each new episode, the illness may aggravate in severity and duration.

It varies for each psychiatric disorder. It should be continued under strict supervision and guidance of a qualified Psychiatrist. Any problem in continuation of medication should be discussed with the Psychiatrist as she will offer you a solution to your problem. Medications should not be altered or stopped on your own.

Each group of medication has few peculiar side effects and some side effects pertain to an individual drug. It is best to discuss this with your psychiatrist. The psychiatrist will inform you about important side effects at the time of starting medications.

All medications do not necessarily cause sleepiness. Most of the newer medicines are designed to adapt to the active lifestyle of the patient by minimally interfering with day-to-day activities. Few patients may experience sedation in the beginning, but that effect wears out soon. In case, you still find it a problem, please discuss it with your psychiatrist.

‘Sleeping pills’ is a loose term and a misnomer for psychiatric medicines used by chemists and patients. The purpose of medication is not necessarily to induce sleep, but to correct the underlying chemical imbalance.

Psychiatry medicines are like any other group of medicines (eg. medicines for heart or stomach). Any treatment which offers significant relief is acceptable even if minor temporary side effects occur. The same is true for psychiatric medicines if you look at harm:benefit ratio. Psychiatric medicines are just one of the scapegoats for the stigma associated with Psychiatry in general. Medicines, when taken under supervision, do not affect the kidneys, the liver or heart, as is believed. Discuss with your doctor if any periodic monitoring is needed for the drugs you are on.

This is a myth propagated all the time without any basis. Many people have taken them life long, for 30 – 40 years without any adverse consequence to their brain. These medicines are marketed after years of research and study. Like any other treatment, medicines should be taken under proper supervision for the best outcome. Similarly, there are medicines designed specially for children to help with their problems.

One can always choose alternative therapies according to one’s preference and faith, but not on the basis of advertisement and hearsay. No treatment is free from side effects, efficacy is equally important. Once diagnosed, no delay is justified in controlling conditions like Depression, Mania and Schizophrenia; and hence, speed of recovery is equally important.

You need to inform doctors of either specialty about your decision to switch. Do not continue allopathic medication without supervision by the Psychiatrist.

All the substances used for medical treatment are “chemicals” by nature. Only their source varies, i.e. herbal, animal or synthetic. From the psychiatric perspective what is important is concrete and quick recovery. Allopathic medicines are refined after years of research. All treatments have their share of adverse effects.

Electroconvulsive therapy (ECT) involves passage of small current through a device which induces seizure like activity in the brain. This seizure like activity brings about changes in the brain cells and neurotransmitters which help in improvement of symptoms in psychiatric patients.

Electric current is used for treatment of many diseases in body, hence shock is a misnomer.

ECT is still a very scientific treatment option for many psychiatric conditions, and is used all over the world. Due to various reasons, including stigma and fear attached to it, the use in day-day clinical practice may have gone down; but it is one of the best options in some of the psychiatric emergencies.

No, ECT is a relatively safe method of treatment. ECT portrayed in movies is just sensationalised. In real life the patient is given anaesthesia and muscle relaxation. So, the pain factor is minimized.

ECT is a safe treatment modality. It should not be considered a last resort. It is extremely effective when patient has active suicidal thoughts, or is extremely aggressive and violent. It also helps in resistant cases.

Patient may experience headache and muscle pains which respond well to pain killers. Some disorientation and memory problems may be seen immediately after treatment, these effects diminish quickly after the course ends.

Dramatized depiction of ECT has done immense harm to public perception. Research has shown that there is no damage to the brain in scientifically conducted ECT.

Usually a course of ECT is planned depending on the patients’ illness and response. The course may involve about 6-10 ECTs. Some patients may be put on a maintenance ECT regimen. There is no need to presume that it is always necessary.

Yes, some surgical procedures are available for treatment of Major Depression and OCD (Psychosurgery), for cases which are chronic, severe and debilitating; have already undergone an exhaustive array of available established treatments, and still have severe illness.

Deep Brain Stimulation (DBS), which is a new procedure and under evaluation, may be helpful in certain psychiatric conditions.

rTMS is a non invasive technique for stimulating brain cells by applying a localised magnetic field over the surface of the head. It is helpful in patients with Depression, and is under evaluation for use in other disorders.

Psychotherapy is commonly known as “Talk Therapy”. In this, psychological principles are used to manage some psychiatric disorders. Psychotherapies are done by skilled professionals.

Cognitive Behaviour Therapy (CBT) is a widely used form of psychotherapy. It is based on the principles of thinking and behaviour.

Hypnosis is a therapeutic technique that has applications in certain types of psychiatric problems. It is a common misperception that it can remove all deep seated conflicts.

The Internet has made a lot of information available to people at the click of a button. However, it is a mix of reliable and unreliable data. The information can often be misleading. It cannot determine one’s treatment. The treatment is best left to the psychiatrist.

Information For Patients on Treatment

Do not double the next dose. Take your next dose at regular time and as prescribed. In the mean time, also keep a check on your symptoms like irritability, sleep disturbance or any of your previous symptoms. If any of the symptoms appear, please consult your Psychiatrist.

Abrupt stoppage of certain kinds of medication can cause such symptoms.These could also be early signs of relapse (return of original illness).Make sure that you do not miss out on regular doses because of:

[ 1] non availability,

[ 2] deliberate stopping medicines to experiment, and

[ 3] Poor supervision and follow up.

Termination of treatment should be decided by the treating psychiatrist only. Usually the medicines are gradually tapered down to avoid “withdrawal” symptoms.

Some of the illnesses do need lifelong medication to keep the symptoms at bay and prevent relapse or recurrence. It is akin to taking medicines for hypertension & diabetes.

At the same time there are  many psychiatric disorders which need treatment with medications for a short period ranging from few months to a couple of years.Medical treatment should be supported with other psychological interventions wherever necessary.

Psychotropic medications cannot be given as over the counter drug. It is prohibited by law to dispense these medications without valid prescription. Some of them are governed by rules which are more stringent and hence all chemists do not stock them. Please consult your Psychiatrist regarding your current status.

  1. a) Can I take cough syrup along with my regular medication?

Sometimes, cough syrups & medicines for common cold (anti histaminic) may contain some ingredient which may cause excessive sleep. Otherwise, they are safe to be taken along with your ongoing psychiatry medicines.

  1. b) Can I take painkillers and antibiotics along with my regular medication?

Most medications prescribed for common ailments like fever, cold, & most of the Over the Counter Drugs are well tolerated along with Psychiatric medication. Whenever you consult any other doctor do remember to inform him about the medications you are on.

Any other physical illness will require immediate attention most of the time. One can directly consult the related doctor without any hesitation.  Whenever you consult any other doctor do remember to inform him about the medications you are on.

Discuss the psychiatric medication with the other doctor. If the doctor feels it’s important to seek opinion from your Psychiatrist, he will usually tell you so or do so. In the next scheduled visit to your psychiatrist, carry the notes & prescription of medicines and share all details.

Under no circumstances stop or alter psychiatric medicines just because there are too many medicines because of other additions

All the medicines should be preserved in a safe and secure place so that they are not knowingly or unknowingly misused.

Check with your doctor whether you can drive. It is preferable to avoid driving when you start the medicines. Once you are sure that you are fine & alert on medications, you can resume. Sometimes you may be on certain group of medicines or high doses which can  influence your reflexes.Doctor may advise you to avoid driving for some time.

Avoid alcohol. Take your doctor’s advice in case you plan to have a drink or two at any social function.Do not manipulate your dose for alcohol.

FOR WOMEN: You do expect alteration in your menstral cycles. It is often because of the illness or the treatment, and usually nothing to worry about.You should definitely inform your psychiatrist before rushing into any evaluation.

PREGNANCY: Inform your doctor if you are planning for a child so that you are on medications which are safe during pregnancy.Otherwise, in the childbearing age ensure that your contraceptive method is foolproof.

Other specific precautions will be told by your doctor.

Yes, this is called maintenance treatment. Supervised treatment is necessary to consolidate the improvement and prevent relapses. The duration of treatment will be decided by the treating doctor.

Regular followup with your Psychiatrist is essential:

a. Fine tuning of the dosage is necessary from time to time, depending on your response.

b. Substitution, or reduction of medicines is often required.

c. Some medicines require periodic laboratory monitoring.

d. Prevent early side effects from being missed out.

e. You may be deprived of the newest developments in the field of psychiatric medication.

f. You may be at a risk for developing tolerance and habituation.

g. You may miss out on counselling and psychotherapy.

It is necessary for the psychiatrist to screen you regularly, even if the doses are not changed. So, do not resort to the shortcut of self medication. You might end up paying more than you should have.

By the same logic, any long term treatment like that for Hypertension and Diabetes should be called an “addiction”.

It is not addiction but there is a need to continue medicines to maintain relief because:

a. All the symptoms cannot be cured, some of them can only be controlled.

b. Some illnesses have a strong genetic & physical component. So, other modalities of treatment [like psychotherapy] besides medicines have a limited value.

c. Having experienced relief from prolonged untreated illness, long term treatment may become necessary to prevent relapse.

d. Some conditions like Bipolar Mood Disorder are cyclical in nature, and hence are better prevented with mood stabilizers.

There are a number of important measures which help in sustaining the improvement. These can be integrated into a treatment program by the treating psychiatrist or another mental health professional. These measures help in reducing personal, interpersonal, social and workplace conflicts.

Support groups play an important role in managing many such issues. Alcoholics Anonymous (AA) is an example which works in the area of alcohol related problems.

Social and occupational rehabilitation is equally important in the recovery process.

Treatment is necessary to reduce the occupational dysfunction that results from a psychiatric disorder. Untreated disorders can lead to a number of work related issues like:

a. Absenteeism

b. Poor focus and poor work output

c. Impaired decision making ability

d. Failures

e. Loss of job

f. Financial problems, Interpersonal conflicts, Loss of respect and status

Overall outcome depends on the nature and severity of the illness. Some adjustments may, therefore, be needed at the workplace. Treatment related issues affecting the workplace are minor as compared to an untreated or a partly treated psychiatric disorder, and can be sorted out under the supervision of the psychiatrist.

It is a myth that marriage is a cure for any mental illness. Patients can talk inappropriately about love, marriage and sex, which can be a part of the underlying thought or mood disturbance. It is necessary to treat the mental illness adequately and not rush into marriage with an intent to cure.

Marriage adds to personal, social and financial responsibilities. Hence, the decision should be taken after discussion with the treating psychiatrist.

Several factors like symptoms, medication, level of functioning etc. need to be considered and discussed with the prospective spouse and the family. Such an important decision should not be taken under social pressure. The decision to plan for a family should, also, be taken after consulting the treating psychiatrist.

Not motivated to work or socialize can be a part of the basic illness. This residual part of the illness may not show a good enough recovery compared to the initial symptom relief.

These symptoms are not related to medicines or ECT.

A center, where efforts are made to help the patient organize his day, equip him with skills to interact with others, and trained to carry out some structured activity, in addition to medical treatment, can be called a Rehabilitation Center.

The set up is not like a conventional hospital, but more like a home.