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Specializing in Mental Health

Anxiety & Depression
Anxiety & Depression

It affects children , adolescents, young adults as well as the elderly. It is universal and both males and females are affected. It causes severe symptoms that affect how you feel, think, and handle daily activities.

Imagine our ancestors facing survival challenges from larger animals, fearful surroundings.

The chemical changes triggered by the hormone adrenaline in the brain would lead to an increase in the heart rate, blood pressure and overall alertness to face the situation or to run away from it to save their lives. The fight or flight reaction as it has famously come to be known.

In our present times we face anxieties related to education, health, jobs, money, housing, family life ,

responsibilities, pressures of performance in different areas of our lives as well as uncertainties of political happenings in our surroundings.

It indeed helps us to safely cross roads as we look both sides before crossing, face examinations and interviews and overall challenges of day to day living without being aware of it.

Anxiety Disorder:

2017 statistics show about 45 million Indians suffering from Anxiety disorders. Imagine in the present days. The most common of all Psychiatric disorders. Most of the patients with physical symptoms visit their GP’s. A large number are underrecognised and undertreated. The feelings of being anxious if prolonged or of severe intensity and out of proportion to the causative factor or stress leads to anxiety disorder. As a result this may lead to an increase in blood pressure or other physical symptoms.

Concerns and intruding thoughts interfere with daily functioning.



Anxiety disorders appear to be caused by an interaction of bio-psychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma.

The common types include:

Generalized Anxiety Disorder:


Generalized anxiety disorder (or GAD) is marked by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry.

Fatigue, mood irritability, muscle aches and pains are frequent complaints. There is a constant expectation of disaster and they can't stop worrying about health, money, family, work, or school.

Social anxiety disorder.


Fear of negative evaluation or judgment by others as well as embarrassment in public places.It includes stage fright, fear of intimacy, rejection as well as fear of humiliation.




A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object, leading to its avoidance.

It arises rapidly and causes significant distress. There are several types of specific phobias related to objects, places, insects etc.


Panic disorder:


There are periods of intense fear arising unexpectedly, spontaneously, reaching a peak within 8-10 minutes.The patient has an overwhelming fear of suffocation and impending death and an intense desire to flee from his place. There is usually no identifiable predictable cause.

To diagnose a person with panic disorder the panic attacks must be associated with longer than one month of subsequent persistent worry about (1) having another attack or consequences of the attack or (2) significant maladaptive behavioral changes related to the attack.

Other symptoms or signs may include headache, cold hands, diarrhea, insomnia, fatigue, intrusive thoughts, and ruminations. The causes of panic disorder are likely biologic and psychosocial, and that panic symptoms are not life-threatening or uncommon.

Association with depression, asthma and heart disease is an increased risk factor.

Identifying trigger factors, Regular treatment of co-existing medical conditions are of great importance.

Selective Mutism:


Selective Mutism (refusal to speak) as in specific situations or places like schools, public places etc

Some children develop selective mutism after a stressor such as illness, separation from their caregiver, or other traumatic experiences such as abuse or neglect and bullying can especially contribute risk and also occur related to the lack of a large supportive peer group.

Other children with selective mutism have an underlying language delay or disorder (most often expressive language disorder) or severe social anxiety and shyness.

Selective mutism significantly impairs the individual's level of functioning, as the individual is unable to complete required educational, social, and family tasks, and the emotional distress engendered in situations requiring the person to speak out loud can result in school refusal.

Separation anxiety disorder (SAD):


Excessive worries and distress of a recurrent occurrence experienced on real separation or anticipation of it, from home or a major attachment figure. It also includes possible harm, injury, accident or death.

A certain amount of clinging behavior and anxiety upon separation from care givers up to the age of 3 years is normal. It may become intense and distressing over time and include:

  • Refusing to be away from home because of fear of separation

  • Not wanting to be home alone and without a parent or other loved one in the house

  • Reluctance or refusing to sleep away from home without a parent or other loved one nearby

  • Repeated nightmares about separation

  • Frequent complaints of headaches, stomachaches or other symptoms when separation from a parent or other loved one is anticipated

Separation anxiety disorder may be associated with panic disorder and panic attacks ― repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.




Agoraphobia is a fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong. Agoraphobia is a type of anxiety disorder that causes people to avoid places and situations that might cause them to feel - Trapped, fearful, panicked, helpless and ashamed. There must be intense fear or anxiety in two of more of the following situations to be diagnosed with agoraphobia:

  • using public transportation, such as a train or bus

  • being in open spaces, such as a store or parking lot

  • being in enclosed spaces, such as an elevator or car

  • being in a crowd

  • being away from home alone


If someone with agoraphobia finds themselves in a stressful situation, they'll usually experience the symptoms of a panic attack, such as:

  • using public transportation, such as a train or bus

  • being in open spaces, such as a store or parking lot

  • being in enclosed spaces, such as an elevator or car

  • being in a crowd

  • being away from home alone

Avoidant behavior:

They'll avoid situations that cause anxiety and may only leave the house with a friend or partner. They'll order groceries online rather than going to the supermarket. This change in behavior is known as avoidance.

Adolescent Therapy
Adolescent Therapy & Substance Abuse

A list of commonly abused substances in India:


  • Nicotine as cigarettes, tobacco chewing,various forms of gutkas.

  • Alcohol 14.6% on national level. (Source 2019)

  • Cannabis ( Charas/ Ganja/ in some countries it has religious sanctity)

  • Cocaine

  • Heroin LSD, PCP

  • Amphetamines and methylphenidate 

  • Sedatives & Hypnotics.

  •  OTC ( over the counter)common syrups for cold and cough containing dextromethmorphan, diphenhydraminea)

    • Acetaminophen​

    • Antacids containing aluminium( in patients with impaired kidney  function can cause aluminium toxicity)

    • Calcium containing antacids in large amounts can cause alkalosis, needing emergency medical care.

  • Non -medication products with known abuse potential, including paint thinners, glues, correction fluids, and aerosol sprays.


For many a patient an ( ED)emergency department,is usually a starting point on their journey to recovery if they realise the desirability of giving up their addiction on their own our under pressure of their families. 

Others are unwillingly literally forced to attend healthcare facilities or simply put into closed door facilities where hardly any proper evaluation or remedial care is available. 


What is addiction?


A compulsive drug seeking behavior or difficulty in controlling ( prescription medicines for genuine medical condition)and giving it up,in spite of its harmful effects. 


Is Addiction curable?

It depends more on the individual’s motivation.Force and    punishment do not work over the long term. 

A dedicated team approach  available at de- addiction  centers, adequate family support, continuing abstinence. 


Rural vs urban:

There is a widespread increase in the addiction rates in smaller towns and villages.Media accessibility, poverty, joblessness, isolation are some important factors for the increase. 


What is intoxication?


It is a condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgement, affect, or behavior, or other psycho physiological functions and responses. (WHO definition)

What is withdrawal from an addiction?


If a person has been using a substance of abuse and had developed a physiological dependence on it, stopping or reducing the dosage of the substance will lead to physical and mental symptoms. The nature ,severity and course of the withdrawal symptoms will be dependent upon the particular substance abused  

Factors leading to development of an addiction: 


  • Family.

  • Genetic factor.

  • Pressure from peer group or very close acquaintance or friend. 

  • Mental illness. 

  • Using a highly addictive substance



Early detection before the condition worsens. Screening for drugs at general hospital and primary health centres 


  • Counselling 

  • Behavior therapy

  • Drug treatment  of underlying psychological and medical conditions

  • Recovery support systems. 

  • Detox in specialist centers 

  • Follow up


Practical difficulties:

  • Only one in ten patients reaches a Specialty detox center 

  • Lower priority in health care system. 

  • Lack of resources. 

  • Lack of well equipped facilities with most existing ones act more like custodial internment with bed and meals only in the name of de-addiction centers. 

  • Lack of trained staff. 

  • Insufficient medical staff perhaps due to lack of glamour and satisfaction as compared to other medical branches. 


Looking ahead:


Mainstream availability in general hospitals and primary health centers. The cost of therapy with inpatient care or residential or outpatient  is cost effective as compared to no treatment with possibly disastrous consequences. 

Relationships, Marital Counseling

It’s a common myth that

  • “time will take care" or

  • “its not a big issue “or

  •  fear of stigma of personal problems being “made public“


Relationships can at times be subjected to severe stresses,a difficult status quo and get stuck with difficulties in moving ahead in an healthy happy manner.The earlier the matter is attended and addressed by working to resolve it, the less the acrimony and burden to carry on ahead with. This needs them to look into the seemingly rational or logical excuses to hide unpleasant controversial anxiety provoking thoughts or feelings.


A safe , supportive confidential environment is provided in therapy sessions. This helps the individuals to work on negative thoughts, revisit previous commitments , possible over expectations and review unexpected new developments in their relations.


The insights obtained in the therapeutic sessions help in better understanding of the problems and working for their satisfactory resolution. The therapist is not the one to make decisions but helps the couple to make proper choices by empowering them. Better coping skills are learnt to deal with and replace negative thoughts.



Marriage counselling can also help couples who plan to get married. It can help couples achieve a better insight of each other, work out on concerns, sharing of household work , involvement of families , money matters, lifestyles, setting of boundaries before going ahead into a lifelong commitment.


More commonly couples seek marriage counseling to improve a troubled relationship when it is very near the breaking point.


Some of the specific issues include:

  • Joint family

  • Job related issues

  • Household responsibilities

    • Communication problems

    • Sexual difficulties

    • Conflicts about child rearing or blended families

    • Substance abuse

    • Anger

    • Infidelity


Marriage counselling helps couples to recognize and work towards conflict resolution and improve their relationships. Marriage counselling contributes towards decisions that help rebuilding and strengthening relationship or amicably going separate ways.

Three ingredients In a nutshell

  • Mutual trust 

  • commitment and

  • sharing of vulnerabilities.


The commitment to these is the glue in holding meaningful happy relationships.


However if the violence has been repetitive, a sense of dread in the company of the partner who feels no remorse and prevents outside visits and contacts by phone, feeling trapped and fearful of one’s safety it’s time for seeking active help from the police and crisis management centers.

Mood Disorders
Mood Disorders


It is a severe disorder. It occurs universally in both males and females. It begins in adolescence and early adulthood . As it is a condition with frequent relapses and at times runs an unremitting course it takes a heavy toll on the patients most productive years of education and employment. The manic episodes are more common in males and the depressive episodes in females.

Both the components are distressing and disruptive if not adequately diagnosed and treated.

Symptoms of Bipolar 1 (mania):


  • At least one week of severe elated mood.

  • Persistently abnormally elated , grandiose ( He is God or a King of Kings/ PM/ has industries ,banks) or irritable mood.

  • Shows easy familiarity with strangers.

  • Markedly impulsive behaviour and easy distractibility.

  • Speaks in a very rapid manner as if under severe pressure to talk , jumps from topic to topic.

  • The other person may not get an opportunity to get in a few words.

  • Has thoughts racing in his mind about different topics, plans and actions.

  • Level of activity is increased and may travel long distances or take on multiple unplanned impulsive visits to far off relatives or friends.

  • Sleep is decreased and he may report that he does not need sleep, has so many things to do.

  • Undertakes risky behaviours like driving recklessly,gambling, drinking alcohol or abusing substances, disinhibited sexual behaviour.

  • Seemingly he is on top of the world, has lots of energy, would not let anybody stop him. Potential to violence is high.

Symptoms of Bipolar 2 (Depression of at least two weeks duration):

Depressive phases last longer and may or may not be intermingled with bouts of hypomania( mild mania) or mild to moderate mania.

  • Mood distinctively depressed

  • Loss of pleasure/interests.

  • Sleep may be decreased or increased

  • Weight disturbances

  • Poor concentration and memory disturbances.

  • Indecisiveness. Taking decisions seems a huge burden.

  • Feelings of helplessness, hopelessness and guilt

  • Most of the time fatigued or low levels of energy.

  • Dependency on others or withdrawn and isolated.

  • Preoccupation with death, suicidal thinking.

The bipolar with mixed features in which symptoms of both mania and depression are present alternating with each other.


What is Rapid cycling bipolar disorder?

Four or more episodes of mania or depression within one year.

What is ultra rapid cycling in bipolar disorders?

24-48 hours cycles of mania/ hypo-mania and depression.

Risk of suicide is high in which phase of bipolar disorders?​

Depressive and mixed phases.


Why are anti epileptics used in the treatment of bipolar disorders?

In addition to their anti epileptic action they have mood stabilizing properties too.


Treatment is absolutely necessary to bring about control of the disruptive symptoms and prevent harm to the patient and others in the case of a manic episode. In severe cases hospitalization will be needed to effectively manage the patient.
In cases of the depressive and mixed phases ,early intervention by both psychotherapy as well as drugs helps in timely relief of the distressing symptoms and prevention of the danger of suicide.


As bipolar 2 presents with depression a careful family history of bipolar manic mood disorder if present should be inquired into. If present it is a sign to be alert and seek information of possible previous episodes of hypo-mania or mania in the patient.

Why is this of great importance?

This helps the treating physician to manage the patient with proper mood stabilizers and not just antidepressants.
Antidepressants can unmask an underlying manic episode with some difficult and unpleasant consequences for both the patient as well as the care givers. Electroconvulsive therapy (ECT) May be needed in markedly disturbed cases of mania as well as severely suicidal depressed patients.

Chronic psychiatric conditions untreated or improperly treated are often accompanied by anxiety as well as substance abuse potential. Add to this the change in the lifestyles, obesity, diabetes as the person ages results in added burden and can be very demanding for the patient.

Regular and proper treatment, understanding of the nature and course of the illness and support by the family is necessary for successful outcomes. Emotional and social rehabilitation is required to help the patient on way to recovery and good health.

Post Traumatic Disorders
Post Traumatic Disorders


Post Traumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.

This concept grew from World War 2, The Korean War and the Vietnam with the returning soldiers being affected by the terrifying experiences they had witnessed and were a part of. From “Shell Shock“ and “Combat Fatigue “the concept has undergone changes and is no more only limited to wars and battles and soldiers surviving these man made disasters.


PTSD exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family. It can also occur as a result of repeated exposure to horrible details of trauma, rape in those working with these cases.

PTSD can occur in all people, in people of any ethnicity, nationality or culture, and any age. Women are twice as likely to be affected as males.


The lifetime incidence is about 1 in 11 likely to have it.


The size of the problem?


A study found that nearly half (48%) of the patients in general medical practices with PTSD were receiving no mental health treatment. One primary reason for this lack of treatment was providers not recognizing the diagnosis and recommending treatment The other is non reporting by the patient for fear of shame and stigma to the reputation of the family.



Risk factors:


Some factors that increase risk for PTSD include:

Rapid heart rate at beginning of the trauma, intense terrifying fear, feeling of suffocation, lonely and helpless in a sudden catastrophic situation with fear of death and no organised help available.

  • Living through dangerous events and traumas

  • Getting hurt

  • Seeing another person hurt, or seeing a dead body

  • Childhood trauma

  • Feeling horror, helplessness, or extreme fear

  • Having little or no social support after the event

  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home

  • Having a history of mental illness or substance abuse


Protective factors:


Some factors that may promote recovery after trauma include:

  • Seeking out support from other people, such as friends and family

  • Finding a support group after a traumatic event

  • Learning to feel good about one’s own actions in the face of danger

  • Having a positive coping strategy, or a way of getting through the bad event and learning from it

  • Being able to act and respond effectively despite feeling fear


The cardinal symptoms PTSD include:


  • Intrusive thoughts

    • Recurring unwanted distressing thoughts and memories of the traumatic event.


  • Avoidance of traumatic triggers or of thinking/talking about the experience. Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories.


  • Negative thoughts.

    • Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”), ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling numb and detached from others.


  • Increased arousal or reactivity: irritability, problems with sleep or concentration, increased startle reaction, increased vigilance for potential danger, self-harming acts, or recklessness which may lead to suicide or homicide.


How to manage a person during a recurrent episode of PTSD:


  • Be calm and talk in a reassuring gentle way.

  • Tell him he is not in any danger.

  • Encourage him to breathe slow and deep.

  • Tell the patient that his feelings are not at present based on reality,calmly instruct him to look around at the surroundings in the present moment.

  • Do not touch him without permission.

  • Management approach and treatments.



Psychological First Aid (PFA) may decrease rates of PTSD following a natural disaster or mass casualty situation. PFA includes emotional support, decreasing stress by reassuring the victim that shelter, food, and access to loved ones is guaranteed.

Stress management:

  • Control of pain.

  • Use of hydrocortisone has been found to be beneficial

  • Use of Propranolol to control the physical symptoms at the outset prevents rapid escalation if the PTSD

  • Building on their existing strengths

  • Peer support groups.

  • Getting back to their lives.

  • Psychotherapy esp based on CBT -Trauma focused.

  • Drugs treatment SSRI , SSNRI, Anxiolytics.

Geriatric Psychiatry
Geriatric Psychiatry 


Dementia is a syndrome in which there is deterioration in memory, thinking, behavior and the ability to perform everyday activities. Although dementia mainly affects older people, it is not a normal part of ageing. Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.Every 3 seconds one new case!


Alzheimer disease is the most common form of dementia and may contribute to 60–70% of cases. Dementia is one of the major causes of disability and dependency among older people worldwide.It leads to a tremendous amount of care takers time, adds to their stress levels.

Dementia has a physical, psychological, social, and economic impact, not only on people with dementia, but also on their carers, families and society at large.

The availability of better health facilities, along with longer life expectancy has contributed to a sizable age in population in the developing countries. The size of this population is expected to double every 20 years with a huge rise in the cases in developing and poor countries.

Vision(WHO Global action Plan on the Public Health Response to Dementia 2017 - 2025):

Those affected by dementia and their carers live well and receive the care and support they need to fulfill their potential with dignity, respect, autonomy and equality.

Behavioral and psychological symptoms of dementia (BPSD).

During the lifetime of the patient there is a 90 percent possibility having at least one episode.


The common symptoms of BPSD are:

  • Apathy

  • Anxiety

  • Agitation

  • Abnormal involuntary motor activity.

  • Dissatisfaction and unease

  • Depression

  • Dis-inhibited behavior

  • Delusions

  • Guilt ridden

  • Hallucinations

  • Irritable

  • Mis-identification

  • Psychosis

  • Screaming

  • Sleep disturbances,

  • Social withdrawal

  • Suspicion

  • Suicidal thoughts



In addition to a variable progressive downhill course the other issues relate to coexisting medical and surgical conditions as well as care giver burden. Lack of information, support, respite and the multifarious tasks needed for care giving can lead to severe strain, stress, negative feelings chronic fatigue , frustration, anger and depression.


The signs of care giver stress.

  • Feeling overwhelmed or constantly worried.

  • Feeling tired often.

  • Getting too much sleep or not enough sleep.

  • Gaining or losing weight.

  • Becoming easily irritated or angry.

  • Losing interest in activities you used to enjoy.

  • Feeling sad.

  • Having frequent headaches, bodily pain or other physical problems.

  • On a personal level the progressive decline in the results of care giving can be very traumatic as one finds curtailment of one’s own activities


Proper information , support and respite from the responsibilities is necessary. One should keep moving ahead with one’s own life to keep physically and mentally healthy and be able to provide care. Offering caregivers the support they want and need could help alleviate their caring burden, improve their and their care-recipients’ well-being, and reduce the risk of institutionalization.


Loneliness and Depression in the Elderly



It's important to remember loneliness can – and does – affect anyone, of any age.Older people are especially vulnerable to loneliness and social isolation – and it can have a serious effect on health.

Hundreds of thousands of elderly people are lonely and cut off from society,especially those over the age of 75.This is not only true of the developed world but of the developing as well as undeveloped world as young people leave to find jobs leaving the elderly behind. Some of the reasons for social isolation :

  • Getting older or weaker

  • Loss of job

  • The passing by deaths of spouses and friends,

  • Disability or illness.


Irrespective of the cause, it's easy to be left feeling alone and vulnerable, which can lead to depression and a serious decline in physical health and well being. In truth, a lonely person perhaps also finds it hard to reach out.


There's a stigma surrounding loneliness, and older people tend not to ask for help because of they realise the necessity of the younger ones to move out for lack of jobs or betterment in education in their home towns, setting up their own families and in many a case the long life attachment to one’s own home and surroundings. Millions across the globe go for over a month without speaking to a friend, neighbor or family member.



It is pretty common for a wide variety of reasons. Everyone feels sad sometimes. But later life can give more reasons to feel down.

One may have to deal with:

  • stopping work

  • having less money

  • health problems

  • the death of a partner or friends.


In India available literature review shows a prevalence between 40-70 %. A large number of cases go unnoticed due to associated medical conditions and wrongly attributed to getting old.


The pain and suffering of the elderly is no less than a younger person’s. The right to a dignified life and good mental health should not be denied just because they are past their age of economic productivity.


What are the differences in Depression of the young vs the elderly?


The younger patients show more of the mood disturbances. The elderly more of cognitive ( thinking, understanding memory physical and


The symptoms of mild depression can be managed with non pharmacological treatments. CBT is quite effective.

Major depression however is treated with medications and if need be by ECT. The need for medicines is usually for several months depending upon a host of factors which the treating doctor will discuss at the outset and during follow up reassessments.


Delirium is a sudden change in mental state, which may be confusion, agitation and difficulties with understanding and memory. It can occur at any age , hospital ICU settings, medical and post surgical procedures. It is more common in the elderly patients.

It is also referred to as acute confusion. It is usually transient, reversible once the underlying cause is identified and managed. Delirium is a medical emergency and requires hospitalization for proper evaluation and management.


The mortality/ morbidity rate in patients who are admitted with delirium, mortality rates are 10-26%. Patients who develop delirium during hospitalization have a mortality rate of 22-76% and a high rate of death during the months following discharge.

As the patient is not in control of his thinking, memory, perceptions,he is potentially likely to act in dangerous ways unless in a safe environment. It is not the same as dementia, although people with dementia are at an increased risk of delirium.


How is delirium diagnosed?


The history of the patient is of paramount importance. The diagnosis of delirium is clinical. No laboratory test can diagnose delirium. Obtaining a thorough history is essential. It develops over hours and days, fluctuates over the day, being worse in the early night , if patient put under restraints, dehydrated, hypoglycemic, recent change of medicines especially marked increase or decrease.


Because delirious patients often are confused and unable to provide accurate information, getting a detailed history from family, caregivers, and nursing staff is particularly important. Nursing notes can be very helpful for documentation of episodes of disorientation, abnormal behavior, and hallucinations.

Delirium always should be high on the list of probable diagnoses when deterioration in behavior, cognition, or function occurs suddenly especially in patients who are elderly, demented, or depressed.Patients of delirium must not be left alone. This is to prevent suicidal or homicidal behavior.


How can relatives and friends help?

Whilst it can be frightening and upsetting for you to see your loved one confused and agitated it is important you stay calm.

  • Reassure them

  • Talk in short, simple sentences, checking you have been understood. You may need to repeat things. Talk about familiar topics.

  • Gently remind them where they are, the date and time and why they are in hospital.

  • Bring in their own calendar or a small clock.

  • Make sure they have their usual glasses and hearing aids and use them.

  • If required, help them to eat and drink. Bring in favorite food /drinks if this helps.

  • Bring in some familiar photos or objects from home.

  • Visit in small groups, particularly in the evening – stimulating the person too much can make things worse.


Preventive care in use of medications, surgical procedures and anesthetics, early intervention with best possible management, support and continuing care.


A serious mental illness generally of insidious onset, occurs universally, spares neither the rich nor the poor. Both  males and females are equally affected. If untreated there is progressive decline in all aspects of normal thinking, emotions and behaviors. 


As it tends to manifest in young adulthood it is more alarming. It affects adversely the most productive years of an individual’s life and if untreated can lead to life long disabilities. It affects around 1 in 100 people across borders, cultures and religious backgrounds. 

Presence of the following are presenting features:

  • Dis-organised behavior:

    • Impaired ability to carry on with normal routines of life bathing, changing clothes, extreme social withdrawal,silly smiling, grimacing , mirror gazing, giggling and other odd behavior. 

  • Dis-organised speech:

    • Incoherent , illogical combination of words,making up own words to describe their weird thoughts, emotions and experiences.​

  • Hallucinations , usually auditory ( hearing voices)

  • Negative symptoms:

    • Decrease in emotional range, poverty of speech, and loss of interests and drive; the person with schizophrenia has tremendous inertia.​

Diagnoses of Schizophrenia:

Continuous signs of the disturbance must persist for at least 6 months, during which the patient must experience at least 1 month of active symptoms (or less if successfully treated), with social or occupational deterioration problems occurring over a significant amount of time. 

Why is it important to get early treatment?

Early diagnosis and treatment of schizophrenia play a very important role in improving  the outcome. 

Generally the origin is so insidious that valuable years are lost. 

Both physical and hormonal changes are usually blamed for the subtle changes that are taking place in the personality and interactions with others and in relationships. 


The fluctuations of thoughts, feelings, behaviors are considered as part of normal growing up and deviations are not given due attention or simply escape due observation. 


Grades in studies start declining, spells of irritability, changes in behavior, loneliness,moodiness, strange experiences, use of difficult to comprehend words or expressions to describe their thoughts and feelings , odd beliefs and mannerisms,inappropriate dressing , make them more isolated. 

Thus schizophrenia strikes at the time the individual is in his most formative years of personality development, education,peer relations,dealing with physical growth and hormonal changes and with his sexuality. Failures in these essential domains will  result in important deficits in years to come in his individuality, independence and success in his career and married life. 


It is the social disruption which can make recovery more difficult, because the more the social isolation  and lack of support networks  that many avenues will be lost. The lack of awareness of proper and adequate treatment, associated stigma, frequent relapses and not being able to return back to to normalcy in a very demanding society puts the patients in a big disadvantage. 

So, the importance of early detection and adequate treatment  in a supportive caring environment is essential to help the patient  to cope with everyday life, work and relationships, regardless of whether or not they are experiencing symptoms. 

Recovery Model:

Psycho-social treatments are currently oriented according to the recovery model. According to this model, the goals of treatment for a person with schizophrenia are as follows:​

  • To have few or stable symptoms.

  • To be in school / vocational set up  or working in a caring environment.

  • To avoid hospital admissions

  • To manage his life, medications and finances. 


There is no reported cure for this devastating mental illness. Advances in drug treatments has contributed to the possible outpatient management and avoidance of mental asylums.Drugs need to be tailored to patient’s specific profiles as far as possible. 

Most modern hospitals have both outpatient as well as short duration admission facilities where highly trained doctors, psychologists, psychiatric nursing staff and care providers treat the patients in a protected caring environment. 


Modern medicines are the mainstay of treatment along with CBT, occupational therapy, behavioral skill training,supported employment

Usefulness of psycho-social interventions?

They can help people pursue their life goals, such as attending school, working, or forming relationships. Individuals who participate in regular psycho-social treatment are less likely to relapse or be hospitalized. The first episode if properly managed sets in a better outcome, compliance from the patient and relatives. 


In addition to daily medicines the alternatives for better compliance are long acting depot injections. Their duration of action is between 2 weeks to 12 weeks depending upon the type of medication. 


In rare conditions like severe psychotic symptoms with muscular stiffness,refusal of food, bed ridden, refusal to speak ECT treatment may be considered as life saving along with injectable medications and supportive care for vital cardiovascular , kidney functions dehydration, and nutrition. 

Brief Psychotic Disorder ( Better prognosis)

Brief psychotic disorder (BPD) according to is the sudden onset of psychotic behavior that lasts less than 1 month followed by complete remission with possible future relapses.(DSM-5)

Schizophreniform Disorder 


The disorder, including its prodromal(precursory) active, and residual phases, lasts longer than 1 month but less than 6 months.

In contrast to schizophrenia, in which prodromal symptoms may develop over several years, in this condition a rather rapid period from the onset of prodromal symptoms to the point at which all criteria for schizophrenia are met (≤6 months)

Schizoaffective Disorder:

Schizoaffective disorder is a perplexing mental illness that has both features of schizophrenia and features of a mood disorder. The coupling of symptoms from these divergent conditions makes diagnosing and treating schizoaffective patients difficult.

Delusional Disorder:

In this disorder,delusions are present in the absence of other psychotic features. Delusions are fixed, firm,false beliefs in the patient’s mind that are not amenable to logic nor in keeping with his culture. Contact with reality is well maintained as well as the functions of cognition are intact the person passed off as normal unless the cure if his delusional system is touched upon. 

Types of common delusions:

  • Persecutory

  • Referential 

  • Grandiose 

  • Nihilistic

  • Somatic

  • Erotomanic

Substance induced psychotic disorder  (SIPD):

Substance/medication-induced psychotic disorder (SIPD) as delusions and/or hallucinations related to the physiological effects of a substance or medication, based on evidence from the history, physical examination, or laboratory findings. (DSM-5)


The activation of the brain’s reward system is central to problems arising from drug use; the  feeling of euphoria, relief from the burdens of life, escape from painful reality of life as well as distress of an existing medical or psychological illness. There is neglect of other normal activities. Drug seeking behavior overrides other important priorities of life and responsibilities   A vicious downward spiral sets in. 


The pharmacological mechanisms for each class of drug are different, the common link is the fleeting escape and euphoria guaranteed by the drug or substance abused. 


Presence of comorbid personality disorder, mood disorder, broken family, family involved in substance abuse behaviour add to the management difficulties and outcomes. 


Early treatment is recommended in a safe setting to avoid access to the offending substances. 

Childhood Mental Disorders
Childhood Mental Disorders

At any given point of time, nearly 50 million Indian children suffer from mental disorders, and this number will increase if the adolescent population is considered. A study conducted in Lucknow estimated the prevalence of child and adolescent mental disorders as 12.1%. Similar results from Bangalore too. A lack of facilities adds to the severity of the matter.


By conventional wisdom or folly the onus of mental illness of the young and the old is left to the family.

We all have to join forces to provide proper mental health in addition to physical health to our children to ensure a healthy next generation. As such normal childhood development is a process that involves continuous change.

Additionally, the symptoms of a disorder may differ depending on a child's age, and children may not be able to explain how they feel or why they are behaving a certain way.


Some of the signs are:


  • Persistent sadness — two or more weeks

  • Headaches ,stomach pains

  • Outburst of Irritable behaviour

  • Angry outbursts

  • Self harm behaviour or harming others

  • Talking of suicide or death

  • Appetite and sleep changes

  • Avoidant behaviour and social withdrawal

  • Fears and worries

  • Poor concentration

  • School refusal

  • Falling grades in education

  • Excessive stubbornness

  • Disruptive behaviors.


If they are persistent and interfering with the normal routines of daily life they need attention to prevent dysfunctions in personality, behavioral, emotional and social well being.


Let’s begin with some very common conditions:


  • Learning and developmental disabilities.

  • Anxiety

  • Depression

  • Oppositional Defiant Disorder (ODD)

  • Conduct Disorder (CD)

  • Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Obsessive-Compulsive Disorder (OCD)

  • Post-traumatic Stress Disorder (PTSD)

  • Autism spectrum disorders

  • Substance use and self-harm.


The earlier the better:

The timely addressing of the issues is essential. It prevents major disruptions in the growing child’s development. Left on his own it may overwhelm the child or the young one. Once the changes are noticed the parents or guardians should seek feedback from the school teachers and counselor to be aware of their child’s classroom , playground activities and behavioral changes do that they can address them.


If symptoms are severe and persistent, and interfere with school, home, or play activities, the child should be referred for assessment and therapy to Child Guidance or Mental Health Clinics for professional help and guidance.

Why seeking help is delayed?

  • Lack of awareness

  • Stigma associated with mental issues.

  • Lack of comprehensive facilities

  • Fear of drugs leading to addiction.

  • Financial constraints.

How can I help my child cope with mental illness?

  • Be involved.You will be taking care of your child as well as yourself.

  • Learn about the condition.

  • Consider getting involved in family counselling so that all are on the same page.

  • Discuss with the care givers ways of looking after and managing your child’s difficult behavior and responding to it.

  • Keep in contact with the school authorities to secure support.

  • Appreciate and praise your child for good behavior.

  • Join self help parent groups.

  • Enjoy games, outings and social activities with your child and groups.

  • Learn simple breathing exercises and muscle relaxation techniques.

  • Learn to handle negative thoughts and manage stress.

  • Have time for yourself to wind down.

  • Be positive and hopeful. You can volunteer to help out the needy.

Help and treatment choices:


How is mental illness in children treated?


Common treatment options for children who have mental health conditions include:

  • Psychotherapy. Psychotherapy, also known as talk therapy behavior therapy

  • It is a way to address mental health concerns by talking with a psychologist or other mental health professional.

  • With young children, psychotherapy may include play time or games, as well as talk about what happens while playing.

  • During psychotherapy, in a friendly environment, children and adolescents learn how to express their thoughts and feelings, how to respond to them, and how to learn new behaviors and coping skills.

  • Medication. In certain cases medications — such as a stimulant, antidepressant, anti-anxiety medication, anti-psychotic or mood stabilizer — as part of the treatment plan. The doctor will explain risks

How is mental illness in children treated?

Common treatment options for children who have mental health conditions include:


Psychotherapy, also known as talk therapy or behavior therapy, is a way to address mental health concerns by talking with a psychologist or other mental health professional. With young children, psychotherapy may include play time or games, as well as talk about what happens while playing. During psychotherapy, children and adolescents learn how to talk about thoughts and feelings, how to respond to them, and how to learn new behaviors and coping skills.


Your child's doctor or mental health professional may recommend a medication — such as a stimulant, antidepressant, anti-anxiety medication, anti-psychotic or mood stabilizer may be prescribed— as part of the treatment plan.

It is of importance to learn about:

  • The necessity for the use of the medicines

  • What to expect from the medicine?

  • The duration of the treatment

  • Side effects of the medicines

Psychological impact of occupational hazards with useful references
Psychological impact of occupational hazards with useful references

Everything in life exacts a price. One of the earliest goal imbibed as we prepare to leave school and its priceless impact on us we are a step close to studying for careers and eventually jobs.Work occupies a very important position in our individual and societal life.It provides a financial independence to base or lives and dreams upon, our usefulness to ourselves and to our society.It is essential for our establishing our personal and social identity, family and social bonds, self esteem and confidence, physical and mental health ,access to routines of life, services and goods.

It is natural that a place where we spend nearly quarter of our active time its environment, composition, interactions with others, level of safety standards and updated technologies to mitigate the negative and harmful effects on our physical and emotional health.

Occupational hazards are personal threats and injuries that occur in the process of production and labor.Each and every occupation is associated with its own level of stress and effect on both physical and mental health of the individual in particular and his environment.

I in 3 of a billion workers earn less than 2 USD per day. (Ref. WHO)
Jobless numbers not reliable for political reasons.

Only 1/3 countries have health programs for the workers ( funds and efficiency?)

Prevention in early stages saves a lot of late detection harm especially in unprotected, exploitative lawless environments like mines and some illegally set chemical, garment ,dust and fungal rich environments.


  • Effort - reward imbalance

  • Exploitation due to scarcity of jobs

  • Lack of supervisor and colleague support

  • Long working hours

  • Lean production and lay offs

  • Emotional labor

  • Work life balance

  • Job insecurity

  • Precarious nature of job

  • Anxieties

  • Depression

  • Post traumatic disorders

  • Violence at place of work

  • Burnout


  • Respiratory

  • Cardiovascular

  • Neurological

  • Musculoskeletal

  • Poisoning

The 5 common workplace hazards grouped into:

  • Safety

  • Chemical

  • Biological

  • Physical

  • Ergonomic

Job stress refers to people’s response under physiological and psychological pressure caused by the imbalance between occupational needs and individual resources, needs, abilities, and knowledge .

With the development of society and the increase in life pressure, people bear more and more pressure from society, work, and life. Job stress has been regarded as the crisis and illness in modern society and life. Factory workers and miners were the occupational group with high demands, low reward, and low job control ,and their working environment was full of dust, chemical factors, physical factors, and biological factors.Excess psychological stress could decline psychological function and cause negative physiological responses, leading to emotional fluctuations and psychological health problems .

Common hazards which if untreated lead to severe and permanent disability, loss of productivity and job with severe financial, physical and emotional burdens.

Factory workers and miners belong to a special professional group, who work in a special environment of high temperature, high pressure, darkness, or dust but have low income and social status. Some studies have already proven that people living in harsh environments have a higher risk of developing mental illnesses and the special environments affect the degree of job stress Research showed that 47.35% and 38.27% of factory workers and miners suffered from job stress and mental health problems, respectively, suggesting that the status of occupational mental health of factory workers and miners should be paid more attention.

The influences of occupational hazards on the job stress of factory workers and miners are statistically significant, and the risks of job stress increased 1.30 times, 1.25 times, and 1.39 times with exposure to asbestos dust, benzene, and noise, respectively.

Coal dust, asbestos dust, benzene, and noise were the risk factors for psychological health problems of factory workers and miners, and the risks of psychological health problems increased 1.19 times, 1.58 times, 1.28 times, and 1.23 times compared with those who had no exposure.

Minimizing or eliminating workplace hazards need not be time-consuming or even expensive. Being aware of possible hazards can increase productivity, prevent illness, reduce days off and save lives.

Early diagnosis and proper treatment for lung cancer, cardiovascular and musculoskeletal disorders especially in our Asian countries is a very costly and often unaffordable.
Elsewhere the Health Insurance is a potentially mitigating factor.


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