Drug abuse - A slow Poison.

I chose to write about this topic following a request from one of my friends who is a pharmacist working in govt sector. Well, I understand the interest and care he has for a common man as he knows better than many others, regarding drugs and its misuse. I would like to share two of my experiences, a positive one and other a negative one regarding drug abuse.

First, the negative experience. We had a man, a painter who was dependent on a painkiller which had opioid drug component in it. He had initially started to take the drug occasionally for his headache. The man was a chronic alcoholic too. But in due course of time he shifted his attention from alcohol to these drugs. He was consuming nearly twenty tablets per day, around five each session for around eight years. Unfortunately for him the government banned the particular drug few months back. He became nervous and restless and started travelling to neighboring places and eventually has travelled hundreds of kilometers in search of these drugs, but in vain. He developed myalgia, tiredness, sleep disturbances and consulted few local physicians before he finally came to the Psychiatry dept. The sad part is that, he came in search of an alternate drug and was unaware about his dependence. The worse part being that his wife, not realizing the grip the drug had on him, was asking us to provide him painkillers. He was admitted in ward and was on treatment and psychotherapy. One evening when I was on duty, the deaddiction nursing staff rang me to inform that he was missing in ward. Yes! He absconded from the ward because he was not provided painkillers! I realized that we had failed in motivating him towards deaddiction.

The second incident was a successful one. This person was a teacher who lost her husband in an accident a few months ago. A General practitioner put her on sleeping pills which had a benzodiazepine drug component in it since she had sleep disturbances and anxiety. She gradually started developing dependence to the drug. She was consuming nearly five times the dose of the actual prescribed dose. She developed lack of interest in her work, loss of appetite and went in for severe depression (Sleeping pills are CNS depressants which on long run can only harm you). She attempted suicide, consuming around thirty sleeping pills. She was treated and referred to psychiatry dept for evaluation. At the dept, she was given counseling and motivated. She stopped her dependence once and for all and is doing well for past two months.

From the two experiences, I have understood that people who develop drug dependence had a premorbid stress or substance abuse to go with before they developed this behavior. It is a common misconception to consider only young people, when we talk about drug abuse and dependence. But the sad truth is that drug dependence is very common among all groups of people. The only thing is young people develop dependence faster compared to others. People are usually unaware they have become victims of substance abuse until they develop complications.

There are four types of drug abuse: a) CNS stimulants like amphetamines b) CNS depressants like barbiturates, benzodiazepines and opioids c)Hallucinogens like LSD d) Other common drugs like paracetamol, antacids etc. Initially people develop tolerance and craving following drug intake, later leading to dependence. People with dependence later develop sleep disturbances, tremors, giddiness, anger outbursts followed by recurrent infections, decreased memory, attention, concentration, suicidal ideations, cardiac arrhythmias, respiratory failure and death. Certain drugs also carry an increased risk of
cancer.

A man under the claws of drug abuse should consult a doctor, preferably a psychiatrist because drug abuse needs physical as well as psychological treatment; if not, relapse is very common. Hence we need to be aware about drug abuse and help other unaware people too….

Have given some of the drug users photos and the visual change in their looks, hope this make you understand things better..

”LETS MAKE A DIFFERENCE”

Dr. Bevinsathya.

Know your Child's Behaviour...

Few weeks back we had a 12 year old boy who was not going to school properly for past sixmonths and found stealing money frequently from house. He used to get dressed in school uniform and go out of house but he doesnt attend school. When questioned what he was doing without going to school he was angry towards his mother. His father was a chronic alcoholic who didnot care for his family.

So his mother decided to follow him to school . He as usual started to school but didnot go to school. He went to his friend's house. His mother caught him red handed inhaling glue from a plastic bag with few of his street boys in the house. She was not aware of the abuse pattern of these volatile/inhalant substances. She had beaten him up. The very next day the boy took 400 rupees from his house and ranaway from his house and went with few of his street boys to railway station.He was caught by the police wandering around .He had a  bag of glue sticks and plastic bags. The police has adviced his mother to consult a doctor.

His mother just then realized her son has some problem and took him for treatment.The magnitude of the abuse pattern of inhalants/volatile substances is more than one could imagine. The most common age group using the inhalants and volatile substances are young adolescents due to the easy availability cheap price and are legally available.The most common used substances are glue,gasoline,spray paints,thinners, varnishremover, stain removers and kerosene. The abusers sniff the vapour or fumes from the volatile

substances sprayed in plastic bags to maximise the effect.The children particularly growing in  low socioeconomic status are found to use the volatile substances more commonly due the cheap price. These substances contain toluene ,butane acetone and few other substances which cause tremors incoordination impaired judgement behavioural disturbances and in severe cases respiratory depression cardiac problems and even death.

The abusers are usually found to have anti social personality traits.They are usually self injurious and have conduct disorders.These persons usually later shift to dependence of alcohol cannabis and other illegal substance usage. It is very necessary to identify the behaviour in a very early stage because in later stages  it is usally difficult to treat. As for the boy was concerned he was inhaling glue for about an year and has even started smoking.The prognosis of this child is poor considering  the factor his father is a chronic alcoholic and  the duration  the  boy was inhaling the substances. The main reason is many parents are ignorant about these type of behaviours like the boy's mother.So please be aware and if you notice any such habits in your child's behaviour please consult your psychiatrist as soon as possible.

Lets make a difference.

Dr. Bevinsathya..

Please don't hurt me..

Even in the modern world a mentally ill person finds himself living in an unsupported and abusive world. He does not get the same recognition a visually handicapped or a physically challenged person gets. It may be partly due to the difficulty in identifying who is normal and who is abnormal and mainly due to our lack of knowledge.
                                                               When i was a small child in our village we had two twin brothers who were mentally ill. They used to have a dis-inhibited behavior and were quite aggressive at times. I was very scared of them. So i used to hide myself if i happen to see them. I have also pelted stones on them a few times. But after my experience with the mentally disturbed persons as a postgraduate student in psychiatry I feel bad that I have behaved more cruelly and aggressively than the two twin brothers.

A mentally ill person is not harmful than any  so called normal person in the outside world who cheats his own wife or mother, kills his trustworthy partner, steals abuses other fellow human beings intentionally  and purposefully clearly knowing what he is doing. To care for a mentally ill person is definitely a tough task but at least we can try not to harm them beat them and tie them to chains. I have seen people being tied to trees beaten with sticks and treated more bad than stray dogs .I have even seen mentally ill persons who are tied to  trees and starved for days eating their own human waste.

What more harm can we do to them than this?

We may not be able to care for him but we can at least guide his care givers to take him to a nearby psychiatric hospital for treatment and try to make the caregivers understand this is an illness like any other and not due to the mentally ill person's previous sins and demonic possessions. Our government has even passed a mental health care bill 2013 which considers the rights of the mentally ill and even gives option for him to choose his treatment mode and punishment for those who run illegal mental-health care establishments. So it is time for we people.

Mental Health Bill 2013 News: http://www.thehindu.com/news/national/new-mental-health-bill-decriminalises-suicide/article5045156.ece

Please friends next time you come across a mentally disturbed person being ill-treated try to help and don’t turn a blind eye.

LET’S MAKE A DIFFERENCE.

Dr.Bevinsathya.

"FEAR and HALLUCINATIONS"

 A doctor once in his op saw a man named Mr.X who came running to him and told to him that he was being chased by two persons who are trying to kill him. He was accompanied by his wife and daughter who were also crying and looking very anxious. He was seemingly very tired and restless.The doctor calmly asked him to elaborate his story. 

He without any hesitation started to tell his story. He was working as a carpenter in a nearby village with his family and two daughters. He is very regular to work. He was happily living with his family. He was living in a rented house for past twenty years. So he and his wife decided to get jewel loan from a nearby private firm. He took the loan and started his work to build a house. As months past he found it difficult to continue the house construction due to financial constraints and did not return the loan amount. On Sunday he was very restless tired and was frequently thinking about his future plans. On Monday morning he went to work as usual in his bicycle. He noticed two persons following him from the end of his street. In the meantime his wife tried to interfere the conversation. The doctor just stopped her and asked her to wait in the waiting area and asked him to continue. 

                                                        Mr.X continued, he told he went to his workplace riding his bicycle very fast. In the work place he was getting ready to do his work. He saw a person running towards him with a big knife. He ran inside a latrine and locked the door. He stayed there for few hours and then he slowly he came out. He saw an old man and his wife walking with a stick in his hand. The old man gave him a smile and went away. He could not work properly. He was advised by his coworkers to take rest. He did not take lunch on that day and slept in the workplace itself. Suddenly he heard the sound of three children playing around him. He woke up and saw some school children playing nearby. He saw his watch and it was time and he returned back home. He was very tired and restless. He had his dinner due to his wife's compulsion and went to sleep. Few hours later he noticed few persons running towards his house with fire sticks. He was very afraid. He locked all the windows and sat there. He did not sleep the full night. On morning he wanted to go to work. He went out riding his bicycle towards his workplace. He noticed again the two persons following him again. So he left behind his cycle and ran as fast as he could and came to hospital to save himself he told. When describing the story he was sweating breathing heavily and restless. The doctor just calmed him and asked him to wait outside. He told the doctor that the two persons are standing outside the hospital. The hospital staff might reveal his presence to the two persons. The doctor assured him and asked him to wait outside. 

Then the doctor called the person's wife and daughter to come in. They came in to the room very afraid. The doctor asked Mr.X’s wife to elaborate the incident. His wife broke down into tears. The daughter was the first to start talking. She told her father was very sincere in his work. He first worked as a car driver to a businessman. He was very regular and sincere in his work. The businessman had a job opportunity abroad. So he shifted with his whole family and even sold his car. When going he felt bad for his ever reliable driver who was with for nearly ten years. So before leaving the country he introduced his driver to a close friend

who was a parcel agent. The parcel agent gave Mr.X a job as lorry driver At once Mr.X's wife intervened and told their problem started from that day he joined as a lorry driver. The doctor questioned his wife that Mr.X told him he was a carpenter. She told that now he is working as a helper to a carpenter for past six months. She continued and told her husband started his work as a lorry driver. During that period he got introduced to two other lorry drivers from the same area. They were both chronic alchoholics.They forced her husband into the habit of drinking alcohol. He slowly started to smoke even beedis.Within months he started to drink daily and smoke around two packets of beedis daily. He did not give money for his family. When enquired about that he said the parcel agent has not given him money for past few months. She went and enquired the parcel agent about that. He told her husband has been given all his salary and he has even got advance for the next month and showed even the salary register.. She was very sad and returned home. When Mr.X returned home she asked him what he has done with all the money. He was in intoxicated state. He slapped her and shouted at the daughters and went out. Within a few days the parcel agent came to his house. He called his wife and shouted at her. He told her that her husband and the lorry were missing from yesterday morning. He asked her about his were-about. She cried and told she was innocent.

The parcel agent called Mr.X's wife to the police station to register a complaint. Two days later a police man came to Mr.X's house and called the wife. He told her husband and two others were spotted by the police with the lorry near the state border. They were trying to transport illicit liquor in the lorry. On seeing the police Mr.X tried to speed away and lost control and met with an accident. He was admitted in a nearby government hospital. She was shocked to hear that. She along with her neighbor and the police personnel travelled to the hospital. Mr.X was in a very serious condition. The doctors there informed that the two persons who accompanied him were dead. The two persons were none other than the two lorry drivers from Mr.X’s residential area. The parcel agent told he is going to file a case for compensation. Mr.X’s wife begged the parcel agent and police to let her husband free. The parcel agent accepted compensation and she had to sell their own house and all her jewels to settle the case and the parcel agent. In the meantime Mr.X recovered well and they shifted to a small rented room in a nearby colony. Mr.X felt guilty and wanted to change his life. So went as an assistant with a carpenter for daily wages. But within few days again he started his same drinking pattern of alcohol. He was drinking alcohol daily for past six months. His wife was very upset. On Saturday she made a suicide gesture following which Mr.X promised to stop drinking alcohol and take deaddiction treatment. On Sunday he was in his house. He was noticed to have tremors sweating and was very restless from Sunday afternoon. He did not take lunch properly. He did not sleep on Sunday night. On Monday morning he went to work as usual. Within a few minutes he came running and told the two lorry drivers who died six months back are standing outside to kill him. His wife assured him and he went to work. In his workplace when he was preparing for work he suddenly shouted that a person was coming running

towards him with a knife to kill him. His fellow workers tried to convince him that there was no one there. But he refused to believe them. He was very afraid and ran and locked himself in a latrine and refused to come out. Few hours later he came out and sat down. He told his grandfather and grandmother have come to see him. His coworkers were confused. They asked him to take rest and sleep. He was then noticed by them to be talking to himself and laughing. When asked he told he was playing with his children. The coworkers were afraid and took him back to his house. They advised his wife to take him for magic religious treatment. The magic religious person told Mr.X was possessed by demons due to his previous sins and he offered some prayers and told the problem is over. He got a handsome amount for his prayers from Mr.X wife. Mr.X and his wife returned home happily. In his house again he shouted that the two lorry drivers have come to kill him. He told people are trying to burn his house down. He did not sleep the whole night. Next day morning his wife decided to bring Mr.X to consult the doctor. On the way to hospital he told the road was tilting and everyone are going to die. After elaborating the incident Mr.X's wife cried and asked the doctor for help.

Well what did the doctor say? 

He told her that what her husband was having was visual hallucinations (false sense of perception without any external stimuli). This occurs in a condition called Delirium tremens. It occurs in alcohol withdrawal state. It occurs due to vitamin deficiency and hyperactivity of glutamate neurotransmitters. This impairs the attention concentration and recent memory. The severe presentation can lead to seizures disorientation and even coma and death. He assured her it can be treated. There are many Mr.X in our day to day life. It never late than not taking treatment at all. Please help people understand the symptoms and get treatment at the earliest .Lets make a difference.

Dr.Bevinsathya.

Are we NORMAL...???

To differentiate what is normal and what is an abnormal human behavior takes a lot of understanding of the human mind. Have we understood that is the real question. Well i will try to explore my experiences as a postgraduate student of psychiatry and try to elaborate the differences to my level of knowledge. After selecting this topic when i was sitting in the hostel balcony i noticed a cat standing on the top of the hostel gate and being confused whether to jump in or jump out. The incident just looked similar to the situation which i was in now after selecting the topic. Well with the sip of our ever reliable energetic coffee of the hostel my neurotransmitters got stimulated and i was full of words. I will like to share with you few of my experiences as a postgraduate student in psychiatry. 

During my first week of joining the course i saw a child around 12yrs coming with his mother for consultation for an alleged consumption of poison. When i asked the reason the boy told he was angry because his mother did not allow him to see cartoon channel because she wanted to see some serials so he consumed the poison. When i asked him where did he get the idea of consuming the poison from he told me that he saw that the previous day in a serial his mother was watching. My next experience was in ward a adolescent girl who was taking treatment for her illness. When i saw her i noticed a mark on her head and i enquired her

mother about that. Her mother told that she took her daughter to a magicoreligious person for some unusual behavior in the girl. He had made a mark on the poor girl's forehead with an iron rod and told the mother that he has chased away the evil spirits which has invaded the girl. From my two experiences I had a doubt now that who is abnormal here. Well I am not interested to go into the details so i leave it to the readers to decide.

 Today's trend even in the advanced scientific world is people going behind magicoreligious people and spending few thousands before landing to the psychiatrist for proper treatment. The sad part of our busy life is people have forgotten to share their normal experiences with each other. I had such a personal experience during preparing for pg exams. I was so tensed during the last few days before exam so even during sleep I was dreaming about my books and what I have studied before. I was so anxious so i went and used to enquire it to my friends asking indirect questions .If anyone of my friends replied to my expectation i would smile happily in the back of mind "oh god i have company here" but i never revealed it to my friends.

Similarly everyone one of us experience different emotions for different psychological stressors. This is a normal phenomenon. This becomes abnormal when we continue to feel the same emotions and do things which may harm you or harm our caregivers and do things which are not socially acceptable. A person seen to have decreased self-care decreased sleep having an irrelevant talk without any insight into their problems is usually abnormal and they need to consult a psychiatrist as soon as possible. Well as in any field of medicine the sooner the person reports the better is the prognosis. So I kindly request all the readers to educate their peer groups about the awareness of mental health and advice them to consult a psychiatrist as soon as possible .Don’t shy away from any person who is mentally disturbed. Maybe tomorrow anyone of us could also be affected. It is just like a fever or loose stools we experience in our day to day life. Let’s unite together and help them to think and behave normally as any other person.

Let’s make a difference.

Dr. Bevin Sathya.

"Psychiatry - The Real Definition"

                          Psychiatry is defined as the study and treatment of abnormal mental problems. This is just a definition of  the textbook and for academic interest. Do we understand the real meaning of the word is still an unsolved  mystery. 

                        When  Johann christian reil coined the word psychiatry in 1808 and defined it as the healing of human mind he would have thought that he has unsolved many unanswered questions regarding human psyche in one word.Today even after 200 hundred years of scientific growth we find ourselves  lagging behind in the knowledge about psychiatry. When a person gets a chest pain he rushes to the best cardiologist when he gets fever he searches a physician or when his wife gets a  labor pain he runs to a ogcian but sadly even today when people get depressed stressed out or even when they have some mental problems they never visit a psychiatrist. Rather they prefer a priest or temple or church or some local black magicians for help and end up in deep trouble. 

The social stigma and cultural  boundaries have always prevented people from consulting a psychiatrist. People should break out of these unseen chains  to understand the large perspective of human mind. People even today are proud to say they are a diabetic or hypertensive or asthmatic but never a mentally disturbed. 

When I joined my post-graduation in MD psychiatry few of my co-doctors and medical professionals questioned me why I preferred this field over the highly fancied surgery and related fields.I just smiled at their ignorance. I can tell confidently that psychiatry is the only field where we can treat humanbeings without any scissors blades and costly investigations. Psychiatry is the only medical field were we treat people who are sadly not aware of their abnormal behavior and psychiatrist is the only doctor who treats the part of human body that is hidden within itself the mind.Psychiatry is nothing but understanding the human mind regarding the person’s personality and emotional behavior in relation to the environment in which he is living.

This brings us back to the same old question what is psychiatry. A person developing abnormal mental problems is mostly a person who lacks parental and social support. So It goes without saying that understanding a human mind starts long before the birth of the child when he his swimming happily in his mother’s womb.To make it more clear a mother is the first psychiatrist of the child , father is the psychiatrist who teaches discipline the school teacher is the psychiatrist who gives knowledge and so on.
 

Hence the development of a normal psyche rather depends on the surrounding in which he develops and not the person himself.So It clearly defines the role every one of us to have in understanding each others emotions and problems to have confidence and to understand psychiatry. In my next blog I will be giving a outline of what are normal and abnormal human psychic behavior .

Dr. Bevinsathya.