An elderly couple stood watching the chaotic traffic. He turned to his wife and said, "The entire world seems mad except me and you." He paused, considered and continued, "and sometimes you seem a little mad too."
His observation was probably not far from the truth. Serious psychotic disorders like schizophrenia, dementia, delusions and paranoia are present in 0.5 % of the population. Mild psychiatric disturbances are present in 20% of the population. In addition, emotions can aggravate or alleviate "real illnesses," leaving no sharp dividing line between the physical and the mental. They tend to overlap and influence each other. This leads to psychosomatic illness where the psyche (mind) influences the soma (body). Almost 60 % of the patients visiting the doctor have stress related or psychiatric illness.
All psychiatric patients are not obviously ill. They do not talk to trees or run naked down the street. There are variations and gradations of the symptoms and manifestations of psychiatric illness as in any other disease process.
Certain families have more members in need of psychiatric care. This has led to postulates that the likelihood of developing such an illness may be inherited, with abnormal personality traits being passed on from the parents. Medical studies in twins and in adopted children, helps to reinforce this claim. Twins separated at birth and reared separately in foster homes with different nurturing environments often develop varying degrees of the same psychiatric illness.
Brain cells communicate with each other by transmitting signals with chemicals called neurotransmitters. A correct balance has to be maintained for a person to function efficiently in society. Injuries to the brain can cause defects in the production, degradation, or the ratio between the various chemicals. This causes manifestations of mental disease.
Damage can occur before birth in the womb, during the birth process itself, or after birth as a result of aging, chemicals or an accident. Mental illness may be triggered in a previously normal person by overwhelming psychological stresses like separation, early untimely death of a parent, extreme neglect, or physical, sexual or emotional abuse. Interplay between various environmental and social factors may then prolong the illness.
Newer scanning techniques have demonstrated that blood flow to certain areas of the brain and even its actual physical size differs in persons with psychiatric illnesses. The chemical reaction (neurotransmitter release) in the brain as a response to day-to-day events is also altered. This is similar to change in the blood flow to the heart muscle and the chemicals released causing damage to the cardiac muscle in heart attacks.. Yet, diabetes, hypertension, heart disease, renal failure or cancers are considered "real" organic diseases. There is no discrimination against people suffering from these ailments. Their families are not ashamed.
Society does not accept mental illness, as a disease of the brain. For centuries psychiatric patients have been referred to derisively as "lunatics". They are the objects of scorn. They are ill-treated, denied their basic human rights, chained, beaten, confined or hidden by their families from society. They are denied treatment. Some are married to unsuspecting partners in the hope that in some mysterious way marriage will cure the illness. Most of these patients would probably readjust to society, with appropriate and timely medical intervention.
General physicians can treat the milder forms like depression, anxiety, panic attacks, somatization, (transfer of symptoms to a part of the body), eating disorders and substance abuse. These may present at only certain times in a persons life. Psychotic illnesses like dementia, schizophrenia, paranoia require expert qualified evaluation and help.
Screening for mild psychiatric illness requires affirmative answers to the questions:
· "During the past month have you felt down, depressed, hopeless, useless, and experienced no interest or pleasure in any activity?"· Or "have you had a recent onset of excessive irrational fatigue, irritability, headaches, chest pains impotence, lack of sex drive or vague stomach symptoms?"A spouse, close friend, relative or caretaker should also have noticed these symptoms.
Depression may occur spontaneously or be precipitated by concurrent illness, death, or some other traumatizing event. The feeling described is one of lethargy, inability to perform day-to-day activities, lack of interest in appearance and a feeling of hopelessness. If it coexists with anxiety, the person appears agitated, and there may be lack of eye contact.
Somatization involves a plethora of medically unexplained symptoms like exhaustion, dizzy spells, intolerance to noise, tingling and unexplained pain in a physically normal adult. The symptoms are not substantiated by physical examination . The investigations all give normal results. Rational treatment offers no relief.
Panic attacks are recognized by the effected individual. They are precipitated and prolonged by hyperventilation and accompanied by sweating and palpitations.
Substance abuse involves alcohol, recreational drugs, smoking or over indulgence in food.
Exercise started at the primary school stage and prolonged into the geriatric age group significantly decreases the incidence and duration of minor psychiatric illnesses. Teenagers interested in fitness and sports do not experiment with banned intoxicating substances. The risk of developing major psychiatric illnesses is also reduced with regular activity. Stress is reduced with a regular structured life. The ability to cope is better and the incidence of minor psychiatric illnesses is less.
Regular aerobic activities like walking, swimming, cycling or jogging for 45 minutes a day, five to six days a week, have been shown to release endorphins from the muscles utilized. These naturally occurring chemicals elevate the mood, increase energy levels and maintain mental equilibrium. The stresses encountered in the roller coaster of life become easier to handle.
Exercise is free and its benefits are immeasurable.
Start today.
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