Dr Aadil Jan Shah, Dr Ovais Wadoo and Dr Javed Latoo, Psychiatrists
Carer’s play a vital role in supporting family members who are sick, infirm or disabled. There is no doubt that the families of those with mental disorders are affected by the condition of their near ones. The demands of caring can bring significant levels of stress for the carer and can affect their overall quality of life including work, socializing and relationships. Research into the impact of care giving shows that one-third to one-half of carer’s suffer significant psychological distress and experience higher rates of mental ill health than the general population.
The association between feelings of burden and the overall caregiver role is very well known. Caregivers provide assistance with activities of daily living, providing emotional support to the patient, dealing with incontinence, feeding and mobility. Due to high burden and responsibilities, caregivers experience poorer self-reported health, engage in fewer health promotion actions than non-caregivers, and experience lower life satisfaction.
There is evidence that depressive symptoms are twice as common among caregivers as noncaregivers. Family caregivers who have significantly depressed mood may be adversely affected in their ability to perform desirable health maintenance behaviour or self-care behaviours in response to symptoms. Women have higher rates of depression than men in the care giving role. Carers can also end up neglecting their own physical health leading to various issues and poor quality of life. Caregiving is also associated with decline in social support, increased isolation and withdrawal.
The impact of caring for different mental disorders and associated risk factors:
Schizophrenia with associated risk factors like; high disability, very severe symptoms, poor support from professionals, poor support from social networks, less practical social support and violence can lead to guilt, loss, helplessness, fear, vulnerability, cumulative feelings of defeat, anxiety, resentment, and anger among caregivers.
Dementia with associated risk factors like decline in cognitive and functional status, behavioural disturbances and dependency on assistance can lead to anger, grief, loneliness and resentment in caregivers.
Mood disorders with associated risk factors like symptoms, changes in family roles, cyclic nature of bipolar disorder, moderate or severe distress can lead to significant distress, marked difficulties in maintaining social and leisure activities, decrease in total family income and considerable strains in marital relationships.
It is therefore very important that carers make sure they are looking after themselves well to do their role better and help reducing any physical or psychological distress. Also, the efforts to identify and treat caregiver psychological distress will need to be multidisciplinary, consider the cultural context of the patient and caregiver, and focus on multiple risk factors simultaneously.
Signs and symptoms of caregiver’s psychological distress can be following:
•Anxiety, low mood, irritability
•Feeling tired and exhausted
•Overreacting to minor problems
•New or worsening health problems
• Problems concentrating
•Feeling increasingly resentful
•Drinking, smoking, or taking drugs to cope
•Cutting back on leisure activities or not socialising well
Coping styles and Interventions to reduce psychological distress in carers are:
Below is the list of websites for different organisations who can provide advice, support, guidance and interventions for carers suffering from any psychological distress or other stresses related to their role.
By Dr. Minal Mistry, Psychiatrist
Marijuana, derived from the Cannabis plant, is also known as “cannabis,” “weed,” “pot,” “ganja” and a variety of other slang terms. It is one of the oldest substances known to have psychoactive effects on our brains. However, with the growing use of marijuana in the general population, increased trends of the legalization of marijuana in United States of America (USA) with similar proposals being made in Canada, and the increased availability of prescribed medical marijuana, should marijuana consumption in younger people be placed under the microscope for further scrutiny?
Marijuana and Psychosis?
Tetrahydrocannabinol (THC) is the main component that binds to cannabinoid receptors in the body. Marijuana can cause a variety of subjective effects which may be positive, such as feeling relaxed, or negative effects such as lethargy, cognitive problems, anxiety or psychotic symptoms. Psychotic symptoms include hallucinations where you may hear or see things where nothing is there, or delusions in which you may believe things that are not true.
One of the major concerns is that marijuana use can lead to the development of psychotic conditions such as Schizophrenia. Although there are conflicting views about the extent to which marijuana truly causes a clinical psychosis in adults, we know that the risk of a clinical psychosis is greater if marijuana is used in adolescence as the developing brain is more sensitive to these psychoactive substances.
However, we now have a new concern about marijuana use in adolescence causing a persistent subclinical psychosis i.e. prolonged psychotic symptoms that are less severe and/or not reaching the threshold for a full diagnosis.
Subclinical psychotic symptoms and marijuana use
New research by Jordan Bechtold, PhD, at University of Pittsburgh Medical Center in Pennsylvania, published in the American Journal of Psychiatry, found that every year of regular marijuana use led to a 21% rise in subclinical psychotic symptoms.
There were three main messages conveyed by this research:
Marijuana and the adolescent brain
Dangers of marijuana use may be less of an issue in the older mature brain. The young adolescent developing brain is a different matter. Compared to a fully developed adult brain, an adolescent’s brain may be more vulnerable to sustained damage. This is an issue that needs to be taken into account with the proposed legalization of marijuana, especially on age limits (just as we have age limits with the use of alcohol and nicotine). These concerns about marijuana are supported by experts who say:
2. Regarding marijuana use: “Starting young and using frequently may disrupt brain development.”Susan Weiss, PhD, director of the division of extramural research at the National Institute on Drug Abuse (NIDA).
The latest research by Bechtold and colleagues magnifies these views. We ought to be looking more closely at this area and educating young people further about the risks.
Cite this article as:
Minal Mistry(2016)New dangers of adolescent marijuana use. The Beautiful Space-A Journal of Mind, Art and Poetry. October 2016: TBSB104
By Dr Abida Sajjad, Psychiatrist
ECT is a treatment for a small number of severe mental illnesses. The use of electricity to treat mental illness started out as an experiment. In the 1930s psychiatrists noticed some heavily distressed patients would suddenly improve after an epileptic fit. Passing a strong electric current through the brain could trigger a similar seizure and - they hoped - a similar response. By the 1960s it was widely used to treat a variety of conditions, notably severe depression.
The idea developed in the days before effective medication. Perhaps more significantly, new anti-depressant drugs introduced in the 1970-80s gave doctors new ways to treat long-term mental illness. But for a group of the most severely depressed patients, ECT has remained one of the last options on the table when other therapies have failed. Annually in the UK around 4,000 patients, still undergo ECT. According to Professor Reid in Aberdeen University "It's not intuitive that causing seizures can be good for depression but its long been determined that ECT is effective”.
We do know that it can change patterns of blood flow through the brain and change the metabolism of areas of the brain which may be affected by depression. There is evidence that severe depression is caused by problems with certain brain chemicals. It is thought that ECT causes the release of these chemicals and, probably, more importantly, makes the chemicals more likely to work, and so help recovery. Recent research has also suggested that ECT can help the growth of new cells and nerve pathways in certain areas of the brain.
Uses of ECT:
It is very helpful for someone who has severe depression, resistant mania or catatonia. ECT should be considered for the rapid treatment of severe depression that is life-threatening, or when other treatments have failed. According to Sienaert P, et al. (Dec 2014) ECT is generally a second-line treatment for people with catatonia who do not respond to other treatments, but is a first-line treatment for severe or life-threatening catatonia. NICE recommends it only in life-threatening situations or when other treatments have failed and as a second-line treatment for bipolar mania.
It should not be used routinely in moderate depression, although it can be helpful for someone with moderate depression if they have not responded to several different drug treatments and psychological treatment.
ECT has been shown to be the most effective treatment for severe depression. It would normally be offered if several different medications have been tried, but have not helped, the side-effects of antidepressants are too severe or ECT has been found helpful in the past.
The National Institute for Health and Care Excellence (NICE) recommends that before ECT, doctors should consider the risks of the treatment which include:
Immediate side effects:
Drowsiness (you may sleep for a while), confusion, headache, feeling sick, aching muscles and loss of appetite
Very rarely, people may experience prolonged fits, especially if they are taking drugs or have medical conditions which lower the seizure threshold. The general anaesthetic (as for any procedure where it is used) carries a risk of illness and a very small risk of death, separate from the ECT treatment itself.
This is the most important side effect of ECT, and the one which causes most concern.It is usually a short-term effect, and most people find their memories gradually return as they recover from ECT.
However, for some people, memory loss can mean both losing personal memories, and having difficulty remembering new information. Some people have been so badly affected that they have lost key skills or knowledge, such as expertise needed to continue their professional work or career.
Guidelines say that you should have a standard test of your memory and thinking abilities as part of your assessment before treatment and after each treatment session
People’s experience of ECT varies enormously. Some people find it the most useful treatment they have had, and would ask for it again if they needed treatment for depression. Others feel violated by it, and would do anything to avoid having it again.
Sixty-four-year-old John Wattie says his breakdown in the late 1990s was triggered by the collapse of his marriage and stress at work. John likens the feeling to being in a hole, a hole he could not get out of despite courses of pills and talking therapies.
But now, he says, all of that has changed thanks to what is one of the least understood treatments in psychiatry - electroconvulsive therapy (ECT).
He says “Before ECT I was the walking dead. I had no interest in life; I just wanted to disappear. After ECT
I felt like there was a way out of it. I felt dramatically better." ( Why are we still using electroconvulsive therapy? By Jim Reed, BBC Newsnight)
Cite this article as:
Abida Sajjad (2016). Role of ECT in mental health. The Beautiful Space-A Journal of Mind, Art and Poetry. September 2016: TBSB103
1. NICE Guidance on the use of electroconvulsive therapy. NICE technology appraisals TA59. Published date: April 2003
2. Sienaert P, et al. (Dec 2014). "A clinical review of the treatment of catatonia." Front Psychiatry. 5: 181.doi:10.3389/fpsyt.2014.00181. PMID 25538636.
3. Malhi GS, et al. (Dec 2012). "Mania: diagnosis and treatment recommendations." Curr Psychiatry Rep. 14 (6): 676–86. doi:10.1007/s11920-012-0324-5.PMID 22986995.
Please check author names highlighted with each article.
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