Psychiatric Rehabilitation

The growing recognition that a large proportion of persons having schizophrenia and mood disorders experience long term disability with persisting symptoms or a relapsing course of illness episodes has given birth to the field of psychiatric rehabilitation.A chronic mental illness is an illness where the illness has got a long prognosis course.The incidence rate of major mental disorder in the world is 35 people out of 1 lakh, which needs rehabilitation.Out of this, 80% of the problems can be dealt with effectively.So psychiatric rehabilitation is a process, which helps the individual to find an alternative for hospitalization.
Psychiatric rehabilitation emphasizes continuous and indefinite treatment of life long disorders. It also emphasizes the maintenance of symptom control, prevention,reduction or relapses and optimization of performance by the chronically ill patients in social, vocational, educational and familial roles with the least amount of support necessary. Rehabilitation is a helping process wherein the client is motivated, facilitated and encouraged to develop his lost skills and develop his/her residual skills so as to become a functional member of the society. Rehabilitation plan is different for each individual for each individual depending on his type of illness, duration, socio-cultural factors, severity, family background, etc.Team work is one of the important factors in the process of rehabilitation. Team cooperation and coordination is very essential for the success of the rehabilitation programme.

Goals and Objectives

1. To help them to involve actively in the treatment decisions.
2. To achieve the highest feasible quality of life in the community.
3. Maximize the residual capacity of the patients

Types of Rehabilitation


Hospital based:- For the patients who are left alone by the family and people who belonged to the low strata of society or people in rural ares, there were no rehabilitation facilities.
 Long Term Hospitals:- The patient who cannot restore completely for long time through medication.
Quarter Way Homes:-Residual facilities available inside the hospital only. Here patients may not need acute medical cure but cannot be discharged because of the clinical conditions. The patients are kept only for a short time.
Community Based:-
Hostels:-Meant for a group of long-term patients, who do not require long-term hospital care but they cannot work in an unstructured environment.
Foster Care Homes:-For mental patients,who cannot be sent back home.
Non-Governmental Charitable Agencies:-This is the modified version of mental hospitals. The organization takes mentally ill patients and allow them to live in an institutional setup.
Short Stay Wards:-It is like the casualty in medical hospitals. They live like a family for a maximum period of one week.

Paranoid Schizophrenia

Paranoid schizophrenia is characterized by presence of delusions, hallucinations and other thought disturbances like thought withdrawal, thought broadcasting etc.

Hallucinations- patients report hearing voices, someone talking to them,  commonly  they say that voices speak bad about me, or I hear people talking, planning about me etc

Delusions- patients report that everyone is looking at me or, someone is looking at me in a particular manner etc, these are called as delusions of reference, the other delusion is delusion of persecution- someone is going to harm me, someone is going to kill me etc.

Thought Disturbances- patients report that everyone can know my thought as if they are broadcasted. They can also report insertion or withdrawal of thoughts, eg.  These thoughts are not mine someone is putting them in my head, or someone is taking away my thoughts.

There can be some bizarre ideation like: transmitters are fitted in the room, my thoughts are being said on the TV etc. They are all part of the symptomatic process.

They  usual  presentation of a patient is they the  patients is withdrawn from the society , stays in the house is fearful, suspicious ,  and  is unwilling to come out or work etc, they also don’t take  care  of themselves- not taking bath , not changing clothes etc. there can also  be increased use of nicotine-smoking,  tobacco etc.

Management- patients should be taken to the doctor acute management can involve: use of anti psychotics, electroconvulsive therapy and admission. Details of treatment of schizophrenia will be posted after all types.

Schizophrenia

Schizophrenia is disease which has quizzed and puzzled people for years. It is one of the major mental illnesses and has been seen in varied forms, from calling it split personality to going and calling someone mad (wandering mentally ill).

You must have seen characters suffering from schizophrenia, in movies like –

English: The Beautiful Mind, Through a Glass Darkly..

Hindi: Sangharsh, Kartik Calling Kartik, 15 Park Avenue, Who Lamhe

and marathi movies like: Devrai, Ratra Aarambh, ek cup chya..

Let’s try and understand Schizophrenia.

 

Schizophrenia is a term coined by Paul Eugen Bleuler (April 30, 1857 – July 15, 1939).

It was derived from the word schisms (meaning) he gave four major symptoms of schizophrenia:-

ambivalence- inability to decide  to  or fro,

autism- regression of though process,

association- abnormal thoughts, and

affect- restricted  emotional response

What’s causes schizophrenia is still unknown but we know that there is dopamine imbalance in the brain. There is also strong evidence to suggest that family history increases the chances of schizophrenia.

Schizophrenia is characteristsed by Delusions, Halluctions and thought disturbances. Lets understand what are these.. The person suffering can present with any or all of the following-

Delusions are false unshakeable beliefs, eg. people are planning to kill me.

There are various types of delusions like:-

Persecutory- people try to kill me,

Grandiose- I am prime minister of India,

Infidelity- my partner is having an affair,

Hallucinations- perception without sensory

Stimulus- hearing voices, seeing things

Thought disturbances- someone is taking away my thoughts, everybody can  know my thoughts, thoughts being broadcasted, someone is commanding /controlling me.

There are many types and presentations of schizophrenia will be belonging about each every day.

- Dr. Rohan Jahagirdar

MD (Psychiatry)

Pune.

Mobile: 93 724 16 491

Clinic: 020 - 3240 5770  

Does Your Child Have Learning Disability

Does your child have difficulties in learning? Does your child have trouble processing information and absorbing the same? If your child can not try harder, pay closer attention or improve motivation your child may have a psychiatrist illness termed Learning Disability or Learning Disorder (LD).

The process of diagnosing Learning Disability starts with a psychiatrist. He will test your child. He has to rule out Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder and Autism as the problem. If so, and he finds the specific problem is LD then with other mental health professionals he coordinates the treatment as a team. Your child may be treated by an Educational, Psychologist, Developmental Psychologist, Neuro-Psychologist, Psychometrist, Occupational Therapist, a Speech & Language Therapist.

Only after a battery of tests you will get to know your child’s specific weakness.

He may have Motor Difficulties or Dyspraxia or difficulties with movement and coordination.

Math Difficulties or Dyscalculia or struggle with the memorization and organization of numbers, operation signs and number facts. The child may have trouble counting and in telling the time.

Language Difficulties or Dyslexia or having problems with verbal language skills or fluency of speech. The affected child may not understand words, parts of speech, directions etc.

Reading Difficulties and/or problems with Auditory Processing. Difficulty in understanding sounds, letters and words. Reading comprehension problems occur when the child can’t grasp the meaning of words, phrases and paragraphs. There is a definite lag in recognizing and understanding words; reading speed and fluency in general vocabulary skills.

Writing Difficulties or Dysgraphia or problems with neatness, consistency and the accurate copying of letters and words. Spelling consistency isn’t there along with word organization and coherence.

Auditory and Visual processing. The first is a problem in distinguishing subtle differences in sound or in hearing sounds. This affects ability to read, write and spell. Problems in visual perception include misperceiving depth and distance which affect motor skills, reading comprehension and math.

After specifying the type of LD your child has, the psychiatrist will assist you in the treatment. The brain has a lifelong ability to change, to form new connections and to generate new brain cells as a response to experiences and learning. This ability called neuroplasticity facilitates skills like reading, writing that might have been disrupted earlier due to some fault in the normal lines of communication in the brain. Hence the effectiveness of psychiatric treatment here.

You will be assisted in taking charge of your child’s entire learning input be it at home and at school. You may operate alone or hire the services of therapist.

You will be assisted in communicating with the school teachers, clarify your goals, listen to school officials, offer new solutions or ideas of your own, focus on the afflicted child in a calm, collected and positive manner and persist in executing plans that help your child.

You will learn that every LD child has a unique learning style. Your psychiatrist will assist you in finding that style.

Your child may be a Visual Learner who learns by seeing or reading but not verbally, benefits from notes, diagrams, charts, maps and pictures. Such a child likes to draw read, write, can spell and organize.

Auditory Learners learn by listening to lectures, oral reports and tests. Classroom discussions, spoken directions and study groups benefit the child. They tend to excel in music, languages and like being on stage.

Kinesthetic Learners learn by doing and moving. They benefit from hands on activities, laboratory classes, props, skits and field trips. They tend to like sports, drama, dance, martial arts, arts & crafts.

Depending on your LD child’s strengths and weaknesses, the psychiatrist will develop the strengths and make up the weaknesses till normalcy occurs.

Your psychiatrist will help raise your child’s self-awareness and self confidence, encourage him/her to resolve problems and persevere in solving them; set goals, reach the child to ask for help and to handle stress.

In short LD in your child isn’t a disaster, but is fully treatable and the treatment can ensure some success in life for the afflicted one.

- Dr. Rohan Jahagirdar

MD (Psychiatry)

Pune.

Mobile: 93 724 16 491

Clinic: 020 - 3240 5770  

Does Your Child Have Attention Deficit Disorder

Does your child exhibit inattention, hyperactivity and impulsivity? Does your child have problems due to this at home and in school? Does it affect the child’s ability to learn and get along with others?

To be more specific inattention is when the child doesn’t pay attention to details, makes careless mistakes, can’t stay focused and is easily distracted, appears not to listen when spoken too, has difficulty remembering and following instructions as well as gets bored with tasks before they are completed.

Hyperactivity means signs like constantly fidgeting, often leaving his seat, moving around constantly, talking excessively, difficulty in playing quietly or relaxing and having a quick temper.

Impulsivity signs are when the child acts, without thinking, blurts out answers out of turn, can’t wait for his turn, talks inappropriately, interrupts others, can’t keep emotions in check resulting in angry outbursts or temper tantrums, guesses rather than takes time to solve problems and overacts emotionally and is moody.

If your child exhibits these symptoms it means he/she has a clea cut psychiatric illness called Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder or ADD / ADHD; and requires specialist treatment from mental health professionals.

The first and essential step if your child exhibits ADD/ADHD symptoms is to consult a Child and Adolescent psychiatrist, who will diagnose and prescribe specific medication as part of various strategies to control ADD/ADHD. However medication does not cure the disease by itself. So your psychiatrist will also recommend and supervise other types of assistance from specialist mental health professionals.

Psychologists will provide talk therapy.

Cognitive-Behavioral Therapists set up behavior modification programs at school, work and home as well as help establish concrete goals for individuals, families and teachers.

Educational Specialists teach techniques for succeeding in school, and also help obtain accommodations, including assistive technology.

Parent Educators focus on training parents to interact more effectively with their ADD/ADHD afflicted children and provides essential support.

Mental health professionals use certain definite methodology to control and reduce symptoms of ADD/ADHD. These include:-

Parenting Tips like staying healthy and positive to influence the child’s emotional and physical health. Establish what tasks you want and create a structure so that the child knows what to expect and what he/she’s expected to do. Setting of clear expectations and rules and using praise as a positive reinforcement. Encouraging movement and physical activity as it improves concentration, decreases depression and anxiety and promotes brain growth. Strategies to combat over stimulation and insomnia to get the child to enjoy better sleep. Tips on eating fresh foods at regular meal times will be given. And assistance, guidance to make friends will also be a strategy used.

School Tips include communicating and formulating plans, meetings, creating goals, listening, sharing information and asking hard questions to give a complete picture to the school teacher. Using of techniques like physical placement away from distracting doors, windows etc. Organizing of PT periods and the breaking of long work periods into shorter chunks. To discipline infarctions and interruptions of the afflicted child while maintaining self esteem. The organization of impulsivity that is allow fidgety and impulsive movements at appropriate times to keep the child calmer at work time. The braking down and reinforcement of steps to allow the child to master one step at a time.

Specific instructions regarding Diet is vital too as it regulates ADD/ADHD symptoms. Advise includes scheduling regular meals and snacks. Getting enough zinc, iron and magnesium, even from a daily multi vitamin tablet. Including protein and complex carbohydrates at each meal or snack. And the adding of Omega-3 fatty acids from fish, fortified eggs and milk products into the diet.

All this appears quite complicated and difficult to execute. It isn’t if you consult a psychiatrist and operate under his directions. This also means using the assistance of other specialist mental health professionals. They will help you to use various strategies to manage symptoms of ADD/ADHD in your child and enable him/her to lead a more normal life.

- Dr. Rohan Jahagirdar

MD (Psychiatry)

Pune.

Mobile: 93 724 16 491

Clinic: 020 - 3240 5770  

Does your child have AUTISM

Autism is a form of mental retardation that shows itself right from infancy. If your child has certain early signs like –

ü Doesn’t make eye contact (look at you when being fed)

ü Doesn’t smile when smiled at

ü Doesn’t respond to its name or to the sound of a familiar voice

ü Doesn’t follow objects visually

ü Doesn’t point or wave goodbye or use other gestures to communicate

ü Doesn’t follow gestures when you point things out

ü Doesn’t make noises to attract attention

ü Doesn’t initiate or respond to cuddling

ü Doesn’t imitate your movements and facial expressions

ü Doesn’t reach out to be picked

ü Doesn’t play with others or show interest and enjoyment

ü Doesn’t ask for help or make basic requests

In order children impaired social skills, speech and language difficulties, non verbal communication difficulties and inflexible behavior all point out to autism.

Autism is caused by inherited genetic glitches and spontaneous DNA mutations. At least five to twenty major genes are involved in autism, with many others also contributing to the risk.

Environmental causes of autism include inhalation or absorption of polluted air, food additives, mercury in fish, flame retardants, pesticides, insecticides, various prescription drugs and chemicals used to make synthetic materials.

Autism is a spectrum disorder. There’s a wide degree or variation in the way it affects people. So a team of specialists are involved in diagnosing and treating the afflicted child. They are-

F Child Psychiatrist

F Child Psychologist

F Speech Pathologist

F Developmental Pediatricians

F Pediatric Neurologist

F Audiologist

F Physical Therapist

F Special Education Teachers

As no single medical test can diagnose autism, multiple evaluation and tests are necessary. These include parent interviews; medical examinations to test general, physical and neurological parameters. Laboratory tests and genetic testing is also vital. Hearing tests will rule out deafness as a cause of autism-like symptoms. The child will be observed. And lead screening will also ensure that lead poisoning isn’t the cause of autistic-like symptoms. Diagnostic assessment also includes speech, intelligence, social, sensory processing and motor skills testing.

The psychiatrist will advise you to be consistent in dealing with your afflicted child; develop and stick to a structured schedule or routine; reward good behavior; and create a safety zone at home where the autistic child can relax and feel secure and safe.

You will be advised to connect and communicate with your child by the way you look at him/her, the way you touch the child and by the tone of your voice and body language. If a temper tantrum is thrown find the need behind it. Does the child want to say something he can’t verbalize? Make time for fun, schedule a play time when you do thing that makes the child smile or laugh. Find out if the child is hyper sensitive or sensory stimuli and whether it triggers bad or disruptive behavior or a positive response.

The psychiatrist will assist in creating a personalized autism treatment plan. This will build on the child’s interests, offer a predictable schedule, teach tasks as a series of simple steps, engage the child in structured activities and provide regular reinforcement for good behavior.

You will also participate in autism therapies which focus on reducing problematic behavior and build communication and social skills. Other therapies deal with sensory integration problems, motor skills, emotional issues and food sensitivities. The goal is to treat all your child’s symptoms. This combined treatment approach ensures your child is as normal as possible.

So if you have any doubts of your child’s lack of normal behavior feel free to consult a psychiatrist as soon as possible. The earlier the treatment starts the better it is for your child.

 - Dr. Rohan Jahagirdar

MD (Psychiatry)

Pune.

Mobile: 93 724 16 491

Clinic: 020 - 3240 5770