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Psychiatry department at Sir H N Reliance foundation hospital and research centre offers quality care for different types of psychiatric disorders. Psychiatric disorders are disorders of the brain manifesting as disturbances in emotions, behaviour, thoughts and cognition. There are about 200 psychiatric disorders classified currently. Brain controls all functions in one’s body. Brain generates thoughts, emotions and controls our behaviour. Cognitive abilities like memory, planning, organisational skills, logic, judgement, critical thinking, impulse control, abstract thinking etc. are possible due to a highly evolved front part of human brain – the frontal cortex. Psychiatric disorders affect all age groups and genders. According to Indian Council of Medical Research (ICMR) data published in December 2019, one in seven individuals in India is suffering from a psychiatric disorder. Psychiatric disorders significantly contribute to the total disease burden in India.
Psychiatric disorders do not have any single cause. Genetic factors, inflammatory conditions, other systemic illnesses, metabolic disorders, head trauma, nutritional deficiency, endocrine related disorders can contribute to development of psychiatric disorders. They are treatable with medications and psychotherapy. Department of psychiatry works in liaison with other specialties to offer good quality care to the patients. HNRFH has panel of psychiatrist, psychologist, nutritionist, physiotherapist, occupational therapist, speech therapist, sports medicine experts and yoga instructor to help patients towards recovery.
Depressive disorders (known as depression in common parlance) are the most prevalent psychiatric disorder. There are several different types of depressive disorders – major depressive disorder, recurrent depressive disorder, persistent depressive disorder (dysthymia), bipolar depressive disorder, depressive disorder due to medical condition, premenstrual dysphoric disorder etcetera.
Symptoms of major depressive disorder are (any 5 of the following persisting for more than 2 weeks): Persistent depressed mood, loss of interest or loss of pleasure in previously pleasurable activities, reduced or excessive sleep, reduced or excessive appetite, weight loss or gain, loss of energy, restlessness or slowing down, difficulty maintaining concentration or indecisiveness, recurrent thoughts of death or suicidal ideas or suicide plan or suicide attempt. The symptoms interfere with work life, family life or social life of an individual. Depressive disorder is a usually co-existing in individuals suffering from chronic (long term) illnesses like diabetes mellitus, cardiac illnesses, stroke, thyroid disorders and cancers.
The hallmark of anxiety disorders is excessive, uncontrollable anxiety or worry about day to day activities over a period of 6 months or more, and is associated with physical symptoms of anxiety like pounding heart, racing pulse, chest discomfort, sweating, trembling or shaking, feeling of loss of control, feeling giddy, light-headedness, chills or hot flushes etc. The symptoms interfere with work life, family life or social life of an individual. There are different types of anxiety disorders like panic disorder, generalised anxiety disorder and specific phobias.
OCD has two components, obsessions and compulsions. Obsessions are recurrent, persistent, anxiety provoking, intrusive and unwanted thoughts, urges or images. Compulsions are repetitive behaviours or rituals that an individual performs in response to obsession in order to reduce the anxiety and distress. These symptoms interfere with work life, family life or social life of an individual. Common obsessions are thoughts of contamination and usually accompanied by compulsive hand washing.
They are a subtype of anxiety disorders characterised by marked, unwanted, irrational, persistent and disabling anxiety or fear about specific objects or situation. Common phobias include fear of heights or flying, fear of insects, fear of crowded places etcetera. Specific phobia, social phobia or agoraphobia are the further subgroups of phobias. These symptoms interfere with work life, family life or social life of an individual.
Sleep is an important physiological function of the body. Sleep is essential for growth, rejuvenation, restoration and overall well-being. Disturbance in sleep causes disturbance in the homeostasis (equilibrium or balance) in the body. Sleep related disorders either are symptoms of, or predispose to other medical and psychiatric disorders. Common sleep related disorders are as follows:
Difficulty in falling asleep or in maintaining sleep.
Excessive time spent in sleep or excessive sleepiness.
Abnormal or unwanted behaviours or perceptions that occur during sleep.
Involves periods of excessive daytime sleepiness and brief involuntary sleep episodes.
Involves repeated temporary cessations in breathing during sleep. The common complaint is snoring.
Bipolar mood disorder is characterised by distinct periods of elevated or irritable mood and depressive mood occurring during the duration of illness over the lifespan. The mood symptoms plus the changes in thoughts, behaviour, sleep and appetite disrupts normal life. These symptoms interfere with work life, family life or social life of an individual
Schizophrenia is a neurodevelopmental disorder of brain characterised by delusions (false, firmly held unshakeable beliefs or thoughts), hallucinations (perception of having heard, seen, touched, tasted or smelled when no such stimuli exist), cognitive difficulties, avolition (no desire to work), anhedonia(inability to feel pleasure), withdrawal along with disturbance in speech and behaviour. These symptoms interfere with work life, family life or social life of an individual. Schizophrenia is usually a chronic illness and requires long-term management.
Alcohol, tobacco, caffeine, opioid, cannabis, hallucinogens, stimulants, sedatives, sleeping medicines, anxiolytics, inhalants are the common class of substances of addiction. Addiction means psychological and physical dependence on a particular substance. The person compulsorily uses the substance in order to control or avoid withdrawal symptoms due to intense urge for the substance. All these substances adversely affect organ systems of the body predisposing one to various illnesses. Apart from substance dependence, an individual could have pathological gambling which is a non-substance addiction. These symptoms interfere with work life, family life or social life of an individual. Treatment of addiction is possible.
Common presentations of sexual dysfunctions are as follows.
Marked delay in ejaculation or marked infrequency or absence of ejaculation.
Ejaculation occurs early during sexual activity or before an individual wishes it.
Reduced or absent interest in sexual activity and/or absent or reduced arousal in response to any sexual cues.
Marked delay in, marked infrequency of or absence of orgasm or marked reduction in intensity of orgasmic sensations.
Pica, anorexia nervosa, bulimia nervosa, binge-eating disorder are types of eating disorders.
Eating non-nutritive substances like paper, paint, metal, stones, soil and chalk etcetera.
Restriction of food intake which is much less than the usual requirement leading to abnormally low body weight, intense fear of weight gain or becoming fat, distorted perception of one’s own body weight and body shape, taking extreme efforts to control weight and body shape which significantly interferes with the individual’s life.
Eating large amount of food in short time with loss of control over eating associated with compensatory behaviours like self-induced vomiting, consumption of laxatives or diuretics or administering enemas or performing excessive exercise to avoid weight gain. There is distorted perception about body weight and shape.
Eating large amount of food in short time, eating very rapidly than usual, feeling uncomfortably full, may eat alone, and feel guilty about the binge eating. It is not associated with compensatory behaviour.
ADHD is a neurodevelopmental disorder. ADHD diagnoses is common in children but infrequently detected for the first time in adolescence or adulthood. It is characterised by inattention, hyperactivity and impulsivity present in varying intensities.
Inattention presents as easy distractibility, difficulty in sustaining attention, losing things easily, forgetfulness, difficulty in following instructions.
Hyperactivity and impulsivity presents as difficulty in waiting for one’s turn, fidgety, difficulty in remaining seated, always on the go, frequently interrupts during conversation, difficulty in age appropriate estimation of risk, difficulty working in groups and restlessness.
These symptoms interfere with school or work life, family life or social life of an individual.
Specific learning disorders are neurodevelopmental disorders. Difficulty in learning and using academic skills indicated by difficulty in reading, writing, mastering numbers, calculations and mathematical reasoning. If detected, certificate issued from authorised government centres can help an individual to avail of special benefits during board and university examinations.
Autism spectrum disorders are neurodevelopmental disorders. The core deficit is in social communication and interaction, difficulty in developing and maintaining relationships, restricted and repetitive pattern of behaviour, interest or activities. The individuals may have coexisting behaviour or mood disorders as well as ADHD, SLD. They may have specific and unique skills like artistic drawing, exceptional mathematical ability or musical geniuses.
Dementias are a group of neurodegenerative disorders with different causes. They cause a chronic progressive decline in brain function and the symptoms interfere with work life, family life or social life of an individual. The progressive decline are in the cognitive abilities of the individual. There is deterioration in memory, thinking, orientation, comprehension, language ability, calculation or mathematical ability, learning ability, judgement, social behaviour, emotional control, motivation and performing activities of daily living. Dementia usually presents in old age but it is not part of normal aging. Several diseases and injuries can potentially affect brain functioning and cause dementia. Alzheimer dementia is the most common type dementia. Other types of dementias are fronto-temporal dementia, vascular dementia, Lewy body dementia, Parkinson’s dementia, mixed dementia etcetera.