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Emotional stress and heart disease

Emotional stress and heart disease

Psychosocial stress is a constraining force or influence to which one is exposed to every day in life. Stress is a normal part of life and is unavoidable. But the response differs between each individual. Things that are stressful for some can be pleasurable for others or have little significance, the classic example being a roller coaster ride. Some find it a torture while thrill -seekers relish the ride. But the right amount of stress motivates us to be alert and focused.Indeed, it’s the individual rather than the stress that is the real problem. People with type A personality (Time sensitive, competitive, impatient, chronic sense of urgency, a tendency towards hostility and anger) are at high risk than people with type B personality (low key, non-competitive, time – insensitive). In other words, given the same stressful situation some will respond with frustration and anger while others will respond in a more even – tempered way.

A heart attack caused by coronary artery disease is the commonest cause of death worldwide.It involves a reduction of blood flow to the heart muscle due to the deposition of fat (plaque) in the arteries that supply blood to heart. Sudden disruption of the covering layer of the fat deposit leads to the formation of a blood clot which could cause the total blockage of the artery, which leads to a heart attack. The exact cause of the original fatty deposition is unknown.

But risk factors like:

  • Hypertension,
  • Hyperlipidemia,
  • Diabetes mellitus,
  • Smoking,

Physical inactivity increases the chance of such an event. In addition, psychosocial factors, predominantly depression and emotional stress, account for considerable risk. Although this has been known for more than a century, scientific data supporting the mechanism and therapeutic options have started to emerge only in the recent years. Stress has become part and parcel of modern life. Common responses to stress includes body
aches, impatience, decreased sleep, decreased energy level, feeling of anxiety, anger and depression. Sudden and severe stress can cause a heart attack, a condition known as ‘broken heart syndrome’ which is more common in women. Such episodes increase significantly following natural disasters like hurricane, earth quake and tsunami. On the other hand, long term stress, both in early life (childhood sexual abuse, parental substance abuse, poor socio-
economic status) and adulthood (marital discord, social isolation or loneliness) has been associated with a 40–60% excess risk of heart disease. Exposure to workplace stress or “job strain” ( high job demands, long hours of work or poor control of conditions like high blood pressure) is related to a 40% excess risk of heart disease.
In the recent years, the mechanisms of stress that lead to heart disease are better understood. For instance, heightened activity in one part of the brain (the amygdala) can lead to over production of white blood cells from bone marrow. which leads to inflammation and plaque formation in arteries. Similarly, stress increases the tendency of blood to clot. Stress also leads to release of chemicals which elevate blood pressure and blood sugar. Stressed
individuals tend to exhibit maladaptive behavior including excessive smoking, over eating, drinking too much alcohol and doing little exercise.

Emerging evidence supports the notion of counteracting stress as a critical component in the prevention and of treatment of heart disease along with the other conventional risk factors. A positive attitude and well-developed self-esteem are good defenses against stress because they help you view stress as a challenge rather than as a problem. Relaxation of the mind is an important strategy. Relaxation is an active process, that could be achieved by deep breathing, listening to music, reading a book, meditation, swimming or structured programs like Yoga. Yoga is associated with physical postures (‘Asana’), breath control (‘Pranayama’), and meditation (‘Dhyana’), all of which have been shown to reduce the negative effects of stress and improve health. The best form of relaxation, of course, is doing something that brings you joy. Once you identify what this activity is, practice relaxation through this for at
least 30 minutes a day. And don’t forget exercise – it helps in reducing stress along with burning calories. Adequate and good quality sleep is important. Finally, in selected individuals, professional counselling may help reduce stress.

Dr.K.G.Sundar Kumar,
MBBS, MD (Internal Medicine),
DM (Cardiology),
Fellowship in Interventional Cardiology (France)
Consultant Interventional Cardiologist

to know more about doctor and for booking appointment visit https://www.imh.ae/departments/cardiology/

Call : +971 4 406 3000 / 02


Cataract & Its treatment– Everything you need to know!


“Wanting to be free. Wanting to be me. Trying to make people see. And accept the real me.” – Scott Lentine

Over the past decade a growing autistic pride movement has been pushing the idea that people with autism awarenessautism are not disabled, they just think differently with multiple abilities.According to the history of human evolution, it is likely our ancestors would have had autism without been noticed. Latest research concludes autism has a long evolutionary history. Incidence and prevalence of autism has dramatically increased over the past few years.

On March 27, 2014, the Centers for Disease Control and Prevention (CDC) released new data on the prevalence of autism in the United States. This surveillance study identified 1 in 68 children (1 in 42 boys and 1 in 189 girls) as having autism spectrum disorder (ASD). In the UAE, the prevalence is estimated at 1 in 50 children.

People with autism traits may not necessarily want to be accepted or best tolerated but they need to be respected for their unique skills. According to Penny Spikins, senior lecturer in the archaeology of human origins, at the University of York a significant diversity or a variation between people positively impact on successful human evolution and people who are gifted with special skills play an important role in their social group.

Many people with autism have exceptional memory skills like recalling information they read weeks ago, procedures followed in experiments and pattern identification. They often outperform others in auditory, visual, smell and taste related skills. They are also gifted with enhanced understanding of natural systems such as animal behaviors. Individuals with autism perform better on non verbal tests of intelligence than verbal.autism’s hidden giftThe incorporation of their gifted skills into a community would play a vital role in the development of specialists in our community. A study done in 2005 about an elderly reindeer herder from Siberia revealed a detailed memory of the parentage, medical history and character of each one of his 2,600 animals.

His vital knowledge would have made a significant contribution to management and survival of his herd of animals. This grandfather was more comfortable in the company of the reindeers than of humans, but was much respected and had a wife and son and grandchildren.

This example has given the various differences among people with autism and how they have been integrated for the development of specialists in the society.

The most important fact is to emphasize the strengths and weaknesses of people with autism. Though the past studies have concentrated mainly on deficits in autism, the field is now taking a broader and deeper view of the disorder.

We are all in the right era to start thinking of autism as an advantage and how to utilize this advantage for the well-being of the society.

Autism TreatmentsThe right environment for people with autism for making sophisticated contributions to the society is the need of the hour. In many instances, people with autism need opportunities and support more than they need treatment.
The major focus of the rehabilitation team is to identify the strength and weakness of the child with autism. For instance, if a child has minimal verbal ability, then you probably want to find a visual route to help him. Your intervention should target the deficits, while working with the strengths.

About the Author: Ms. Hiranthi Karunarathna is a Speech Therapist at International Modern Hospital with 4 years of clinical experience in Speech Language Pathology. She specializes in stuttering, autism spectrum disorders & other childhood communication disorders. Her experience includes both pediatric & adult rehabilitation care.

How to help my toddler (between 2-3 years of age)?

What does the toddler understand?

  • By now (s)he will understand two steps commands take your shoe off and keep on rack.how to help toddler
  • And also understand opposites like hot/cold, stop/go, nice/ugly.(s)he hears ringing of the telephone , door bell and may become excited, get you to answer or tries to answer themselves

What does (s)he speak?

  • Your toddler’s vocabulary is going to explode. They seem to have a word for almost everything. Their sentence contains of one, two or three words.
  • Speech is probably not very clear, but family members can easily understand them.
  • Your toddler loves to hold your attention of what they hear and see.
  • They may draw your attention to something by naming it, for an example, Bus, Candy, Big, Hot, Wow, see.

How can I help my child?

  • Children learn by imitating adults. Use clear, simple words & sentences what is easy to imitate .Show your interest to their speech. When the child says doggie!!! ; Expand his/her word, Oh yes it’s a doggie, Doggie is running. Doggie says bow bow. It is black. Does Anny love doggie?
  • Have his/her help to arrange cloths, toys, food at home. These are what Anny eats put all into this bucket. Foods are here. We will put Anny cloths in this bucket. Teach the child basic function, features and class of objects with examples.Help toddler
  • Encourage the child to increase the length of speech. Which puzzle do you want? Try to give him/her open ended questions than close ended. For e.g. rather than asking Do you want rice? Do you want bread? Ask would you like to eat rice or bread? This will simply limit Yes & No answers.
  • Reinforce the child effectively .Positive reinforcement is the key for the successful communication. How good Anny speaks, Thank you Anny, mommy understood.
  • Introduce books, picture books, games & activities to expand your child’s vocabulary. Use colorful picture books and name object with the child. And describe the object using a simple sentence. Create the situation to use newly learned words in context. E.g. his is an Apple. Anny eats apple./ Apple is red
  • Have the child have the habit of collecting pictures from magazines, books. Help him/her to glue then paste or write the name under each object.


Attention Deficit Hyperactivity Disorder

Attention deficit / hyperactivity disorder (ADHD) is a highly prevalent condition in children that has generated considerable public interest and debate. It is a chronic, pervasive childhood disorder characterized by developmentally inappropriate activity level, low frustration tolerance, impulsivity, poor organization of behavior, distractibility, and inability to sustain attention and concentration (American Psychiatric Association, 2000)which occurs in 3% to 7% of school-age children (Egger et al., 2000).

Boys are at least four times as likely as girls to develop the disorder (4:1); indeed some studies have found that boys with ADHD outnumber girls with the condition by nine to one (9:1), possibly because boys are genetically more prone to disorders of the nervous system. In children between ages 5 and 15 years it was found that 3.62% of boys and 0.85% of girls have ADHD (Ford et al., 2003). In adults 3.4 % (1.2 to 7.3 %) are presented with ADHD, in individuals aged 18 – 44 years in low-income countries (1.9%) and in high-income countries (4.2%). (Fayyad et al., 2007; Barkley R et al., 2006). 0.6 –1.2% of adults retains the childhood diagnosis ADHD by the age of 25 years.

The causes of attention deficit hyperactivity disorder still remain unknown. It is transmitted in families and most likely is due to the influence of multimodal factors, e.g., the result of a complex set of factors including genetic inheritance, environmental factors, function in several brain regions and level of neurotransmitter activity. It is believed that mutations in several genes that are normally very active in the prefrontal cortex and basal ganglia, tends to play role in the genesis of ADHD. The right prefrontal cortex, vermis region of the cerebellum, caudate nucleus, and the globus pallidus are significantly smaller in children with ADHD than the normal children. Parents of children with ADHD are often noted to be experiencing mental difficulties, high levels of stress, and conflict- laden parent – child interactions. Non-genetic factors that are known to be linked to ADHD include premature birth, maternal alcohol and tobacco use, complications during pregnancy or birth and illnesses of early infancy, exposure to high levels of lead in early childhood, brain injuries that involve prefrontal cortex, overstimulation hypothesis, and metabolic dysfunction of the central nervous system.

The essential features of ADHD continue to include the triad of inattention, impulsivity, and hyperactivity. There are three subtypes: predominantly hyperactive –impulsive type, the predominantly inattentive type (PI), and the combined type. The DSM IV criteria indicate that symptoms must be present for at least 6 months, with onset before age 7. Attention span and sitting tolerance increases with the age of child. Inattention appears to be more evident in girls. The symptoms of the disorder can cause problems in learning; socialization and behavior for those individuals afflicted with it and put them at high risk for serious psychopathology in adulthood. There is growing literature on the ADHD- PI subtype with even later age of onset. These children have lower comorbidity with disruptive disorders, and higher levels of substance abuse, anxiety and mood disorders.

There are developmental differences in the presentation of symptoms. Given below are some of them:


  • Gross motor hyperactivity- running, climbing
  • Difficulty remaining quiet
  • Non-compliant
  • 3-5 years onset – 50% of them continue to have ADHD


School age:

  • Difficulty focusing
  • Losing things
  • Forgetfulness
  • Poor Organizing
  • Adolescents
  • Incomplete assignments and projects
  • Academic under-performance
  • Conflicts with peers, teachers and parents
  • Poor planning, organizing skills

Management involves two phases: Assessment and Treatment

Assessments are usually multimodal: Interview: Parent and Child, Observation, School workbook, Individual testing: cognitive functions, Rating Scale- Parent, Teacher, Self-report (e.g., Conners rating scale; Vanderbilt scale)
Treatment: Psychological and pharmacological Intervention of child ADHD

Evidence based treatments for ADHD include behavioral interventions such as parent behavior management training, contingency management, and cognitive- behavior therapies, administered individually or in group settings, or pharmacologic treatment, with a variety of stimulant formulations and the non-stimulant atomoxetine approved for this indication. For many patients, the optimal treatment is multimodal, meaning the combination of medication and psychosocial treatments addressing all the impaired areas of life.

Conclusion: Despite considerable progress over the past three decades, much is to be learned regarding the neurophysiological basis and genetics of ADHD. Psychological Assessment can serve to essentially validate the diagnosis of ADHD in children and Adults. There have been considerable advances in psychosocial, pharmacological and multimodal treatment of ADHD.

How to help my toddler (between 1-2 years of age)?

What does the toddler understand?

  • Her his receptive vocabulary is increasing day by day
  • The child points to pictures in a book when you name them, and also (s)he points to a few body parts when asked(nose, eyes, tummy, head).
  • She or He follows simple commands like push the chair, don’t touch, it’s hot, wash hands and understand simple questions (where is daddy, what is your frock, who is bunny).
  • Their interest shift from singing songs or say rhymes to simple story telling.
  • Your toddler now likes to listen to simple stories over songs.
  • This is the stage where you become exhausted with repeating the same story, game, rhymes many many times. But (s)he wants to listen the same again & again.

What does the toddler speak?

  • His/her expressive vocabulary keep increasing.,(s)he accumulating more and more words as each month passes.

  • (S)he can even combine 2 words and questions like mama ball, what is that, give me chocos, more chips, all gone, doggie ,daddy poo(car).

How to help my toddler?

Talk to the child while doing household things, going out or performing any activity. For an example Baby is going to bathe, run the tap. Water is coming ( put toys in the tub)Duckie is swimming, push push dickiee. Second example. I see a doggie, Doggie is running. It’s a big dog, Doggie says bow wow .Keep your language grammatically correct and easy to imitate. Talk about present activities what the child What does the toddler understand?sees around him/her. Use rhymes such as jonny jonny yes papa. Encourage the child to say hahahahaa/aaaaaa with you. Associate the object with sound e,g introduce the clock to the child, t-t-t-t-t clock, ding- dong- ding-dong .pi pi pi pi daddy car. Make him listen to the sounds of objects and create a sound associated with the object. mow mow mow mow cow. Use the sound like p-p-p-p-, m-m-m-m-, b-b-b-b-b, brooo-brooo, grrrr- ggrr while bathing, playing with toys, pampering him/her. These sounds will help him to learn better in preschool and kindergarten. Expand on words what the child says, for an example, if (s)he says car or sound likes car. Expand on words saying oh! yes it is a CAR, Biiig CAR, Big red CAR! Show the child big colorful picture book with large pictures. Name them, read aloud and talk about the picture. Wait your child to explore the picture, Ask him/her what is this and you answer. Make him/her point to picture Repeat the same several days. You would be surprised one day hearing(s)he names the picture.

Depression in children and adolescents: an overview

Depression – Let’s talk”, the World Health Day theme 2017 ring an alarm bell in our heart about the presence of this disorder amid our dear n’ near ones. Depression was once thought to be a disease of adults. It is no more considered rare among the children and adolescents, with an incidence of 2 – 4% and 4 – 8 % respectively. A youngster who appears withdrawn and lonely is most likely going through a period of “intense internal emotional turmoil”. They often feel sad and may consistently understand their plight as hopeless. They may frequently show poor concentration, lack of initiation; poor sleep and eating habits, negativity, get tired easily, feel guilty or worthless etc. Depression In ChildrenSubsequently, this often results in chronic depression, poor scholastic performance, psycho-social problems, substance abuse and even suicide. It’s equally prevalent in both sexes during pre-puberty stage whereas more in females with a ratio of 2:1 post-puberty. Mean duration of an episode of depression is 7 to 9 months. 70 to 80 % recover at the end of one year. Increased chance of recurrence is seen in children with early onset and those with the history of previous episodes, co-morbid psychotic symptoms, poor drug compliance, negative life events and positive family history in parents. 20 to 30 % of depressive children develop manic episodes (Bipolar Disorder) on follow up.
Majority of them may reach the general practitioner or the pediatrician with vague so called ‘functional symptoms’. A recent change in behavior with sad or irritable mood lasting for more than 2 weeks indicates a depression. Unfortunately, these disorders often go unrecognized by families and physicians alike. Early diagnosis and treatment of depressive disorders are critical to healthy emotional, social and behavioral development.
Clinical presentation varies according to the developmental stage of the child. They can be seen as given below:
Preschool child: apathetic, refuses food, unhappy and irritable, looks miserable, frequent crying spells, ‘failure to thrive’, insecure and unhappy child without any physical abnormality.
Middle childhood (Pre-adolescence): Apathy, verbal and motor retardation, and loss of appetite are the classic features of depression in this age group. Other features are: psychosomatic symptoms (e.g., head ache or pain abdomen); decline in academic performance with poor attention and concentration, irritability and social withdrawal, low self-esteem (I am not good enough compared to others), feeling bored and lack of interest in usual activities, sleep and appetite disturbances may be present though less common.
Adolescence: Clinical features are more similar to those of adult depression. Feeling sad, apathetic, lack of energy; sleep and appetite disturbances are more common. Bodily preoccupation, worries over his/her appearance or minor health problems (e.g., acne); suicidal thoughts are relatively common.
Etiology: There are multiple factors which individually or in combination with other factors, could contribute to depression. Depression In Children and adolescentsFew predisposing factors/ vulnerability factors are: Genetic; biological factors (neurotransmitters -monoamine metabolism and endocrine abnormalities); and temperament (e.g. quiet children with regular habits and slow to adapt to new experiences). Chronic life adversities are also likely to contribute to develop depression – broken homes, parental alcoholism, abuse, rejection etc. Undesirable life events in previous 12 months are important e.g., an event at home, or school and experience of loss.
Some points to be considered by a parent or caregivers to alleviate emotional disturbances:

  • Use positive reinforcement while disciplining them; avoid overprotecting and over directing.
  • Don’t expect absolute compliance. Don’t use your child to fulfill your own unachieved goals.
  • Take the problem seriously. It will be important to them and give them a feel of being understood.
  • Encourage them to talk to other people (may be a trusted adult friend or grandparents) as well as to you.
  • Treatment strategies for Depression – right time; right way; right people

A proper assessment is needed to establish depression – understand the nature, extent and Depression in Children: Symptoms, Causes, Treatmentsdisability by obtaining the history from all available sources; to explore into the stressors in the school/home; to consider differential diagnosis – Physical conditions like hypothyroidism; psychosis; normal reactive feelings of sadness and unhappiness; look for co morbid condition.
Treatment can include a combination of pharmacological management and various psychotherapeutic approaches – Supportive counseling and ways to relieve stress; Cognitive behavior therapy; Interpersonal therapy.
To conclude, Depression is a treatable emotional/behavioral condition. What is needed is treatment by “right technique at right time by right people” (trained mental health professionals).

It may be real or unreal , but their distress is real!!!

 “ Real beauty isn’t about symmetry or weight or makeup; it’s about looking life right in the face and seeing all its magnificence reflected in your own.”

(Valerie Monroe)


“15 yr old 10th grade girl, not attending school, saying that she was not good looking and her face has some asymmetry. She doesn’t want to go out, and if at all she goes out, she covers her most of her face with scarf. She expresses severe suicidal ideas and was very much depressed.”

Most of us have something we don’t like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small, but they don’t interfere with our daily lives.

Body Dysmorphophobic Disorder (BDD) people think about their real or perceived flaws for hours each day.

bdd-1They can’t control their negative thoughts and don’t believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Who they are? & what they do?

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance.

They can dislike any part of their body, but most commonly find fault with their hair, skin, nose, chest, or stomach. In real sense, a perceived defect may be only a slight imperfection or nonexistent, but for people with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.bdd-1

Most often it develops in adolescents and teens, and research shows that it affects men and women almost equally.

They suffer from obsessions about their appearance that can last for hours or up to an entire day. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

They may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

They may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws.

 Examples are:

  • Camouflaging (with body position, clothing, makeup, hair, hats, etc.)
  • comparing body part to others’ appearance
  • seeking surgery
  • checking in a mirror
  • avoiding mirrors
  • skin picking
  • excessive grooming
  • excessive exercise
  • changing clothes excessively


CBT & Antidepressants

“The human body is the best work of art.” 

(Jess C. Scott)

It’s Ability and not Disability


“Let us work together for the full and equal participation of persons with disabilities in an inclusive and sustainable world that embraces humanity in all its diversity.” 

(UN-Secretary-General Ban Ki-moon)

According to the 2011 World Report on Disability by the World Health Organisation, there are an estimated 1 billion persons with disabilities worldwide. It also states that 1 in 5 of the world’s poorest people has disabilities


  • 7 billion people: world population.
  • Over 1 billion people in the world have some form of disability, that’s 1 in 7.
  • More than 100 million disabled persons are children.
  • Children with disabilities are almost four times more likely to experience violence than non-disabled children.
  • 80% of all people with disabilities live in a developing country.
  • 50% of disabled persons cannot afford health care.


A condition or function judged to be significantly impaired relative to the usual standard of an individual of their group. It used to refer to individual functioning, including physical impairment, sensory impairment, cognitive impairment, intellectual impairment, mental illness, and various types of chronic disease.disability-5

Persons with disabilities

“The world’s largest minority”, has generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them (like information and communications technology (ICT), justice or transportation) and the many obstacles they face in their everyday lives. These obstacles can take a variety of forms, including those relating to the physical environment, or those resulting from legislation or policy, or from societal attitudes or discrimination.

International Day of Persons with Disabilities, 3 December 2016- “Achieving 17 Goals for the Future We Want”.

The 2030 Agenda has 17 goals for sustainable development. disability-7

Disability is referenced specifically in parts related to education, growth and employment, inequality, accessibility of human settlements.

Goal 4 on inclusive and equitable quality education and promotion of life-long learning opportunities for all focuses on eliminating gender disparities in education and ensuring equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities.

Goal 8: to promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all, the international community aims to achieve full and productive employment and decent work for all women and men, including for persons with disabilities, and equal pay for work of equal value.

Goal 10, which strives to reduce inequality within and among countries by empowering and promoting the social, economic and political inclusion of all, including persons with disabilities.

Goal 11 would work to make cities and human settlements inclusive, safe and sustainable. To realise this goal, Member States are called upon to provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, such as persons with disabilities. In addition, the proposal calls for providing universal access to safe, inclusive and accessible, green and public spaces, particularly for persons with disabilities.

Goal 17 stresses that in order to strengthen the means of implementation and revitalise the global partnership for sustainable development, the collection of data and monitoring and accountability of the SDGs are crucial.

 Inclusive society

Evidence and experience shows that when barriers to their inclusion are removed and persons with disabilities are empowered to participate fully in societal life, their entire community benefits.

disability-2The Convention on the Rights of Persons with Disabilities (CRPD) recognises that the existence of barriers constitutes a central component of disability.

Accessibility and inclusion of persons with disabilities are fundamental rights recognised by the Convention on the Rights of Persons with Disabilities.

“Science may have found a cure for most evils; but it has found no remedy for the worst of them all – the apathy of human beings.”

(Helen Keller)


What is stuttering? 

Stuttering is a communication disorder in which the  smooth continuous flow of speech is broken by repetitions (I- I -I want), prolongations (lllllet  me go), or abnormal stoppages (no sound silence pauses) of sounds and syllables . There may also be unusual facial and body movements associated with the effort to speak. Stuttering is also called to as stammering. But if you talk effort fully, with multiples disruptions that should be taken into consideration.stutter-2

What causes stuttering? 

There are four factors most likely to contribute to the development of stuttering:

Genetics (approximately 60% of those who stutter have a family member who does also);

Child development (children with other speech and language problems or developmental delays are more likely to stutter);

Neurophysiology (recent neurological research has shown that people who stutter process speech and language slightly differently than those who do not stutter);

and family atmosphere  (high expectations and fast-paced lifestyles can contribute to stuttering).

What is the ratio of males to females who stutter?

Males are affected four times more than females.

I think my child is beginning to stutter.

Should I wait or seek help? It is best to seek ways that you, the parents. How can I help him/her as soon as possible? If the stuttering persists beyond three to six months or is particularly severe, you may want to seek help from a speech-language pathologist who specializes in stuttering right away.

Can stuttering be treated?

Yes, of course there are a variety of successful approaches for treating both children and adults. In general, the earlier, the better……

Shot of a little boy talking to a psychologist

I read about a new cure for stuttering. Is there such a thing? 

There are no instant miracle or treatment cures for stuttering. However, a specialist in stuttering can help not only children but also teenagers, young adults and even older adults make significant progress toward fluency.

Good Sleep is a Reachable Dream



Natural periodic state of rest for the mind and body, in which the eyes usually close and consciousness is completely or partially lost, so that there is a decrease inbodily movement and responsiveness to external stimuli.

Why to Sleep?

It plays a vital role in good health and well-being throughout your life. It protects your mental health, physical health, quality of life, and safety. We spent 33% of our lives in sleep.

Normal requirement:
3   to 5   yrs  —-  10 to 13  hrs
6   to 13 yrs  —-  9   to 11  hrs
14 to 17 yrs  —-  8   to 10  hrs
Adults           —-  7   to 9    hrs

Stages of Sleep

sleep-1Sleep follows a pattern of alternating REM (rapid eye movement) and NREM (non-rapid eye movement) sleep throughout a typical night in a cycle that repeats itself about every 90 minutes. NREM (75% of night): As we begin to fall asleep, we enter NREM sleep, which is composed of stages 1-4. REM (25% of night).

Almost 60 % of total population reports sleep problems at any point of their life time. Roughly 1/3 of general population are having sleep problems at any given time.

Common Sleep Disorders:

Insomnia (initial, middle, terminal insomnias or non restorative sleep).
Sleep apnea.
Restless legs syndrome.

Impacts of Poor Sleep:

sleep-3Persons get irritable and exhausted, easily distracted and often don’t make sound decisions. Sleep deprivation negatively impacts the immune system, may also lead to weight gain, high blood pressure, cancer, heart disease, stroke, diabetes, bone loss and depression Sleep deprivation may also impair learning, memory, alertness, concentration, judgment, problem solving and reasoning, as well as increase your risk of accidents.


    • Keep a sleep log, Polysomnography (sleep lab)
    • How to treat?
    • Sleep hygiene
    • Medicines
    • Behavioral treatments
    • Surgery (OSA)

Sleep Hygiene:

  • Avoid napping during the day.
  • Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime.
  • Exercise can promote good sleep.
  • Food can be disruptive right before sleep.
  • Ensure adequate exposure to natural light.
  • Establish a regular relaxing bedtime routine. Associate your bed with sleep.
  • Make sure that the sleep environment is pleasant and relaxing.

Medications: What to know about it?

  • Avoid as much as possible.
  • Always with advice from the specialist.
  • Be cautious about addiction.
  • Avoid driving while on medications.

“Sleep is that golden chain that ties health and our bodies together”

(Thomas Dekker)

To undergo treatment, you have to be very healthy !!!

Drug Safety (Rational and Safe use of Medicines)

“To undergo treatment you have to be very healthy, because apart from your sickness you have to withstand the medicine” (Molière)

pharmacovigilanceDrug safety ( Pharmacovigilance) – The science and activities relating to the detection, evaluation, understanding and prevention of adverse drug reactions or any other drug-related problems.

Why drug safety? – Adverse Drug Reactions are among the top ten causes of mortality. The percentage of hospital admissions due to drug related events in some countries is about or more than 10%. Economic impact Drug related morbidity and mortality expenses exceeded US$ 177.4 billion in the USA in 2000.ADR database shows- No of reports: more than 3.5 million, each year increase ~160,000 / year.safe

Drug safety heavily focuses on Adverse Drug Reactions (ADR), which are defined as any response to a drug which is noxious and unintended. ADR is considered serious if it meets one or more of the following criteria:

  1. Results in death or is life-threatening;
  2. Requires inpatient hospitalization or prolongation of existing hospitalization;
  3. Results in persistent or significant disability or incapacity;
  4. Results in a congenital anomaly (birth defect)

FDA drug categories – A, B, C, D or X

Category A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Eg: atorvastatin, warfarin, methotrexate,

Pharmaceutical companies perform clinical trials, testing new drugs on people before they are made generally available to see their risk / benefit profile

Specific Patient Populations

Senior man and daughter at homePregnant woman with daughter

Pregnant and lactating women

A pregnant woman must not take any medication without consulting a specialist about the safety of the medication as it may affect the formation of the fetus. During the period of lactation, mothers should consult professionals before use of any medication because some medications can be excreted in breast milk, which may have a negative impact on the infant.


We should take extreme caution when using any medications for children. The reasons are- the lack of scientific studies and clinical trials needed to evaluate the safety of these medications in this age group and also their vital organs are not mature, and thus exposure to certain medications may lead to toxic side effects as the body is mostly unable to fully metabolize or excrete the drugs.

Old people

This group is considered to be most vulnerable to the effect of medications and so it is very important to consider their health status before prescribing any medication, for several reasons. The physiological functions of many body organs decline with age, especially important organs such as the liver and kidneys. Older people can suffer from many chronic illnesses, such as high blood pressure, diabetes, and high blood cholesterol and lipids, possibly necessitating the chronic use of multiple medications, which may conflict with each other.

Drug interactions

Every patient must ensure they are aware of all necessary information regarding those drugs, as well as the possibility of interactions with other drugs or certain food types, through consulting the pharmacist or physician. Groups that are at extreme risk and exposure to those drug interactions include: Patients who use multiple medications, Elderly patients, Patients with multiple chronic diseases and illnesses

Ensuring drug safety

Drug safety is the main aspect of medical therapy that can play a major role in deciding which drug should be given to a patient. Considering the concept of benefit–risk balance drugs with a high risk profile should be avoided unless needed. Personalized medicine should be considered when medications are given to patients.

It is possible to avoid these side effects by using the drug in the proper way, and by following the instructions included in the drug leaflet or provided by the pharmacist or the physician. Knowing the necessary information about a medicine is considered the first step in avoiding side effects.

The risks from medications could be minimized through patient education about drug safety and openness with the patient, allowing him/her to ask questions related to their disease or medications. A good relationship between the medical team and the patient is one of the most important determinants for drug safety.

“Dying from a disease is sometimes unavoidable. But, dying from an adverse drug reaction is unacceptable”(Dr. Vladimir Lepakhin)

Myths About Mental Illness


Mental illnesses can affect anyone. We all likely know someone who has experienced a mental illness at some point. Yet there are still many hurtful attitudes around mental illnesses that fuel stigma and discrimination and make it harder to reach out for help. It’s time to look at the facts. Here are ten common myths about mental illnesses.

psychiatry-myth-n-fact-1Myth #1: Mental illnesses aren’t real illnesses.
Fact: Mental illnesses are not the regular ups and downs of life. Mental illnesses create distress, don’t go away on their own, and are real health problems with effective treatments. People who experience mental illnesses should be treated with the same concern and respect shown to a cancer patient or a person with pneumonia.

psychiatry-myth-n-fact-2Myth #2: Mental illnesses will never affect me.
Fact: All of us will be affected by mental illnesses. You may not experience a mental illness yourself, but it’s very likely that a family member, friend, or co-worker will experience challenges.

psychiatry-myth-n-fact-3Myth #3: Mental illnesses are just an excuse for poor behavior.
Fact: It’s true that some people who experience mental illnesses may act in ways that are unexpected or seem strange to others. We need to remember that the illness, not the person, is behind these behaviors. No one chooses to experience a mental illness. People who experience a change in their behavior due to a mental illness may feel extremely embarrassed or ashamed around others.

psychiatry-myth-n-fact-4Myth #4: Bad parenting causes mental illnesses.
Fact: No one factor can cause mental illnesses. Mental illnesses are complicated conditions that arise from a combination of genetics, biology, environment, and life experiences. Family members and loved ones do have a big role in support and recovery.

psychiatry-myth-n-fact-5Myth #5: People with mental illnesses are violent and dangerous.
Fact: People who experience a mental illness are no more violent than people without a mental illness. It’s also important to note that people who experience mental illnesses are much more likely to be victims of violence than to be violent.

psychiatry-myth-n-fact-6Myth #6: People don’t recover from mental illnesses and should be kept in hospital for life.
Fact: People can and do recover from mental illnesses. Today, there are many different kinds of treatments, services, and supports that can help. No one should expect to feel unwell forever. The fact is, people who experience mental illnesses can and do lead productive, engaged lives. They work, volunteer, or contribute their unique skills and abilities to their communities. Even when people experience mental illnesses that last for a long time, they can learn how to manage their symptoms so they can get back to their goals. If someone continues to experience many challenges, it may be a sign that different approaches or supports are needed.

psychiatry-myth-n-fact-7Myth #7: People who experience mental illnesses are weak and can’t handle stress.
Fact: Stress impacts well-being, but this is true for everyone. People who experience mental illnesses may actually be better at managing stress than people who haven’t experienced mental illnesses. Many people who experience mental illnesses learn skills like stress management and problem-solving so they can take care of stress before it affects their well-being.

psychiatry-myth-n-fact-8Myth #8: People who experience mental illnesses can’t work.
Fact: Whether you realize it or not, workplaces are filled with people who have experienced mental illnesses. Mental illnesses don’t mean that someone is no longer capable of working. Most people who experience serious mental illnesses want to work but face systemic barriers to finding and keeping meaningful employment.

psychiatry-myth-n-fact-9Myth #9: Kids can’t have a mental illness like depression. Those are adult problems.
Fact: Even children can experience mental illnesses. In fact, many mental illnesses first appear when a person is young. Mental illnesses may look different in children than in adults, but they are a real concern. Mental illnesses can impact the way young people learn and build skills, which can lead to challenges in the future. Unfortunately, many children don’t receive the help they need.

psychiatry-myth-n-fact-10Myth #10: Everyone gets depressed as they grow older. It’s just part of the aging process.
Fact: Depression is never an inevitable part of aging. Older adults may have a greater risk of depression because they experience so many changes in roles and social networks. If an older adult experiences depression, they need the same support as anyone else.

These myths—and many more—exclude people with mental illnesses from our communities and create barriers to well-being. If we want to reduce the impact of mental illnesses on our communities, we need to learn the facts and start with our own assumptions and behaviors.

Parents & Mind Wellness of Kids

WHO says “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This reiterates the importance of mental wellbeing to live and remain healthy.

bigstock-family-love-heart-symbol-10963130Raising kids is one of the toughest and most fulfilling jobs in the world and we are least prepared for that. Children’s physical and emotional status, as well as their social and cognitive development, greatly depends on their family dynamics. The rising incidence of behavioural problems among children could suggest that some families are struggling to cope with the increasing stresses they are experiencing.

Parenting styles and tips for healthy parenting:

There are four major recognized parenting styles: authoritative, neglectful, permissive, and authoritarian.

“Authoritative parenting” is one that communicates in a warm, accepting and nurturing manner, while maintaining firm expectations and restrictions on their children’s behaviour. (The most accepted or the best way of parenting)

“Authoritarian Parenting” is an extremely strict form of parenting that expects a child to adhere to rules and regulations set out by the parents with little to no input and communication from the child.

“Permissive Parenting” is an extremely relaxed approach where parents are generally warm, nurturing and affectionate. However, they are overly accepting of their children’s behaviour, good or bad.

“Uninvolved Parenting”, as the name implies, the parent is totally dis- engaged and emotionally uninvolved in their child’s life. There is little, if any expression of love and affection…

Parenting tips

kids-cooking-clipart-clipart-panda-free-clipart-images-irj2nx-clipart-1             c8c53762a9f33e17e41ec4ea88e709c6

  • Be a Good Role Model
  • Make Time for Your Kids(kids misbehaviour and acting outs are basically attention seeking behaviours)
  • Communicate with your kids with respect
  • Enhance Your Child’s Self-Esteem (giving acknowledgement, praising, allowing them to do things independently- All these will increase their self esteem; at the same time avoid belittling comments.)
  • Reward your Kids when they do Good(try to find something to praise every day)
  • Set Limits and Be Consistent with Your Discipline; practice time out (This help kids choose acceptable behaviours and learn self-control.)
  • Be Flexible and Willing to Adjust Your Parenting Style
  • Show That Your Love Is Unconditional
  • Know Your Own Needs and Limitations as a Parent

Common behavioural problems:

Tantrums,stuttering,Autism, ADHD, Conduct disorders and Learning disability are common early childhood problems,  while Depression, Anxiety disorders, Substance use disorders and Eating disorders are the common adolescent behavioural problems,

Warning signs in children

Irritable, distractible children with poor scholastic performance points towards early childhood behavioural problems

Mood changes, intense fear, drastic changes in personality, difficulty in concentrating, unexplained weight loss, physical symptoms, and self harm behaviour- these are some of the warning signals of adolescent behavioural problems

What the parents can do?

Reach out to our kids…

Be an empathetic non judgemental listener…

Take history from his peers and teachers…

Give him unconditional support and instil confidence

Understand and accept this as like any other medical problem

Don’t hesitate to take help from an appropriate mental health professional

Alzheimer’s Disease

anigif_sub-buzz-22090-1465935906-25Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.


The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age . Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

imagesPeople with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. At International Modern Hospital, we offer specialised care for such patients under the guidance of our psychiatrist, Dr. Shaju George


Alzheimer’s is not the only cause of memory loss.

Many people have trouble with memory — this does NOT mean they have Alzheimer’s. There are many different causes of memory loss. If you or a loved one is experiencing symptoms of dementia, it is best to visit a doctor so the cause can be determined.

The role of plaques and tangles

 Plaques and tangles tend to spread through the cortex as Alzheimer’s progresses.

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.

healthyvsadPlaques are deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that build up in the spaces between nerve cells.

Tangles are twisted fibers of another protein called tau (rhymes with “wow”) that build up inside cells.

Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. They also tend to develop them in a predictable pattern, beginning in areas important for memory before spreading to other regions.

Scientists do not know exactly what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive.

It’s the destruction and death of nerve cells that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer’s disease.

 Diagnosis of Alzheimer’s Disease


Doctors use several methods and tools to help determine whether a person who is having memory problems has “possible Alzheimer’s dementia” (dementia may be due to another cause) or “probable Alzheimer’s dementia” (no other cause for dementia can be found).

To diagnose Alzheimer’s, doctors may:

  • Ask the person and a family member or friend questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
  • Conduct tests of memory, problem solving, attention, counting, and language
  • Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
  • Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms.

These tests may be repeated to give doctors information about how the person’s memory and other cognitive functions are changing over time.

Alzheimer’s disease can be definitely diagnosed only after death, by linking clinical measures with an examination of brain tissue in an autopsy.

Treatment of Alzheimer’s Disease

Alzheimer’s disease is complex, and it is unlikely that any one drug or other intervention can successfully treat it. Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow or delay the symptoms of disease. Researchers hope to develop therapies targeting specific genetic, molecular, and cellular mechanisms so that the actual underlying cause of the disease can be stopped or prevented.blog-alz

CONNECT, COMMUNICATE, CARE – World Suicide Prevention Day

14231876_1060620760658541_7316520330448059815_oThe World Health Organization estimates that over 800,000 people die by suicide each year – that’s one person every 40 seconds. Up to 25 times as many again make a suicide attempt. There are many, many more people who have been bereaved by suicide or have been close to someone who has tried to take his or her own life. ‘Connect, communicate, care’ is the theme of the 2016 World Suicide Prevention Day. These three words are at the heart of suicide prevention.


14317628_1060620923991858_7388485385653221106_nSocial connectedness reduces the risk of suicide, so being there for someone who has become disconnected can be a life-saving act. Connecting them with formal and informal supports may also help to prevent suicide. Individuals, organisations and communities all have a responsibility here.


14317602_1060620803991870_7393260786696702560_nOpen communication is vital if we are to combat suicide. We need to discuss suicide as we would any other public health issue if we are to dispel myths about it and reduce the stigma surrounding it. Equipping people to communicate effectively with those who might be vulnerable to suicide is an important part of any suicide prevention strategy. Showing compassion and empathy, and listening in a non-judgemental way is very important.


14212830_1060620883991862_138179977086114850_nAll the connecting and communicating in the world will have no effect without care. We need to ensure that we are caring ourselves. We need to look out for others who may be struggling, and let them tell their story in their own way and at their own pace.


How to control Screen Addiction in your kid

screen-time-and-games-heighten-aggression-and-decrease-social-skillsChildren are not immune to forces that have driven many adults toward healthy lifestyles and spa and wellness therapies. They too are living in an electronic-gadget-obsessed world, crouching over devices, as they’re fed information and images at incredible speed. Children spend more time than ever hunched over glowing screens.

  1. Talk with your child about his/her excessive computer usage.Find out if there are any specific reasons that he/she spends so much time on the computer – sometimes the computer functions as an escape from reality. If your child is facing problems that are causing a desire to “escape”, try to address those.
  2. Move the computer to an open area if it’s not already in one –it makes it easier to monitor their usage.
  3. Set a password for the computer so that only you can log on to it.Your child will have to ask to be logged on to the computer in order to use it. However, this is not recommended for older children in the house, who will need this for study etc.
  4. Set a time limit on the amount of time your child can spend on the computer each day.
  5. Replace the time that your child would normally spend on the computer with other activities – play board games with them, take them to the library, get them together with friends to play sports, etc.
  6. Be aware of what your child is doing on the computer.Check the Internet browser’s history to see what websites he/she’s visiting.



What is Anorexia?

Male-AnorexiaAnorexia Nervosa is a psychological and possibly life-threatening eating disorder defined by an extremely low body weight relative to stature (this is called BMI [Body Mass Index] and is a function of an individual’s height and weight), extreme and needless weight loss, illogical fear of weight gain, and distorted perception of self-image and body.

Additionally, women and men who suffer with anorexia nervosa exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.

Types of Anorexia

There are two common types of anorexia, which are as follows:

  • Anorexia Nervosa Binge / Purge Type – The individual suffering from anorexia nervosa binge / purge type, will purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives, or excessively exercising.
  • Restrictive Anorexia Nervosa – In this form of anorexia nervosa, the individual will fiercely limit the quantity of food consumed, characteristically ingesting a minimal amount that is well below their body’s caloric needs, effectively slowly starving him or herself.


Anorexia is not a simple disorder. It has many symptoms and effects, and its causes are complex as well

  1. Environmental factors

The effects of the thinnessculture in media, that constantly reinforce thin people as ideal stereotypes

  • Professions and careers that promote being thin and weight loss, such as ballet and modeling
  • Family and childhood traumas: childhood sexual abuse, severe trauma
  • Peer pressure among friends and co-workers to be thin or be sexy.
  1. Biological factors
  • Irregular hormone functions
  • Genetics (the tie between anorexia and one’s genes is still being heavily researched, but we know that genetics is a part of the story).
  • Nutritional deficiencies

Signs and Symptoms 

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you won’t be able to deny their instincts that something is wrong—and neither should you.

food behavior signs and symptoms

  • Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
  • Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
  • Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of
  • Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
  • Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways.

appearance and body image signs and symptoms

  • Rapid weight loss with no medical cause.
  • Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places, such as the stomach, hips, or thighs.
  • Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
  • Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
  • Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

purging signs and symptoms

  • Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
  • Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
  • Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Steps to recovery

  • Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.
  • Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  • Stay away from people, places, and activities that trigger your obsession with being thin.You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.
  • Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

The difference between dieting and anorexia

Healthy Dieting


Healthy dieting is an attempt to control weight. Anorexia is an attempt to control your life and emotions.

Your self-esteem is based on more than just weight and body image.

Your self-esteem is based entirely on how much you weigh and how thin you are.
You view weight loss as a way to improve your health and appearance. You view weight loss as a way to achieve happiness.
Your goal is to lose weight in a healthy way.

Becoming thin is all that matters; health is not a concern.

Learn to tolerate your feelings

Identifying the underlying issues that drive your eating disorder is the first step toward recovery, but insight alone is not enough. Let’s say, for example, that following restrictive food rules makes you feel safe and powerful. When you take that coping mechanism away, you will be confronted with the feelings of fear and helplessness your anorexia helped you avoid.

Challenge damaging mindsets

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, try to excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless.

Develop a healthier relationship with food

Even though anorexia isn’t fundamentally about food, over time you’ve developed harmful food habits that can be tough to break. Part of recovery is developing a healthier relationship with food.

Medical treatment

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight.

Autism or Autism Spectrum Disorder (ASD)

What Is Autism or Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.
ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art.

How Common Is Autism?
An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States.
What Causes Autism?
First and foremost, there is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by them. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development.
A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception.
What Does It Mean to Be “On the Spectrum”?
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to improve the lives of all those on the autism spectrum. For some, this means the development and delivery of more effective treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support.

Did you know …
• Autism now affects 1 in 68 children and 1 in 42 boys
• Autism prevalence figures are growing
• Autism is one of the fastest-growing developmental disorders in the U.S.
• Autism costs a family $60,000 a year on average
• Boys are nearly five times more likely than girls to have autism
• There is no medical detection or cure for autism

Prepare your kids for exams!!!

Exams are important milestones in your children’s education. Younger children need much more assistance than older children in preparing for exams. The guidance that you provide in the early stages will enable your children to study with discipline and dedication later on, on their own. If your children are still in kindergarten or primary classes, you will need to invest much more time. However, with older children, you may face problems of a different kind—disobedience and rebellion, which require greater tact.

Prepare your kids for exams Prepare kids for exams

• Never let your children postpone studying until a day before the exams. This will only increase their anxiety and stress levels. Preparation is the key to success. Don’t listen to any excuses and don’t be swayed by assurances. The best course is to have your children study for some time everyday. Even if this is not possible, ensure that they begin preparing for the exams at least two to three weeks in advance.

• Do not impose yourself on your children. Some children require more support while others are happier studying on their own. This depends on your children’s nature. However, let them know that you’re always there to help them.

• It is not enough to read up matter. Your children should be able to recall the same in the examination hall. Hold question and answer sessions where you ask them random questions on the subject once they have finished studying.

• Prepare a timetable for each child. You can cover subjects in the order of the examination schedule or you can tackle difficult subjects first. For younger children, two to three hours of study a day should suffice. Children in the secondary and higher secondary classes should study for four or five hours a day when the exams are due. Alternate languages and practical subjects like mathematics to minimise boredom.

• Especially for older children, access to question papers from previous years is a must. These may be available in the school library, with teachers or you can secure them from the senior students. Have them solve at least one or two papers in each subject, within the given time limit. This is like a rehearsal and helps in mitigating exam nerves. It will also give your child an idea of how much time to allot for each question.

• Don’t allow your children to stay up or wake up too early. Make sure that they get at least eight hours of sleep. Inadequate sleep affects the brain’s functioning and will reduce your children’s retention. Discourage use of caffeine or other stimulants to remain awake.

• Children these days suffer from as much stress as adults. Do not pressurise your child ever. Do not entertain negativity and empower them with confidence if they start moaning about previous performances.

• Create a study-ritual for your children. Encourage them to use the same place to study everyday, preferably somewhere quiet and pleasant. The outdoors is a great option as well. Let them be silent and make a resolve to study well before beginning the session. End every session with a revision of what has been covered. Set small goals–one or two chapters or even topics. If they are studying for long durations, schedule breaks every one or two hours. Let them do what they like such as go for a walk, meditate or solve a puzzle.

• Older children may benefit from group study, especially for subjects that they find difficult. It is preferable if your child can go to his friends’ houses rather than having them over. This way, he can leave if the session is proving to be a waste of time.

• On the D-Day, wake your children up well in time and serve them a light breakfast. Set aside time for a disciplined revision. Teach them relaxation exercises. Ensure that they have their pens and pencils, examination pad and other necessary items before leaving the house. Wish them luck and hope for the best!


Key  Points :-

  • Feeling good makes you healthy.
  • Chemistry of body and mind interacts.
  • You can’t buy happiness – it is free!

When you  feel  happy, your body chemistry acts in ways  that make you feel  better able to cope with pain and stress and to ward off  illness. Some volunteers visit hospitals where they  make patients smile and laugh. Their visits are eagerly anticipated by both patients and  staffs , who say they make their world look brighter. It is all about feeling better in oneself and having an optimistic outlook.

We all know of those  who are  faced with adversity  or sickness, unemployment or just bad luck. For them it is a major challenge to keep optimistic and cheerful. It may be that,  they need an external catalyst to help them do so. Effects  of happiness on your health  are enormous and when you smile you certainly draw people to you rather than push them away .The fact is that if you are happy, you are likely to live longer and more satisfying life.

Many people work because they have to; but not many go to work  because  they just love what they do. There is no doubt that performance and productivity would be 100 per cent if  “work is love” made visible n words of famous poet, Khalil Gibran. When you care  for those in your family , they feel loved,  reassured and secure. So why can’t  it be the same  within  the  company which is also a family. Of course, this is not easy particularly at times of restructuring; but, the challenge is upon everyone to try to introduce a feeling of community in their work place. This will ward off pressure at work to a great extent.

Few steps to feel Happy:-

  1. Use Self Talk: When you have negative thoughts, talk to yourself as to how you could re-frame them  into positive emotion. Think of what you do have, not the things that you have not.
  2. Help others: Give your time to others less fortunate than yourself and by doing so, you give additional meaning to your own life.
  3. Enjoy the environment: Instead of walking around with your eyes closed, look at the natural beauty that is around you.
  4. Talk to others: Indulge in conversation in a sincere and genuine way. By listening others, you will also gain.
  5. At the end of the day, don’t just sit and watch the TV. Spend time playing with the children or go for a walk with the family or friends.
  6. Exercise or play some sports: A sure way to beat sadness  and depression is to stretch your body physically, because your mind also benefit at the same time. Body and mind go together. There is a chemistry, they interact each other to an extra ordinary degree.
  7. Having right attitude. If you only see doom and gloom, that is what there will  But if you see positive aspects of that are going on in your life and build on these, then your  whole  personality can change overnight.
  8. Enjoy fun: Just sit and watch some  funny show or film with your friends or children and enjoy a good laugh. Laughter is a good medicine that will make you instantly better.


Dr. (Mrs.) Remadevi Unnikrishnan

Employment: The Autism Advantage

Employment: The Autism Advantage

It is estimated that more than 80% of adults with autism are unemployed. Research suggests that employers are missing out on abilities that that people on the autism spectrum have in greater abundance– such as, heightened abilities in pattern recognition and logical reasoning, as well as a greater attention to detail. The United Nations declared 2’nd April as World Autism Awareness Day to highlight the need to help improve the quality of life of children and adults, who are affected by autism, so they can lead full and meaningful lives.
The word “autism,” which has been in use for about 100 years, comes from the Greek word “autos,” meaning “self.” The term describes conditions in which a person is removed from social interaction — hence, an isolated self.
Autism now affects 1 in 68 children and 1 in 42 boys and in UAE it is one in 50 children. Autism prevalence figures are growing over the years.

Autism Day - Wear it Blue

Persistent deficits in social communication and social interaction :-

These children can present with a variety of symptoms By 8 to 10 months of age, many infants who go on to develop autism are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with autism have difficulty playing social games, don’t imitate the actions of others and prefer to play alone. They may fail to seek comfort or respond to parents’ displays of anger or affection in typical ways. To parents, it may seem as if their child is disconnected. Both children and adults with autism also tend to have difficulty interpreting what others are thinking and feeling. Subtle social cures such as a smile, wave or grimace may convey little meaning. The tendency to “lose control” may be particularly pronounced in unfamiliar, overwhelming or frustrating situations. Frustration can also result in self-injurious behaviors such as head banging, hair pulling or self-biting. Young children with autism tend to be delayed in babbling and speaking and learning to use gestures. Some infants who later develop autism coo and babble during the first few months of life before losing these communicative behaviors. Others experience significant language delays and don’t begin to speak until much later. When language begins to develop, the person with autism may use speech in unusual ways. Some have difficulty combining words into meaningful sentences. They may speak only single words or repeat the same phrase over and over. Some go through a stage where they repeat what they hear verbatim (echolalia).
Restricted, repetitive patterns of behavior, interests, or activities
Unusual repetitive behaviors and/or a tendency to engage in a restricted range of activities are another core symptom of autism. Common repetitive behaviors include hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases. Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in front of the eyes. The tendency to engage in a restricted range of activities can be seen in the way that many children with autism play with toys. Some spend hours lining up toys in a specific way instead of using them for pretend play. Similarly, some adults are preoccupied with having household or other objects in a fixed order or place. It can prove extremely upsetting if someone or something disrupts the order. Along these lines many children and adults with autism need and demand extreme consistency in their environment and daily routine. Slight changes can be extremely stressful and lead to outbursts.
“red flags”
• No big smiles or other warm, joyful expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
• No babbling by 12 months
• No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
• No words by 16 months
• No meaningful, two-word phrases (not including imitating or repeating) by 24 months
• Any loss of speech, babbling or social skills at any age.
If you see any of these red flags please rule out Autism

What causes autism?

Recent research has identified more than a hundred autism risk genes. Most cases involve a complex and variable combination of genetic risk and environmental factors that influence early brain development.

Who are autistic prodigies?

Savant syndrome is a condition which is seen in 10% of autistic children where he/ she demonstrates profound and prodigious capacities or abilities far in excess of what would be considered normal. The most dramatic examples of savant syndrome occur in individuals who score very low on IQ tests, while demonstrating exceptional skills or brilliance in specific areas, such as rapid calculation, art, memory, or musical ability.

What can we offer?

Multi modal approach is the general treatment approach for autistic disorders which recommends the following strategies for helping a child to improve overall function and reach his or her potential:

1. Behavioral training and management:- positive reinforcement, self-help, and social skills training to improve behavior and communication. Many types of treatments have been developed, including Applied Behavioral Analysis (ABA), and sensory integration.
2. Specialized therapies which include speech, occupational, and physical therapy.
3. Medicines: Medicines are most commonly used to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.

4.Community support and parent training:Talk to your doctor or contact an advocacy group for support and training.
Plan it in a good way…
• Build on your child’s interests.
• Offer a predictable schedule.
• Teach tasks as a series of simple steps.
• Actively engage your child’s attention in highly structured activities.
• Provide regular reinforcement of behavior.
Involve the parents.

What are their rights?

Individuals with Disabilities Act (IDEA)
IDEA envisages
1, “Free and Appropriate Public Education” (FAPE)
2, “Least Restrictive Environment” (LRET)- mainstreaming or inclusive education.
3, Early Intervention Services at no cost
4,Special Education Services

5, Extended School Year (ESY) Services

How do you deal with autism diagnosis in your children?

Give yourself time to adjust. Be patient with yourself. It will take some time to understand your child’s disorder and the impact it has on you and your family. Difficult emotions may resurface from time to time. There may be times when you feel helpless and angry that autism has resulted in a life that is much different than you had planned. But you will also experience feelings of hope as your child begins to make progress.

Yes, it is our responsibility…
Persons with AUTISM are Always Unique Totally Interesting Sometimes Mysterious; we can focus, target and polish their strength which will help them to come to the mainstream of the society by excelling in professions where these capabilities can be used. In fact they may perform better than many others in selected professions if we can do judicious selection of careers for autistic friends. Respect their rights understand their strengths and thereby we can deliver our responsibilities towards them in a better way to take them with us to contribute for our nations development

Specialist Psychiatrist
Mind Wellness Department



Most sleep disorders are preventable or treatable, yet less than one-third of sufferers seek professional help. Sleep problems constitute a global epidemic that threatens health and quality of life for up to 45% of the world’s population

The three elements of good quality sleep are:

A. Duration- The length of sleep should be sufficient for the sleeper to be rested and alert the following day.

B. Continuity- Sleep cycles should be seamless without interruption.

C. Depth- Sleep should be deep enough or sufficiently sound to be restorative and refreshing.

A recent American study on sleep shows(correlates well with world statstics)

General Statistics

Adults require an average of 8 to 8.5 hours of sleep each night

Sleep problems add an estimated $15.9 billion to national health care costs

84 classifications of sleep disorders exist

Insomnia Statistics

20-40% of all adults have insomnia in the course of any year

1 out of 3 people have insomnia at some point in their lives

Over 70 million Americans suffer from disorders of sleep and wakefulness

Of those, 60% have a chronic disorder

Sleep Apnea Statistics

Over 18 million Americans suffer from sleep apnea

An estimated 10 million Americans remain undiagnosed

Over 50% of all apnea cases are diagnosed in people aged 40 and over

More prevalent in men than women

4 to 9% of middle-aged men suffer from apnea

2 to 4% of middle-aged women suffer from apnea

Narcolepsy Statistics

Affects as many as 200,000 Americans

Fewer than 50,000 are diagnosed

8 to 12% have a close relative with the disease

Affects men slightly more than women

20 to 25% of people with narcolepsy have all four symptoms
(excessive daytime sleepiness, sudden loss of muscle function, sleep paralysis, hallucinations)

Restless Leg Syndrome Statistics

Affects as many as 10% of Americans

Can begin at an early age and worsens with age

Pregnancy or hormonal changes can temporarily worsen this disorder

Children & Sleep Statistics
Over 2 million children suffer from sleep disorders

Estimated that 30 to 40% of children to not sleep enough

Children require an average of 9 to 10 hours of sleep each night

Women & Sleep Statistics
Women are twice as likely as men to have difficulty falling and staying asleep

Pregnancy can worsen sleep patterns

Menopause and hormone changes cause changes in sleep

Older Adult Statistics
Over half of those over the age of 65 experience disturbed sleep

Those over 65 make up about 13% of the US population, but consume over 30% ofprescription drug and 40% of sleeping pills


1. Set a consistent bed time and an awakening time.
2. If you are in the habit of taking naps, try not to exceed 45 minutes of daytime sleep.
3. Avoid excessive alcohol ingestion four hours before bedtime and do not smoke.
4. Avoid caffeine six hours before bedtime. This includes coffee, tea and sodas, as well as chocolate.
5. Avoid heavy, spicy or sugary foods four hours before bedtime. A light snack before bed is acceptable.
6. Exercise regularly, but not right before bed.
7. Use comfortable bedding.
8. Find a comfortable temperature setting for sleeping and keep the room well ventilated.
9. Block out all distracting noise and eliminate as much light as possible.
10. Reserve the bed for sleep. Don’t use the bedroom as an office, workroom or recreation room


We are here to Identify, Assess, and Advice

Dr.Shaju George
Specialist psychiatrist
International modern hospital
Mind Wellness Department
Appointments : 971 4 406 3000


Strategies for Good Mental Health WellnessMHM2013_Pathways_to_Wellness_Logo_web

Strategies for Good Mental Health Wellness

Meditation and Relaxation Techniques: Practicing deep breathing techniques, the relaxation response, or progressive muscle relaxation are ways to help reduce stress and induce relaxation.

Time to Yourself: It is important to set aside time everyday to allow yourself to relax and escape the stress of life. Give yourself a private, mini vacation from everything going on around you.

Physical Activity: Moving around and getting the heart rate up causes the body to release endorphins (the body’s feel good hormones). Exercising provides some stress relief.

Reading: Escape from reality completely by reading. Reading can help you to de-stress by taking your mind off everyday life.

Friendship: Having friends who are willing to listen and support one through good and bad times is essential.

Humor: adding humor to a stressful situation can help to lighten the mood.

Hobbies: Having creative outlets such as listening to music, drawing or gardening are great ways to relax and relieve everyday stress.

Spirituality: Actively believing in a higher power or divine being can have many health benefits. In recent studies, it has been found that people who pray have better mental health than those who do not.

Pets: Taking care of a pet helps distract the mind from stressful thoughts. Studies Show that pets are a calming influence in people’s lives.

Sleeping: The human body needs a chance to rest and repair itself after a long and stressful day. Sleeping gives the body this chance so that it is ready to perform another day.

Nutrition: Eating foods that are good for you not only improve your physical health, but they play a major role in your mental health. When your body gets the proper nutrients, it is better able to function in every capacity.

There are also negative coping skills which can hinder progress in dealing more positively with stress. Actions that are harmful to both mental and physical health include:
Excessive alcohol use
Ignoring or storing hurt feelings
Excessive working
Avoiding problems
These actions offer only temporary relief, if any, from stress. Ignoring or covering up how you feel does not solve the problem and the next time the situation arises, you will still have no way of dealing with it.

The next time you find yourself faced with a difficult or stressful circumstance, remember to practice your new coping skills. These skills lead to good mental health and happier you.

Ten Tips for Better Mental Health

Build Confidence – identify your abilities and weaknesses together, accept them, build on them and do the best you can with what you have.

Accept Compliments – many of us have difficulty accepting kindness from others but we all need to remember the positive in our lives when times get tough.

Make Time for Family and Friends – these relationships need to be nurtured; if taken for granted they will dwindle and not be there to share life’s joys and sorrows.

Give and Accept Support – friends and family relationships thrive when they are “put to the test.” Just as you seek help when you are having a tough time, a friend or family member might come to you in their time of need.

Create a Meaningful Budget – financial problems are big causes of stress, especially in today’s economy. Over-spending on our “wants” instead of our “needs” can compound money worries. Writing down where you money is going helps you keep a closer eye on your finances.

Volunteer – being involved in community gives a sense of purpose and satisfaction that paid work cannot. Find a local organization where you life skills can be put to good use.

Manage Stress – we all have stressors in our lives but learning how to deal with them when they threaten to overwhelm us will help to maintain our mental health.

Find Strength in Numbers – sharing a problem with others who have had similar experiences may help you find a solution and will make you feel less isolated. Even talking about situation with people who have not experienced what you are going through is a good way to gain outside perspective.

Identify and Deal with Moods – we all need to find safe and constructive ways to express our feelings of anger, sadness, joy and fear. Channeling your emotions creatively is a wonderful way to work off excess feelings. Writing (keeping a journal), painting, dancing, making crafts, etc. are all good ways to help deal with emotions.

Learn to Be at Peace with Yourself – get to know who you are, what makes you really happy and learn to balance what you can and cannot change about yourself.

Adapted from the Canadian Mental Health Association of Richmond, BC

Dr.Shaju George
Specialist psychiatrist
International modern hospital
Mind Wellness Department
Appointments : 971 4 406 3000

10 strategies for supportive and effective assistance with school assignments

This school year, your children’s homework may be challenging for everyone. Discover which methods are best for helping them learn how to study and complete assignments.

“What’s the answer?” may be the question your child expects you to resolve. But handing over the answers will not help in the long run. Doing their homework for them will not earn them the top grades they’re seeking, even if it is tempting and seems easier.
The point of homework is to reinforce classroom material, add information, improve study habits and test knowledge. Your job is to ensure your children meet these goals in order to improve their grades and retain the knowledge. It’s the reason for education.
The following methods of assisting with homework are beneficial for developing long-lasting skills.

1. Stick with a schedule

Schedule specific times for homework—whether after school or after dinner, it should be free from television viewing, video games, texting or other social functions, even if they prefer to multitask. It’s proven that they aren’t as focused. Stick consistently with the same time and be flexible with other activities.

2. Pick a location

Whether at a desk in their room, the dining room or kitchen table, with siblings or alone, find out which space has the least distractions and is most conducive to productivity. Some kids prefer sound in the background in order to focus, but keep television, phone, internet (except for research) and other tech stuff off-limits.

3. Help them find the answer

“Look it up, you’ll remember it longer,” is a wise remark passed on over generations. Don’t do homework for your child just because you know how. Do one problem together and let them do the rest on their own. This helps them learn and problem solve, a critical skill to acquire. Show interest and be available. This improves a student’s performance.

4. Review work

Follow up to see how your child scored on an assignment and look over mistakes. Mistakes are opportunities for discussion to see if they understand the material. Suggest tips for remembering facts, use flash cards to review material or review concepts. An interactive way of learning is effective, perhaps with an older sibling or fellow student.

5. Meet with teachers

Parent involvement shows teachers that there’s a supportive environment at home that gives a student an advantage in the learning process. If your child lags behind, show concern and teachers will have suggestions to encourage your child and perhaps recommend supplemental studies with a tutor in a subject. Maybe other students don’t understand a lesson either, and the teacher needs to know a method needs reinforcement.

6. When you don’t know the answer

Ask questions. Your child’s homework is also an opportunity for you to learn. Do some research to find out the answers even though you won’t hand them over. Like a reference librarian, be a valuable resource to show kids how to research answers. Be sensitive to their needs. How do your child learn—are they a visual or audial type—by seeing or hearing or both?

7. Make a plan

Get an assignment schedule calendar. When the workload increases and kids are juggling various assignments, your support with timemanagement skills will offer valuable guidance in working through difficult tasks and completing homework. Find out about long-term projects in order to schedule and develop a work plan and get necessary supplies to avoid a last-minute rush to finish.

8. Offer incentives

Motivate children and show them how to prioritize their workload, such as studying for tests. If they receive good scores and maintain grade averages, give them certain privileges.

9. Set an example

Read books. Discuss ideas. Go to a science museum together. Augment their studies with relevant information, such as word and math games. Your actions speak volumes when advice may be ignored.

10. Offer praise

Show off work well done—a test with a high grade, an art or science project. Encourage your kids. If you show you believe in them, it builds confidence. Complimenting children gives them a sense of pride in their academic accomplishments.

Mental Heath in UAE


‘Living with Schizophrenia’
“On October 11, 1994, John Forbes Nash Jr.won the Nobel Prize for the pioneering works in game theory. Nash was 66 and most of his adult life he’d suffered from paranoid schizophrenia.
Nash began his Ph.D at Princeton in 1948- when he was just 20. He went on to MIT and for eight years dazzled the mathematical world. Then, disaster! Mental illness wrapped about him like an evil cloud. He began hearing voices. For 25 years, mental illness owned John Nash. He became a ghost, wandering the halls of Princeton and suffering in some private hospital. It was in mid 1980s that Nash at last learned to manage the demon and once again, he could do mathematics”.
World Mental Health Day is observed on 10th October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The theme for 2014 is “Living with schizophrenia”. The focus of the World Health Organization will be living a healthy life with schizophrenia.
What is schizophrenia?

Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. It affects about 24 million people worldwide. Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Men tend to experience symptoms a little earlier than women. People with the disorder may hear voices other people don’t hear. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated.

Mental health – world scenario

It is estimated that approximately 450 million people worldwide have a mental health problem.( WHO 2001) One in four families worldwide is likely to have at least one member with a behavioural or mental disorder.CDC report :Mental illness surveillance among US adults shows, Mental illness is an important public health problem in itself- about 25% of US adults have a mental illness. The office for National Statistics Psychiatric Morbidity report found that in any one year 1 in 4 British adults experience at least one mental disorder and 1 in 6 experiences this at any given time. In United Arab Emirates, Neuropsychiatric disorders are estimated to contribute to 19.9% of global burden of disease (WHO, 2008).
Mental health scenario in UAE
Even when well standardized studies on mental health in UAE are scarce, the available old and new studies show alarming increase of mental health problems in this Middle Eastern country. Depressive disorders, addictive disorders, stress related disorders, anxiety disorders, childhood behavioural problems like ADHD are in the forefront along with other psychotic disorders like schizophrenia.

Living with schizophrenia
WHO aims at healthy living with schizophrenia for people who are inflicted with this disease and also for their caretakers. “Living with Schizophrenia” as a theme is the need of the hour. It is important because of the great burden imposed by schizophrenia on the family and on society as a whole but essentially on the patient him (her) self.
“Living with Schizophrenia” can be approached from many perspectives. Who are those who live with schizophrenia? It is basically the patients themselves. The experience is an intense, long-lasting and often unbearable pain coupled with a perception of social isolation produced by prejudice and discrimination. The relatives (the carers) also live with schizophrenia and such is also the case with the professionals, the advocates and society as a whole. WHO, this year aims at targeting a healthy life for schizophrenia patients, their care takers and society at large.
Stigma, poor awareness, absence of proper screening, lack of insight & poor help seeking, acceptance problems in family and society, poor drug compliance, difficulties with reintegration of schizophrenic people back into society, inadequate funding, care centers and resource personals, huge financial expenses incurred on long term treatment and absent insurance schemes, inadequate mental health policies by the government are some of them.
Region specific challenges
The quantum and impact of mental health issues in these parts of world are not well studied. Available short and small studies show the prevalence and incidence of mental illness at par with rest of the world statistics. A study conducted in early 90s in Dubai by prof Rafia Gubash shows overall prevalence rate of psychiatric disorders as 22.7%,depressive disorders 13.7%, anxiety disorders 7.0 %, psychotic disorders 1.9%, which are in line with international rates. Outpatient and inpatient statistics in Mind wellness clinic at International modern hospital Dubai also shows similar numbers. WHO statistics 2011 shows in UAE – mental health professionals working in mental health sector, per 100,000 is for Psychiatrists 0.3,Nurses 2.12,Psychologists 0.51,social worker 0.25 and that of developed countries, like US and Australia-Psychiatrists(US-7.79,Aus-12.76)Nurse(US-3.07,Aus-69.54)psychologist(US-29.03,Aus-62.48).World health statistics 2014 shows UAE spends2.2% of its GDP on health while UK and USA spend 7.0%, 13.6% of their GDP respectively. When we talk about schizophrenia status DALY (Disability adjusted life years) in UAE is 267.316 against164.255 and 185.182 in Australia and UK respectively. Discrepancies between DALY rates and prevalence may arise from differences in availability of medical treatment: Years lived with mental disorders carry significantly higher DALY values when un-medicated than when medicated.
Challenges specific to this part of world regarding schizophrenia are; No mental health act, inadequate funding, no insurance coverage, non availability of adequate resource persons and appropriate treatment options like depot injections and ECT, absence of rehabilitation centers and shortage of standard studies on prevalence, incidence and other variable aspects of mental illness and finally poorly sensitized family members and society.
The impact of schizophrenia / mental illness
The impact of mental illness especially schizophrenia ranges from ostracisation, debts, social drift and shift, issues related to education , marriage, rehabilitation / social reintegration and depression, adjustment problems and burning out of care takers etc…

What can we do?
To make person’s life better is all about improving his quality of life .There is no absolutism in it, rather it is a continuum.30 yr old A.A, a young schizophrenic was found missing in Dubai in July this year, when he came out with his family. A Good Samaritan helped him to reunite with his family. We can do many things to make the life with schizophrenia better. Understand and accept the person with mental illness is the most important. This we can start from the family, then to the society and to the bigger society, our country. Yes all of us should change the attitude towards them. A good empathetic attitude will serve the purpose.
Drafting mental health policies and Act will help a lot to develop sensible and sensitive attitudes towards a biological disorder of the brain – mental illness. This will provide better treatment options and will help those with mental illness to lead a respectable life by enjoying their rights.
Developing or investing on better hospital / rehabilitation / care centers for behaviourally ill clients is the need of the hour. We have only very few such centers for inpatient treatment and rehabilitation. International modern hospital Dubai is one among the few. Government and private investors can look into such areas to ensure better health care delivery to these downtrodden people.
Changing the existing drug policies will help to make available the drugs fairly freely to those, who are in need. Most of the medications used by mental health professionals are Non addictive. Unfortunately most of them are put under controlled medicine group which make these medicine inaccessible to needy patients in the most needed time.
Mental illness is just like any other medical illness, it is a disorder of the brain. Here in UAE most of the treatment is covered under insurance, so it is not a big burden to a person or his family. Unfortunately mentally ill persons are getting the worst lot always. Neither the consultation nor medications are covered under most of the insurance for mental illness. Mental illness affects the performance of an employee in any organization just like any other medical illness. So ignoring these facts or denying the treatment rights for these persons will affect the prospect of the institution so also the prosperity of the country.
Ignorance, stigma, financial burden and inadequate time, all these factors might have contributed to the insensitivity of family members towards people with mental illness. Developing countries where there is better family ties reports better improvement rates with long lasting medical disorders like schizophrenia than developed countries with disintegrated family structure. Good sensible support from the family and society will reduce the burden of these disorders.
Spreading the awareness will help in early screening, early detection and early treatment seeking, which in turn ensures better improvement and lesser disabilities.
R.D. Laing’s words ring in my ears “Schizophrenia cannot be understood without understanding despair.”
Let this world mental health day give us a healthy mind to understand and participate in nation building process by maintaining a sensible empathetic attitudes towards mentally sick individuals like people with schizophrenia.

Dr.Shaju George
Specialist psychiatrist
International modern hospital
Mind Wellness Department
Appointments : 971 4 406 3000