Mental Health in Neurorehabilitation

Brain Damage from Drugs and Alcohol; One of the side effects of drug and alcohol abuse that is not well known is brain damage and injury. Most publicized is the potential for acute damage due to overdose or even damage to other organs in the body, such as liver damage from alcohol abuse or heart damage from use of stimulants. These effects are certainly alarming, and provide plenty of motivation for avoiding, and treating, drug abuse and addiction. Nevertheless, considering that the key action of psychoactive substances is on the brain, it is no surprise that long-term use of drugs or alcohol can result in brain injury. The debilitating and potentially life-threatening results warrant a further understanding of exactly what the risks are, whether or not they can be prevented or reversed, and how to treat them. Brain Damage Caused by Drug and Alcohol Use Drugs and alcohol have a number of effects on the brain, including: Disruption of nutrients needed by brain tissue Direct damage, injury, and death of brain cells, including neurotransmitter receptors Alterations to brain chemical concentrations, including neurotransmitters and hormones Deprivation of oxygen to brain tissue Different substances induce these effects to different degrees, including the specific drugs discussed below. Alcohol,Wernicke-Korsakoff Syndrome, and Alcoholic Dementia One of the ways that substance abuse can result in brain damage is by interfering in the use of nutrients required to maintain brain chemistry. An example of this occurs with alcohol abuse, which can result in thiamine deficiency. Thiamine, one of the B vitamins, is not able to be produced by the body, which means it must be ingested because it is required by nearly all the tissues in the body, including the liver, heart, and brain. However, alcohol interferes with the body’s ability to absorb thiamine, resulting in deficiency. As described in an article from the National Institute on Alcohol Abuse and Alcoholism, this thiamine deficiency can result in brain injury that includes a combination of Wernicke’s encephalopathy and Korsakoff’s psychosis. This debilitating and potentially deadly neurological condition causes nerve paralysis and mental confusion, as well as an inability to coordinate muscle movement. The thiamine deficiency can also cause brain cell damage that results in incapacitating dementia. Stimulants and Anhedonia Stimulants like cocaine and methamphetamine have direct action on dopamine and its receptors in the brain, reducing the uptake of the neurotransmitter, which is the source of the extreme euphoria these drugs can cause. However, another result of this action is that, over time, the dopamine receptor cells in the brain can be damaged or even die off, as described in a study from the European Journal of Pharmacology. The result of this brain damage is a condition called anhedonia, which is a diminished ability, or even lack of ability, to feel pleasure if the drug is not being used. Because this is the result of actual cell death, the lack of ability to feel pleasure can last long after use of the drug is stopped. The follow-up result then can be deep depression, including suicidal thoughts and self-destructive actions. However, with treatment and continued abstinence from the substance, dopamine receptors and capabilities can repair and return to some function. Marijuana and Psychosis The development of psychosis has been noted in some individuals who use marijuana regularly; however, the mechanisms through which this happens are not fully understood. Through some research, speculation has risen that this may only occur in people who already have a predisposition toward schizophrenia or other conditions. However, this may not be the whole story. Many studies have demonstrated a potential lack of damage to the brain due to cannabis use. However, a study discussed by the Schizophrenia Research Institute has found that the hippocampus and amygdala can experience reduction in size due to long-term marijuana use. These two parts of the brain are implicated in schizophrenia. Hallucinogens and Persisting Perception Disorder The journal Psychopharmacology discusses just one incident of hallucinogen persisting perception disorder, a condition that appears to affect visual perception, resulting in visual hallucinations or perceptions, such as: Snow (similar to static on a television channel) Flashbacks Echoes Visual distortion While the causes of this condition are not fully understood, there are multiple hypotheses about it, including one that optic nerve damage results in inflammation or that an enzyme that supports visual perception is disrupted. Whatever the case, this condition can persist many years after hallucinogen use is stopped. Opioids and Hypoxia Depressants like opioids cause suppression of breathing, which in turn can result in decreased blood oxygen concentrations. This can result in a wide range of damage, including oxygen deprivation to the brain. As explained by the National Library of Medicine, lack of oxygen to the brain can directly result in brain cell death and quickly lead to coma. Hypoxia is often an acute condition brought on by opioid overdose, but it can also accumulate over years of abuse of these drugs, resulting in diminished oxygen to the brain that causes slow-developing damage over time. Permanent or Transient Damage Depending on the type of damage, it may be possible to reverse the damage caused by drug or alcohol abuse. By reintroducing missing nutrients or promoting reestablishment of chemical pathways in the brain, early-stage damage can be reversed or at least somewhat repaired. However, in cases of extensive cell death or damage, reversal may not be possible. The National Institute on Drug Abuseprovides hope, noting that treatment and technology advances are helping to improve the chances that lost functions can be recovered after substance abuse is stopped. This includes abilities to reduce cravings that make a person more likely to relapse to substance use and continue contributing to further damage.

CHARAK SERIES Chapter -1 Deergha Jeevitiya Adhyaya 03.07. 17 Very Good Afternoon to All. Glad to represent the next episode in the series of " CHARAK SAMHITA". We are already discussed the 41 ( Fourty One ) number of GUNAS as described in Ayurveda. Among the 41 GUNAS , till now we have described in details of Theoretical and Clinical aspects of " 10 PARADI GUNAS" and " 05 INDRIYA GUNAS". The rest of 2 I.e. " 06 ADHYATMA GUNAS" and " 20 GURVADI GUNAS" are going to be described in next episodes. Let us have a look on " 06 ADHYATMA GUNAS" and understand it's Theoretical and Clinical aspects in Chikitsha Karma. ////////////. TODAY 'S DISCUSSION. \\\\\\\\\\\\ ADHYATMA GUNAS In Ayurveda, The Chikitsha Purusha ( To whom we treat ) is described as - " PANCHAMAHABHUT SARIRI SAMAVAY PURUSHA " It means - we treat such an individual where the eternal relationship between the PanchaMahabhut ( Body ) and Shariri ( ATMA or Soul ) is well established. The qualities of PanchaMahabhut I.e. Under the section of 05 INDRIYA GUNAS ( Sabd, Sparsh, Rupa, Rasa, Gandha ) are already described and their Clinical aspects to disease Correlation in the PanchaMahabhut Body are mentioned in the previous 2 posts. Today we concentrate our discussion on the rest part of Chikitsha Purusha I.e. ATMA. So the Theoretical and Clinical aspects of these 06 ADHYATMA GUNAS help us to detect different diseases of Components of ATMA. I mean to say, these have great importance in diagnosing diseases of ManoVaha Srotas ( Psychiatric Diseases). 1. BUDDHI GUNA - What is Buddhi ? In this context, the Commentator " Dalhana" of Sushruta Samhita has described - " BUDDHI NISCHAYATMIKA " - By which we are able to get a definitive knowledge of Something ( Object, Animal, Human ) is called " Buddhi" - It has 4 components / Parts Smruti, Chetana, Dhruti, Ahamkar. ( CHAKRA DUTTA ) - Smruti - Related to Smaran - Memory - Chetana - Related to Chetas - Knowledge of Living Status ( Jivita Abasta) - Dhruti - Related to Dharan - Knowledge of taking decision which one is Good and bad; and prevents the mind and senses in indulgement of Bad things or thoughts. " DHRUTI HI NIYAMATMIKA" - Ahamkar - Related to AHAM - Knowledge of I and My ( self ) I.e. I am the Prime Minister, I am the reputed lawyer of my locality etc. Clinical Aspects - Any disturbances in the Buddhi GUNA by the 2 Manashik Doshas result disturbances in the functioning of its 4 components. As a result of which, the person is unable for self identification, doesn't know what is to be done or not, No idea about What is right or wrong, losses memory of past events - which are the main symptoms of almost all Psychiatric Diseases. Can be managed by proper counselling, go to the depth of cause for what these condition arises, Medicines which affect the Buddhi and it's components. 2. ICCHA GUNA - ( Desire ) Desire or Attachment in something or someone. Due to apart of this, the ICHHA GUNA is affected and it's symptoms are found in the activities I.e. Excessive cry, No reason Laugh, Talking with yourself, Not interested in anything. or Due to Excessive attachment, Anxiety, obsession are developed in mind. 3. DWESHA GUNA - ( Dislike ) Disliking or repulsion of someone or something. Due to by force involvement in things or in relationships, the DWESHA GUNA is affected as a result of which fear, depression, enemy feelings ,angriness are found. 4. SUKHA GUNA - ( Happiness) " ANUGRAHA LAKSHANAM SUKHAM" When the desired thing or person is available , SUKHA GUNA can be felt. Excessive involvement in SUKHA GUNA , resulting " Akarana Hasya "- No reason Laugh, "Akarana Vashya "- Absurd conversation or conversation with yourself,,. Anxiety, Unmadata etc. 5. DUKHA GUNA - ( Sadness ) "PRATIKULA VEDANIYAM DUKHAM" When the desired thing or person not available after several attempts, " DUKHA" GUNA can be felt. Excessive involvement in DUKHA GUNA, resulting Depression, frustration, Angriness, Suicidal thoughts, Not talking with anyone etc. 6. PRAYATNA GUNA - " PRAYATNA KARYA AARAMVESHU UTSHAHA" The act of something with full interest is called Prayatna. It shows a Stable and healthy state of Mind. lf the UTSHAHA ( interest ) becomes loosened or Decreased or Nil, then it may reflects the feelings of Faliure,Frustration, Udash Bhava( Not interest in anything ) Hope Today's Article is capable of bringing the basics behind the Psychiatric Diseases. Now is the time to give rest my Pen and Mind. N.B. - Sorry to inform you all, from tomorrow to next 3-4 days, I am unable to post the regular serious due to busy journey schedule. Thanks, With Regards, Vaidya Niranjan Ram

this a young male Pt with h,/0 of anxiety depression 2yrs .now stable but have weight gain puffiness on face bl pitting edema also develope rough facial skin and ring worm like infection. no Ho of hypothyroid.

ADJUSTMENT DISORDER Work problems, going away to school, an illness — any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an adjustment disorder. An adjustment disorder is a type of stress-related Mental illness. You may feel anxious or depressed, or even have thoughts of suicide. Your normal daily routines may feel overwhelming. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences. You don't have to tough it out on your own, though. Adjustment disorder treatment — usually brief — is likely to help you regain your emotional footing. SYMPTOMS Adjustment disorders symptoms vary from person to person. The symptoms you have may be different from those of someone else with an adjustment disorder. But for everyone, symptoms of an adjustment disorder begin within three months of a stressful event in your life. Emotional symptoms of adjustment disorders Signs and symptoms of adjustment disorder may affect how you feel and think about yourself or life, including: Sadness Hopelessness Lack of enjoyment Crying spells Nervousness Jitteriness Anxiety, which may include Separation anxiety Worry Desperation Trouble sleeping Difficulty concentrating Feeling overwhelmed Thoughts of suicide Behavioral symptoms of adjustment disorders Signs and symptoms of adjustment disorder may affect your actions or behavior, such as: Fighting Reckless driving Ignoring bills Avoiding family or friends Performing poorly in school or at work Skipping school Vandalizing property Length of symptoms How long you have symptoms of an adjustment disorder also can vary: 6 months or less (acute). In these cases, symptoms should ease once the stressor is removed. Brief professional treatment may help symptoms disappear. More than 6 months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment may help symptoms improve and prevent the condition from continuing to get worse. When to see a doctor Sometimes the stressful change in your life goes away, and your symptoms of adjustment disorder get better because the stress has eased. But often, the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again. Talk to your doctor if you're having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again. If you have suicidal thoughts If you or someone you know has thoughts of suicide, get help right away. Consider talking to your doctor, nurse, a mental health professional, a trusted family member or friend, or your faith leader. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. Or call a suicide hot line number. In the United States, you can call the 24-hour National Suicide Prevention Lifeline at 800-273-8255 (toll-free) to talk with a trained counselor. CAUSES Researchers are still trying to figure out what causes adjustment disorders. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain. RISK FACTORS Although the cause of adjustment disorders is unknown, some things make you more likely to have an adjustment disorder. Among children and teenagers, both boys and girls have about the same chance of having adjustment disorders. Among adults, women are twice as likely to be diagnosed with adjustment disorders. Stressful events One or more stressful life events may put you at risk of developing an adjustment disorder. It may involve almost any type of stressful event in your life. Both positive and negative events can cause extreme stress. Some common examples include: Being diagnosed with a serious illness Problems in school Divorce or relationship breakup Job loss Having a baby Financial problems Physical assault Surviving a disaster Retirement Death of a loved one Going away to school In some cases, people who face an ongoing stressful situation — such as living in a crime-ridden neighborhood — can reach a breaking point and develop an adjustment disorder. Your life experiences If you generally don't cope well with change or you don't have a strong support system, you may be more likely to have an extreme reaction to a stressful event. Your risk of an adjustment disorder may be higher if you experienced stress in early childhood. Overprotective or abusive parenting, family disruptions, and frequent moves early in life may make you feel like you're unable to control events in your life. When difficulties then arise, you may have trouble coping. Other risk factors may include: Other mental health problems Exposure to wars or violence Difficult life circumstances COMPLICATIONS Most adults with adjustment disorder get better within six months and don't have long-term complications. However, people who also have another mental health disorder, a substance abuse problem or a chronic adjustment disorder are more likely to have long-term mental health problems, which may include: Depression Alcohol and Drug addiction Suicidal thoughts and behavior Compared with adults, teenagers with adjustment disorder — especially chronic adjustment disorder marked by behavioral problems — are at significantly increased risk of long-term problems. In addition to Depression, substance abuse and suicidal behavior, teenagers with adjustment disorder are at risk of developing psychiatric disorders such as: Schizophrenia Bipolar disorder Antisocial personality disorder PREPARING FOR YOUR APPOINTMENT If you have symptoms of an adjustment disorder, make an appointment with your primary care doctor. While adjustment disorders resolve on their own in most cases, your doctor may be able to recommend coping strategies or treatments that help you feel better sooner. What you can do To prepare for your appointment, make a list of: Any symptoms you've been experiencing,and for how long Key personal information, including any major stresses or recent life changes, both positive and negative Medical information, including other physical or mental health conditions, and names and dosages of any medications or supplements you're taking Questions to ask your doctor so that you can make the most of your appointment Ask a family member or friend to go with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says. For adjustment disorder, some basic questions to ask your doctor include: What do you think is causing my symptoms? Are there any other possible causes? How will you determine my diagnosis? Is my condition likely temporary or long term (chronic)? Do you recommend treatment? If yes, with what approach? How soon do you expect my symptoms to improve? Should I see a mental health specialist? Do you recommend any temporary changes at home, work or school to help me recover? Should people at my work or school be made aware of my diagnosis? Are there any brochures or other printed material that I can have? What websites do you recommend? Don't hesitate to ask questions during your appointment anytime you don't understand something. What to expect from your doctor Be ready to answer your doctor's questions so you have time to focus on your priorities. Your doctor may ask: What are your symptoms? When did you or your loved ones first notice your symptoms? What major changes have recently occurred in your life, both positive and negative? Have you talked with friends or family about these changes? How often do you feel sad or depressed? Do you have thoughts of suicide? How often do you feel anxious or worried? Are you having trouble sleeping? Do you have difficulty finishing tasks at home, work or school that previously felt manageable to you? Are you avoiding social or family events? Have you been having any problems at school or work? Have you made any impulsive decisions or engaged in reckless behavior that doesn't seem like you? What other symptoms or behaviors are causing you or your loved ones distress? Do you drink alcohol or use illegal drugs? How often? Have you been treated for other psychiatric symptoms or Mental illness in the past? If yes, what type of therapy was most helpful? TESTS AND DIAGNOSIS Adjustment disorders are diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with adjustment disorder, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. For an adjustment disorder to be diagnosed, several criteria must be met, including: Having emotional or behavioral symptoms within three months of a specific stressor occurring in your life Experiencing more stress than would normally be expected in response to the stressor, or having stress that causes significant problems in your relationships, at work or at school — or having both of these criteria An improvement of symptoms within six months after the stressful event ends The symptoms are not the result of another diagnosis Types of adjustment disorders Your doctor may ask detailed questions about how you feel and how you spend your time. This will help pinpoint which type of adjustment disorder you have. There are six main types. Although they're all related, each type has certain signs and symptoms: Adjustment disorder with depressed mood.Symptoms mainly include feeling sad, tearful and hopeless, and experiencing a lack of pleasure in the things you used to enjoy. Adjustment disorder with anxiety.Symptoms mainly include nervousness, worry, difficulty concentrating or remembering things, and feeling overwhelmed. Children who have adjustment disorder with anxiety may strongly fear being separated from their parents and loved ones. Adjustment disorder with mixed anxiety and depressed mood. Symptoms include a mix of Depression and anxiety. Adjustment disorder with disturbance of conduct. Symptoms mainly involve behavioral problems, such as fighting or reckless driving. Youths may skip school or vandalize property. Adjustment disorder with mixed disturbance of emotions and conduct. Symptoms include a mix of Depression and anxiety as well as behavioral problems. Adjustment disorder unspecified.Symptoms don't fit the other types of adjustment disorders, but often include physical problems, problems with family or friends, or work or school problems. TREATMENTS AND DRUGS Most people find treatment of adjustment disorder helpful, and they often need only brief treatment. Others may benefit from longer treatment. There are two main types of treatment for adjustment disorder — psychotherapy and medications. Psychotherapy The main treatment for adjustment disorders is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can learn healthy coping skills to help you deal with other stressful events that may arise. Medications In some cases, medications may help, too. Medications can help with such symptoms as Depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat adjustment disorders. As with therapy, you may need medications only for a few months, but don't stop taking any medication without talking with your doctor first. If stopped suddenly, some medications, such as certain antidepressants, may cause withdrawal symptoms. LIFESTYLE AND HOME REMEDIES There are no guaranteed ways to prevent adjustment disorder. But developing healthy coping skills and learning to be resilient may help you during times of high stress. Resilience is the ability to adapt well to stress, adversity, Trauma or tragedy. Some of the ways you can improve your resilience are: Having a good support network Seeking out humor or laughter Living a healthy lifestyle Learning how to think positively about yourself If you know that a stressful situation is coming up — such as a move or retirement — call on your inner strength in advance. Remind yourself that you can get through it. In addition, consider checking in with your doctor or mental health provider to review healthy ways to manage your stress.

71 year old woman. She has depressif symptoms. Dont want to talk. She has frequent breathing, she has the fear that her family leaves her alone. We give her 20mg paroxetine for one month with alprazolam 3mg/day she was alittle fine but the anxiety of leaving and being alone was so high still. We start olanzepine for her psychotic toughts about being alone. She got allergic to olanzepine. We stoped olanzepine and paroxetine as well and add velnafaxine 37.5 mg and increaesd the dose to 75 mg later. She discharged with no problme from ward but when she comes for control having problmes the Same