#ChildMentalHealth #India

A 13 yr old with severe Obsessive Compulsive Disorder. He has to wash hands to reduce anxiety even temporarily.
It is so bad that his hands are white with painful linear breaks in skin (ulcers).

Referred to a child psychiatrist. Started on single medication (fluoxetine). Cognitive therapy not possible as child lives 250km away.
Excellent response to meds in 2 months.
This should be happy ending isn't it ?

But it is not....
A 🧵- After those 2 months parents buy the tablet locally and continue for 3 more months and stop using it. All by themselves.

Symptoms come back within a month and they restart meds in half dose on their own for another 6 months. Majority of symptoms go away and some remain.

One more suicide.
A young doctor studying at THE most prestigious institution loses life to suicide.
I realised that he was following me on this platform. That realisation makes this even more sad at personal level. Was there any way i could have helped him and prevented the tragedy?

I dont know perfect answers to all these questions.
Attempting to write a few that can be helpful for all young adult students (18-25 age group) - 1. Irrespective of what your seniors tell you, mental health IS important.
It is based on combination of your brain chemistry, your formative experiences and your circumstances. There is no SINGLE cause or simple single remedy.
Getting help from professionals remains single most effective life saver as of now.

A day well spent at Chitale Dairy at Bhilawadi. Thanks to @nikhilchitale and Chitale family.

Their milk and milk products factory is state of the art. Sharing few photographs- Command centre powered by AI that detects break in pattern and activates action.

#Psychotherapy #Reality

One thing that makes therapy relationship different in a beneficial way is privacy.
It is not about "confidentiality " (your information is not shared with others by treating team) only.
Therapy also helps people process their own difficulties in the solitude of their own mind and come up with their own conclusions, processes, emotions. They OWN the solution.

I see this process destroyed quite frequently by well meaning (and sometimes self serving) others in patient's life.

How? Pl read on - Many adults have friends and family who help them in difficult times. Patients have already discussed their difficulties with these people before meeting a therapist.

For children, parents play a serious supervisory role out of concern and parental authority as well.

Why is (almost) everybody unhappy about state of healthcare in India?

There is lot of scholarly work and comments about what ails indian healthcare.

I am putting forth my thoughts here. Trying to think at first principle level -
At most fundamental level, govt needs to decide on "nature" of health care.
Is it -
1. Fundamental right of all citizens
2. A social service rendered by doctors and other professionals
3. A professional service
4. A business

Details - Modern healthcare needs training colleges for professionals, modern equipment, effective medicines, non pharmacological treatments, systems to bring this all together and deliver it, ongoing research about effectiveness of delivery systems.

How does it all tie up?

#thread
Good communication skills are seen as key component in medicine. All doctors are expected to explain things to their patients so that patients can participate in decision making.

Mental health poses unique challenges.

Please read on - Challenges -
1. In India family is actively involved and wants to be kept in the loop. Most patients also accept this cultural reality and welcome it.
A psychiatrist has a job of communicating patient's experiences to the family in a language that they can follow.

#India
#Parenting

Few days ago I wrote about a difficult question faced by many parents - how to motivate kids to do long term things in life?

I am writing more details about this here. It is not a complete answer at all. I hope to get you to think and change your behaviour. Motivation is grossly divided into 2 groups -
1. Push motivation - when you want to get away from your present conditions so you are motivated to undertake steps that will help you get out.

Some children are like wise adults and meeting them opens different doors of human mind.

I met him in clinic. All of 15yr old and looking just 11-12. Small, pale and fragile.

Parents brought him on his insistence to see a "therapist"

A thread ... Few days before while traveling in a school bus, a friend pointed to a woman on the street and said, "you will look like that when you are 50". Everyone laughed and he made an awkward smile.

When he came home, he just collapsed in his mother's arms and remained in bed for a… twitter.com/i/web/status/1…

I asked this question because IQ is a much maligned psychometric test now a days.

Unfortunately, we psychiatrists and clinical psychologists who use this test almost daily (for children) have not done enough work to spread correct information about it. #Thread

https://twitter.com/docbhooshan/status/1640610220228632577

Most people (including doctors) are unaware what actually goes into IQ test, how it has evolved and why it exists.

There is wealth of information available on wikipedia about IQ. If you like technical info, you can read it here -
en.wikipedia.org/wiki/Intellige…

Indian Psychiatric Society, West Zone. Annual CME.
29 and 30th April 2023. Nanded.
Interesting line up of topics and speakers. Don't miss #India #Psychiatry It will be intolerably hot in Nanded at the end of April so you will remain in the air-conditioned hall. Good academic activity guaranteed.

Helping a child come to terms with divorce of parents is now a unfortunately frequent work at clinic.

The way death of a parent and divorce forces growing up in a child is astonishing and painful.

That carefree joy and curiosity that we so firmly associate with childhood.. dissolves in matter of days.

Sometimes children who have seen a marriage breaking apart for years, actually welcome the divorce. Some even try their best to push for it. For them it is a relief of sorts.

One key emotional skill in parenting -
To stop yourself from giving logical explanations when your child is experiencing negative emotions like fear, anger, sadness, disgust, etc.

It comes from parental need to get child out of misery as soon as possible.
#Thread Out ability to use words with precise meaning and our ability to retrofit logic onto any event gives undesirable outcomes in parenting young kids (and human kids remain young for a loooong time).

College students (engineering/psychology/arts) keep approaching for help to develop "app" as their college project requirement.
In last 15 years, I have not come across a SINGLE idea that actually needs app.

It is not the student's fault. Their professors are outdated dinasours Profs don't know that "information" is no longer delivered thru apps.
YouTube cornered that market decade ago.

Apps are for specific service!
Now I am approached for advice to develop an app for "sex education" for teenagers!

Who even comes up with such ridiculous stuff?

This is serious -

A close friend / relative yourself is diagnosed with a health condition that you knew almost nothing about e.g. OCD

Being an educated person, you decide to do your own "research" about this.

What usually happens next is important. It can harm you.
A thread - You spend next few hours / days reading up everything available on internet, especially about cause and treatment.

If at the end of this reading you start feeling very confident that you know all there is to know about this condition and you are ready to advice /take decision,

A friend asked me - there are so many people who have these stress related issues - physical health, mental health, relationships and sexual health as well. How come psychiatrists aren't able to solve their problems? Why medicines haven't been invented for this?

Long answer- Stress is concept from physiology. Every system has a reserve and some mechanisms that come into action when more than optimum or ordinary is demanded from the system.
E.g. you consume huge amount of sugary sweets and your metabolism has to deal with this extra load.

Thread about something I found in Geeta when I was trying to be practical. 👉

Most of us are familiar with the most famous Shloka - I struggled a lot with this one because not feeling responsible for the outcome seems....well irresponsible!

As I read on and reached the final (18th) adhyaya. I found something that made sense to me. So I am sharing it here with you all. Please read on -

#Parenting #Thread

Most people are aware of terrible effects of abusive parenting. Narcissistic and uncaring parents usually top the list of bad parenting models.

In clinical practice i see one more personality quality to be corrosive but almost unknown to people. This personality characteristic is high level of anxiety in one parent or both.

Parent's anxiety is often disguised as "care". And this is the real root of the problem.

#Thread
#ParentingAdvice

To be successful in this complex and rapidly changing world, you need to be obsessed with your vision.

Hardwork, talent, luck all count. No doubt.

But obsession is central identifying factor.

It involves doing things differently, NOT doing most things that other people are doing. That is a cost one MUST pay.

It is a high risk endeavour. No escaping that.

This is where well meaning parents and kids get in a conflict.

There is a way out. A low risk, high reward way (now I have your attention). Read on -

What can a private medical practitioner say about layoffs and losing jobs?

We doctors (in pvt practice) are hired and fired on daily basis.
Each new patient hires us. Decision to retain our services or go elsewhere (firing present doctor) depends on multiple factors disconnect, loss of faith, lack of desired effect, problem getting better, are few of the causes.

Sometimes patients realise that they don't see it as problem anymore so no further doctoring is needed.

Yes. Many people hire and fire us on daily basis.

#Thread #compassion

Few days ago i was invited to give a talk at SKN Medical College,Pune on Positive Mental Health with Compassion. Audience was doctors. Postgrad trainees and teaching staff.

This is what i spoke - 1. Of all the people i meet socially, doctors are the most unhappy lot. They complain, whine and in general one feels horrible at the end of interaction.

What are we doing wrong?
Is the pain of our patients and our punishing work schedules making us unhappy?

#Rant warning. #India
There is no clear answer at the end of the thread. So read at your own risk.

Start - 1/ quality of everyday life for 99% Indians is quite horrible. Pathetic infra and services, corrupt system, rotting education and healthcare.

You struggle to earn and then pump back almost all of your earnings into Neta-Babu-Contractor nexus just to be able to live.