Some illnesses in Psychiatry requires long term treatment ,in a private hospital it is very costly i have recently taken over a old age home in virar where i am helping these people to recover easily
Schizophrenia Rehabilitation
Stages of Rehabilitation
The psychotic stage
This involves hospitalization and a biological line of treatment.
Gentle reassurance and counselingThe patient and his relatives are explained the nature of the illness, the need for a gradual step–ladder approach to work, the fragility of the patient’s ego and the need for continued supervised medication.
Usage of simple capabilities and faculties
The patient is entrusted with easy work which involves usage of very simple abilities and takes to task his mechanical capabilities and rote functioning. Manual work involving sweeping, swabbing, cleaning, dusting, embroidery, stitching, packaging, counting or light duty work such as that of a security person, helper or clerk is allotted to the patients. This phase by and large does not take into account the intellectual or the decision–making or the memory faculties of the patient, even though the prior functioning before the onslaught of the illness may be that of a highly qualified person.
Part–time functioning with high schedules of reinforcement
The patient is involved in work patterns of schedules on a part–time basis viz. 2–3 hours per day as per the patient’s convenience viz. morning shift or afternoon shift. In this phase the patient is subjected to a lot of reinforcement or praise. Monetary payment or any other appropriate reward is made to him on a frequent basis, may be even daily. Often the reward or reinforcement may far surpass the actual quality or the quantum of work achieved, with the sole criterion of the reinforcement being to increase the patient’s confidence and instill in him/her the desire to keep functioning.
Full time functioning but still involving easy nature of work
This phase involves qualitatively the same easy work as before, but over a stretch of time and with monetary payment, reward or reinforcement being awarded on a fortnightly or a monthly basis.
Repeat reassurance and further counseling
The patient and his family members are gradually made to understand the need to give up the earlier mechanical work and seek an outlet in tune with the patient’s actual caliber and true potential.
Phase of intellectual workIn this phase
the patient is assigned work more in touch with his intellectual faculties e.g. a tutor, an accountant, an assistant to a specialized professional etc. If the patient himself is a doctor or a lawyer or a chartered accountant, then this phase may involve his taking up apprenticeship under other professionals with similar qualifications. Again, this phase wherever practical and feasible, should be in a protected environment with the patient being subjected to a lot of morale boosting and reinforcement, and his occasional mistakes and blunders being neglected and tided over by his superiors.
Phase of full utilization of patient’s potentialIn
this phase the patient does what he wants to do in any field of his choice, something which he would have done either way had he not been afflicted with the illness. The disclosure of the fact that he had a prior illness is made without any expectations of sympathy or adjustments. The duration of each phase of rehabilitation is not predetermined but instead is dependent upon the individual case, based on how stable the patient is in each phase. By and large, each phase may involve anywhere between 1 to 6 months. Medication may be added, or adjusted depending upon:
Clinical progress.
The re–immergence of psychotic features.
The need to treat concomitant post–psychotic depression.
The hampering of work caused by side–effects of medicines e.g. tremors or drowsiness. The psychotic stageThis involves hospitalization and a biological line of treatment.
Gentle reassurance and counselingThe patient and his relatives are explained the nature of the illness, the need for a gradual step–ladder approach to work, the fragility of the patient’s ego and the need for continued supervised medication.
Usage of simple capabilities and facultiesThe patient is entrusted with easy work which involves usage of very simple abilities and takes to task his mechanical capabilities and rote functioning. Manual work involving sweeping, swabbing, cleaning, dusting, embroidery, stitching, packaging, counting or light duty work such as that of a security person, helper or clerk is allotted to the patients. This phase by and large does not take into account the intellectual or the decision–making or the memory faculties of the patient, even though the prior functioning before the onslaught of the illness may be that of a highly qualified person.
Part–time functioning with high schedules of reinforcementThe patient is involved in work patterns of schedules on a part–time basis viz. 2–3 hours per day as per the patient’s convenience viz. morning shift or afternoon shift. In this phase the patient is subjected to a lot of reinforcement or praise. Monetary payment or any other appropriate reward is made to him on a frequent basis, may be even daily. Often the reward or reinforcement may far surpass the actual quality or the quantum of work achieved, with the sole criterion of the reinforcement being to increase the patient’s confidence and instill in him/her the desire to keep functioning.
Full time functioning but still involving easy nature of workThis phase involves qualitatively the same easy work as before, but over a stretch of time and with monetary payment, reward or reinforcement being awarded on a fortnightly or a monthly basis.
Repeat reassurance and further counselingThe patient and his family members are gradually made to understand the need to give up the earlier mechanical work and seek an outlet in tune with the patient’s actual caliber and true potential.
Phase of intellectual workIn this phase the patient is assigned work more in touch with his intellectual faculties e.g. a tutor, an accountant, an assistant to a specialized professional etc. If the patient himself is a doctor or a lawyer or a chartered accountant, then this phase may involve his taking up apprenticeship under other professionals with similar qualifications. Again, this phase wherever practical and feasible, should be in a protected environment with the patient being subjected to a lot of morale boosting and reinforcement, and his occasional mistakes and blunders being neglected and tided over by his superiors.
Phase of full utilization of patient’s potentialIn this phase the patient does what he wants to do in any field of his choice, something which he would have done either way had he not been afflicted with the illness. The disclosure of the fact that he had a prior illness is made without any expectations of sympathy or adjustments. The duration of each phase of rehabilitation is not predetermined but instead is dependent upon the individual case, based on how stable the patient is in each phase. By and large, each phase may involve anywhere between 1 to 6 months. Medication may be added, or adjusted depending upon:
Clinical progress.
The re–immergence of psychotic features.
The need to treat concomitant post–psychotic depression.
The hampering of work caused by side–effects of medicines e.g. tremors or drowsiness.
Thursday, February 10, 2011
Friday, January 28, 2011
Childrens in Depression
Not only adults become depressed. Children and teenagers also may have depression, as well. The good news is that depression is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.
About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.
The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.
If one or more of these signs of depression persist, parents should seek help:
Frequent sadness, tearfulness, crying
Decreased interest in activities; or inability to enjoy previously favorite activities
Hopelessness
Persistent boredom; low energy
Social isolation, poor communication
Low self esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger, or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from home
Thoughts or expressions of suicide or self destructive behavior
A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.
Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and
About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.
The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.
If one or more of these signs of depression persist, parents should seek help:
Frequent sadness, tearfulness, crying
Decreased interest in activities; or inability to enjoy previously favorite activities
Hopelessness
Persistent boredom; low energy
Social isolation, poor communication
Low self esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger, or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from home
Thoughts or expressions of suicide or self destructive behavior
A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.
Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and
Monday, December 20, 2010
Sleep Tight All NIght
If you have trouble sleeping - or know someone who has - this leaflet is for you. It covers common problems with sleep, as well as some of the more unusual problems that can happen. There are some simple tips on how to sleep better, and how to decide if you need professional help.
Introduction
We don't usually need to think very much about sleep. It's just a part of life's routine. Even so, most of us sometimes find that we can't sleep properly. We call it insomnia. It's usually just for a short time, perhaps when we're worried or excited. When things settle down, we start sleeping properly again. If you can't sleep properly, it can be a real problem - we need sleep to keep healthy.
What happens when we sleep?
When you sleep, you become unconscious and unaware of what's going on around you. As you sleep, you pass through different stages - and there are two main types:
Rapid Eye Movement (REM) sleep
This comes and goes throughout the night, and makes up about one fifth of your sleep. The brain is very active, eyes move quickly from side to side and you dream. Although your brain is active, your muscles are very relaxed.
Non-REM sleep
Your brain is quiet, but your body moves around while you sleep. Hormones are released into the bloodstream and your body repairs itself after the wear and tear of the day. There are 3 stages of non-REM sleep:
'pre-sleep' - your muscles relax, your heart beats slower and your body temperature falls
light sleep - you can wake up easily without feeling confused
'slow wave' sleep - your blood pressure falls, you may talk or sleep walk and it's hard to wake up. If somebody does wake you, you feel confused.
You move between REM and non-REM sleep about 5 times throughout the night, dreaming more towards the morning.
Most people during a normal night will wake up for 1 or 2 minutes every 2 hours or so. They aren't usually aware of these 'mini wakes' but may remember them if you feel anxious or there is something else going on - noises outside, your partner snoring etc.
How much sleep do we need?
This mainly depends on your age.
Babies sleep for about 17 hours each day.
Older children only need 9 or 10 hours each night.
Most adults need around 8 hours sleep each night.
Older people need the same amount of sleep, but will often only have 1 period of deep sleep during the night, usually in the first 3 or 4 hours. After that, they wake more easily. We tend to dream less as we get older.
There are differences between people of the same age. Most will need 8 hours a night, but some (a few) people will get by with only 3 hours a night.
The short periods of being awake can feel much longer than they really are. This can make you feel that you are not sleeping as much as you really are.
What happens if I don't sleep?
An occasional night without sleep will make you feel tired the next day, but it won't affect your health.
However, after several sleepless nights, you will start to find that:
you feel tired all the time
you drop off during the day
you find it difficult to concentrate
you find it hard to make decisions
you start to feel depressed
you start to worry about not being able to sleep.
This can be very dangerous if you are driving or operating heavy machinery. Many deaths are caused each year by people falling asleep at the wheel while driving.
Lack of sleep can make you more likely to get high blood pressure, diabetes and to be overweight.
Sleep problems in adult life
Sleeping too little (Insomnia)
You may feel that you aren't getting enough sleep or that, even if you do get the hours, you just aren't getting a good night's rest.
There are many everyday reasons for not sleeping well:
the bedroom may be too noisy, too hot or too cold
the bed may be uncomfortable or too small
you don't have a regular sleep routine
you partner has a different pattern of sleep from you
you aren't getting enough exercise
you eat too late - and find it hard to get off to sleep
you go to bed hungry - and wake up too early
cigarettes, alcohol and drinks containing caffeine, such as tea and coffee
illness, pain or a high temperature.
More serious reasons include:
emotional problems
difficulties at work
anxiety and worry
depression - you wake very early and can't get back to sleep
thinking over and over about problems - usually without getting anywhere with them.
Helping yourself
Here are some simple tips that many people find helpful:
Do's
Make sure that your bed and bedroom are comfortable - not too hot, not too cold, not too noisy.
Make sure that your mattress supports you properly. If it's too firm, your hips and shoulders are under pressure. If it's too soft, your body sags, which is bad for your back. Generally, you should replace your mattress every 10 years to get the best support and comfort.
Get some exercise. Don't overdo it, but try some regular swimming or walking. The best time to exercise is in the daytime - particularly late afternoon or early evening. Later than this can disturb your sleep.
Take some time to relax properly before going to bed. Some people find aromatherapy helpful.
If something is troubling you and there is nothing you can do about it right away, try writing it down before going to bed and then tell yourself to deal with it tomorrow.
If you can't sleep, get up and do something relaxing. Read, watch television or listen to quiet music. After a while, you should feel tired enough to go to bed again.
Don'ts
Don't go without sleep for a long time. Go to bed when you feel tired and stick to a routine of getting up at the same time every day, whether you still feel tired or not.
Caffeine hangs around in your body for many hours after your last drink of tea or coffee. Stop drinking tea or coffee by mid-afternoon. If you want a hot drink in the evening, try something milky or herbal (but check there's no caffeine in it).
Don't drink a lot of alcohol. It may help you fall asleep, but you will almost certainly wake up during the night.
Don't eat or drink a lot late at night. Try to have your supper early in the evening rather than late.
If you've had a bad night, don't sleep in the next day - it will make it harder to get off to sleep the following night.
Don't use slimming tablets - many of these will tend to keep you awake.
Don't use street drugs like Ecstasy, cocaine and amphetamines - they are stimulants, and like caffeine, will tend to keep you awake.
If you try these tips and you still can't sleep, go and see your doctor. You can talk over any problems that may be stopping you from sleeping. Your doctor can make sure that your sleeplessness is not being caused by a physical illness, a prescribed medicine, or emotional problems. There is evidence that cognitive behavioural therapy can be helpful if you haven't been sleeping well for some time.
Psychological Treatments
Cognitive therapy is a way of changing unhelpful ways of thinking that can make you more anxious, and so stop you from sleeping.
Stimulus control helps you to:
strengthen the link of being in bed with sleeping - by only getting into bed when you feel tired, and only using your bed for sleep and sex
weaken the link of being in bed with doing things that are likely to keep you awake - like watching exciting TV programmes, doing work, or organising things
weaken the link of being in bed with worrying - if you can't sleep, instead of lying in bed worrying, you get up and do something for a while until you feel tired again.
Sleep restriction helps you to go to bed later. Too much time in bed can stop you from sleeping.
Progressive muscle relaxation helps you to relax your muscles deeply. One by one, you tense and then release the muscles of your body, working up from your feet to your legs, arms, shoulders, face and neck.
What about medication?
People have used sleeping tablets for many years, but we now know that they:
don't work for very long
make you tired and irritable the next day
lose their effect quite quickly, so you have to take more and more to get the same effect
are addictive. The longer you take sleeping tablets, the more likely you are to become dependent on them.
There are some newer sleeping tablets (Zolpidem, Zaleplon and Zopiclone), but these seem to have many of the same drawbacks as the older drugs, such as Nitrazepam, Temazepam and Diazepam.
Sleeping tablets should only be used for short periods (less than 2 weeks) - for instance, if you are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long time, it is best to cut down the dose slowly after discussing it with your doctor.
In some cases, antidepressant tablets can be helpful.
Over the counter medication
You can buy sleeping remedies at your chemist without a prescription. They often contain an anti-histamine, like you find in medicines for hay-fever, coughs and colds. These do work, but they can make you sleepy well into the next morning. If you do use them, take the warnings seriously and don't drive or operate heavy machinery the next day. Another problem is tolerance - as your body gets used to the substance, you need to take more and more to get the same effect. It is best not to take anti-histamines for a long time.
Herbal medicines are usually based on a herb called Valerian. It probably works best if you take it every night for 2-3 weeks or more. It doesn't seem to work as well if you take it occasionally. As with the anti-histamines, you need to be careful about the effects lasting into the following morning. If you are taking any medication for your blood pressure (or any other sleeping tablets or tranquillisers), have a chat with your doctor before using an over the counter remedy.
Sleeping at the wrong time - shift work and parenthood
Your may have to work at night, staying awake when you would normally be asleep. If you only have to do this occasionally, it's quite easy to adjust. It is much harder to cope with if you do it regularly. Shift workers, doctors and nurses working all night or nursing mothers may all find that they sleep at times when they ought to be awake. It's like jet lag where rapid travel between time zones means that you are awake when everybody else is asleep.
A good way to get back to normal is to make sure that you wake up quite early at the same time every morning - whatever time you fell asleep the night before. Use an alarm clock to help you. Make sure that you don't go to bed again before about 10 pm that night. If you do this for a few nights, you should soon start to fall asleep naturally at the right time.
Sleeping too much
You may find that you fall asleep during the day at times when you want to stay awake. This will usually be because you have not been getting enough sleep at night.
If you are still falling asleep in the daytime, even after a week or two of getting enough sleep, see your doctor. Physical illnesses such as diabetes, a viral infection, or a thyroid problem, can cause this sort of tiredness.
There are other conditions which make people sleep too much:
Narcolepsy (daytime sleepiness)
This is an uncommon problem, so it's easy for a doctor to miss it.
There are two main symptoms:
you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness even when you are with other people
cataplexy - you suddenly lose control of your muscles and collapse when you are angry, laughing or excited; it sometimes gets better with age.
You may also find that you:
can't speak or move when falling asleep or waking up - (sleep paralysis)
hear odd sounds or see dream-like images (hallucinations)
'run on auto-pilot' - you have done things, but can't remember doing them, as if you had been asleep
wake with hot flushes during the night.
The cause for this has recently been found - a lack of a substance called orexin, or hypocretin.
Treatment consists of taking regular exercise and getting yourself into a regular night-time routine. If this simple approach does not work, medication may help. These include:
Modafinil which makes you more awake in the day-time
antidepressants, such as Clomipramine or Fluoxetine, can help with cataplexy
Sodium Oxybate helps the day-time sleepiness and poor sleep at night.
You snore loudly and stop breathing for short periods during the night. This happens because the upper part of your airway closes. Every time you stop breathing, you wake suddenly and your body or arms and legs may jerk.
You stay awake just for a short time, then fall off to sleep again. This will happen several times during the night. You may have a dry mouth and a headache when you wake up in the morning. You feel tired in the day and may have an irresistible urge to go to sleep.
You are more likely to get sleep apnoea if you are:
older
overweight
a smoker
a heavy drinker
The problem is often noticed by a partner. Treatment is usually simple - cut down smoking and drinking, lose weight, and sleep in a different position. If your apnoea is very bad, you may need to wear a Continuous Positive Airway Pressure (CPAP) mask. This blows high-pressure air into your nose which keeps the airway open.
Other problems with sleeping
At some point in their life, about 1 in 20 adults have night terrors, and 1 in 100 report that they sleep-walk. Both these conditions are more common in children.
Sleepwalking
When you sleepwalk, you appear (to other people) to wake from a deep sleep. You then get up and do things. These may be quite complicated, like walking around or going up and down stairs. This can land you in embarrassing (and occasionally dangerous) situations. Unless someone else wakes you up, you won't remember anything about it. Sleepwalking sometimes happen after a night terror (see below). If your sleep is broken or you aren't getting sleep, you are more likely to sleepwalk.
A sleepwalker should be guided gently back to bed and should not be woken up. You may need to take precautions to protect them or other people, such as locking doors and windows, or locking away sharp objects, like knives and tools.
Night terrors can happen on their own, without sleepwalking. Like a sleepwalker, a person with night terrors will appear to wake suddenly from a deep sleep. They look half-awake and very frightened, but will usually settle back to sleep without waking up completely. All you can do is sit with them until they fall asleep again.
Night terrors are different from vivid dreams or nightmares as people don't seem to remember anything about them the next morning.
Nightmares
Most of us have had frightening dreams or nightmares. They usually happen during the later part of the night, when we have our most vivid and memorable dreams. They don't usually cause problems unless they happen regularly, perhaps because of emotional distress. Nightmares often follow a distressing or life-threatening event such as a death, a disaster, an accident or a violent attack. Counselling may be helpful.
Restless Legs Syndrome (RLS)
You feel you have to move your legs (but also, sometimes, other parts of the body).
You may have uncomfortable, painful or burning feelings in your legs.
These feelings only bother you when you are resting.
They are generally worse at night.
Walking or stretching helps, but only for as long as you carry on doing it.
You may not be able to sit still in the daytime or sleep properly.
People usually first ask for help with this in middle age even though they may have had symptoms since childhood. It often runs in families.
RLS usually occurs on its own. Pregnancy or a physical illness (iron and vitamin deficiencies, diabetes or kidney problems) can occasionally be responsible.
If it is not caused by another physical illness, treatment depends on how bad it is. In mild RLS, the symptoms can usually be controlled by simple steps designed to help you sleep better (see above 'Helping yourself'). In more severe RLS, medications may help. These include medications used in Parkinson's disease, anti-epileptic medications, benzodiazepine tranquillisers and pain-killers.
If simple measures do not help, you can be referred to a sleep or movement disorders specialist.
Autism
Some people with autism do not seem to realise that night time is for sleeping, and may be up and about when everyone else wants to sleep. This will usually need the help of a specialist.
REM Sleep Behaviour Disorder (RBD)
A person will start trashing about during REM or dream sleep, as though responding to a dream. They may punch, kick, shout, or jump out of bed. Quite often, the person will wake and be able to remember the dream that prompted their physical reactions. Someone sharing the same bed can be disturbed and, sometimes, injured.
The problem seems to be that, unlike normal REM sleep where the muscles are relaxed, in RBD they are not. It can happen on its own or it can be a symptom of a neurological illness, so it's best to be seen by a specialist
Introduction
We don't usually need to think very much about sleep. It's just a part of life's routine. Even so, most of us sometimes find that we can't sleep properly. We call it insomnia. It's usually just for a short time, perhaps when we're worried or excited. When things settle down, we start sleeping properly again. If you can't sleep properly, it can be a real problem - we need sleep to keep healthy.
What happens when we sleep?
When you sleep, you become unconscious and unaware of what's going on around you. As you sleep, you pass through different stages - and there are two main types:
Rapid Eye Movement (REM) sleep
This comes and goes throughout the night, and makes up about one fifth of your sleep. The brain is very active, eyes move quickly from side to side and you dream. Although your brain is active, your muscles are very relaxed.
Non-REM sleep
Your brain is quiet, but your body moves around while you sleep. Hormones are released into the bloodstream and your body repairs itself after the wear and tear of the day. There are 3 stages of non-REM sleep:
'pre-sleep' - your muscles relax, your heart beats slower and your body temperature falls
light sleep - you can wake up easily without feeling confused
'slow wave' sleep - your blood pressure falls, you may talk or sleep walk and it's hard to wake up. If somebody does wake you, you feel confused.
You move between REM and non-REM sleep about 5 times throughout the night, dreaming more towards the morning.
Most people during a normal night will wake up for 1 or 2 minutes every 2 hours or so. They aren't usually aware of these 'mini wakes' but may remember them if you feel anxious or there is something else going on - noises outside, your partner snoring etc.
How much sleep do we need?
This mainly depends on your age.
Babies sleep for about 17 hours each day.
Older children only need 9 or 10 hours each night.
Most adults need around 8 hours sleep each night.
Older people need the same amount of sleep, but will often only have 1 period of deep sleep during the night, usually in the first 3 or 4 hours. After that, they wake more easily. We tend to dream less as we get older.
There are differences between people of the same age. Most will need 8 hours a night, but some (a few) people will get by with only 3 hours a night.
The short periods of being awake can feel much longer than they really are. This can make you feel that you are not sleeping as much as you really are.
What happens if I don't sleep?
An occasional night without sleep will make you feel tired the next day, but it won't affect your health.
However, after several sleepless nights, you will start to find that:
you feel tired all the time
you drop off during the day
you find it difficult to concentrate
you find it hard to make decisions
you start to feel depressed
you start to worry about not being able to sleep.
This can be very dangerous if you are driving or operating heavy machinery. Many deaths are caused each year by people falling asleep at the wheel while driving.
Lack of sleep can make you more likely to get high blood pressure, diabetes and to be overweight.
Sleep problems in adult life
Sleeping too little (Insomnia)
You may feel that you aren't getting enough sleep or that, even if you do get the hours, you just aren't getting a good night's rest.
There are many everyday reasons for not sleeping well:
the bedroom may be too noisy, too hot or too cold
the bed may be uncomfortable or too small
you don't have a regular sleep routine
you partner has a different pattern of sleep from you
you aren't getting enough exercise
you eat too late - and find it hard to get off to sleep
you go to bed hungry - and wake up too early
cigarettes, alcohol and drinks containing caffeine, such as tea and coffee
illness, pain or a high temperature.
More serious reasons include:
emotional problems
difficulties at work
anxiety and worry
depression - you wake very early and can't get back to sleep
thinking over and over about problems - usually without getting anywhere with them.
Helping yourself
Here are some simple tips that many people find helpful:
Do's
Make sure that your bed and bedroom are comfortable - not too hot, not too cold, not too noisy.
Make sure that your mattress supports you properly. If it's too firm, your hips and shoulders are under pressure. If it's too soft, your body sags, which is bad for your back. Generally, you should replace your mattress every 10 years to get the best support and comfort.
Get some exercise. Don't overdo it, but try some regular swimming or walking. The best time to exercise is in the daytime - particularly late afternoon or early evening. Later than this can disturb your sleep.
Take some time to relax properly before going to bed. Some people find aromatherapy helpful.
If something is troubling you and there is nothing you can do about it right away, try writing it down before going to bed and then tell yourself to deal with it tomorrow.
If you can't sleep, get up and do something relaxing. Read, watch television or listen to quiet music. After a while, you should feel tired enough to go to bed again.
Don'ts
Don't go without sleep for a long time. Go to bed when you feel tired and stick to a routine of getting up at the same time every day, whether you still feel tired or not.
Caffeine hangs around in your body for many hours after your last drink of tea or coffee. Stop drinking tea or coffee by mid-afternoon. If you want a hot drink in the evening, try something milky or herbal (but check there's no caffeine in it).
Don't drink a lot of alcohol. It may help you fall asleep, but you will almost certainly wake up during the night.
Don't eat or drink a lot late at night. Try to have your supper early in the evening rather than late.
If you've had a bad night, don't sleep in the next day - it will make it harder to get off to sleep the following night.
Don't use slimming tablets - many of these will tend to keep you awake.
Don't use street drugs like Ecstasy, cocaine and amphetamines - they are stimulants, and like caffeine, will tend to keep you awake.
If you try these tips and you still can't sleep, go and see your doctor. You can talk over any problems that may be stopping you from sleeping. Your doctor can make sure that your sleeplessness is not being caused by a physical illness, a prescribed medicine, or emotional problems. There is evidence that cognitive behavioural therapy can be helpful if you haven't been sleeping well for some time.
Psychological Treatments
Cognitive therapy is a way of changing unhelpful ways of thinking that can make you more anxious, and so stop you from sleeping.
Stimulus control helps you to:
strengthen the link of being in bed with sleeping - by only getting into bed when you feel tired, and only using your bed for sleep and sex
weaken the link of being in bed with doing things that are likely to keep you awake - like watching exciting TV programmes, doing work, or organising things
weaken the link of being in bed with worrying - if you can't sleep, instead of lying in bed worrying, you get up and do something for a while until you feel tired again.
Sleep restriction helps you to go to bed later. Too much time in bed can stop you from sleeping.
Progressive muscle relaxation helps you to relax your muscles deeply. One by one, you tense and then release the muscles of your body, working up from your feet to your legs, arms, shoulders, face and neck.
What about medication?
People have used sleeping tablets for many years, but we now know that they:
don't work for very long
make you tired and irritable the next day
lose their effect quite quickly, so you have to take more and more to get the same effect
are addictive. The longer you take sleeping tablets, the more likely you are to become dependent on them.
There are some newer sleeping tablets (Zolpidem, Zaleplon and Zopiclone), but these seem to have many of the same drawbacks as the older drugs, such as Nitrazepam, Temazepam and Diazepam.
Sleeping tablets should only be used for short periods (less than 2 weeks) - for instance, if you are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long time, it is best to cut down the dose slowly after discussing it with your doctor.
In some cases, antidepressant tablets can be helpful.
Over the counter medication
You can buy sleeping remedies at your chemist without a prescription. They often contain an anti-histamine, like you find in medicines for hay-fever, coughs and colds. These do work, but they can make you sleepy well into the next morning. If you do use them, take the warnings seriously and don't drive or operate heavy machinery the next day. Another problem is tolerance - as your body gets used to the substance, you need to take more and more to get the same effect. It is best not to take anti-histamines for a long time.
Herbal medicines are usually based on a herb called Valerian. It probably works best if you take it every night for 2-3 weeks or more. It doesn't seem to work as well if you take it occasionally. As with the anti-histamines, you need to be careful about the effects lasting into the following morning. If you are taking any medication for your blood pressure (or any other sleeping tablets or tranquillisers), have a chat with your doctor before using an over the counter remedy.
Sleeping at the wrong time - shift work and parenthood
Your may have to work at night, staying awake when you would normally be asleep. If you only have to do this occasionally, it's quite easy to adjust. It is much harder to cope with if you do it regularly. Shift workers, doctors and nurses working all night or nursing mothers may all find that they sleep at times when they ought to be awake. It's like jet lag where rapid travel between time zones means that you are awake when everybody else is asleep.
A good way to get back to normal is to make sure that you wake up quite early at the same time every morning - whatever time you fell asleep the night before. Use an alarm clock to help you. Make sure that you don't go to bed again before about 10 pm that night. If you do this for a few nights, you should soon start to fall asleep naturally at the right time.
Sleeping too much
You may find that you fall asleep during the day at times when you want to stay awake. This will usually be because you have not been getting enough sleep at night.
If you are still falling asleep in the daytime, even after a week or two of getting enough sleep, see your doctor. Physical illnesses such as diabetes, a viral infection, or a thyroid problem, can cause this sort of tiredness.
There are other conditions which make people sleep too much:
Narcolepsy (daytime sleepiness)
This is an uncommon problem, so it's easy for a doctor to miss it.
There are two main symptoms:
you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness even when you are with other people
cataplexy - you suddenly lose control of your muscles and collapse when you are angry, laughing or excited; it sometimes gets better with age.
You may also find that you:
can't speak or move when falling asleep or waking up - (sleep paralysis)
hear odd sounds or see dream-like images (hallucinations)
'run on auto-pilot' - you have done things, but can't remember doing them, as if you had been asleep
wake with hot flushes during the night.
The cause for this has recently been found - a lack of a substance called orexin, or hypocretin.
Treatment consists of taking regular exercise and getting yourself into a regular night-time routine. If this simple approach does not work, medication may help. These include:
Modafinil which makes you more awake in the day-time
antidepressants, such as Clomipramine or Fluoxetine, can help with cataplexy
Sodium Oxybate helps the day-time sleepiness and poor sleep at night.
You snore loudly and stop breathing for short periods during the night. This happens because the upper part of your airway closes. Every time you stop breathing, you wake suddenly and your body or arms and legs may jerk.
You stay awake just for a short time, then fall off to sleep again. This will happen several times during the night. You may have a dry mouth and a headache when you wake up in the morning. You feel tired in the day and may have an irresistible urge to go to sleep.
You are more likely to get sleep apnoea if you are:
older
overweight
a smoker
a heavy drinker
The problem is often noticed by a partner. Treatment is usually simple - cut down smoking and drinking, lose weight, and sleep in a different position. If your apnoea is very bad, you may need to wear a Continuous Positive Airway Pressure (CPAP) mask. This blows high-pressure air into your nose which keeps the airway open.
Other problems with sleeping
At some point in their life, about 1 in 20 adults have night terrors, and 1 in 100 report that they sleep-walk. Both these conditions are more common in children.
Sleepwalking
When you sleepwalk, you appear (to other people) to wake from a deep sleep. You then get up and do things. These may be quite complicated, like walking around or going up and down stairs. This can land you in embarrassing (and occasionally dangerous) situations. Unless someone else wakes you up, you won't remember anything about it. Sleepwalking sometimes happen after a night terror (see below). If your sleep is broken or you aren't getting sleep, you are more likely to sleepwalk.
A sleepwalker should be guided gently back to bed and should not be woken up. You may need to take precautions to protect them or other people, such as locking doors and windows, or locking away sharp objects, like knives and tools.
Night terrors can happen on their own, without sleepwalking. Like a sleepwalker, a person with night terrors will appear to wake suddenly from a deep sleep. They look half-awake and very frightened, but will usually settle back to sleep without waking up completely. All you can do is sit with them until they fall asleep again.
Night terrors are different from vivid dreams or nightmares as people don't seem to remember anything about them the next morning.
Nightmares
Most of us have had frightening dreams or nightmares. They usually happen during the later part of the night, when we have our most vivid and memorable dreams. They don't usually cause problems unless they happen regularly, perhaps because of emotional distress. Nightmares often follow a distressing or life-threatening event such as a death, a disaster, an accident or a violent attack. Counselling may be helpful.
Restless Legs Syndrome (RLS)
You feel you have to move your legs (but also, sometimes, other parts of the body).
You may have uncomfortable, painful or burning feelings in your legs.
These feelings only bother you when you are resting.
They are generally worse at night.
Walking or stretching helps, but only for as long as you carry on doing it.
You may not be able to sit still in the daytime or sleep properly.
People usually first ask for help with this in middle age even though they may have had symptoms since childhood. It often runs in families.
RLS usually occurs on its own. Pregnancy or a physical illness (iron and vitamin deficiencies, diabetes or kidney problems) can occasionally be responsible.
If it is not caused by another physical illness, treatment depends on how bad it is. In mild RLS, the symptoms can usually be controlled by simple steps designed to help you sleep better (see above 'Helping yourself'). In more severe RLS, medications may help. These include medications used in Parkinson's disease, anti-epileptic medications, benzodiazepine tranquillisers and pain-killers.
If simple measures do not help, you can be referred to a sleep or movement disorders specialist.
Autism
Some people with autism do not seem to realise that night time is for sleeping, and may be up and about when everyone else wants to sleep. This will usually need the help of a specialist.
REM Sleep Behaviour Disorder (RBD)
A person will start trashing about during REM or dream sleep, as though responding to a dream. They may punch, kick, shout, or jump out of bed. Quite often, the person will wake and be able to remember the dream that prompted their physical reactions. Someone sharing the same bed can be disturbed and, sometimes, injured.
The problem seems to be that, unlike normal REM sleep where the muscles are relaxed, in RBD they are not. It can happen on its own or it can be a symptom of a neurological illness, so it's best to be seen by a specialist
Monday, December 29, 2008
Want To Quit Smoking
What should I do first?
Pick a date to stop smoking and then stick to it.
Write down your reasons for quitting. Read over the list every day, before and after you quit. Here are some tips to think about.
Write down when you smoke, why you smoke and what you are doing when you smoke. You will learn what triggers you to smoke.
Stop smoking in certain situations (such as during your work break or after dinner) before actually quitting.
Make a list of activities you can do instead of smoking. Be ready to do something else when you want to smoke.
Ask your doctor about using nicotine gum or patches. Some people find these aids helpful.
How can I avoid relapsing?
Don't carry a lighter, matches or cigarettes. Keep all of these smoking reminders out of sight.
If you live with a smoker, ask that person not to smoke in your presence.
Don't focus on what you are missing. Think about the healthier way of life you are gaining.
When you get the urge to smoke, take a deep breath. Hold it for 10 seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
Keep your hands busy. Doodle, play with a pencil or straw, or work on a computer.
Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette break.
When you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops or libraries.
Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.
Exercise. Exercising will help you relax.
Get support for quitting. Tell others about your milestones with pride.
How will I feel when I quit
You may crave cigarettes, be irritable, feel very hungry, cough often, get headaches or have difficulty concentrating. These symptoms of withdrawal occur because your body is used to nicotine, the active addicting agent within cigarettes.When withdrawal symptoms occur within the first two weeks after quitting, stay in control. Think about your reasons for quitting. Remind yourself that these are signs that your body is healing and getting used to being without cigarettes.The withdrawal symptoms are only temporary. They are strongest when you first quit but will go away within 10 to 14 days. Remember that withdrawal symptoms are easier to treat than the major diseases that smoking can cause.You may still have the desire to smoke, since there are many strong associations with smoking. People may associate smoking with specific situations, with a variety of emotions or with certain people in their lives. The best way to overcome these associations is to experience them without smoking.If you relapse do not lose hope. Seventy-five percent of those who quit smoke again. Most smokers quit three times before they are successful. If you relapse, don't give up! Plan ahead and think about what you will do next time you get the urge to smoke.
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com
Pick a date to stop smoking and then stick to it.
Write down your reasons for quitting. Read over the list every day, before and after you quit. Here are some tips to think about.
Write down when you smoke, why you smoke and what you are doing when you smoke. You will learn what triggers you to smoke.
Stop smoking in certain situations (such as during your work break or after dinner) before actually quitting.
Make a list of activities you can do instead of smoking. Be ready to do something else when you want to smoke.
Ask your doctor about using nicotine gum or patches. Some people find these aids helpful.
How can I avoid relapsing?
Don't carry a lighter, matches or cigarettes. Keep all of these smoking reminders out of sight.
If you live with a smoker, ask that person not to smoke in your presence.
Don't focus on what you are missing. Think about the healthier way of life you are gaining.
When you get the urge to smoke, take a deep breath. Hold it for 10 seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
Keep your hands busy. Doodle, play with a pencil or straw, or work on a computer.
Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette break.
When you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops or libraries.
Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.
Exercise. Exercising will help you relax.
Get support for quitting. Tell others about your milestones with pride.
How will I feel when I quit
You may crave cigarettes, be irritable, feel very hungry, cough often, get headaches or have difficulty concentrating. These symptoms of withdrawal occur because your body is used to nicotine, the active addicting agent within cigarettes.When withdrawal symptoms occur within the first two weeks after quitting, stay in control. Think about your reasons for quitting. Remind yourself that these are signs that your body is healing and getting used to being without cigarettes.The withdrawal symptoms are only temporary. They are strongest when you first quit but will go away within 10 to 14 days. Remember that withdrawal symptoms are easier to treat than the major diseases that smoking can cause.You may still have the desire to smoke, since there are many strong associations with smoking. People may associate smoking with specific situations, with a variety of emotions or with certain people in their lives. The best way to overcome these associations is to experience them without smoking.If you relapse do not lose hope. Seventy-five percent of those who quit smoke again. Most smokers quit three times before they are successful. If you relapse, don't give up! Plan ahead and think about what you will do next time you get the urge to smoke.
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com
Friday, December 26, 2008
My Clinic Adresses And Timings
Krishna Nursing Home,
Near Railway Station,
Dahisar East.
Tell No.02228283114
Daily 10 am to 11 am.
Cardinal Gracious Hospital,
Sandor,Bangli.
Vasai West.
Tell No.0250232518
Mon,Wed,Fri. 12pm to 1 pm
Gurukrapa Hospital.
B P Road,
Bhyander East
Tell No 02228192954
Daily 4 pm to 5 pm
Kasturi Hospital,
Near Navrang Hotel,
Bhyander west.
Tell No 02228147676
Daily 5.30. pm to 7 pm
Purohit Medical Center,
Next To Indraprashta Shopping Center,
Borivali West.
Tell No 02228985370
Daily 7.30 to 9 pm
Near Railway Station,
Dahisar East.
Tell No.02228283114
Daily 10 am to 11 am.
Cardinal Gracious Hospital,
Sandor,Bangli.
Vasai West.
Tell No.0250232518
Mon,Wed,Fri. 12pm to 1 pm
Gurukrapa Hospital.
B P Road,
Bhyander East
Tell No 02228192954
Daily 4 pm to 5 pm
Kasturi Hospital,
Near Navrang Hotel,
Bhyander west.
Tell No 02228147676
Daily 5.30. pm to 7 pm
Purohit Medical Center,
Next To Indraprashta Shopping Center,
Borivali West.
Tell No 02228985370
Daily 7.30 to 9 pm
Friday, December 19, 2008
Suicide--self harm
1 in 10 people will self-harm by taking tablets; cutting, burning, piercing or swallowing objects. It is more common in young people, women, gay and bisexuals and in some sub-cultures. Some people self-harm regularly - it can become almost an addiction.
What makes people self-harm?It usually happens in a state of high emotion and inner turmoil. This may be caused by abuse; feeling depressed; feeling bad about yourself or relationship problems. You may do it because you feel that people don't listen to you; hopelessness; isolation, feeling alone, out of control or powerless. People who self-harm are more likely to have been abused in childhood.
How does it make you feel?Self harming can help you to feel in control and less tense. So, it can be a 'quick fix' for feeling bad.
What help is there?
Talking: Talking can help you to feel less alone, to see your problems more clearly.
Self-help groups: People with the similar problems can provide support and practical advice – and, believe it or not, sharing your problems in a group does help
Help with relationships: Group therapy can often help you to sort out difficulties in getting on with other people
Talking Therapy: Problem solving, Cognitive Behavioural or Psychodynamic psychotherapy;
What works best?
All these treatments help. Some evidence suggests that problem-solving therapy may be best.
What if I don't get help?
1 in 3 people who self-harm will do it again within a year. People who self-harm are 50 times more likely to kill themselves. The risk increases with age and is much greater for men. Cutting can cause scarring, numbness or paralysis.
How can I help myself ?
When you want to harm yourself: If you can ride out how you feel without self-harming, the feelings will usually go after a few hours. You can talk to someone, distract yourself by going out, sing or listen to music, or do anything (harmless) that interests you. Try to relax and focus your mind on something pleasant. Find another way to express your feelings such as squeezing ice cubes (make them with red juice to mimic blood if that helps), or draw red lines on your skin. Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower. Focus on positives. Be kind to yourself – get a massage. Write a diary or a letter, to explain what is happening to you – no one else needs to see it.
When the urge has gone: Think about the times that you have self-harmed and what (if anything) has helped. Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there. Where were you, who were you with, and what you were feeling? Try to work out why you began feeling like you did. Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you. Make a recording by talking about your good points and why you don't want to self-harm. When you feel bad, play this back to remind you of the parts of you that are worthwhile. Make a 'crisis plan' of what to do when you feel bad.
I don't want to stop
OK, but reduce the damage. If you cut, use clean blades. Find ways of hurting yourself that don't damage your body (see above)
If you can say YES to at least 3 of the questions below, it's worth trying to stop?
Are there at least two people who are willing to help me stop?
Do I have friends that I can go to if I get desperate?
Have I found at least two safe ways that reduce the feelings that make me self-harm?
Can I really say to myself that I want to stop hurting myself?
Can I tell myself that I WILL tolerate feelings that make me want to self harm?
Is there a professional who will give me support and help in a crisis?
If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many departments have a psychiatric liaison nurse, or a social worker, who can talk with you. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.
What can I do if I know someone who self-harms?
Listen to them without being critical. This can be very hard if you are upset or angry. Try to focus on them rather than your feelings – this is hard.
Try to understand their feelings, and then move the conversation to other things.
Take the mystery out of self-harm by helping them find out about self-harm on the internet or at the library.
Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.
Don't
Try to be their therapist – you have enough to deal with as their friend.
Expect them to stop overnight – it's difficult and takes time.
Get angry this may make them feel worse. Talk calmly about the effect it has on you - in a way that shows how much you care for them.
Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
Make them promise not to do it again or make your involvement conditional on them stopping.
Self-Harm
This provides information about self-harm and is for anyone who is harming themselves, or feels that they might. We hope it will also be helpful for their friends and families.
What is self-harm?
Self-harm happens when someone hurts or harms themselves. They may:
take too many tablets;
cut themselves;
burn their body;
bang their head;
throw their body against something hard;
punch themselves;
stick things in their body;
swallow inappropriate objects.
It can feel to other people that these things are done coolly and deliberately – almost cynically. But someone who self-harms will usually do it in a state of high emotion, distress and unbearable inner turmoil. Some people plan it in advance, others do it suddenly. Some people self-harm only once or twice, but others do it regularly - it can become almost like an addiction.
Some of us harm ourselves in less obvious - but still serious - ways. We may behave in ways that suggest we don't care whether we live or die – we may take drugs recklessly, have unsafe sex, or binge drink. Some people simply starve themselves.
Other words that are used to describe self-harm
These terms are inaccurate and going out of use:
Deliberate self-harm (DSH) - the word 'deliberate' unhelpfully blamed self-harm as a reaction to painful feelings.
Suicide/Parasuicide - most people who self-harm do not want to kill themselves, so these terms are misleading.
Who self-harms?
About 1 in 10 young people will self-harm at some point, but it can occur at any age.
It is more common in young women than men.
Gay and bisexual people seem to be more likely to self-harm.
Sometimes groups of young people self-harm together - having a friend who self-harms may increase your chances of doing it as well.
Self-harm is more common in some sub-cultures – "goths" seem to be particularly vulnerable.
People who self-harm are more likely to have experienced physical, emotional or sexual abuse during childhood.
Research probably under estimates how common self-harm is, and surveys find higher rates in communities and schools than in hospitals. Some types of self-harm, like cutting, may be more secret and so less likely to be noticed by other people. In a recent study of over 4000 self-harming adults in hospital, 80% had overdosed and around 15% had cut themselves. In the community, these statistics would probably be reversed.
What makes people self-harm?
Emotional distress – people often struggle with difficulties for some time before they self-harm:
physical or sexual abuse;
feeling depressed;
feeling bad about yourself;
relationship problems with partners, friends, and family.
If you feel:
that people don't listen to you;
hopeless;
isolated, alone;
out of control;
powerless – it feels as though there's nothing you can do to change anything.
Using alcohol or drugs – it may feel that these are as out of control as the rest of your life.
If you want to show someone else how distressed you are or to get back at them or to punish them. This is not common – most people suffer in silence and self-harm in private.
How does it make you feel?
Self-harm can help you to feel in control, and reduce uncomfortable feelings of tension and distress. If you feel guilty, it can be a way of punishing yourself and relieving your guilt. Either way, it can become a 'quick fix' for feeling bad.
Are people who self-harm mentally ill?
Most people who self-harm are not mentally ill. However, some may be depressed, or have severe personality difficulties, or be addicted to alcohol and drugs. But they all still need help - the risk of killing yourself increases after self-harm. Everyone who self-harms should be taken seriously and offered help.
Getting help
A lot of people who self-harm don't ask for help. Many young people who self-harm know that they have serious problems, but don't feel that they can tell anyone – so they don't talk to friends, family, or professionals. Other young people don't feel that they have serious problems - they use self-harm as a way of coping, but their situation stays the same.
What's more, less than half of those who go to hospital after self-harming are seen by a specialist in this area. You are less likely to be seen by a specialist if you are young, if you cut yourself, or if you have taken an overdose.
Danger signs
Those who are most likely to harm themselves badly:
use a dangerous or violent method;
self-harm regularly;
are socially isolated;
have a psychiatric disorder.
They should be assessed by someone with experience of self-harm and mental health problems.
What help is there?
Talking with a non-professional
Many people find that it's helpful just to talk anonymously to someone else about what is happening to them. Knowing that someone else knows what you are going through can help you to feel less alone with your problems. It can also help you to think about your difficulties more clearly – maybe even see ways of solving them that you wouldn't think of on your own. You can do this on the internet or by telephone (see contacts section at the end of this leaflet).
Self-help groups
A group of people who all self-harm meet regularly to give each other emotional support and practical advice. Just sharing your problems in a group can help you to feel less alone - others in the group will almost certainly have had similar experiences.
Help with relationships
Self-harm is often the result of a crisis in a close relationship. If this is the case, help with the relationship will be needed rather than help with self-harm.
Talking with a professional
For people who use self-harm to cope with other problems, one-to-one treatments can help. These include:
Problem solving therapy;
Cognitive psychotherapy;
Psychodynamic psychotherapy;
Cognitive behavioural therapy.
Family meetings
Where this is appropriate, family meetings with a therapist can help to relieve the tiring, daily stress for everyone in the family.
Group therapy
This is different from a self-help group. A professional will lead (or facilitate) the group in a way that helps the members to deal with problems in getting on with other people.
What works best?
There is little evidence to say that any one of these therapies is better than any of the others for self-harm, although what evidence there is supports problem-solving therapy.
What if I don't get help?
About 1 in 3 people who self-harm for the first time will do it again during the following year.
About 3 in 100 people who self-harm over 15 years will actually kill themselves. This is more than 50 times the rate for people who don't self-harm. The risk increases with age and is much greater for men.
Cutting can give you permanent scarring, numbness, or weakness/paralysis of fingers.
How can I help myself ?
When you want to harm yourself
The feelings of self-harm go away after a while. If you can cope with your upset without self-harming for a time, it will get easier over the next few hours. You can:
Talk to someone – if you are on your own perhaps phone a friend.
If the person you are with is making you feel worse, go out.
Distract yourself by going out, singing or listening to music, or by doing anything (harmless) that interests you.
Relax and focus your mind on something pleasant – your very own personal comforting place.
Find another way to express your feelings such as squeezing ice cubes (which you can make with red juice to mimic blood if the sight of blood is important), or just drawing red lines on your skin.
Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower.
Focus in your mind on positives.
Be kind to yourself – get a massage.
Write a diary or a letter, to explain what is happening to you – no one else needs to see it.
When you don't feel like harming yourself
When the urge has gone, and you feel safe, think about the times that you have self-harmed and what (if anything) has been helpful.
Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there.
Where were you, who were you with, and what you were feeling?
Try to work out why you began feeling like you did.
Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you.
How did other people react?
What did you do about the feeling?
Could you have done anything else?
Make a tape or MP3 recording. Talk about your good points and why you don't want to self-harm. Or, ask someone you trust to do this. When you start to feel bad, you can play this back to remind yourself of the parts of you that are good and worthwhile.
Make a 'crisis plan' so you can talk to someone instead of self-harming. Being able to get in touch with someone quickly can help you control your urge to self-harm. While you are talking, your wish to harm yourself may start to go away.
What if you don't want to stop self-harming?
If you decide that you don't want to stop self-harming, you can still:
reduce the damage to your body (for example, use clean blades);
keep thinking about possible answers to the things that make you harm yourself;
every so often, re-visit your decision not to stop.
Self-harm can be very damaging physically and psychologically – in the end, you'll do better by stopping.
There are a number of questions to ask yourself to see if you are ready to stop. If you can honestly say YES to half of the questions below, or more, then why not try stopping?
Are there at least two people who are willing to help me stop?
Do I have friends that know about my self-harm, who I can go to if I get desperate?
Have I found at least two alternative safe ways that reduce the feelings that lead me to self-harm?
Am I able to tell myself, and to believe it, that I want to stop hurting myself?
Can I tell myself that I WILL tolerate feelings of frustration, desperation, and fear?
If necessary, is there a professional who will also give me support and help in a crisis?
If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many Accident and Emergency departments now have either a psychiatric liaison nurse, or a social worker, who will be able to talk with you about how you are feeling, and to see if there are any further ways of helping. They should be able to consider all your needs, whatever they may be, and to write an assessment of them. You should be able to go through this with them and, if you disagree with their assessment, to write this in the notes. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.
What can I do if I know someone who self-harms?
It can be very upsetting to be close to someone who self-harms - but there are things you can do. The most important is to listen to them without judging them or being critical. This can be very hard if you are upset - and perhaps angry - about what they are doing. Try to concentrate on them rather than your own feelings – although this can be hard.
Do
Talk to them when they feel like self-harming. Try to understand their feelings, and then move the conversation to other things.
Take some of the mystery out of self-harm by helping them find out about self-harm perhaps on the internet at the local library.
Find out about getting help - maybe go with them to see someone.
Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.
Don't
Try to be their therapist – therapy is complicated and you have enough to deal with as their friend, partner or relative.
Expect them to stop overnight – it's difficult. and takes time and effort.
React strongly, with anger, hurt, or upset - this is likely to make them feel worse. Talk honestly about the effect it has on you, but do this calmly - in a way that shows how much you care for them.
Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
Make them promise not to do it again or make your involvement with them the basis for an agreement for stopping.
Make yourself responsible for their self-harm or become the person who is supposed to stop them. You must get on with your own life as well. Make sure you talk to someone close to you, so you get some support.
What makes people self-harm?It usually happens in a state of high emotion and inner turmoil. This may be caused by abuse; feeling depressed; feeling bad about yourself or relationship problems. You may do it because you feel that people don't listen to you; hopelessness; isolation, feeling alone, out of control or powerless. People who self-harm are more likely to have been abused in childhood.
How does it make you feel?Self harming can help you to feel in control and less tense. So, it can be a 'quick fix' for feeling bad.
What help is there?
Talking: Talking can help you to feel less alone, to see your problems more clearly.
Self-help groups: People with the similar problems can provide support and practical advice – and, believe it or not, sharing your problems in a group does help
Help with relationships: Group therapy can often help you to sort out difficulties in getting on with other people
Talking Therapy: Problem solving, Cognitive Behavioural or Psychodynamic psychotherapy;
What works best?
All these treatments help. Some evidence suggests that problem-solving therapy may be best.
What if I don't get help?
1 in 3 people who self-harm will do it again within a year. People who self-harm are 50 times more likely to kill themselves. The risk increases with age and is much greater for men. Cutting can cause scarring, numbness or paralysis.
How can I help myself ?
When you want to harm yourself: If you can ride out how you feel without self-harming, the feelings will usually go after a few hours. You can talk to someone, distract yourself by going out, sing or listen to music, or do anything (harmless) that interests you. Try to relax and focus your mind on something pleasant. Find another way to express your feelings such as squeezing ice cubes (make them with red juice to mimic blood if that helps), or draw red lines on your skin. Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower. Focus on positives. Be kind to yourself – get a massage. Write a diary or a letter, to explain what is happening to you – no one else needs to see it.
When the urge has gone: Think about the times that you have self-harmed and what (if anything) has helped. Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there. Where were you, who were you with, and what you were feeling? Try to work out why you began feeling like you did. Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you. Make a recording by talking about your good points and why you don't want to self-harm. When you feel bad, play this back to remind you of the parts of you that are worthwhile. Make a 'crisis plan' of what to do when you feel bad.
I don't want to stop
OK, but reduce the damage. If you cut, use clean blades. Find ways of hurting yourself that don't damage your body (see above)
If you can say YES to at least 3 of the questions below, it's worth trying to stop?
Are there at least two people who are willing to help me stop?
Do I have friends that I can go to if I get desperate?
Have I found at least two safe ways that reduce the feelings that make me self-harm?
Can I really say to myself that I want to stop hurting myself?
Can I tell myself that I WILL tolerate feelings that make me want to self harm?
Is there a professional who will give me support and help in a crisis?
If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many departments have a psychiatric liaison nurse, or a social worker, who can talk with you. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.
What can I do if I know someone who self-harms?
Listen to them without being critical. This can be very hard if you are upset or angry. Try to focus on them rather than your feelings – this is hard.
Try to understand their feelings, and then move the conversation to other things.
Take the mystery out of self-harm by helping them find out about self-harm on the internet or at the library.
Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.
Don't
Try to be their therapist – you have enough to deal with as their friend.
Expect them to stop overnight – it's difficult and takes time.
Get angry this may make them feel worse. Talk calmly about the effect it has on you - in a way that shows how much you care for them.
Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
Make them promise not to do it again or make your involvement conditional on them stopping.
Self-Harm
This provides information about self-harm and is for anyone who is harming themselves, or feels that they might. We hope it will also be helpful for their friends and families.
What is self-harm?
Self-harm happens when someone hurts or harms themselves. They may:
take too many tablets;
cut themselves;
burn their body;
bang their head;
throw their body against something hard;
punch themselves;
stick things in their body;
swallow inappropriate objects.
It can feel to other people that these things are done coolly and deliberately – almost cynically. But someone who self-harms will usually do it in a state of high emotion, distress and unbearable inner turmoil. Some people plan it in advance, others do it suddenly. Some people self-harm only once or twice, but others do it regularly - it can become almost like an addiction.
Some of us harm ourselves in less obvious - but still serious - ways. We may behave in ways that suggest we don't care whether we live or die – we may take drugs recklessly, have unsafe sex, or binge drink. Some people simply starve themselves.
Other words that are used to describe self-harm
These terms are inaccurate and going out of use:
Deliberate self-harm (DSH) - the word 'deliberate' unhelpfully blamed self-harm as a reaction to painful feelings.
Suicide/Parasuicide - most people who self-harm do not want to kill themselves, so these terms are misleading.
Who self-harms?
About 1 in 10 young people will self-harm at some point, but it can occur at any age.
It is more common in young women than men.
Gay and bisexual people seem to be more likely to self-harm.
Sometimes groups of young people self-harm together - having a friend who self-harms may increase your chances of doing it as well.
Self-harm is more common in some sub-cultures – "goths" seem to be particularly vulnerable.
People who self-harm are more likely to have experienced physical, emotional or sexual abuse during childhood.
Research probably under estimates how common self-harm is, and surveys find higher rates in communities and schools than in hospitals. Some types of self-harm, like cutting, may be more secret and so less likely to be noticed by other people. In a recent study of over 4000 self-harming adults in hospital, 80% had overdosed and around 15% had cut themselves. In the community, these statistics would probably be reversed.
What makes people self-harm?
Emotional distress – people often struggle with difficulties for some time before they self-harm:
physical or sexual abuse;
feeling depressed;
feeling bad about yourself;
relationship problems with partners, friends, and family.
If you feel:
that people don't listen to you;
hopeless;
isolated, alone;
out of control;
powerless – it feels as though there's nothing you can do to change anything.
Using alcohol or drugs – it may feel that these are as out of control as the rest of your life.
If you want to show someone else how distressed you are or to get back at them or to punish them. This is not common – most people suffer in silence and self-harm in private.
How does it make you feel?
Self-harm can help you to feel in control, and reduce uncomfortable feelings of tension and distress. If you feel guilty, it can be a way of punishing yourself and relieving your guilt. Either way, it can become a 'quick fix' for feeling bad.
Are people who self-harm mentally ill?
Most people who self-harm are not mentally ill. However, some may be depressed, or have severe personality difficulties, or be addicted to alcohol and drugs. But they all still need help - the risk of killing yourself increases after self-harm. Everyone who self-harms should be taken seriously and offered help.
Getting help
A lot of people who self-harm don't ask for help. Many young people who self-harm know that they have serious problems, but don't feel that they can tell anyone – so they don't talk to friends, family, or professionals. Other young people don't feel that they have serious problems - they use self-harm as a way of coping, but their situation stays the same.
What's more, less than half of those who go to hospital after self-harming are seen by a specialist in this area. You are less likely to be seen by a specialist if you are young, if you cut yourself, or if you have taken an overdose.
Danger signs
Those who are most likely to harm themselves badly:
use a dangerous or violent method;
self-harm regularly;
are socially isolated;
have a psychiatric disorder.
They should be assessed by someone with experience of self-harm and mental health problems.
What help is there?
Talking with a non-professional
Many people find that it's helpful just to talk anonymously to someone else about what is happening to them. Knowing that someone else knows what you are going through can help you to feel less alone with your problems. It can also help you to think about your difficulties more clearly – maybe even see ways of solving them that you wouldn't think of on your own. You can do this on the internet or by telephone (see contacts section at the end of this leaflet).
Self-help groups
A group of people who all self-harm meet regularly to give each other emotional support and practical advice. Just sharing your problems in a group can help you to feel less alone - others in the group will almost certainly have had similar experiences.
Help with relationships
Self-harm is often the result of a crisis in a close relationship. If this is the case, help with the relationship will be needed rather than help with self-harm.
Talking with a professional
For people who use self-harm to cope with other problems, one-to-one treatments can help. These include:
Problem solving therapy;
Cognitive psychotherapy;
Psychodynamic psychotherapy;
Cognitive behavioural therapy.
Family meetings
Where this is appropriate, family meetings with a therapist can help to relieve the tiring, daily stress for everyone in the family.
Group therapy
This is different from a self-help group. A professional will lead (or facilitate) the group in a way that helps the members to deal with problems in getting on with other people.
What works best?
There is little evidence to say that any one of these therapies is better than any of the others for self-harm, although what evidence there is supports problem-solving therapy.
What if I don't get help?
About 1 in 3 people who self-harm for the first time will do it again during the following year.
About 3 in 100 people who self-harm over 15 years will actually kill themselves. This is more than 50 times the rate for people who don't self-harm. The risk increases with age and is much greater for men.
Cutting can give you permanent scarring, numbness, or weakness/paralysis of fingers.
How can I help myself ?
When you want to harm yourself
The feelings of self-harm go away after a while. If you can cope with your upset without self-harming for a time, it will get easier over the next few hours. You can:
Talk to someone – if you are on your own perhaps phone a friend.
If the person you are with is making you feel worse, go out.
Distract yourself by going out, singing or listening to music, or by doing anything (harmless) that interests you.
Relax and focus your mind on something pleasant – your very own personal comforting place.
Find another way to express your feelings such as squeezing ice cubes (which you can make with red juice to mimic blood if the sight of blood is important), or just drawing red lines on your skin.
Give yourself some 'harmless pain' - eat a hot chilli, or have a cold shower.
Focus in your mind on positives.
Be kind to yourself – get a massage.
Write a diary or a letter, to explain what is happening to you – no one else needs to see it.
When you don't feel like harming yourself
When the urge has gone, and you feel safe, think about the times that you have self-harmed and what (if anything) has been helpful.
Go back in your mind to the last time when you did not want to self-harm, and move forward in your memory from there.
Where were you, who were you with, and what you were feeling?
Try to work out why you began feeling like you did.
Did your self-harm give you a sense of escape, or relief, or control? Try to work out something to do that might give you the same result, but that doesn't damage you.
How did other people react?
What did you do about the feeling?
Could you have done anything else?
Make a tape or MP3 recording. Talk about your good points and why you don't want to self-harm. Or, ask someone you trust to do this. When you start to feel bad, you can play this back to remind yourself of the parts of you that are good and worthwhile.
Make a 'crisis plan' so you can talk to someone instead of self-harming. Being able to get in touch with someone quickly can help you control your urge to self-harm. While you are talking, your wish to harm yourself may start to go away.
What if you don't want to stop self-harming?
If you decide that you don't want to stop self-harming, you can still:
reduce the damage to your body (for example, use clean blades);
keep thinking about possible answers to the things that make you harm yourself;
every so often, re-visit your decision not to stop.
Self-harm can be very damaging physically and psychologically – in the end, you'll do better by stopping.
There are a number of questions to ask yourself to see if you are ready to stop. If you can honestly say YES to half of the questions below, or more, then why not try stopping?
Are there at least two people who are willing to help me stop?
Do I have friends that know about my self-harm, who I can go to if I get desperate?
Have I found at least two alternative safe ways that reduce the feelings that lead me to self-harm?
Am I able to tell myself, and to believe it, that I want to stop hurting myself?
Can I tell myself that I WILL tolerate feelings of frustration, desperation, and fear?
If necessary, is there a professional who will also give me support and help in a crisis?
If I harm myself and need treatment?
You have the right to be treated with courtesy and respect by the doctors and nurses in the Accident and Emergency department. Many Accident and Emergency departments now have either a psychiatric liaison nurse, or a social worker, who will be able to talk with you about how you are feeling, and to see if there are any further ways of helping. They should be able to consider all your needs, whatever they may be, and to write an assessment of them. You should be able to go through this with them and, if you disagree with their assessment, to write this in the notes. Staff may want to go through a questionnaire with you as a way of judging how at risk you are.
What can I do if I know someone who self-harms?
It can be very upsetting to be close to someone who self-harms - but there are things you can do. The most important is to listen to them without judging them or being critical. This can be very hard if you are upset - and perhaps angry - about what they are doing. Try to concentrate on them rather than your own feelings – although this can be hard.
Do
Talk to them when they feel like self-harming. Try to understand their feelings, and then move the conversation to other things.
Take some of the mystery out of self-harm by helping them find out about self-harm perhaps on the internet at the local library.
Find out about getting help - maybe go with them to see someone.
Help them to think about their self-harm not as a shameful secret, but as a problem to be sorted out.
Don't
Try to be their therapist – therapy is complicated and you have enough to deal with as their friend, partner or relative.
Expect them to stop overnight – it's difficult. and takes time and effort.
React strongly, with anger, hurt, or upset - this is likely to make them feel worse. Talk honestly about the effect it has on you, but do this calmly - in a way that shows how much you care for them.
Struggle with them when they are about to self-harm – it's better to walk away and to suggest they come and talk about it rather than do it.
Make them promise not to do it again or make your involvement with them the basis for an agreement for stopping.
Make yourself responsible for their self-harm or become the person who is supposed to stop them. You must get on with your own life as well. Make sure you talk to someone close to you, so you get some support.
Tuesday, November 18, 2008
Depression- Following Pregnancy
Postnatal Depression
This is for anyone who suffers from postnatal depression (PND for short). We hope it will also be helpful to family and friends and to anyone who wants to know more about this problem.
What is PND?
Postnatal Depression is what happens when you become depressed after having a baby. Sometimes, there may be an obvious reason, often there is none. It can be particularly distressing when you have so looked forward to having your baby through the months of pregnancy. You may feel guilty for feeling like this, or even feel that you can't cope with being a mother. It can last for weeks or several months. Mild PND can be helped by better support from family and friends; more severe PND will need extra help from your GP, health visitor or, in some cases, mental health professionals.
How common is it?
Around 1 in every 10 women has PND after having a baby. If untreated, it can last for months, or sometimes longer.
What does it feel like to have PND?
Depressed
You feel low, unhappy and wretched for much or all of the time. You may feel worse at particular times of the day, like mornings or evenings. Sometimes, there are good days that make you hope that it is over. It can be very disappointing when they are followed by bad days. It can sometimes seem that life is not worth living.
Irritable
You may get irritable with other children and, occasionally, with your baby. You are most likely to get 'ratty' with your partner, who may well wonder what is wrong.
Tired
All new mothers get pretty weary, but depression can make you feel so utterly exhausted that you feel physically ill.
Sleepless
When, at last, you get to bed you find you can't fall asleep. You wake at the crack of dawn, even if your partner has fed the baby overnight.
Not hungry
Depressed mothers usually haven't the time or the interest to eat, and this can make you feel irritable and run down. On the other hand, if you find yourself eating for comfort, you may feel guilty and uncomfortable about getting fat.
Unable to enjoy anything
You find that you can't enjoy or be interested in anything. This may be especially true of sex. Some women get interested in sex again before the 6 week postnatal check-up, but PND usually takes away any desire or enthusiasm. Your partner may seek the comfort and excitement of intercourse, but you don't. This can put a further strain on the relationship. There are, of course, many other reasons for you to lose interest in sex after having a baby – it may be painful, you may be too tired, or you may be just trying to adjust to having a child.
Unable to cope
PND can make you feel that you have too little time, do nothing well, and that you can't do anything about it. It can be hard to establish a new routine to cope with the baby, as well as everything else.
Guilty
Depression alters your thinking, making you see things in a negative light. This can produce feelings of guilt and self-blame that you are responsible for your illness, or of no help to your family.
Anxious
You may find that you are afraid to be alone with your baby. You may worry that he or she might scream, or choke, or be harmed in some way. Instead of feeling close to your baby, you may feel detached. You can't work out what your baby is feeling, or what your baby needs.
Even if you have strong loving feelings for your baby, you can still feel anxious. Most new mothers worry about their baby’s health, but PND can make this overwhelming. You worry that you might lose your baby through infection, mishandling, faulty development or a 'cot death'. You worry about 'snuffles', or how much weight has been (or not been) gained. You worry if your baby is crying or is too quiet (has the baby stopped breathing?). Sometimes, you may even worry that you might harm your baby. You may find that you need reassurance all the time from your partner, the health visitor, the GP, your family or a neighbour.
You may also worry about your own health. You may feel panicky – your pulse races, your heart thumps and you may feel that you have heart disease or are on the brink of a stroke. Your tiredness may make you wonder if you have some dreadful illness, or if you will ever have any energy again.
Even the most capable person can feel frightened and unable to cope with all this, wanting desperately to cling to their partner.
Baby Blues
On the third or fourth day after having a baby, about half of new mothers feel a bit weepy, flat and unsure of themselves. This is known as the 'Baby Blues', and it passes after a few days.
Puerperal Psychosis
This is a serious condition, which needs urgent support and treatment. It affects around 1 in
500 women, usually within days or weeks of childbirth. You may have rapid mood swings, strange or bizarre beliefs or hear voices and can behave in odd and unpredictable ways – if so, you will need medical help and support. This may have to be in hospital, where you can have your baby with you while you recover. It is more likely to happen if you have:
a family history of puerperal psychosis
a family history of bipolar (manic-depressive) illness
a previous episode of puerperal psychosis or bipolar disorder.
It is important to let your doctors and midwives know about any of these factors while you are pregnant because your treatment can reduce the risk of it happening. Although it is a serious condition, the proper treatment will mean that you can make a full recovery.
Depression in pregnancy
It’s important to know that depression can occur during pregnancy as well. This is more common than people think, and can be helped in much the same way as with postnatal depression.
What about men?
Although PND is much more common in women, it can affect men as well. The birth of a new baby can be stressful for both parents. Fathers may have difficulty coping with the new situation – both the practical problems of looking after a new baby, but also the fact that their partner is giving all their attention to the baby. PND in either partner can put a strain on the parents' relationship.
When does PND happen?
Most cases of PND start within a month of the birth, but it can start up to six months later.
What causes PND?
We don't know enough about why women get PND to be sure who will or won't suffer from it. There is probably no single reason, but a number of different stresses may add up to cause it. We know you are more likely to have PND if you:
have had depression (especially PND) before
do not have a supportive partner
have a premature or sick baby
lost your own mother when you were a child
have experienced several stresses in a short period of time.These could be things like a bereavement, you or your partner losing a job, or housing and money problems.
In spite of this, you can still have PND when none of these things have happened and there is no obvious reason. On the other hand, having these problems does not necessarily mean that you will get PND.
What about hormones?
Levels of oestrogen, progesterone (and other hormones to do with conception and birth) drop suddenly after the baby is born. How exactly they affect your mood and emotions is not clear. No real differences have been found in the hormone changes of women who do and do not get PND and research does not suggest that this is a major reason for depression. Hormone changes may be more important in the ‘baby blues’ and puerperal psychosis.
Do women with PND harm their babies?
This is very rare – although depressed mothers often worry that it might happen. It can help to talk these feelings over with your health visitor or doctor.
Occasionally, through utter tiredness and desperation, you might feel like hitting or shaking your baby. Many mothers (and fathers) occasionally feel like this, not just those with PND. In spite of having these feelings at times, most mothers never act on them. This is also true in PND.
What can be done?
The first thing is to recognise the depression for what it is. In the past it has often been overlooked or dismissed as the 'baby blues'.
You may not realise what is wrong and feel ashamed to admit that you are less than thrilled by being a mother. You may worry that, if you do, your baby may be taken away. This is very unlikely. Your doctor, health visitor or midwife want to help you get better so you can enjoy and care for your baby.
People are now generally more aware of depression, so PND shouldn't be missed so often. A questionnaire, such as the Edinburgh Postnatal Depression Scale, can help health visitors and GPs to spot PND.
Ways of helping yourself
Say how you feel:
If you feel miserable, irritable, incompetent, frightened and not all that keen on your baby, then tell someone. Many other women have felt like this. If you don't feel you can talk to your family or friends, talk to your health visitor or GP. They will know that these feelings are common and will know how to help.
Don't let the diagnosis frighten you. At least you know what is wrong, and that it is a problem that many other mothers have shared, and that you will get better in time. It can help your partner, friends and family to know this so they can understand what you are going through and know how to help.
Ways for other people to help
Ways for other people to help
Don't be shocked or disappointed if your wife, partner, sister or girlfriend confesses that she has felt awful since the birth of her baby. Take the time to listen and make sure that she gets the help she needs.
Try not to be shocked or disappointed by a diagnosis of PND – it can be well treated and your loved-one can get back to normal.
Do all you can to help with the practical things that need to be done, while your partner does not feel up to doing them – shopping, feeding and changing the baby, or housework. It may be difficult for a while, but it is worth it.
Make sure that you are clear about what is happening and that you get advice on how to help, especially if you are the mother's partner.
Make sure that you have some support yourself. If this is your first baby, you may feel pushed to one side, both by the baby and by your partner's needs. Try not to feel resentful. Your partner needs your support and encouragement. Practical help with the baby, sympathetic listening, patience, affection and being positive will go a long way. Your partner will appreciate this even when she’s feeling b
What if I don't want treatment?
Most women will get better without any treatment after a period of weeks, months or sometimes longer. However, this can mean a lot of suffering. PND may spoil the experience of new motherhood, and strain your relationship with your baby and partner. So the shorter it lasts, the better. It's important to get help as soon as possible to relieve the depression and to support your developing relationship with your baby. This will help your baby’s development in the long run.
What about talking treatments?
It can be a great relief just to talk to a sympathetic, understanding, uncritical listener – this could be a friend, a relative, a volunteer or a professional. Many general practices now have a counsellor and trained health visitors who can help treat PND.
There are more specialised psychological treatments. Cognitive Behavioural Therapy can help you to understand and resolve the depression by examining how you think about yourself, the world and other people.
Psychotherapy can help you to understand the depression in terms of what has happened to you in the past.
These can be arranged through your GP, with a community psychiatric nurse, a psychologist or a psychiatrist.
Are there problems with these treatments?
These treatments are usually very safe, but they can have unwanted effects. Talking about things may bring up bad memories from the past and this can make you low or distressed. Other people have found that therapy puts a strain on their relationship with their partner.
Make sure that you can trust your therapist and that they have the necessary training. Another problem with talking therapies is that they are still hard to get in some areas. There are long waiting lists, so you may not get any treatment for quite a while.
What about tablets?
If you have a more severe depression, or it has not improved with support and reassurance, one of the antidepressant drugs will probably help. Antidepressants take two weeks or so to start working and should be taken for four to six months after you start to feel better.
How do they work?
It is not entirely clear, but antidepressants affect the activity of two chemicals in the brain, serotonin (also called 5HT) and noradrenaline.
Do antidepressants have side effects?
Modern antidepressants are relatively safe. They may cause nausea or an increase in anxiety in the early stages, but these usually wear off. Others can make you sleepy or give you a dry mouth. Make sure that your doctor knows if you are breast-feeding. For many antidepressants, there is no evidence that they cause problems for breastfed babies, so it is usually possible to breastfeed while taking them. However, this is your decision – your doctor can help with information and advice.
Some people get withdrawal symptoms when they stop these medicines, so it's best to reduce slowly.
Hormones have been suggested as a treatment for PND. However, there is little evidence that they work, and they have their own dangers, particularly if you have had thromboses (blood clots in the veins) of any sort.
Are there alternatives?
There is some evidence that regular exercise can boost your mood and help you to feel less isolated. It can be helpful to do this with other people.
So which treatment is best?
Everyone can try the simple measures outlined in this leaflet. Talking treatments and antidepressants are equally effective, but antidepressants are more likely to be recommended if the depression is severe or has gone on for a long time. They also work a bit quicker than talking treatments.
Talking treatments and antidepressants can be given together. Your GP or health visitor will be willing to give advice. It is also sometimes helpful to talk over the options with your family or a close friend. It is important that you feel comfortable with the choice of help or treatment.
Mothers with special needs
Mothers who have a history of mental health problems or physical or learning disability do face additional problems, or, equally challenging, additional scrutiny. They should
get extra help and support to keep mother
and baby well.
Self-help
We don't yet know enough about PND to prevent it in the first place, but certain principles make sense:
DON'T try to be 'superwoman'. Try to do less during your pregnancy and make sure that you don't over-tire yourself. If you are at work, make sure you get regular meals and put your feet up in the lunch hour.
DON'T move house (if you can help it) while you are pregnant or until the baby is six months old.
DO make friends with other couples who are expecting or have just had a baby; among other things, this could lead to a baby-sitting circle.
DO find someone you can talk to. It helps so much to have a close friend you can turn to. (If you can't easily find someone, try the National Childbirth Trust or MAMA – their local groups are very supportive both before and after childbirth).
DO go to ante-natal classes – and take your partner with you.
DO keep in touch with your GP and your health visitor if you have suffered PND before. Any signs of PND can be recognised early and you can start treatment at once.
After the baby has arrived:
DO take every opportunity to get your head down. Try to learn to cat-nap. Your partner can give the baby a bottle-feed at night. If you like, you can use your own expressed breast milk for this.
DO get enough nourishment. Healthy foods like salads, fresh vegetables, fruit, fruit juices, milk and cereals are all good for you, packed with vitamins and don't need much cooking.
DO find time to have fun with your partner. Try to find a baby-sitter and get out together for a meal or to see friends.
DO let yourself and your partner be intimate if you can – at least kiss and cuddle, stroke and fondle. This will comfort you both and help bring about the return of full sexual feelings sooner. Do not feel guilty if this takes some time.
DON'T blame yourself or your partner: life is tough at this time, and tiredness and irritability on both sides can lead to quarrels. 'Having a go' at each other may weaken your relationship when it needs to be at its strongest.
DON'T be afraid to ask for help when you need it. If you have learnt about PND from ante-natal classes (and leaflets like this), you may spot the warning signs before anyone else.
This is for anyone who suffers from postnatal depression (PND for short). We hope it will also be helpful to family and friends and to anyone who wants to know more about this problem.
What is PND?
Postnatal Depression is what happens when you become depressed after having a baby. Sometimes, there may be an obvious reason, often there is none. It can be particularly distressing when you have so looked forward to having your baby through the months of pregnancy. You may feel guilty for feeling like this, or even feel that you can't cope with being a mother. It can last for weeks or several months. Mild PND can be helped by better support from family and friends; more severe PND will need extra help from your GP, health visitor or, in some cases, mental health professionals.
How common is it?
Around 1 in every 10 women has PND after having a baby. If untreated, it can last for months, or sometimes longer.
What does it feel like to have PND?
Depressed
You feel low, unhappy and wretched for much or all of the time. You may feel worse at particular times of the day, like mornings or evenings. Sometimes, there are good days that make you hope that it is over. It can be very disappointing when they are followed by bad days. It can sometimes seem that life is not worth living.
Irritable
You may get irritable with other children and, occasionally, with your baby. You are most likely to get 'ratty' with your partner, who may well wonder what is wrong.
Tired
All new mothers get pretty weary, but depression can make you feel so utterly exhausted that you feel physically ill.
Sleepless
When, at last, you get to bed you find you can't fall asleep. You wake at the crack of dawn, even if your partner has fed the baby overnight.
Not hungry
Depressed mothers usually haven't the time or the interest to eat, and this can make you feel irritable and run down. On the other hand, if you find yourself eating for comfort, you may feel guilty and uncomfortable about getting fat.
Unable to enjoy anything
You find that you can't enjoy or be interested in anything. This may be especially true of sex. Some women get interested in sex again before the 6 week postnatal check-up, but PND usually takes away any desire or enthusiasm. Your partner may seek the comfort and excitement of intercourse, but you don't. This can put a further strain on the relationship. There are, of course, many other reasons for you to lose interest in sex after having a baby – it may be painful, you may be too tired, or you may be just trying to adjust to having a child.
Unable to cope
PND can make you feel that you have too little time, do nothing well, and that you can't do anything about it. It can be hard to establish a new routine to cope with the baby, as well as everything else.
Guilty
Depression alters your thinking, making you see things in a negative light. This can produce feelings of guilt and self-blame that you are responsible for your illness, or of no help to your family.
Anxious
You may find that you are afraid to be alone with your baby. You may worry that he or she might scream, or choke, or be harmed in some way. Instead of feeling close to your baby, you may feel detached. You can't work out what your baby is feeling, or what your baby needs.
Even if you have strong loving feelings for your baby, you can still feel anxious. Most new mothers worry about their baby’s health, but PND can make this overwhelming. You worry that you might lose your baby through infection, mishandling, faulty development or a 'cot death'. You worry about 'snuffles', or how much weight has been (or not been) gained. You worry if your baby is crying or is too quiet (has the baby stopped breathing?). Sometimes, you may even worry that you might harm your baby. You may find that you need reassurance all the time from your partner, the health visitor, the GP, your family or a neighbour.
You may also worry about your own health. You may feel panicky – your pulse races, your heart thumps and you may feel that you have heart disease or are on the brink of a stroke. Your tiredness may make you wonder if you have some dreadful illness, or if you will ever have any energy again.
Even the most capable person can feel frightened and unable to cope with all this, wanting desperately to cling to their partner.
Baby Blues
On the third or fourth day after having a baby, about half of new mothers feel a bit weepy, flat and unsure of themselves. This is known as the 'Baby Blues', and it passes after a few days.
Puerperal Psychosis
This is a serious condition, which needs urgent support and treatment. It affects around 1 in
500 women, usually within days or weeks of childbirth. You may have rapid mood swings, strange or bizarre beliefs or hear voices and can behave in odd and unpredictable ways – if so, you will need medical help and support. This may have to be in hospital, where you can have your baby with you while you recover. It is more likely to happen if you have:
a family history of puerperal psychosis
a family history of bipolar (manic-depressive) illness
a previous episode of puerperal psychosis or bipolar disorder.
It is important to let your doctors and midwives know about any of these factors while you are pregnant because your treatment can reduce the risk of it happening. Although it is a serious condition, the proper treatment will mean that you can make a full recovery.
Depression in pregnancy
It’s important to know that depression can occur during pregnancy as well. This is more common than people think, and can be helped in much the same way as with postnatal depression.
What about men?
Although PND is much more common in women, it can affect men as well. The birth of a new baby can be stressful for both parents. Fathers may have difficulty coping with the new situation – both the practical problems of looking after a new baby, but also the fact that their partner is giving all their attention to the baby. PND in either partner can put a strain on the parents' relationship.
When does PND happen?
Most cases of PND start within a month of the birth, but it can start up to six months later.
What causes PND?
We don't know enough about why women get PND to be sure who will or won't suffer from it. There is probably no single reason, but a number of different stresses may add up to cause it. We know you are more likely to have PND if you:
have had depression (especially PND) before
do not have a supportive partner
have a premature or sick baby
lost your own mother when you were a child
have experienced several stresses in a short period of time.These could be things like a bereavement, you or your partner losing a job, or housing and money problems.
In spite of this, you can still have PND when none of these things have happened and there is no obvious reason. On the other hand, having these problems does not necessarily mean that you will get PND.
What about hormones?
Levels of oestrogen, progesterone (and other hormones to do with conception and birth) drop suddenly after the baby is born. How exactly they affect your mood and emotions is not clear. No real differences have been found in the hormone changes of women who do and do not get PND and research does not suggest that this is a major reason for depression. Hormone changes may be more important in the ‘baby blues’ and puerperal psychosis.
Do women with PND harm their babies?
This is very rare – although depressed mothers often worry that it might happen. It can help to talk these feelings over with your health visitor or doctor.
Occasionally, through utter tiredness and desperation, you might feel like hitting or shaking your baby. Many mothers (and fathers) occasionally feel like this, not just those with PND. In spite of having these feelings at times, most mothers never act on them. This is also true in PND.
What can be done?
The first thing is to recognise the depression for what it is. In the past it has often been overlooked or dismissed as the 'baby blues'.
You may not realise what is wrong and feel ashamed to admit that you are less than thrilled by being a mother. You may worry that, if you do, your baby may be taken away. This is very unlikely. Your doctor, health visitor or midwife want to help you get better so you can enjoy and care for your baby.
People are now generally more aware of depression, so PND shouldn't be missed so often. A questionnaire, such as the Edinburgh Postnatal Depression Scale, can help health visitors and GPs to spot PND.
Ways of helping yourself
Say how you feel:
If you feel miserable, irritable, incompetent, frightened and not all that keen on your baby, then tell someone. Many other women have felt like this. If you don't feel you can talk to your family or friends, talk to your health visitor or GP. They will know that these feelings are common and will know how to help.
Don't let the diagnosis frighten you. At least you know what is wrong, and that it is a problem that many other mothers have shared, and that you will get better in time. It can help your partner, friends and family to know this so they can understand what you are going through and know how to help.
Ways for other people to help
Ways for other people to help
Don't be shocked or disappointed if your wife, partner, sister or girlfriend confesses that she has felt awful since the birth of her baby. Take the time to listen and make sure that she gets the help she needs.
Try not to be shocked or disappointed by a diagnosis of PND – it can be well treated and your loved-one can get back to normal.
Do all you can to help with the practical things that need to be done, while your partner does not feel up to doing them – shopping, feeding and changing the baby, or housework. It may be difficult for a while, but it is worth it.
Make sure that you are clear about what is happening and that you get advice on how to help, especially if you are the mother's partner.
Make sure that you have some support yourself. If this is your first baby, you may feel pushed to one side, both by the baby and by your partner's needs. Try not to feel resentful. Your partner needs your support and encouragement. Practical help with the baby, sympathetic listening, patience, affection and being positive will go a long way. Your partner will appreciate this even when she’s feeling b
What if I don't want treatment?
Most women will get better without any treatment after a period of weeks, months or sometimes longer. However, this can mean a lot of suffering. PND may spoil the experience of new motherhood, and strain your relationship with your baby and partner. So the shorter it lasts, the better. It's important to get help as soon as possible to relieve the depression and to support your developing relationship with your baby. This will help your baby’s development in the long run.
What about talking treatments?
It can be a great relief just to talk to a sympathetic, understanding, uncritical listener – this could be a friend, a relative, a volunteer or a professional. Many general practices now have a counsellor and trained health visitors who can help treat PND.
There are more specialised psychological treatments. Cognitive Behavioural Therapy can help you to understand and resolve the depression by examining how you think about yourself, the world and other people.
Psychotherapy can help you to understand the depression in terms of what has happened to you in the past.
These can be arranged through your GP, with a community psychiatric nurse, a psychologist or a psychiatrist.
Are there problems with these treatments?
These treatments are usually very safe, but they can have unwanted effects. Talking about things may bring up bad memories from the past and this can make you low or distressed. Other people have found that therapy puts a strain on their relationship with their partner.
Make sure that you can trust your therapist and that they have the necessary training. Another problem with talking therapies is that they are still hard to get in some areas. There are long waiting lists, so you may not get any treatment for quite a while.
What about tablets?
If you have a more severe depression, or it has not improved with support and reassurance, one of the antidepressant drugs will probably help. Antidepressants take two weeks or so to start working and should be taken for four to six months after you start to feel better.
How do they work?
It is not entirely clear, but antidepressants affect the activity of two chemicals in the brain, serotonin (also called 5HT) and noradrenaline.
Do antidepressants have side effects?
Modern antidepressants are relatively safe. They may cause nausea or an increase in anxiety in the early stages, but these usually wear off. Others can make you sleepy or give you a dry mouth. Make sure that your doctor knows if you are breast-feeding. For many antidepressants, there is no evidence that they cause problems for breastfed babies, so it is usually possible to breastfeed while taking them. However, this is your decision – your doctor can help with information and advice.
Some people get withdrawal symptoms when they stop these medicines, so it's best to reduce slowly.
Hormones have been suggested as a treatment for PND. However, there is little evidence that they work, and they have their own dangers, particularly if you have had thromboses (blood clots in the veins) of any sort.
Are there alternatives?
There is some evidence that regular exercise can boost your mood and help you to feel less isolated. It can be helpful to do this with other people.
So which treatment is best?
Everyone can try the simple measures outlined in this leaflet. Talking treatments and antidepressants are equally effective, but antidepressants are more likely to be recommended if the depression is severe or has gone on for a long time. They also work a bit quicker than talking treatments.
Talking treatments and antidepressants can be given together. Your GP or health visitor will be willing to give advice. It is also sometimes helpful to talk over the options with your family or a close friend. It is important that you feel comfortable with the choice of help or treatment.
Mothers with special needs
Mothers who have a history of mental health problems or physical or learning disability do face additional problems, or, equally challenging, additional scrutiny. They should
get extra help and support to keep mother
and baby well.
Self-help
We don't yet know enough about PND to prevent it in the first place, but certain principles make sense:
DON'T try to be 'superwoman'. Try to do less during your pregnancy and make sure that you don't over-tire yourself. If you are at work, make sure you get regular meals and put your feet up in the lunch hour.
DON'T move house (if you can help it) while you are pregnant or until the baby is six months old.
DO make friends with other couples who are expecting or have just had a baby; among other things, this could lead to a baby-sitting circle.
DO find someone you can talk to. It helps so much to have a close friend you can turn to. (If you can't easily find someone, try the National Childbirth Trust or MAMA – their local groups are very supportive both before and after childbirth).
DO go to ante-natal classes – and take your partner with you.
DO keep in touch with your GP and your health visitor if you have suffered PND before. Any signs of PND can be recognised early and you can start treatment at once.
After the baby has arrived:
DO take every opportunity to get your head down. Try to learn to cat-nap. Your partner can give the baby a bottle-feed at night. If you like, you can use your own expressed breast milk for this.
DO get enough nourishment. Healthy foods like salads, fresh vegetables, fruit, fruit juices, milk and cereals are all good for you, packed with vitamins and don't need much cooking.
DO find time to have fun with your partner. Try to find a baby-sitter and get out together for a meal or to see friends.
DO let yourself and your partner be intimate if you can – at least kiss and cuddle, stroke and fondle. This will comfort you both and help bring about the return of full sexual feelings sooner. Do not feel guilty if this takes some time.
DON'T blame yourself or your partner: life is tough at this time, and tiredness and irritability on both sides can lead to quarrels. 'Having a go' at each other may weaken your relationship when it needs to be at its strongest.
DON'T be afraid to ask for help when you need it. If you have learnt about PND from ante-natal classes (and leaflets like this), you may spot the warning signs before anyone else.
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