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

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

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.

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.

Difficilty in sleeping -Sleeping disorder

About this leaflet
This leaflet is for anyone who has trouble with their sleep, or who lives with somebody who can't sleep well. It includes both common problems with sleep, and some of the more unusual difficulties that people may have. There are some simple tips on how to sleep better, and some information to help you decide if you need professional help.
Introduction
We don't usually need to think very much about our sleep - it's just a part of life that we take for granted. When we can't sleep, though, it can be a real problem. In fact, most of us will find it hard to sleep at some point in our lives. We have a word for it - insomnia. It's often just for a short time, perhaps when we're worried or excited. After a few days, things settle down and we get back to sleeping normally. However, we need sleep to keep our minds and bodies healthy. If we carry on sleeping badly, we start to notice the effects.
What is sleep?
Sleep is the regular period in every 24 hours when we are unconscious and unaware of our surroundings. There are two main types of sleep:
§ Rapid Eye Movement (REM) sleep
It comes and goes throughout the night, and makes up about one fifth of our sleep time. During REM sleep, our brain is very active, our muscles are very relaxed, our eyes move quickly from side to side and we dream.
§ Non-REM sleep
The brain is quiet, but the body may move around. Hormones are released into the bloodstream and our body repairs itself after the wear and tear of the day. There are 4 stages of non-REM sleep:
1. The muscles relax, the heart beats slower and body temperature falls - "pre-sleep".
2. Light sleep - we can still be woken easily without feeling confused.
3. "Slow wave" sleep - our blood pressure falls, we may talk in our sleep or sleep walk.
4. Deep "slow wave" sleep - we become very hard to wake. If we are woken, we feel confused.

We move between REM and non-REM sleep about five times throughout the night, dreaming more as we get toward the morning.

During a normal night, we will also have short periods of waking. These last 1 or 2 minutes and happen every 2 hours or so. We aren't usually aware of them. We are more likely to remember them if we feel anxious or there is something else going on - noises outside, our partner snoring etc.
How much sleep do we need?
This depends mainly on how old we are.

§ Babies sleep for about 17 hours each day.
§ Older children only need 9 or 10 hours a night.
§ Most adults need around 7-8 hours sleep each night.
§ Older people need the same amount of sleep, but will often only have one period of deep sleep during the night, usually in the first 3 or 4 hours, after which they wake more easily. We also tend to dream less as we get older.

There are also differences between people of the same age. Most of us need 7-8 hours a night, but some (a few) people can get by with only 3 hours a night. It's not helpful to regularly sleep more than 7-8 hours each night.

The short periods of being awake feel much longer than they really are. So it's easy to feel that we are not sleeping as much as we actually are.
What if I don't sleep?
It's easy to worry when you can't sleep. The occasional night without sleep will make you feel tired the next day, but it won't harm your physical or mental health.

However, after several sleepless nights, you will start to find that:

§ you are 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.

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 may also make us more vulnerable to high blood pressure, obesity and diabetes.

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 don't get 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 partner may have a different pattern of sleep from yourself
§ you may not have a regular routine, or may not be getting enough exercise
§ eating too much can make it difficult to get off to sleep
§ going to bed hungry can make you wake too early
§ cigarettes, alcohol and drinks containing caffeine, such as tea and coffee
§ illness, pain or a high temperature.

Some more serious causes include:

§ emotional problems
§ difficulties at work
§ anxiety and worry
§ depression - you may wake very early in the morning and not be able to get back to sleep
§ thinking over and over about day to day problems.
Can medication help?
People have used sleeping tablets for many years, but we now know that they:

§ don't work for very long.
§ Leave 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.
§ some people may become addicted to them. The longer you take sleeping tablets, the more likely you are to become physically or psychologically dependent on them.
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 may be helpful.

Over the counter medicationYou can buy several remedies at your chemist, without the need for a prescription. These products will 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.

Psychological TreatmentsA technique called cognitive behavioural therapy has been shown to be helpful. It involves looking at unhelpful ways of thinking that can make you more anxious, and so interfere with your sleep.
Things to avoid
§ Alcohol. Everybody knows that alcohol can help you to fall asleep. The problem is that you will usually wake up half-way through the night. If you drink alcohol regularly to help you sleep, you will find that you need to drink more and more to get the same effect. If you drink regularly and you stop drinking suddenly, you may find it hard to sleep for a week or two.
§ Slimming tablets make it hard to sleep, as do street drugs like Ecstasy, cocaine and amphetamines.
Helping yourself
Here are some simple tips that many people have found 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. It should not be so firm that your hips and shoulders are under pressure or so soft that your body sags. 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. Exercising later than this may disturb your sleep.
§ 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 you find 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 are 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.

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 some evidence that cognitive behavioural therapy (see above), can be helpful if your sleeplessness has gone on for a long time.

Sleeping at the wrong time - Shift Work and ParenthoodYou may have to work at night and to stay awake when you would normally be asleep. If you only have to do this from time to time, it's quite easy to adjust. It is much more difficult if you have to do this more often. Shift workers, doctors and nurses working all night, or nursing mothers may all have this problem. They find themselves sleeping at times when they ought to be awake. This is similar to jet lag, where rapid travel between time zones means that you find yourself 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. It doesn't matter how late 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 muchYou may find that you often fall asleep during the day at times when you want to stay awake. The commonest reason is not getting enough sleep at night.
However, you may find that you are still falling asleep in the daytime even after a week or two of getting enough sleep at night. Sometimes, a physical illness can be responsible - diabetes, a viral infection, or a thyroid problem.

There are other conditions which make people sleep too much:

Narcolepsy (Daytime sleepiness)This is uncommon condition that has often not been recognised by doctors.
There are two main symptoms:

§ you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness even when you are with other people
§ you suddenly lose control of your muscles and collapse when you are angry, laughing or excited - this is called cataplexy.

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 having a regular night time routine. Depending on the pattern of your symptoms, medication may be helpful - an antidepressant or a drug which increases wakefulness, such as Modafinil.

Sleep Apnoea (Interrupted Sleep)

§ 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 are awake just for a short time before falling off to sleep again.
§ This often happens several times during the night. So, you feel tired the next day, often with an irresistible urge to go to sleep. You may also have a dry mouth and a headache when you wake up in the morning.

It is more common in:

§ older people
§ the overweight
§ smokers
§ those who drink a lot of alcohol.

Sometimes, the problem is noticed more by their partner than by the sufferer. Treatment usually involves correcting the parts of your lifestyle that may be making the problem worse - cutting down smoking and drinking, losing weight, and sleeping in a different position. If your apnoea is very bad, it may be necessary to wear a Continuous Positive Airway Pressure mask. This fits over your nose and supplies high pressure air to keep your 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.

SleepwalkingIf you sleepwalk, you will appear (to other people) to wake from a deep sleep. You will 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 will remember nothing about it the next day. Sleepwalking may sometimes happen after a night terror (see below).

A sleepwalker should be guided gently back to bed and should not be woken up. It may be necessary to take precautions to protect them or others from injury. You may need to lock doors and windows, or lock away sharp objects, like knives and tools.

Night terrors can occur on their own, without leading to 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 down 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.

NightmaresMost 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 do not normally cause problems unless they happen regularly, usually because of an emotional upset. 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.
§ They are relieved by movement, such as walking or stretching, for as long as you carry on doing it.
You may not be able to sit still in the daytime, making it difficult to work, and may be unable to sleep properly.

Sufferers usually first seek help in middle age, although they may have had symptoms since childhood. It seems to run in families.

RLS usually occurs on its own. It can occasionally be caused by a physical illness, such as iron and vitamin deficiencies, diabetes or kidney problems. It can also happen in pregnancy.

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.

In more severe RLS, medications may help. These include medications used in Parkinson's disease, anti-epileptic medications, benzodiazepine tranquillisers and painkillers.
.

Useful reading
Get a Better Night's Sleep (Positive Health Guides), Ian Oswald and Kirstine Adam, Optima.
Insomnia: Doctor I can't sleep, Adrian Williams, Amberwood Publishing.
References
Sleep Disorders (1988) Williams R.L., Karacan I. & Moore C.A. John Wiley & Sons ISBN 0471837210.

Over-the-counter medicines and the potential for unwanted sleepiness in drivers: a review (2001) Horne, J.A. & Barrett, P.R. Department of Transport: HMSO.

Valerian for insomnia: a systematic review (2000) Stevinson C. & Ernst E. Sleep Medicine, 1: 91-99.
Behavioural and pharmacological therapies for late-life insomniacs (1999) Norin C.M. et al JAMA, 281: 991-999.

Management of insomnia (1997) Kupfer D.J. & Reynolds C.F. New England Journal of Medicine, 336: 341-346.

Impact of sleep debt on metabolic and endocrine function (1999) Spiegel, K., Leproult, R & Van Cauter, E. The Lancet, 354, 1435-1439.


Non-pharmacological interventions for insomnia: a meta-analysis of treatment efficacy (1994) American Journal of Psychiatry, 151, 1172-1180



Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com

Too worried or always worried

Anxiety Disorders
Introduction
Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult.

People often call this feeling stress but the word 'stress' can be used to mean two different things - on the one hand, the things that make us anxious and on the other, our reaction to them. This makes it a confusing word and so it will not be used in this leaflet.

When our anxiety is a result of a continuing problem, such as money difficulties, we call it worry, if it is a sudden response to an immediate threat, like looking over a cliff or being confronted with an angry dog, we call it fear.

Normally, both fear and anxiety can he helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. However, if the feelings become too strong or go for too long, they can stop us from doing the things we want to and can make our lives miserable.

A phobia is a fear of particular situations or things that are not dangerous and which most people do not find troublesome.

Symptoms: Anxiety

In the mind:
Feeling worried all the timeFeeling tiredUnable to concentrateFeeling irritableSleeping badly
In the body:
Irregular heartbeats (palpitations)SweatingMuscle tension and painsBreathing heavilyDizzinessFaintnessIndigestionDiarrhoea

These symptoms are easily mistaken by anxious people for evidence of serious physical illness - their worry about this can make the symptoms even worse. Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to quickly get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel glum, lose our appetite and see the future as bleak and hopeless.

Phobias

A person with a phobia has intense symptoms of anxiety, as described above. But they only arise from time to time in the particular situations that frighten them. At other times they don't feel anxious. If you have a phobia of dogs, you will feel OK if there are no dogs around, if you are scared of heights, you feel OK at ground level, and if you can't face social situations, you will feel calm when there are no people around.

A phobia will lead the sufferer to avoid situations in which they know they will be anxious, but this will actually make the phobia worse as time goes on. It can also mean that the person's life becomes increasingly dominated by the precautions they have to take to avoid the situation they fear. Sufferers usually know that there is no real danger, they may feel silly about their fear but they are still unable to control it. A phobia is more likely to go away if it has started after a distressing or traumatic event.

Are they common?

About one in every ten people will have troublesome anxiety or phobias at some point in their lives. However, most will never ask for treatment.

Causes
Some of us seem to be born with a tendency to be anxious - research suggests that it can be inherited through our genes. However, even people who are not naturally anxious can become anxious if they are put under enough pressure.

Sometimes it is obvious what is causing anxiety. When the problem disappears, so does the anxiety. However, there are some circumstances that are so upsetting and threatening that the anxiety they cause can go on long after the event. These are usually life threatening situations like car crashes, train crashes or fires. The people involved can feel nervous and anxious for months or years after the event, even if they have been physically unharmed. This is part of what we now call post-traumatic stress disorder.

Sometimes anxiety may be caused by using street drugs like amphetamines, LSD or Ecstasy. Even the caffeine in coffee can be enough to make some of us feel uncomfortably anxious!

On the other hand, it may not be clear at all why a particular person feels anxious, because it is due to a mixture of their personality, the things that have happened to them, or life-changes such as pregnancy.

Seeking help
If we are put under a lot of pressure, we may feel anxious and fearful for much of the time. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most of us will feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.
However, some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are 'mad'. In fact, people with anxiety and fears hardly ever have a serious mental illness. It's much better to get help as soon as you can rather than suffer in silence.

People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a door-bell ringing or a car's horn. They will tend to be irritable and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. Although friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable.

Anxiety & phobias in children
Most children go through times when they feel very frightened about things. It's a normal part of growing up. For instance, toddlers get very attached to the people who look after them. If for any reason they are separated from them, they can become very anxious or upset. Many children are scared of the dark or of imaginary monsters. These fears usually disappear as a child grows older, and they do not usually spoil the child's life or interfere with their development. Most will feel anxious about important events like their first day at school, but they stop being frightened afterwards and are able to get on and enjoy their new situation.

Teenagers may often be moody. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex. These worries can usually be dealt with by talking about them. However, if they are too strong other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.

If a child or teenager feels so anxious or fearful that it is spoiling their life, it's a good thing to ask the family doctor to look into it.

Helping people with anxiety and phobias
Talking about the problem This can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or losing a job. Who should we talk to? Try friends or relatives who you trust, whose opinions you respect, and who are good listeners. They may have had the same problem themselves, or know someone else who has. As well as having the chance to talk, we may be able to find out how other people have coped with a similar problem.

SeIf-help groups: These are a good way of getting in touch with people with similar problems. They will both be able to understand what you are going through, but may be able to suggest helpful ways of coping. These groups may be focussed on anxieties and phobias, or may be made up of people who have been through similar experiences.

Learning to relax: It can be a great help to learn a special way of relaxing, to help us control our anxiety and tension. We can learn these through groups, through professionals, but there are several books and videotapes we can use to teach ourselves (see below). It's a good idea to practice this regularly, not just when we are in a crisis.

Psychotherapy: This is a more intensive talking treatment which can help us to understand and to come to terms with reasons for our anxieties that we may not have recognised ourselves. The treatment can take place in groups or individually and is usually weekly for several weeks or months. Psychotherapists may or may not be medically qualified.

If this is not enough, there are several different kinds of professionals who may be able to help - the family doctor, psychiatrist, psychologist, social worker, nurse or counsellor.

Medication: Drugs can play a part in the treatment of some people with anxiety or phobias.

The most common tranquillisers are the Diazepam-like drugs, the benzodiazepines (most sleeping tablets also belong to this class of drugs). They are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.

Antidepressants: can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. One of the draw-backs is that they usually take 2 to 4 weeks to work and some can cause nausea, drowsiness, dizziness, dry mouth and constipation.

Beta blockers are usually used to treat high blood pressure. In low doses, they control the physical shaking of anxiety and can be taken shortly before meeting people or before speaking in public.

Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder


Introduction
"He's an obsessive football fan" - "she's obsessive about shoes" - "he's a compulsive liar". We use these expressions when we talk about people who do something again and again, even when others can't see any reason for it. It isn't usually a problem and, in some lines of work, can even be helpful. However, the urge to do or think certain things repeatedly can dominate your life unhelpfully.

So, if:
you get awful thoughts coming into your mind, even when you try to keep them out
or
you have to touch or count things or repeat the same action like washing over and over
you could have Obsessive Compulsive Disorder (OCD).
What is it like to have OCD?
Asha "I'm afraid of catching something from other people. I spend hours bleaching all the surfaces in my house to stop the germs, and wash my hands many times each day. I try not to go out of the house if possible. When my husband and children come back home, I ask them in great detail where they have been, in case they have visited somewhere dangerous, like a hospital. I also make them take off all their clothes, and wash themselves thoroughly. Part of me realises these fears are stupid. My family are sick of it, but it has gone on for so long now I can't stop".

Raj "My whole day is spent checking that nothing will go wrong. It takes me an hour to get out of the house in the morning, because I am never sure that I've turned off all the electrical appliances like the cooker, and locked all the windows. Then I check to see that the gas fire is off five times, but if it doesn't feel right I have to do the whole thing again. In the end, I ask my partner to check it all for me again anyway. At work I am always behind as I go through everything several times in case I have made a mistake. If I don't check I feel so worried I can't bear it. Its ridiculous I know, but I think if something awful did happen, I'd be to blame".

Pooja "I fear I will harm my baby daughter. I know I don't want to, but bad thoughts keep coming into my head. I can picture myself losing control and stabbing her with a knife. The only way I can get rid of these ideas is to say a prayer, and then have a good thought such as "I know I love her very much". I usually feel a bit better after that, until the next time those awful pictures come into my head. I have hidden away all sharp objects and knives in my house. I think to myself "you must be a horrible mother to think like this. I must be going mad".
OCD has three main parts:
the thoughts that make you anxious (obsessions);
the anxiety you feel;
the things you do to reduce your anxiety (compulsions).

What you think (obsessions)
Thoughts - single words, short phrases or rhymes that are unpleasant, shocking or blasphemous. You try not to think about them, but they won't go away. You worry that you might be contaminated (by germs, dirt, HIV or cancer), or that someone might be harmed because you have been careless
Pictures in your mind - showing your family dead, or seeing yourself doing something violent or sexual which is completely out of character - stabbing or abusing someone, or being unfaithful. We know that people with obsessions do not become violent, or act on these thoughts.
Doubts - you wonder for hours whether you might have caused an accident or misfortune to someone. You may worry that you have knocked someone over in your car, or that you have left your doors and windows unlocked
Ruminations – you endlessly argue with yourself about whether to do one thing or another so you can't make the simplest decision.
Perfectionism – you are bothered, in a way that other people are not, if things are not in the exactly the right order, not balanced or not in the right place. For example, if books are not lined up precisely on a bookshelf.

anxiety you feel (emotions)
The You feel tense, anxious, fearful, guilty, disgusted or depressed.
You feel better if you carry out your compulsive behaviour, or ritual - but it doesn't last long.

What you do (compulsions)
Correcting obsessional thoughts – you think alternative 'neutralising' thoughts like counting, praying or saying a special word over and over again. It feels as though this prevents bad things from happening. It can also be a way of getting rid of any unpleasant thoughts or pictures that are bothering you.
Rituals – you wash your hands frequently, do things really slowly and carefully, perhaps arrange objects or activities in a particular way. This can take up so much time that it takes ages to go anywhere, or do anything useful.
Checking - your body for contamination, that appliances are switched off, that the house is locked or that your journey route is safe.
Avoidance – of anything that is a reminder of worrying thoughts. You avoid touching particular objects, going to certain places, taking risks or accepting responsibility. For example, you may avoid the kitchen because you know you will find sharp knives there.
Hoarding – of useless and worn out possessions. You just can't throw anything away.
Reassurance – you repeatedly ask others to tell you that everything is alright.
How common is OCD?
About 1 in every 50 people suffer from OCD at some point in their lives, men and women equally. That adds up to about 1 million people in the U.K. Famous sufferers may have included the biologist Charles Darwin, the pioneer nurse, Florence Nightingale, and John Bunyan, author of Pilgrim's Progress.
If you gamble, eat or drink 'compulsively', do you have OCD?
No. The words 'compulsive' and 'obsessive' are sometimes used to describe people who gamble, drink alcohol, use street drugs – or even exercise too much. However, these behaviours can be pleasurable. The compulsions in OCD never give pleasure – they are always felt as an unpleasant demand or burden.
How bad can OCD get?
It varies a lot, but work, relationships and family life are all more productive and satisfying if you are not constantly having to cope with OCD. Severe OCD can make it impossible to work regularly, to take part in family life – or even to get on with your family. In particular, they may become upset if you try to involve them in your rituals.
Are people with OCD 'mad'?
No - but you may be reluctant to seek help if you think that that others will think you are mad. Although you may worry that you will loose control, we know that people with OCD don't.
Other conditions similar to OCD
Body dysmorphic disorder, or 'the distress of imagined ugliness'. You become convinced that part of your face or body is the wrong shape, and spend hours in front of a mirror checking and trying to cover it up. You may even stop going out in public.
An urge to pluck your hair or eyebrows (Trichotillomania)
A fear of suffering from a serious physical illness, such as cancer (Hypochondriasis)
People with Tourette's syndrome (where a sufferer may shout out suddenly, or jerk uncontrollably) often have OCD as well.
Children with some forms of autism, like Asperger's syndrome, can appear to have OCD because they like things to be the same, and may like to do the same thing over and over again, to help them feel less anxious.
When does OCD begin?
Many children have mild compulsions. They organise their toys very precisely, or avoid stepping on cracks in the pavement. This usually goes away as they grow older. Adult OCD usually begins in the teens or early twenties. Symptoms can come and go with time, but sufferers often don't seek help until they have had OCD for many years.
What is the outlook without help or treatment?
Many people with mild OCD improve without treatment. This does not usually happen with moderate to severe OCD, although there may be times when the symptoms seem to go away. Some will slowly get worse, for others the symptoms get worse when they are stressed or depressed. Treatment will usually help.
What causes OCD?
Genes: OCD is sometimes inherited, so can occasionally run in the family.
Stress: Stressful life events bring it on in about one out of three cases.
Life changes: Times where someone suddenly has to take on more responsibility – for example, puberty, the birth of a child or a new job.
Brain changes: We don't know for certain, but if you have the symptoms of OCD for more than a short time, researchers think that an imbalance of a chemical called serotonin (also known as 5HT) develops in the brain.
Personality: If you are a neat, meticulous, methodical person with high standards you may be more likely to develop OCD. These qualities are normally helpful, but can slip into OCD if they become too extreme.
Ways of Thinking: Nearly all of us have odd or distressing thoughts or pictures in our minds at times - "what if I stepped out in front of that car?" or "I might harm my child". Most of us quickly dismiss these ideas and get on with our lives. But, if you have particularly high standards of morality and responsibility, you may feel that it's terrible to even have these thoughts. So, you are more likely to watch out for them coming back – which makes it more likely that they will.
What keeps OCD going?
Surprisingly, some of the ways in which you help yourself can actually keep it going:
Trying to push unpleasant thoughts out of your mind - this usually only makes the thoughts return. Try not to think of a pink elephant for the next minute – you will probably find it difficult to think of anything else.
Rituals, checking, avoiding and seeking reassurance will all make you less anxious for a short time - especially if you feel that this might prevent something dreadful from happening. But, every time you do them, you strengthen your belief that they stop bad things from happening. And so you feel more pressure to do them.... and so on.
Thinking neutralising thoughts – if you spend time 'putting right' a disturbing thought with another thought (for example, counting to ten) or picture (for example, seeing a person alive and well) – then stop it, and wait until your anxiety goes away.

Helping Yourself
Expose yourself to your troubling thoughts
It sounds odd, but it's a way of getting more control of them. You record them and listen back to them, or write them down and re-read them. You need to do this regularly for around half an hour every day until your anxiety reduces.
Resist the compulsive behaviour, but not the obsessional thought.
Don't use alcohol to control your anxiety.
If your thoughts involve worries about your faith or religion then it can sometimes be helpful to speak to a religious leader to help you work out if this is an OCD problem.
Contact one of the support groups or websites listed at the end of this leaflet.
Buy a self help book such as one of those listed at the end of this leaflet.

Getting Help
Cognitive Behavioural Therapy (CBT)
There are two types of CBT used to treat OCD - Exposure and Response Prevention (ERP) and Cognitive Therapy (CT).

Exposure and response prevention (ERP)
This is a way to stop compulsive behaviours and anxieties from strengthening each other. We know that if you stay in a stressful situation long enough, you gradually become used to it and your anxiety goes away. So, you gradually face the situation you fear (exposure) but stop yourself from doing your usual compulsive rituals, checking or cleaning (response prevention), and wait for your anxiety to go away.
It's usually better to do it in small steps:
make a list of all the things you fear or avoid at the moment;
put the situations or thoughts you fear the least at the bottom, the worst ones at the top;
then start at the bottom and work up, tackling one at a time. Don't move onto the next stage until you have overcome the last one.

This needs to be done every day for at least one or two weeks. Each time, you do it for long enough for your anxiety to fall to less than half what it is at its worst – around 30 to 60 minutes to start with. It can help to write down a measure of how anxious you are every 5 minutes, for example, from 0 (no fear) to 10 (extreme fear). You will see how your anxiety rises, then falls.

You may practice some of the steps with your therapist, but most of the time you will be doing it on your own, at a pace you feel comfortable with. It is important to remember that you do not need to get rid of all your anxiety, just enough to manage it better. Remember that your anxiety:
is unpleasant but won't do you any harm;
will go away eventually;
will be easier to face with regular practice.

There are two main ways of trying ERP:

Guided self-help
You follow the guidance in a book, tape, video, DVD or software programme. You also have occasional contact with a professional for advice and support, but less often. This approach may be suitable if your OCD is mild, and you have the confidence to try out ways of helping yourself.

Direct regular contactwith a professional, on your own or in a group.
This can be face to face or over the phone. This usually happens every week or two weeks to start with, and can last for between 45 and 60 minutes at a time. Up to ten hours of contact is recommended to start with, but you may need more.

An Example:
Rahul could not leave the house on time for work every day, because he had to check so many things in the house. He worried that the house might burn down, or he might be burgled if he did not check certain things five times each. He made a list of what he was checking, starting with the easiest to tackle. It looked like this:
the cooker (least feared)
the kettle
the gas fire
the windows
the doors ( the most feared)
He began with step one. Instead of making sure that the cooker was switched off several times, he checked it only once (exposure). At first he felt very anxious. He stopped himself from going back to check again. He agreed not to ask his wife to check everything for him as well, and not to ask her for reassurance that the house was safe (response prevention). His fear gradually lessened over two weeks. Then he moved on to step 2 (the kettle) and so on. Eventually, he was able to leave the house without any of his checking rituals and get to work on time.

Cognitive Therapy (CT)
Cognitive therapy is a psychological treatment which helps you to change your reaction to the thoughts, instead of trying to get rid of them. This is useful if you have worrying obsessional thoughts, but do not perform any rituals or actions to make yourself feel better. It can be added to exposure treatment (ERP) to help overcome OCD. It targets:
unrealistic self-critical thoughts, such as:
- placing too much importance on your thoughts;
- overestimating the chances of something bad happening
- taking responsibility for bad things happening, even when they are out of your control;
- trying to get rid of all risk in the lives of your loved ones;
unpleasant, intrusive thoughts.

Cognitive therapy helps you to:
Get a different perspective:
We all have odd thoughts at times, but that is all they are. They do not mean you are a bad person or that bad things are going to happen – and trying to get rid of such thoughts just doesn't work. Relax in their presence. Treat them with mild curiosity or amusement. If even more unpleasant thoughts intrude, don't resist, let them happen, and think about them in the same way.

Look at individual thoughts
What is the evidence for and against this idea being true?
How useful is this thought? What's another way to look at this?
What's the worst/best/most realistic outcome?
How would I advise a friend who had my problems? If different to the advice I give myself, what makes me so special?
A cognitive therapist will help you to decide which of your ideas you want to change, and will help you to build new ideas that are more realistic, balanced, and helpful.

Most meetings with a therapist take place at your local GP practice, a clinic or sometimes a hospital. You might be able to have CT over the phone or in your own home if you can't leave your house. Qualified therapists are often registered with the British Association of Behavioural and Cognitive Psychotherapies (www.babcp.org)

Antidepressant medication
SSRI antidepressants can help to reduce obsessions and compulsions, even if you are not depressed. They can be used alone, or with CBT, for moderate to severe OCD. If treatment with an SSRI has not helped at all after 3 months, the next step is to change to a different SSRI or a medication called Clomipramine.
How well do these treatments work?
Exposure Response Treatment (ERP)
About 3 out of 4 people who complete ERP are helped a lot. Of those who get better, about 1 in 4 will develop symptoms in the future, and will need extra treatment. BUT, about 1 in 4 people refuse to try ERP, or else do not finish it. They may be too fearful, or too overwhelmed to do it.

Medication
About 6 out of 10 people improve with medication. On average, their symptoms reduce by half. Anti-obsessional medication does help to prevent OCD coming back for as long as it is taken, even after several years. Unfortunately, about 1 in 2 of those who stop medication will get symptoms again in the months after stopping it. This is much less likely to happen if the medication is combined with CBT.
Which approach is best for me – medication or talking treatments?
Exposure therapy (ERP) can be tried without professional help (in milder cases) and is effective and has no side-effects, apart from anxiety. On the other hand, it needs a lot of motivation and hard work, and it does involve some extra anxiety for a short time.

CBT and medication are probably equally effective. If you have only mild OCD, CBT on its own is effective.

If you have moderately severe OCD then you could choose either CBT (up to 10 hours of contact with a therapist) or medication (for 12 weeks) first. If you are no better, then you should try both treatments. There may be a waiting list to see a professional of several months in some parts of the country.

If your OCD is severe, it's probably best to try medication and CBT together from the start. Medication alone is an optionif your OCD is more than mild and you don't feel you can face the anxiety of ERP and your OCD. It helps about 6 out of 10 people, but thee is more chance that the OCD will return in the future – about 1 in 2 compared with about 1 in 4 for exposure treatments (ERP). It does have to be taken for about a year, and is obviously not ideal during pregnancy or breastfeeding.

It's worth talking these options over with your doctor who should be able to give you any further information you need. You may also want to ask trusted friends or family members.
What if the treatment does not help?
Your doctor can refer you to a specialist team, which may include psychiatrists, psychologists, nurses, social workers and occupational therapists. They may suggest:
adding cognitive therapy to exposure treatment or medication;
taking two anti-obsessional medicines at the same time, such as clomipramine plus citalopram;
treating other conditions including anxiety, depression & alcohol misuse;
adding antipsychotic medication;
working with your family and carers, to support and advise them.

If you have difficulty living on your own, they may also suggest finding suitable accommodation with people who can help you become more independent.
Will I need to go into hospital for treatment?
Most people get better by attending a GP surgery, or a clinic that can be attached to a hospital. Admission to a mental health unit will only be suggested if:
your symptoms are very severe, you cannot look after yourself properly or you have thoughts about suicide;
you have other serious mental health problems, such as an eating disorder, schizophrenia, psychosis or a severe depression;
your OCD prevents you getting to a clinic for treatment.
Which treatments do not work for OCD?
Some of these approaches may work in other conditions – but there is not strong evidence for them in OCD:
Complementary or alternative therapies such as hypnosis, homeopathy, acupuncture and herbal remedies – even though they sound attractive.
Other types of antidepressant medication, unless you are suffering from depression as well as OCD.
Sleeping tablets and tranquillisers, (zopiclone, diazepam, and other benzodiazepines) for more than two weeks. These drugs can be addictive.
Couple or marital therapy – unless there are other problems in the relationship besides the OCD. It is helpful for a partner and family to try and find out more about OCD and how to help.
Counselling and psychoanalytical psychotherapy. Some people find it helpful to think about the childhood and past experiences. However, the evidence suggests that facing our fears seems to work better than talking about them.
Tips for family and friends
The behaviour of someone with OCD can be quite frustrating – try to remember that he or she is not trying to be difficult or behave oddly - they are coping the best they can.
It may take a while for someone to accept that they need help. Encourage them to read about OCD and talk it over with a professional.
Find out more about OCD.
You may be able to help exposure treatments by reacting differently to your relative's compulsions:
- encourage them to tackle fearful situations;
- say 'no' to taking part in rituals or checking;
- don't reassure then that things are alright.
Don't worry that someone with an obsessional fear of being violent will actually do it. This is very rare.
Ask if you can go with them to see their GP, psychiatrist or other professional.
What if there is a long wait to start CBT?
At the moment, there is a shortage of NHS professionals trained in CBT. In some areas, you may have to wait several months to start treatment. If the measures outlined in the "helping yourself" section don't help, you can start antidepressant treatment in the meantime.







Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com

HEADACHE

According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 20% of children and adolescents also have significant headaches.

What types of headaches are there?

There are several types of headaches - 150 diagnostic headache categories have been established!Below is a list of the most common types of headaches.Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions and other changes in the brain as well as inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as light sensitivity; noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms.A small percentage of pediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis -- about once a month. These types of migraines are sometimes called abdominal migraines.Mixed headache syndrome: Also called transformed migraines, this is a combination of migraine and tension headaches. Both adults and children experience this type of headache.Cluster headaches: The least common, although the most severe, type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.Acute headaches: Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician's office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

Are headaches hereditary?

Yes, headaches, especially migraines, have a tendency to run in families. Most children and adolescents (90%) who have migraines have other family members with migraines. When both parents have a history of migraines, there is a 70% chance that the child will also develop migraines. If only one parent has a history of migraines, the risk drops to 25%-50%.
What causes headaches?
Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place.There is a migraine "pain center" or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin, and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.Headaches that occur suddenly (acute-onset) are usually due to an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat) or otitis (ear infection or inflammation).In some cases, the headaches may be the result of a blow to the head (trauma) or rarely a sign of a more serious medical condition.Common causes of tension headaches or chronic nonprogressive headaches include emotional stress related to family and friends, work or school; alcohol use; skipping meals; changes in sleep patterns; excessive medication use; tension and depression. Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.Headaches can also be triggered by specific environmental factors that are shared in a family's household, such as exposure to second-hand tobacco smoke strong odors from household chemicals or perfumes, exposure to certain allergens or eating certain foods. Stress, pollution, noise, lighting and weather changes are other environmental factors that can trigger headaches for some people.Too much physical activity can also trigger a migraine in both adults and children.Be sure to consult apsychiatrist to find out what is causing your headaches.

Do children outgrow headaches?

Headaches may improve as children gets older. The headaches may disappear and then return later in life. By junior high school, many boys who have migraines outgrow them, but in girls, migraine frequency increases because of hormone changes. Migraines in adolescent girls are three times more likely to occur than in boys.

How are headaches evaluated and diagnosed?

The good news for headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.If you have headache symptoms, the first step is to go to your doctor. He or she will perform a complete physical examination and a headache evaluation. During the headache evaluation, your headache history and description of the headaches will be evaluated. You will be asked to describe your headache symptoms and characteristics as completely as possible.A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless you have experienced a loss of consciousness with a headache.If your headache symptoms become worse or become more frequent despite treatment, ask your doctor for a referral to a specialist. Your family doctor should be able to provide the names of headache specialists. If you need more information, contact one of the organizations in the resource list for a list of member doctors in your state.

How are headaches treated


Your doctor may recommend different types of treatment to try or he or she may recommend further testing, or refer you to a headache specialist. You should establish a reasonable time frame with your family doctor to evaluate your headache symptoms.The proper treatment will depend on several factors, including the type and frequency of the headache and its cause. Not all headaches require medical attention. Treatment may include education, counseling, stress management, biofeedback and medications. The treatment prescribed for you will be tailored to meet your specific needs.






What happens after I start treatment?

When your doctor starts a treatment program, keep track of the results and how the treatment program is working. Keep your scheduled follow-up appointments so your doctor can monitor your progress and make changes in the treatment program as needed.

Tension headaches are the most common type of headaches among adults. They are commonly referred to as muscle contraction headaches or stress headaches.A tension headache may appear periodically ("episodic," less than 15 days per month) or daily ("chronic," more than 15 days per month). An episodic tension headache may be described as a mild to moderate constant band-like pain or tightness or pressure around the forehead or back of the head and neck.These headaches may last from 30 minutes to several days. Episodic tension headaches usually begin gradually, and often occur in the middle of the day.The "severity" of a tension headache increases significantly with its frequency. Chronic tension headaches come and go over a prolonged period of time. The pain is usually throbbing and affects the front, top or sides of the head. Although the pain may vary in intensity throughout the day, the pain is almost always present. Chronic tension headaches do not affect vision, balance or strength.

Who gets tension headaches?

About 30%-80% of the adult population suffers from occasional tension headaches; approximately 3% suffer from chronic daily tension headaches. Women are twice as likely to suffer from tension-type headaches as men.Most people with episodic tension headaches have them no more than once or twice a month, but the headaches can occur more frequently.Chronic tension headaches tend to be more common in females. Many people with chronic tension headaches have usually had the headaches for more than 60-90 days.



What causes tension headaches

There is no single cause for tension headaches. This type of headache is not an inherited trait that runs in families. In some people, tension headaches are caused by tightened muscles in the back of the neck and scalp. This muscle tension may be caused by:
Inadequate rest
Poor posture
Emotional or mental stress, including depression
Anxiety
Fatigue
Hunger
Overexertion
In others, tightened muscles are not part of tension headaches, and the cause is unknown.Tension headaches are usually triggered by some type of environmental or internal stress. The most common sources of stress include family, social relationships, friends, work and school. Examples of stressors include:
Having problems at home/difficult family life
Having a new child
Having no close friends
Returning to school or training; preparing for tests or exams
Going on a vacation
Starting a new job
Losing a job
Being overweight
Deadlines at work
Competing in sports or other activities
Being a perfectionist
Not getting enough sleep
Being over-extended (involved in too many activities/organizations)
Episodic tension headaches are usually triggered by an isolated stressful situation or a build-up of stress. Daily stress, such as from a high-pressured job, can lead to chronic tension headaches.


What are the symptoms of tension headaches?

People with tension headaches commonly report these symptoms:
Mild to moderate pain or pressure affecting the front, top or sides of the head
Headache upon awakening
Difficulty falling asleep and staying asleep
Chronic fatigue
Irritability
Disturbed concentration
Mild sensitivity to light or noise
General muscle aching
A tension headache may appear periodically (episodic, less than 15 days per month) or daily (chronic, more than 15 days per month). Chronic tension headaches may vary in intensity throughout the day, but the pain is almost always present.Unlike migraine headaches, there are no associated neurological symptoms (such as muscle weakness, or blurred vision) in people with tension headaches. In addition, severe sensitivity to light or noise, stomach pain, nausea and vomiting are not symptoms usually associated with tension headaches.


How are tension headaches treated?

The goals of treatment are to prevent further attacks and relieve any current pain. Prevention includes:
Taking the medications recommended by your doctor
Pain relievers
Muscle relaxants
Antidepressants
Others
Avoiding or minimizing the causes or triggers
Stress management/relaxation training
Biofeedback
Home treatments
The goals of treatment are to prevent further attacks and relieve any current pain. Prevention includes:
Taking the medications recommended by your doctor
Pain relievers
Muscle relaxants
Antidepressants
Others
Avoiding or minimizing the causes or triggers
Stress management/relaxation training
Biofeedback
Home treatments
Treating the HeadacheOver-the-counter (OTC) painkiller medications are often the first treatments recommended for tension headaches.Some of these painkillers can also be used to prevent headaches in people with chronic tension headaches.If OTC pain relievers don't help, your doctor may recommend a prescription strength pain reliever or an muscle relaxant.Preventing headaches in chronic sufferersPreventive treatments include painkillers. If those don't work, your health care provider may recommend an antidepressant or another drug to prevent the headache.Keep in mind that medications don't cure headaches and that, over time, pain-relievers and other medications may lose their effectiveness. In addition, all medications have side effects. If you take medication regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Also, remember that pain medications are not a substitute for recognizing and dealing with the stressors that may be causing your headaches.Regardless of the treatment, tension headaches are best treated when the symptoms first begin and are mild, before they become more frequent and painful.

Cluster Headaches
The term "cluster headache" refers to a type of headache that recurs over a period of time. People who have cluster headaches experience an episode one to three times per day during a period of time (the cluster period), which may last from 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur. A cluster headache typically awakens a person from sleep 1 to 2 hours after going to bed. These nocturnal attacks can be more severe than the daytime attacks. Attacks appear to be linked to the circadian (or "biological") clock. Most people with cluster headaches will develop cluster periods at the same time each year -- either in the spring or fall or the winter or summer.Cluster headaches are one of the most severe types of headache. It can be 100 times more intense than a migraine attack.

Who gets cluster headaches?


Cluster headaches are the least common type of headaches, affecting less than 1 in 1,000 people. Cluster headaches are a young person's disease: the headaches typically start before age 30. Cluster headaches are more common in men, but more women are starting to be diagnosed with this problem. The male to female ratio is 2-3:1.

What causes cluster headaches


The true biochemical cause of cluster headaches is unknown. However, the headaches occur when a nerve pathway in the base of the brain (the trigeminal-autonomic reflex pathway) is activated. The trigeminal nerve is the main nerve of the face responsible for sensations (such as heat or pain.)When activated, the trigeminal nerve causes the eye pain associated with cluster headaches. The trigeminal nerve also stimulates another group of nerves that causes the eye tearing and redness, nasal congestion and discharge associated with cluster attacks.The activation of the trigeminal nerve appears to come from a deeper part of the brain called the hypothalamus. The hypothalamus is home to our "internal biologic clock" which regulates our sleep and wake cycles on a 24-hour schedule. Recent imaging studies have shown activation or stimulation of the hypothalamus during a cluster attack.Cluster headaches usually are not caused by an underlying brain condition such as a tumor or aneurysm.

What triggers cluster headaches?

The season is the most common trigger for cluster headaches, which often occur in the spring or autumn. Due to their seasonal nature, cluster headaches are often mistakenly associated with allergies or business stress. The seasonal nature of cluster headaches most likely results from stimulation or activation of the hypothalamus (see above).Cluster headaches are also common in people who smoke and drink alcohol frequently. During a cluster period, the sufferer is more sensitive to the action of alcohol and nicotine, and minimal amounts of alcohol can trigger the headaches. During headache-free periods the person can consume alcohol without provoking a headache.

What are the symptoms of a cluster headache

Cluster headaches generally reach their full force within five or ten minutes after onset. The attacks are usually very similar, varying only slightly from one attack to another.
Type of Pain: The pain of cluster headache is almost always one-sided, and during a headache period, the pain remains on the same side. When a new headache period starts, it rarely occurs on the opposite side.
Severity/Intensity of Pain: The pain of a cluster headache is generally very intense and severe and is often described as having a burning or piercing quality. It may be throbbing or constant. The pain is so intense that most cluster headache sufferers cannot sit still and will often pace during an attack.
Location of Pain: The pain is located behind one eye or in the eye region, without changing sides. It may radiate to the forehead, temple, nose, cheek, or upper gum on the affected side. The scalp may be tender, and the pulsing in the arteries often can be felt.
Duration of Pain: The pain of a cluster headache lasts a short time, generally 30 to 90 minutes. It may, however, last from 15 minutes to three hours. The headache will disappear only to recur later that day. Typically, in between attacks, people with cluster headaches are headache free.
Frequency of Headaches: Most sufferers get one to three headaches per day during a cluster period (the time when the headache sufferer is experiencing daily attacks). They occur very regularly, generally at the same time each day, and have been called "alarm clock headaches" because they often awaken the person at the same time during the night.
Most cluster sufferers (80%-90%) have episodic cluster headaches that occur in periods lasting seven days to one year, separated by pain-free episodes lasting 14 days or more.In about 20% of people with cluster headaches, the attacks may be chronic, meaning there are less than 14 headache-free days per year. Chronic cluster headaches vary from episodic cluster headaches, as they are continuous without remission periods.Cluster headaches are not typically associated with nausea or vomiting. It is possible for someone with cluster headaches to also suffer from migraines.

Is there any way to tell that a cluster headache is coming?

Although the pain of a cluster headache starts suddenly, there may be a few subtle signs of the oncoming headache. Some signs include:
Feeling of discomfort or a mild, one-sided burning sensation.
The eye on the side of the headache may become swollen or droop. The pupil of the eye may get smaller and the conjunctiva (the pink tissue that lines the inside of the eyelid) will redden.
Nasal discharge. There may be nasal discharge or congestion and tearing of the eye during an attack, which occur on the same side as the pain.
Excessive sweating.
Flushing of the face on the affected side.
Light sensitivity.

How are cluster headaches treated?

Abortive medications: The most successful treatments are Imitrex (sumatriptan) injections and breathing oxygen through a face mask for twenty minutes. Other choices include: Zomig (zolmitriptan) tablets, ergotamine drugs and intranasal lidocaine.
Preventive medications: Your doctor can prescribe preventive medications to shorten the length of the cluster headache period as well as decrease the severity of the headaches. All cluster headache sufferers should take preventive medication unless their cluster periods last less than two weeks. Some medications used in the prevention of cluster headaches include: calcium channel blockers (verapamil), lithium, divalproex sodium, corticosteroids (only short courses), methysergide, melatonin and Topamax.
Surgery: This may be an option for people with chronic cluster headaches who have not been helped with standard therapy. Most of the procedures involve blocking the trigeminal nerve.
All of these treatments should be used under the direction of a doctor familiar with treating cluster headaches. As with any medication, it is important to carefully follow the label instructions and your doctor's advice.


Migraine headache
A migraine headache is a vascular headache associated with changes in the size of the arteries within and outside of the brain.

Who gets migraines


The National Headache Foundation estimates that 28 million Americans suffer from migraines. More women than men get migraines and a quarter of all women with migraines suffer four or more attacks a month; 35% experience 1-4 severe attacks a month, and 40% experience one or less than one severe attack a month. Each migraine can last from four hours to three days. Occasionally, it will last longer.



What causes migraine headaches

The exact causes of migraines are unknown, but the headaches are linked to changes in the brain as well as to genetic causes. Experts believe that migraines may be caused by inherited abnormalities in certain areas of the brain. People with migraines may inherit the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, and weather changes. Additional possible triggers include:
Emotional stress
Sensitivity to specific chemicals and preservatives in food. Certain foods, beverages and food additives may be responsible for triggering up to 30% of migraines. Aged cheeses, alcoholic beverages, nitrates (sometimes found in processed meats), and monosodium glutamate (MSG) have been linked to migraines.
Caffeine. Excessive caffeine consumption or withdrawal from caffeine can cause headaches when the caffeine level abruptly drops. The blood vessels seem to become sensitized to caffeine. When caffeine is not ingested, a headache may occur. Caffeine itself is often helpful in treating acute migraine attacks.
Changing weather conditions. Storm fronts, barometric pressure changes, strong winds, and altitude changes have been linked to migraines.
Menstrual periods
Tension
Excessive fatigue
Skipping meals
Changes in normal sleep patterns



What are the symptoms of migraines?


The pain of a migraine can be described as a pounding or throbbing. The headache often begins as a dull ache and develops into a throbbing pain. The pain is usually aggravated by physical activity. Migraine pain can be classified as mild, moderate, or severe. Some other associated symptoms of migraine headaches include:
Sensitivity to light, noise, and odors
Nausea and vomiting, stomach upset, abdominal pain
Loss of appetite
Sensations of being very warm or cold
Paleness
Fatigue
Dizziness
Blurred vision
Types of MigrainesThere are several tyoes of migraine headaches, including:
Migraine with aura (classic migraine): This type is usually preceded by an aura. Most often, an aura is a visual disturbance (outlines of lights or jagged light images). This type of migraine usually is much worse than a common migraine.
Migraine without aura (common migraine): This type accounts for 80% of migraine headaches. There is no aura before a common migraine.
Status migrainosus: This is the term used to describe a long-lasting migraine that does not go away on its own.




How are migraines treated?

People with migraine headaches can manage mild-to-moderate attacks at home with the following strategies:
Applying a cold compress to the area of pain
Resting with pillows comfortably supporting the head or neck
Drinking a moderate amount of caffeine
Trying certain over-the-counter headache medications
Resting in a room with little or no sensory stimulation (light, sound, odors)
Withdrawing from stressful surroundings
Sleeping
When these efforts do not help, migraine headaches may be eased with prescription medications. Migraines can be treated in two ways: with abortive therapy or preventive therapy.The goal of abortive therapy is to prevent a migraine attack or to stop it once it starts. Some
Preventive treatments are considered if migraine headaches occur more than once a week. These drugs are meant to lessen the frequency and severity of the migraine attacks.
Medications used to treat high blood pressure.
Antidepressants.
Antiseizure medications.
Some antihistamines and anti-allergy drugs.
Hormones and Headaches

It has been estimated that 70% of migraine sufferers are female. Of these female migraine sufferers, 60%-70% report a menstrual relationship to their migraine attacks.

What is the relationship between hormones and headaches?


Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone estrogen during a woman's menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow.Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels.Migraine attacks typically disappear during pregnancy. In one study, 64% of women who described a menstrual link to their headaches noted that their headaches disappeared during pregnancy. However, some women have reported the initial onset of migraines during the first trimester of pregnancy, with disappearance of their headaches after the third month of pregnancy.


What triggers migraines in women?


Birth control pills as well as hormone replacement therapy during menopause have been recognized as migraine triggers in some women. As early as 1966, investigators noted that migraines can become more severe in women taking birth control pills, especially those containing high doses of estrogen.The frequency of side effects, such as headache, decreased in those who took birth control pills containing lower doses of estrogen and did not occur in those who took birth control pills containing progesterone.

What are the treatment options for menstrual migraines?

The medications of choice in the treatment of menstrual migraines are non-steroidal anti-inflammatory medications (NSAIDs).NSAID treatment should be started 2 to 3 days before the menstrual period starts and continue til the period ends. Because the therapy is of short duration, the risk of gastrointestinal side effects is limited.For people who have severe menstrual migraines or who want to continue taking their birth control pills, doctors recommend taking a NSAID, starting on the l9th day of the cycle and continuing through the second day of the next cycle.Other medications prescribed include:
Small doses of ergotamine (including Bellergal-S) or a similar compound, methylergonovine maleate (for example, Methergine)
Beta-blocker drugs such as propranolol
Anticonvulsants such as valproate (Depakote)
Calcium channel blockers such as verapamil
These drugs should also be started 2 to 3 days pre-menses, and continued throughout the menstrual flow.Because fluid retention is often associated with menses, diuretics have been used to prevent menstrual migraine. Some doctors may recommend limiting salt-intake immediately before the start of menses.








What are the treatment options for migraines during pregnancy?

During pregnancy, no treatment is recommended to treat migraines. Medication therapy used to treat migraines can affect the uterus and can cross the placenta and affect the baby, so these medications should be strictly avoided during pregnancy.A mild pain-reliever can be used, such as Tylenol. It is important that pregnant women suffering from headaches discuss the safety of headache medications with their obstetricians and headache specialists before taking anything



Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com