Dr. Sumanth T P

Loss and grief are two unfortunate partners where the latter follows the former. While the type of grief or the nature of the loss may differ from person to person, there are five distinct stages of loss and grief that all people universally go through, when faced with such a situation. Here are the five stages of this process and the different ways in which one can cope with each stage.

-  Denial and Isolation

In this phase, the patient usually ends up blocking out the words as well as the thoughts and reactions that surround this sad event, which can lead to a numbing action of the brain. While we all do this in some measure during such situations, some people take it especially hard by acting as if nothing has happened at all. If this phase does not come to pass within a short frame of time, then psychological and medical intervention may be required. 

-  Anger

When a person begins to acknowledge the loss, there is a sense of unfairness which can lead to frustration and anger that is basically the way the person may be dealing with the re-emergence of the pain and the fact that it is here to stay. Therapy and sedation may be required if this frustration and repeated spells of tantrums carries on for a prolonged period. Do not hesitate to talk things out rather than flaring up at this point, as the unchangeable has already happened. 

-  Bargaining

In this phase, desperation enters the mind of the patient where a lot of 'what ifs' come up. The patient begins to question what if things had been done differently and other such aspects. If not dealt with in an engaging manner and with empathy, this phase can lead back to anger and frustration.

-  Depression

Private mourning of the loss and regret to do with the practical aspects like loneliness and the cost of the loss can strike at this stage. Here, the patient must be made aware of rights as well as the people around him or her who can help out to prevent this depression from becoming a full-fledged condition.

-  Acceptance

In this final stage, the patient becomes more accepting of this new reality. Yet, even this must be taken up cautiously as a grief stricken heart may lead to a variety of mental ailments in the long run.

The way to deal with these stages is with therapy and proper guidance where the patient is allowed to channel all the thoughts and anger before accepting the situation. Do not hesitate to ask for counselling and embrace the changes in your life without regret, guilt and depression.

Forensic psychiatry is generally identified as a specialized offshoot of psychiatry, dealing with the calculated treatment and evaluation of mentally disordered offenders in secure hospitals, prisons and in the community. This branch of psychiatry requires an in-depth understanding and thorough knowledge of the connection between legality and mental health. Patients are generally those with personality dysfunctions, mental illness, psychopathic disorders, organic brain damage, learning disability and other conditions such as histories of abuse and traumatic experiences as well as substance abuse and misuse.

Nature of the work

The most important prerequisite of this branch of psychiatry is a secure and safe environment where the subjects are liable to legal restrictions. Evaluation and assessment may vary from highly secured hospitals and prisons to low secure units and community based services. Forensic psychiatrists must have a thorough knowledge of civil, criminal and case law because of their frequent dealings with criminal justice agencies and the courts. An important component of forensic psychiatry is risk assessment and evaluation. Forensic psychiatrists must be fluent and adept at handling patients during emergencies or routine situations. Moreover, they should be calm, composed and professional in their dealings especially with patients who display instability or violent and aggressive behavior.

The probation service, the prison service and the courts generally rely on forensic psychiatrists for expert advice, precisely because of their familiarity with preparing reports for mental health review tribunals and criminal justice agencies.

Imperatives 

1) Quintessentially, the obligatory role of a forensic psychiatrist requires:
2) Ability to treat others with understanding and respect
3) Ability to work flexibly
4) Emotional resilience along with the ability to empathize with patients
5) Anticipation and an inherent initiative to work in challenging situations
6) Good communication skills
7) A scientific and analytic approach and assessment
8) Good leadership qualities

Dementia cannot be singularly regarded as a specific disease, but rather indicates a group of symptoms associated with your memory, cognitive thinking and social abilities, up to the point where daily functioning gets affected. In most cases, Dementia steadily worsens over time (progressive dementias). Dementia is not to be confused with memory loss alone; because it is natural with old people to experience memory loss, but that does not necessarily mean they have Dementia. If the reason is Dementia, then you may require medical treatment.

Causes

Dementias are generally caused either by damage to or changes in the nerve cells operating in the brain. The causes can be grouped differently based on the type of dementia experienced and the part of the brain affected. While some causes can be reversed with effective treatment, others, unfortunately, cannot.

The most common causes of Dementia which cannot be reversed include :

1. Alzheimer's disease
2. Vascular dementia
3. Parkinson's disease
4. Frontotemporal dementia
5. Dementia with Lewy (Dementia which is neurodegenerative and progressive in nature) bodies
6. Severe head injuries

Other irreversible causes which are relatively rarer than usual include :

1. Huntington's disease (breakage of the brain's nerve cells)
2. Creutzfeldt-Jakob disease (irreversible and fatal brain disease)
3. Multiple sclerosis or Amyotrophic lateral sclerosis
4. Infections like syphilis
5. Leukoencephalopathies (diseases affecting the brain's 'white' areas)
6. Brain injuries
7. Multiple system atrophy

Causes of Dementia which can be treated include :

1. Hypothyroidism
2. Heavy metal poisoning
3. Certain brain tumors
4. Chronic alcoholism
5. HIV/AIDS
6. Vitamin B12 deficiency
7. Medicinal side effects or abnormal drug reactions
8. Normal pressure hydrocephalus
9. Certain cases of encephalitis

Symptoms of Dementia include

1. Memory loss
2. Difficulty finding the right words
3. Difficulty exercising judgments, especially during emergencies
4. Inability to recall particular events or to recognize people and places
5. Depression or other mood disorders, in addition to symptoms like uncontrolled aggression or constant agitation

A certain psychiatric condition which causes a person to be functionally impaired in social and occupational settings is known as Impulse Control Disorder. Most of you are granted with the ability to think before you act but it isn't the case for people suffering with such a condition. People diagnosed with this condition are not able to withstand the urge to do something detrimental to themselves or other people.

This condition is similar to other disorders such as kleptomania, compulsive gambling and pyromania to name a few. Although people suffering from this disorder do not plan their acts, the acts they do perform generally fulfill their conscious wishes. Other disorders of such similar nature like Kleptomania and ADHD, which are associated with difficulty in controlling impulses but that is not their chief feature. Patients of impulse control disorder find it highly distressful and are hence often seen to lose control of their actions and consequently their lives.

What causes this disorder ?

Some medical practitioners are of the opinion that this disorder is a subgroup of other conditions such as stress, anxiety, OCD and other such. Scientists and researchers are not particularly sure what causes this condition but have determined that it can be caused due to a combination of physiological, emotional and psychological factors pertaining to cultural and societal aspects. Also, certain brain structures linked to emotions and memory functions in and around the frontal lobe are linked to planning functions and impulses.

Some studies show that certain hormones such as testosterone which are associated with aggression and violence may also play a role in forming such disorder. Aggressive and violent behaviors are apparent in people suffering from this disorder. Certain studies have shown a connection between certain forms of seizure disorders and aggressive impulsive behaviors.

People with such disorders are also more likely to contract addiction and mood disorders. Antidepressants are usually prescribed in treating such disorders.

The brain is not a stagnant realm fed with a granted quota of intelligence and memory at birth. It is always in a state of flux. Exercising your brain in various ways accelerates its ability to perform better. It is in your hands to have a sharper take on situations and occurrences. Playing games that require brainstorming, solving quizzes, crosswords or playing chess makes you feel rejuvenated and tired at the same time; the reason being activated brain cells. A healthy brain will affect your life decisions positively and you probably will think rightly before you leap.

Tips to exercise those brain cells -

1. Meditate and calm your mind

Ten minutes of meditation each day can help you get over anxiety. When your mind is at peace you think out pros and cons with enhanced insight. This composure reflects in each of your actions. Meditation demands your brain to be quiet when it is accustomed to work; you therefore have greater control over it.
     
2. Music can improve your brain abilities

Music is the best antidote for a sloppy brain. Music excites the neurons healing a bruised memory. It gifts you with clarity of thought. Apart from listening to music one must try to play a musical instrument. Teaching yourself things puts your mind through a strict regimen of constructive activities.
   
3. Take out time to learn a new language

We are paralyzed the minute our brain gives up. Due to several external and internal reasons each one of us is likely to suffer from cognitive disorders on being subjected to extreme pressure or shock. Trying to learn a new language motivates your brain cells to have a wider vocabulary which further restricts your chances of brain damage.   

4. Mental mathematics could better your intelligence

Calculators, computers, and phones are ridding us of our ability to compute individual data. Computation and consolidation of data helps your mind to work faster with precision. So, you now know those lessons on mental mathematics in childhood were actually the key to a well- rounded brain. 

5. Think of something novel

The more the number of neurons the merrier is your brain. Take pains to direct your mind on a novel track. Thinking beyond what is given and expected helps your brain grow new neurons. It builds up your creativity letting you discover more of your capabilities.