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Bharathiraja Superspeciality Hospital & Research Centre

Psychiatrist Clinic

No.20,G N Chetty Road, T.Nagar. Landmark:Opp To Buhari Hotel & Near Vani Mahal Signal, Chennai Chennai
1 Doctor · ₹300
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Bharathiraja Superspeciality Hospital & Research Centre Psychiatrist Clinic No.20,G N Chetty Road, T.Nagar. Landmark:Opp To Buhari Hotel & Near Vani Mahal Signal, Chennai Chennai
1 Doctor · ₹300
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It is important to us that you feel comfortable while visiting our office. To achieve this goal, we have staffed our office with caring people who will answer your questions and help you ......more
It is important to us that you feel comfortable while visiting our office. To achieve this goal, we have staffed our office with caring people who will answer your questions and help you understand your treatments.
More about Bharathiraja Superspeciality Hospital & Research Centre
Bharathiraja Superspeciality Hospital & Research Centre is known for housing experienced Psychiatrists. Dr. Poorna Chandrika, a well-reputed Psychiatrist, practices in Chennai. Visit this medical health centre for Psychiatrists recommended by 97 patients.

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T.Nagar Chennai, Tamil Nadu
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Mental Health

MBBS, MD - Psychiatry
Psychiatrist, Chennai
Mental Health

When your body is broken, you have no problem in seeking doctors help but when your mind is broken, why are you hesitant? Your mind is no holier than your body. 
Always seek doctor's help but never destroy your precious life.

1 person found this helpful

Parkinson s Disease

MBBS, DNB, Fellowship in Neurosurgery
Neurosurgeon, Kolkata
Parkinson s Disease

Deep brain stimulation in Parkinson’s disease

Abstract: Deep brain stimulation (DBS) is a widely accepted therapy for medically refractory Parkinson’s disease (PD). Both globus pallidus internus (GPi) and subthalamic nucleus (STN) stimulation are safe and effective in improving the symptoms of PD and reducing dyskinesias. STN DBS is the most commonly performed surgery for PD as compared to GPi DBS. Ventral intermediate nucleus (Vim) DBS is infrequently used as an alternative for tremor predominant PD patients.

Patient selection is critical in achieving good outcomes. Differential diagnosis should be emphasized as well as neurological and nonneurological comorbidities. Good response to a levodopa challenge is an important predictor of favorable long-term outcomes. The DBS surgery is typically performed in an awake patient and involves stereotactic frame application, CT/MRI imaging, anatomical targeting, physiological confirmation, and implantation of the DBS lead and pulse generator. Anatomical targeting consists of direct visualization of the target in MR images, formula-derived coordinates based on the anterior and posterior commissures, and reformatted anatomical stereotactic atlases. Physiological verification is achieved most commonly via microelectrode recording followed by implantation of the DBS lead and intraoperative test stimulation to assess benefits and side effects. The various aspects of DBS surgery will be discussed.

Key words: deep brain stimulation (DBS); Parkinson’s disease(PD),  stereotaxis

Introduction

Parkinson's disease is a slowly progressive, neurodegenerative disease characterized by tremor, rigidity, bradykinesia and postural instability. It is the most common movement disorder in middle or late life with a prevalence of about 0.3% of the general population, rising to 1% in people over 60 years of age. Approximately 130 000 people suffer from it in the UK and it presents an increasing burden in our ageing population. Pathological findings in Parkinson's disease demonstrate greatly diminished neuromelanin pigmented neurons in the substantia nigra of the basal ganglia with associated gliosis, and Lewy bodies present in many remaining neurons.

James Parkinson, in his original 1817 Essay on The Shaking Palsy, gave an account of six patients in which he noted signs of tremor, festinating gait and flexed posture.  Nearly two centuries from Parkinson's observations, and almost four decades after Cotzias' dramatic demonstration of levodopa's efficacy, the limitations and complications of levodopa treatment for Parkinson's disease have become well documented Five years after initiation of therapy, a majority of patients develop medication related motor complications, namely levodopa induced dyskinesias (LID) and motor fluctuations. Deep brain stimulation (DBS) has been developed primarily to address these treatment related motor complications and therapeutic failures.

Pathophysiology of PD

The loss of dopaminergic neurons in the substantia nigra, the main functional characteristic of PD, affects the circuit described above and leads to the cardinal motor symptoms of PD. While the exact mechanism of this process is unknown, animal research as well as human recordings have provided functional and biochemical evidence that bradykinesia in PD results from excessive activity in the STN and the GPi. This leads to an exaggerated beta (10-30 Hz) synchronization within and between structures in the basal ganglia circuitry  that could also contribute to rigidity and akinesia.

The pathophysiology of rest tremor in PD is less clear and probably more complicated. This symptom most likely results from a dysfunction of both the striato-pallidal-thalamocortical and the cerebellodentato-thalamocortical circuits, with hyperactivity and hypersynchronization between central oscillators.

Possible mechanism of action of DBS

DBS acts through delivering an electrical current in a specific target area of the brain. This current can be modulated through modification of voltage, frequency and duration of each electrical pulse delivered. The delivered energy creates an electrical field of variable size and shape according to the parameters used for stimulation. Although initially believed to stimulate the target, thus the name of the whole process, it seems that

DBS actually excites the neuronal fibers, but inhibits the neural cells. In fact, GPi DBS decreases the GPi mean firing rate back to a normal range in animal models as well as PD patients, and high frequency DBS has a similar effect as dopamine replacement therapies, and promotes faster (about 70 Hz) nonhypersynchronous activity in the basal ganglia, correlated with clinical improvement. This might be achieved through stimulation of bypassing inhibitory pathways, synaptic inhibition, depolarizing blockade, synaptic depression, and simulation-induced disruption of pathological network activity. Overall, this leads to modifications of the firing rate and pattern of neurons in the basal ganglia, as well as local release of neurotransmitters such as glutamate and adenosine. In addition, it seems that DBS also increases blood flow and stimulates neurogenesis. Over the last few years, functional imaging, specifically functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT), has been used in an attempt to clarify the mechanism of action of DBS. In fMRI, blood-oxygen-level-dependent (BOLD) signals are acquired, and oxygenated blood marks areas of neural stimulation or inhibition. On the other hand, PET and SPECT allow for imaging of multiple activity markers, such as blood flow, glucose and oxygen metabolism. While fMRI is less powerful than nuclear medicine techniques, it provides a much better spatial and temporal resolution. Because of the suspected inhibitory DBS effects in electrophysiological studies, reduced STN blood flow or glucose metabolism would have been expected on functional imaging. However, the opposite has been found to be true in an overwhelming majority of imaging studies to date. In addition, BOLD activation in the area surrounding the electrode has been reported, despite the electrode imaging artifact preventing direct observation of the STN around the electrode. This discrepancy between apparent STN inhibition in single-cell studies and activation in imaging studies might be explained by a few hypotheses. First, electrophysiological recordings identify short neuronal modulation (in the order of milliseconds) while neuroimaging methods may reflect the summed activity changes over seconds to minutes. Second, non-neuronal contributions to the change in blood flow and/or glucose metabolism cannot be excluded, and could confound the results of neuroimaging.

Finally, it is possible that PET and fMRI actually detect the increased activity in the axons, rather than in the cell bodies. Complicating matters further, some imaging studies after STN DBS have showed increased

activity in the GPi while others reported decreased activity in that nucleus. In summary, it is still unclear how exactly DBS affects the firing rate and pattern of neurons and how these changes actually modify the symptoms of Parkinson’s disease. DBS is presently more of an empirically proven treatment in search of physiological explanation.

The effect of DBS on the cardinal symptoms of PD have been established in three randomized controlled clinical trials --- 

TABLE 1

Author, year

 

No of patients

Follow up

Target

Results

Deuschl et al., 2006

156

6 months

BL STN

QOL better with DBS, motor symptom better with DBS

 

Weaver et al., 2009

255

6 months

BL STN or GPi

Dyskinesia free ON time better with DBS

 

Williams et al., 2010

366

12 months

BL STN  or GPi

QOL better with DBS

 

 

PATIENT SELECTION for DBS in PD

Patient selection is a critical first step as poorly chosen candidates may not have optimal benefits and have increased morbidity. Several factors must be considered before determining if a patient is an appropriate candidate for DBS surgery. A multidisciplinary approach involving the neurosurgeon, neurologist, and neuropsychologist is important to determine the appropriate surgical candidate. It is also important that the diagnosis of idiopathic PD be confirmed prior to proceeding with DBS surgery. Key to this assessment is evaluating the surgical candidate in both the on and off medication states with a corroborating levodopa challenge. Perhaps the best prognostic indicator of a patient’s suitability for DBS surgery is their response to levodopa.In general, a levodopa challenge following a 12-hour medication withdrawal should provide at least a 33% improvement in the motor section of the Unified Parkinson’s Disease Rating Scale (UPDRS).

                     In our institute, we follow a simple chart(below) for screening of patients for DBS in PD.

 

 

  1.  

Age<75 years

 

  •  

No

  1.  

Idiopathic PD ( No PSP/MSA/NSD etc)

 

  •  

No

  1.  

Levodopa responsive  

                      

  •  

No

  1.  

Poor/adverse response to drug          

 

  1.  Increased off period                                                              

 

  1. Disabling dyskinesia                                                              

 

 

  1. Disabling motor fluctuations                 

 

 

Yes

 

Yes

 

 

Yes

 

 

No

 

No

 

 

No

  1.  

Degree of disability(UPDRS part III score)>25

 

  •  

No

  1.  

Neuropsychology, MMSE>24

 

  •  

No

  1.  

LEVODOPA CHALLENGE RESPONSE POSITIVE                                                   

 

(30% improvement in UPDRS after 12-hours off medication)

 

  •  

No

  1.  

Advanced  co-morbidity

 

Yes

  •  
  1.  

long term anticoagulation

 

Yes

  •  
  1.  

Willing for surgery and programming

 

  •  

No

 

 

PREOPERATIVE MANAGEMENT

A full medical assessment is a necessary part of the preoperative evaluation, as advanced PD patients tend to be elderly with significant comorbidities. Major issues are---

 

Anticoagulation/antiplatelets--- The risk of discontinuing medications that affect anticoagulation and

platelet aggregation should be weighed against the potential benefits in the quality of life offered by DBS surgery. However, timely discontinuation of these latter medications is mandatory for stereotactic surgery since intracerebral hematomas are the most serious of all potential complications from DBS. Any anticlotting medications, including aspirin, ticlopidine, clopidogrel, and all nonsteroidal anti-inflammatory drugs should be discontinued at least 7 to 10 days preoperatively to ensure the return of normal blood clotting function.

Arterial hypertension can also increase the risk of intracranial bleeding during stereotactic procedures and must be controlled in the weeks prior to surgery.

A prolonged discussion on the short- and long-term effects of DBS on Parkinson’s disease should be carried out with the patient, family, and caregivers.

The night prior to DBS surgery, the antiparkinsonian medications are typically held to pronounce the Parkinson’s symptoms at the time of surgery to see the clinical effects on symptoms during surgery and the families must be counselled regarding their role in facilitating the patient.

Target selection

The two main targets considered for DBS in PD are the STN and the GPi. current tendency is to prefer targeting the STN because of a greater improvement in the OFF phase motor symptoms as well as a higher chance to decrease the medication dosage and a lower battery consumption linked to the use of lower voltage in the STN compared to the GPi DBS. GPi can be the preferred target if LID is the main complaint. GPi DBS might be preferred for patients with mild cognitive impairment and psychiatric symptoms. Because STN DBS might have a higher rate of cognitive decline and/or depression and worsening of verbal fluency in some studies.

Surgical technique

The basic components of DBS implantation surgery involve frame placement, anatomical targeting, physiological mapping, evaluation of macrostimulation thresholds for improvement in motor symptoms or induction of side effects, implantation of the DBS electrode and implantable pulse generator (IPG).

Head-frame placement

The CRW frame is the most commonly used followed by the Leksell frame. Placement of the frame is done under local anesthesia unless anxiety or uncontrollable movements necessitate the use of sedation or general anesthesia.

Leksell stereotactic frame  placed over the head of a patient showing the correct method for placement of the Leksell head-frame. The frame should be placed parallel to orbito-meatal line in order to approximate the AC-PC plane. It is attached to the patient’s head using four pins under local anesthesia.

Imaging and anatomic targeting

Computerized Tomography (CT) scans and MRI are the two main imaging modalities used for targeting when performing DBS implantations. A thin cut stereotactic CT (_2 mm slices with no gap and no gantry tilt) is obtained after frame placement and is then fused with the stereotactic MRI on a planning station (Stealth station). The advantage of fusing the CT with MRI is the ability to avoid image-distortions inherent to MR imaging adding to the stereotactic accuracy. To better define the STN, T2-weighted images (TR 2800, TE 90, flip angle 90˚, slice thickness 2.0 mm) were obtained.

The AC and the PC were marked and the centre of the AC–PC line determined. The next step is planning the entry point and trajectory. The strategy here is to avoid surface and sub-cortical vessels. After trajectory planning, the patient is placed supine on the operating table and the frame attached to the table using an adaptor. Prophylactic antibiotics are given at least 30 min prior to incision. The head is prepped and draped in a sterile fashion. Under local anesthesia, a burr-hole is placed on the calculated entry point marked on the skull. The entry point is determined by the calculated arc and ring angles. Hemostasis is achieved with bone wax and bipolar cautery.

A Medronic Stim-Loc anchoring device (Medtronic, Minneapolis, MN) burr-hole base ring is then placed on the burr-hole and secured with two screws which are used at the end of the procedure to anchor the DBS electrode.

The dura is then cauterized and opened exposing the underlying surface of the brain. The microdrive is then assembled and cannulae inserted 10 mm above the target to avoid lenticulostriate vessels found deeper. Gel- foam and fibrin glue is applied on dural hole to minimize cerebrospinal fluid (CSF) loss and air entry into the skull. Subsequently, microelectrode recording and stimulation is undertaken.

Microelectrode recording/ Mapping

Microelectrode mapping is used to precisely define the target STN and its boundaries as well as nearby critical structures. We believe microelectrode mapping is crucial in order to give one the best chance for optimal placement of the DBS lead given anatomical inaccuracies due to image distortion and intraoperative brain shifts secondary to CSF loss, and pneumocephalus that can lead to inaccuracies in defining the initial target coordinates and shifts in the target itself once the skull is opened. Microelectrode mapping is performed using platinum-iridium glass coated microelectrodes dipped in platinum black with an impedance of around 0.3–0.5 Mo. These platinum-iridium microelectrodes are capable of recording single unit activity and can also be used for micro-stimulation up to 100 mAwithout significant breakdown in their recording qualities.

As the recording electrode was advanced, entry into the STN was identified by a sudden increase in the density of cellular discharge, with the characteristic irregular pattern of discharge—spikes of different sizes, occurring at random intervals. On coming out of the STN a quiet period (background noise) was seen followed by recording from the substantia nigra if the recording was continued far enough, described as high frequency (50–60 spikes/s) discharge pattern.11 Characteristic STN recordings (visual and audio) were identified and the depth of the STN activity was noted. Identification of STN activity was only based on the visual identification. The centre of the point of best electrical activity was selected as the final target. The microelectrode was replaced with a permanent quadripolar macroelectrode (Medtronic electrode no. 3389) to target the centre of the STN electrical activity. The proximal part of this electrode consists of four nickel conductor wires insulated with a polytetrafluoroethylene jacket tubing. The distal part has four metallic noninsulated contacts of 1.5 mm spaced at 0.5 mm intervals. The diameter of the distal electrode is 1.27 mm. Based on the clinical response any of the four contacts can be used for stimulation. Macrostimulation using the DBS electrode itself is then used to determine benefits and side effects. In most cases lateral skull x rays were obtained at this point with image intensifier carefully positioned to locate the target point in the centre of the Leksell-G frame rings.

Initial programming is always refined by using intra-operative macrostimulation data and a mono-polar review to identify the thresholds of stimulation for improvement in parkinsonian motor signs as well as the thresholds for inducing side effects at the level of each contact. The four variables that are used in programming are choice of contacts (0, 1, 2 or 3 used either as the cathode or anode), frequency of stimulation (hertz), pulse-width (ms) and amplitude (voltage).

POSTOPERATIVE MANAGEMENT

In the immediate hours after surgery, it is important to keep arterial blood pressure in the normal range. In addition, the patient’s preoperative drug regimen should be restarted immediately after surgery to avoid problems with dopaminergic withdrawal. Patients should undergo postoperative CT scans and/or MRI scans to assess the electrode location and intracranial status. In addition, plain X-rays are obtained to assess the location and geometry of the leads and hardware. Parkinson’s medications may need to be adjusted depending on the patient’s status. Cognitive and behavioral changes may occur in the postoperative period, particularly in older patients. Patients can be discharged as early as 24 hours after surgery, depending on their neurological and cognitive status.

Conclusion

For the last 50 years, levodopa has been the cornerstone of PD management. However, a majority of patients develop motor fluctuations and/or LID about 5 years after the initiation of therapy. DBS of the STN or the GPI grant to patients with PD improved quality of life and decreased motor complications, and has been approved as such by the Food and Drug Administration in the US in 2002. We reviewed the experience and available literature on DBS for Parkinson’s disease over the last decade and arrive at the following understandings.

The success of DBS surgery depends on the accurate placement of the leads and meticulous programming of the stimulation. Therefore, it is best accomplished by an experienced team of neurosurgeon, neurologist, and support staff dedicated to the treatment.

Reports of surgical complication rates and long-term side-effects of DBS are very variable, so benefits and potential adverse results should not be under- or over-emphasized.

While essentially equal in improving the motor symptoms of PD, STN and GPi might have their own benefits and risks, and the choice of the target should be individualized and adapted to the patient’s situation.

Knowledge to further improve DBS treatment for Parkinson’s disease, such as a more scientific and reliable protocol on programming, strategies to minimize cognitive and psychiatric complications, and the better

long-term maintenance of the implanted device, are still lacking.

Data on the impact of DBS on non-motor symptoms affecting the quality of life of PD patients, such as pain, speech or gastro-intestinal complaints, are still scarce. Further research in these areas will help make this useful treatment even more beneficial.

Does A Healthy Diet Reduce The Risk Of Depression?

M.Sc. in Dietetics and Food Service Management , Post Graduate Diploma In Computer Application, P.G.Diploma in Clinical Nutrition & Dietetics , B.Sc.Clinical Nutrition & Dietetics
Dietitian/Nutritionist, Mumbai
Does A Healthy Diet Reduce The Risk Of Depression?

Depression is a mental illness marked by feelings of profound sadness and low interest in positive activities. It is a persistent low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. There could be various causes of depression, but poor diet is one of the reasons revealed by researchers.

A certain study reinforces the hypothesis that a “healthy diet has the potential to not only ward off depression, but also prevent it."

Depressed individuals often have a poor diet quality and a decreased intake of nutrient rich food. But this is not yet clear in the case of healthy individuals suffering from depression.

A healthy diet characterized by vegetables, fruits, cereals, milk and low fat dairy products, pulses, fish, meat and poultry is associated with a lower risk of depression.

Increased intake of folate was also associated with a decreased risk of depression because low folic acid levels leads to low same (s-adenosylmethionine), which increases symptoms of depression. By improving folic acid status, same increases, and depressive symptoms drop. Vegetables, fruits, berries, whole-grains, meat and liver are the most important dietary sources of folate.

In addition, coffee and tea also act as anti-depressants to an extent because caffeine promotes the production of dopamine (a neurotransmitter released by the brain) which is responsible for the feeling of well being and happiness. But the amount of caffeine consumed should not be more than 300mg per day as caffeine is an addictive substance.

Omega 3-fatty acids, which are found in vegetable oil, nuts and fish oil, increase the level of serotonin (known as the happy hormone), which reduces the level of depression. Not only this, essential amino acids like tryptophan play a role in the formation of serotonin. Meat, fish, beans and eggs are good sources of essential amino acids.

Having refined carbohydrate and processed foods increases your blood sugar levels and does not provide any kind of nutrient to the body and brain. It even utilizes the mood enhancing vitamin b. Sugar also diverts the supply of another nutrient involved in mood enhancing, chromium. The best way to lower your sugar level is to have food low on the glycemic index.

Lastly, vitamin d deficiency may cause depression because vitamin d is responsible for brain development. So consume vitamin d rich foods such as egg, mushrooms, fish etc.

Depression is one of the leading health challenges in the world and its effect on public health, economics and quality of life are enormous. Not only the treatment of depression, but even the prevention of depression needs new approaches. Change in dietary and lifestyle factors are one of the possible approaches.

2 people found this helpful

For e.g.l lost somebody close last year and since then feel very depressed and prefer keeping to myself all the time. Please help me.

MBBS, MD - Psychiatry
Psychiatrist, Delhi
For e.g.l lost somebody close last year and since then feel very depressed and prefer keeping to myself all the time....
Persistent sadness, irritability, keeping to the self ,loneliness, decreased interest in surroundings, impaired concentration could be due to depression. It is a common condition. It can be treated using both pharmacological and non pharmacological measures. Do not shy away, seek help.
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Hello actually I am feel anxiety all the time also I don't have friends actually I expect the way I treat them they should treat me but that doesn't happens and whoever comes do not stay much my first weakness is that I get attached to anybody very easily it is very घबराहट type in my body.

Reparenting Technique, BA, BEd
Psychologist, Bangalore
Hello actually I am feel anxiety all the time also I don't have friends actually I expect the way I treat them they s...
I am afraid that you may be suffering from the rejection issue wherein you feel unwanted and also abandoned, and suffer separation anxiety. This can complicate your whole life. There must have been some incident in your early childhood that may have provoked this feeling: be it true or not. It is however possible to resolve this by learning to accept yourself and love yourself. The rejection issue will make you feel like you do not belong, although externally there may be all the signs that they do love you. It is your perception based on some incident in childhood that is influencing this feeling. The perception is more important than the actual event. You must do all kinds of loving things for yourself. That includes respecting your life, health and well being. Do not frequent people or places or situations where you are not wanted. You must exercise daily, eat a good diet and sleep well. Your identity is also something to work on. In the meantime, do a personality development course; attend workshops and conferences and talks to further your growth. The more educated you become, the more confidence you will develop. Generally meet more people and gradually learn to dispel all fear around them: they are also sometimes equally afraid of others!
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I am taking 1 nexito plus tab every night from last six month for my anxiety related problem, now how can I withdraw this medicine, please give advice, I tried to leave it but anxiety increased after leaving this tablets.

BSc
Ayurveda, Ujjain
I am taking 1 nexito plus tab every night from last six month for my anxiety related problem, now how can I withdraw ...
First reduce dose 1/2 for one week than 1/4 tablet for 2 weeks than 1/4 tablet AlterNet day for 1 week than 1/4 tablet once in a week than AlterNet in a week than stop .For maintain if you required than take 1/4.Dr. Tare.
1 person found this helpful
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Hello doctor. I don't know whether I'm right or wrong. 7 years competed to my married life in this April. But in that 7 years. Starting 5 years had lots of problems in relation due to family, due to financial and lot of responsibilities in his shoulders. So we live separately I'm in my home for my studies and he in his job place. He comes once a week or month to see me. Afterwards I complete my diploma. I got job. So he take me with him to his job place. But we live for 1 week then again separate then after 1 year he come back and try to contact me. So I thought may be it's new beginning. He changes a lot, so we decided to go somewhere for 3 4 days. So on that days when I go bath he check my mobiles and social chats. So I too ask him his mobile. So when I check it he throughly chatting with his office girls and in his other history and all when check it all porn sites. I totally get upset. I scold him his colleagues. He say sorry he promised again not do all that. From that situations and now we have 14 months baby. He is good now. But the problems is that I never forget that incident of girls and his watching that kind of videos. I always doubting him that he again like that and I also fight regarding past. He change a lot for me but I cannot able till now. Always have doubt in him.

MBBS, MD - Psychiatry
Psychiatrist, Chennai
Hello doctor. I don't know whether I'm right or wrong. 7 years competed to my married life in this April. But in that...
Hi lybrate-user Don't worry. It happens in most of the marriages. Success of marriage is not depends on what you sacrifice for him and what he sacrificed for you. It always lies on UNDERSTANDING AND ACCEPTING. Try to understand him holistically both his positives and negatives. Try to accommodate his negatives. Having negatives is not a weakness but failure to aware one negatives is a weakness. Make him to accept his negatives. Then there won't be any problem. If there would be no problem between you peoples then nobody can enter between you. All the best.
1 person found this helpful
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I feel really lonely. I lost my concentration and l always thinking negatively. I can't change my thoughts. Daily I lost my sleep .My mind thinking continuously about some other thoughts and I can't sleep. Please help me to sleep.

MBBS
General Physician, Madhubani
I feel really lonely. I lost my concentration and l always thinking negatively. I can't change my thoughts. Daily I l...
Just you have to change your routine. Do morning brisk walking. Evening you can join gym. Keep urself busy with people. For further management you can contact me.
2 people found this helpful
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He is having anxiety attack sometimes recurrent with intervals and that also depends it could months gap or weeks gap or days gap. please guide with proper medication.

PhD Psychology
Psychologist, Bangalore
He is having anxiety attack sometimes recurrent with intervals and that also depends it could months gap or weeks gap...
Dear lybrate-user: The patient needs to be assessed for underlying psychological factors. Developmental history and personality factors also need to be evaluated. If the anxiety attack seems sudden, with no apparent situational correlates, you need to check for signs of panic attack. If the diagnosis is panic attack, then treatment may be done either by a psychiatrist or by an experienced psychologist with therapeutic skills in managing anxiety disorder and panic attack.
1 person found this helpful
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I was smoking from past 3 years and now I stopped and switched to vape. I would like to know if vape is still dangerous for health. Pls help me.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Dear user. I can understand. Smoking e cigarettes are also as dangerous as normal cigarettes. Tobacco is addictive. Cigarette also contains 4000+ carcinogenic chemicals other than nicotine. Smoking can affect your mouth, throat, lungs, heart, stomach and brain in many ways. Cancer is one among the potential diseases smoking can cause. The best method is to leave it and continue with your will power. There are other methods like Nicotine Replacement therapy and pharmacotherapy combined. Nicotine chewing gums too help as an alternative for cigarettes. But still you will need will power. You may consult a physician or deaddiction therapist or a rehabilitation facility for further advice. You can also opt for online deaddiction therapy. Take care.
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I want to improve my memory. But How to improve the memory & Brain power? I want quick learning, quick action by mind.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Dear Lybrate user. I can understand. Memory and mind power depends on three aspects. Understanding, retention and recollection. Recollection is easy if your retention is proper and flawless. Retention is possible when you are able understand what you read or learn. To understand you should have concentration. Concentration comes from effective learning techniques based on creative and active learning. Physical exercise, outdoor games, entertainment, socializing coupled with systematic learning improves your memory and mind power. Vegetables, fruits and nuts are perfect for memory. Brain games like sudoku and jigsaw puzzles helps too. Avocados, Beetroots, Blueberries, Broccoli. Celery, Coconut Oil, Dark Chocolate etc are good for improving concentration and memory. I suggest online education counseling. Take care.
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I am suffering from anxiety depression and mental disorders for last 10 years Now I'm taking sertraline, mirtazapine, petril beta10 and olanzipam 2.5 since 2 years.

Doctor of Homeopathic Medicine (H.M.D.)
Homeopath, Ahmednagar
I am suffering from anxiety depression and mental disorders for last 10 years Now I'm taking sertraline, mirtazapine,...
Anxiety and depression are the mental disorders may be due to stress, strain, fear, disappointment or any major tragedy in the life. We in homoeopathy go into the details of constitutional modalities, milestones in life help us to treat the patient like you. Homoeopathic medicines cures the root cause of the disease and bring back patient to the normal hormony of the life.
1 person found this helpful
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I'm an 18 year old student. I think I have OCD. Whenever I study, I repeat the simplest of the words over and over again until I satisfy myself that it sounds the same and is the same word which I read. It is frustrating to repeat words like "development" in my head to make sure that it is the same word that I'm seeing in my book. The same goes for learning and understanding things. If I don't repeat anything many times and visualise even the simplest thing​, then I get scared that I'm going to forget it and I'm dragged into a vicious cycle of repeating the same stuff. This wastes a lot of my time and decreases my efficiency. Kindly suggest something. Thanks.

MD - Psychiatry
Psychiatrist, Chennai
Obsessive-compulsive disorder (OCD) is a common mental health problem. Symptoms typically include recurring thoughts and repetitive actions in response to the recurring thoughts. A common example is recurring thoughts about germs and dirt, with a need to wash your hands repeatedly to "clean off the germs" repeating something in mind, counting, checking, etc. However, there are many other examples. The usual treatments are cognitive behavioural therapy (CBT), a selective serotonin reuptake inhibitor (SSRI) antidepressant medicine, or both. Treatment often works well to reduce the symptoms and distress of OCD greatly. Consult a psychiatrist. All the best.
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I am 25 years male and I have Pure-O Ocd which gives me intrusive thoughts and anxiety. What is the best treatment for this. Medicines didn't work for me.

MD - Psychiatry
Psychiatrist, Chennai
Give the details and dosage of medications you took before concluding it to be resistant OCD. Obsessive-compulsive disorder (OCD) is a common mental health problem. Symptoms typically include recurring thoughts and repetitive actions in response to the recurring thoughts. A common example is recurring thoughts about germs and dirt, with a need to wash your hands repeatedly to "clean off the germs" However, there are many other examples. The usual treatments are cognitive behavioural therapy (CBT), a selective serotonin reuptake inhibitor (SSRI) antidepressant medicine, or both. Treatment often works well to reduce the symptoms and distress of OCD greatly. Consult a psychiatrist. All the best.
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I have a problem is, I'm getting more angry easily, suppose what I'm saying if they are not following meas its disappointing more to me. I want to handle this situation frequently. Any possibility is there for cure this problem.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Dear lybrate user, Anger and aggression are emotions. Anger comes when you become irritated. Irritation happens when you don't like something, or when something is repeated. As anger is an emotion, it should be vent out. You should be able to throw anger out instead of controlling it. But more perfect will be, know the frustrating situations and stop being emotional. If practiced properly, you will not get irritated at those circumstances at all. Those techniques are much easier to understand. Take care.
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I am depressed. I feel everything around myself is dirty. I have a phobia of cleanliness. I wash my hands several time. I feel sad. every time when someone came to my house, I clean my floor. Please help me.

MD Psychiatry, MBBS
Psychiatrist, Mohali
I am depressed. I feel everything around myself is dirty. I have a phobia of cleanliness. I wash my hands several tim...
Dear lybrate-user, From what you have mentioned, it seems that you are suffering from symptoms of Obsessive Compulsive disorder (OCD). OCD causes symptoms of repeated thoughts, in your case regarding contamination. It could also be doubts. Due to these thoughts, compulsive repeated behaviour results, in your case repeated cleaning and hand washing. In case of doubts, it could be repeated checking behaviour. OCD is a treatable condition. Medications and psychotherapy in form of exposure and response prevention will help you recover from all the symptoms. Please consult a psychiatrist and get yourself evaluated. Accordingly treatment can be initiated. I do hope that you recover completely. Best wishes.
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I overthink a lot. this has reduced my weight. Bcoz of over thinking, I get depressed many times. There is a lot of negativity in my me. It is affecting my health and many relations. I am not able to ignore the things which is not good for me. Lots of unnecessary thoughts are there in my mind.

MD Psychiatry, MBBS
Psychiatrist, Mohali
I overthink a lot. this has reduced my weight. Bcoz of over thinking, I get depressed many times. There is a lot of n...
Dear Ms. lybrate-user, I can understand what you must be going through. Overthinking, negative thoughts are suggesting of underlying depressive and anxiety disorder. You should consult a psychiatrist and get yourself evaluated completely. Depression and anxiety disorders respond well to treatment. Medications and psychotherapy will help you recover. In addition, start exercising daily. Start writing diary daily in order to vent out your feelings and emotions. I do hope that you recover completely. Best wishes.
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