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Institute Of Living Cloud Psychiatry Centre

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Bangalore, Karnataka - 560097
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MD - Psychiatry
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Psychiatrist And Opiate Deaddiction And Buprenorphine Replacement Therapy at Online Psychiatry
Sr Consultant Psychiatrist at Institute Of Living Online Clinic
  • MBBS, DPM, Fellow of Academy of General Education (FAGE), FIPS, MD - Psychiatry, MD-PhD, INCEPTOR, MRACGP, BHARAT JYOTI
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS

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    Melanoma of nail unit
    Melanoma of the nail unit is usually a variant of acral lentiginous melanoma (melanoma arising on the palms of the hands and soles of the feet). Other types of melanoma rarely arising under the nails are nodular melanoma and desmoplastic melanoma.
    Melanoma of the nail unit usually affects either a thumb nail or great toenail but any finger or toenail may be involved. The term includes:
    Subungual melanoma (melanoma originating from the nail matrix)
    Ungual melanoma (melanoma originating from under the nail plate)
    Periungual melanoma (melanoma originating from the skin beside the nail plate)
    Who gets melanoma of nail unit?
    Melanoma of the nail unit is rare, accounting for only about 1% melanoma in white-skinned individuals. It arises in people of all races, whatever their skin colour. Although no more common in dark skin than fair skin, it is the most common type of melanoma diagnosed in deeply pigmented individuals. It is most diagnosed between the age of 40 and 70.
    It is not thought to be due to sun exposure. Trauma may be a factor, accounting for the greater incidence in the great toe and thumb.
    What does melanoma of the nail unit look like?
    Subungual melanoma often starts as a pigment band visible the length of the nail plate (melanonychia). Over weeks to months, the pigment band:
    Becomes wider, especially at its proximal end (cuticle)
    Becomes more irregular in pigmentation including light brown, dark brown
    Extends to involve the adjacent nail fold (Hutchinson sign)
    May develop a nodule, ulcerate or bleed
    May cause thinning, cracking or distortion of the nail plate (nail dystrophy).
    However, in up to half of all cases subungual melanoma is amelanotic (not pigmented). Ungual melanoma can form a nodule under the nail plate, lifting it up (onycholysis). It may sometimes look like a wart (verrucous). It is usually painless, but an advanced tumour invading underlying bone may cause severe pain.
    Melanoma of nail unit Melanoma of nail unit Melanoma of nail unit
    © Dr Ph Abimelec – dermatologue, used by DermNet NZ with permission
    Melanoma of the nail unit
    More images of melanoma of the nail unit ...
    How is the diagnosis of nail unit melanoma made?
    Subungual melanoma may be suspected clinically because of a wide (>3mm) new or changing pigment band in a single nail. Dermoscopic examination may reveal more details showing pigmented lines of varying colour, width and spacing. These lines tend to lose their usual tendency to run parallel to each other along the length of the nail. Ungual melanoma forms a non-pigmented lump under the nail plate, eventually resulting in its destruction.
    The diagnosis of melanoma is confirmed by biopsy of the nail matrix and nail bed. It can be a difficult diagnosis requiring examination by expert dermatopathologists. The pathologist should report whether the melanoma is in-situ or invasive. The description of invasive melanoma should include its thickness in millimetres and what level of tissue has been invaded.
    If the clinical diagnosis is subungual haematoma (a purple mark under the nail due to bleeding or bruising), the nail may be observed for a few weeks. Normal-appearing nail should then be seen growing behind the mark. Dermoscopy is helpful, as haematoma does not conform to the band-like pattern of subungual melanoma. However, it must be remembered that melanoma may bleed.
    Other diagnoses that are often considered include onychomycosis (fungal infection), paronychia, pyogenic granuloma and squamous cell carcinoma.
    What is the treatment of melanoma of the nail unit?
    The melanoma must be removed surgically. This requires removal of the entire nail apparatus. Sometimes the end of the finger or toe is amputated.
    Some patients may be offered sentinel node biopsy to determine whether the melanoma has spread to local lymph nodes.
    What is the outlook for patients with melanoma affecting the nail unit?
    The main factor associated with risk of spread of melanoma (metastasis) and death is the thickness of the melanoma at the time of complete excision of the primary tumour. Delay in diagnosis is common with subungual melanoma, particularly when it affects the toe, and some of these tumours have already spread at the time of diagnosis.
    The 5-year survival rate ranges widely from 16% to 87%, depending on the series, with 2 larger series in the 51% to 55% range2.
    Related information
    Chamberlain A. Ng J. Cutaneous melanoma – Atypical variants and presentations. Aust Fam Physician. 2009 Jul;38(7):476-82.
    Ruben BS. Pigmented Lesions of the Nail Unit: Clinical and Histopathologic Features. Seminars in Cutaneous Medicine and Surgery 2010;29(3):148-158
    On DermNet NZ NZNZ:
    Acral lentiginous melanoma
    Superficial spreading melanoma
    Lentigo maligna
    Nodular melanoma
    Desmoplastic melanoma
    Ocular melanoma
    Metastatic melanoma
    Skin cancer
    Other websites:
    Melanome – Dr Ph Abimelec website (French)
    Books about skin diseases:
    See the DermNet NZ bookstore
    Author: Dr Amanda Oakley, Dermatologist, Hamilton NZ.
    Created 2011. Last modified 23 May 2014. © 2015 DermNet New Zealand Trust. You may copy for personal use only. Please refer to our disclaimer and copyright policy.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS

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    Reliable indicators are of great help in the diagnosis of any disease. This fact assumes more importance in the diagnosis of mental illness because a clinician has to depend on interpretation of clues discernible from a patient’s behaviour, including emotional outbursts. Fortunately, researchers from the University of California, San Diego School of Medicine are reported to have identified, for the first time, a biological marker. Their study has been published in the journal EBioMedicine.

    Researchers know that the XIST gene works overtime in female patients with mental illness. They also know that this gene inactivates one of the two copies of the X chromosome in cells that store genetic material. Keeping all this in view, they decided to focus on the identification of biomarkers for mental illness, which would, in turn, facilitate further research paving the way for the development of effective drugs.

    The study was led by Xianjin Zhou, assistant professor in the Department of Psychiatry at UC San Diego School of Medicine and lead author. They carried out their study on 60 lymphoblastoid cell lines from female patients, most of whom were found with a family history of mental illness.

    Results revealed that nearly 50 per cent of the female patients were found to have XIST gene and other genes related to the X chromosome. The team led by Zhou pointed out that a new treatment option for treating mental illness may be to reverse the abnormal activity of the inactive X chromosome in the patients.

    The whole team is optimistic about the results, which have revealed the possibility of early diagnosis of mental illness with a simple blood test. Encouraged by the results, they intend to pursue their research, aimed at finding effective treatment options for mental illness.

  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Yoga and the mind: can yoga reduce symptoms of major psychiatric disorders?

    Yoga does the body good, and according to a new study, it may ease the mind as well.

    Yoga has also become such a cultural phenomenon that it has become difficult for physicians andconsumers to differentiate legitimate claims from hype,? researchers from duke university medical center write in their study, published in the journalfrontiers in psychiatry. In order to explore the widely held belief that practicing yoga can relieve mental stress, the team reviewed more than 100 studies on the effect of yoga and mental health.

    Most individuals already know that yoga produces some kind of a calming effect. Individually, people feel better after doing the physical exercise,? says lead study author Dr. P. Murali doraiswamy, a professor of psychiatry and medicine at duke university medical center. ?mentally, people feel calmer, sharper, maybe more content. We thought it?s time to see if we could pull all [the literature] together ? to see if there?s enough evidence that the benefits individual people notice can be used to help people with mental illness.?
    (more: yoga can help stroke survivors regain their balance)
    their findings suggest that yoga does in fact have positive effects on milddepression and sleep problems, and it improves the symptoms of psychiatric disorders like schizophrenia and adhd among patients using medication.
    the researchers focused on 16 studies that recorded the effects of practicing yoga on mental-health issues ranging from depression, schizophrenia, adhd, sleep complaints and eating disorders to cognitive problems. They found positive effects of the mind-and-body practice for all conditions with the exception of eating disorders and cognition. Those studies involved too few participants or produced conflicting results to draw any meaningful conclusions.
    some of the studies included in the analysis even suggested that yoga might affect the body in ways similar to antidepressants and psychotherapy. For instance, yoga may influence brain chemicals known as neurotransmitters (boosting levels of feel-good agents like serotonin), lower inflammation, reduce oxidative stress and produce a healthier balance of lipids and growth factors ? just as other forms of exercise do.
    (more: we tried this: aerial vinyasa (or upside-down) yoga)
    embracing yoga as a complementary treatment for mental disorders is not uncommon. Yoga is a feature in many veterans? centers throughout the country, backed by research funded by the department of veterans affairs. Thehuffington post reported that many troops use yoga as a form of treatment for ptsd, for example, with companies like warriors at ease training instructors in yoga techniques specifically catered to those in the military. A studypublished earlier this month of 70 active-duty troops found daily yoga eased anxiety and improved sleep.
    the researchers say there?s enough evidence to warrant a larger study on the effects of yoga on mental health, and it should be considered as part of treatment for more disorders. ?many millions of americans are doing yoga and many millions of americans have mental illnesses and are popping psychiatric pills daily. Despite all of this, the vast majority of studies looking at the benefits of yoga are all small studies. We did not come across a single study where there was a coordinated effort done by some large agency to really conduct a large national study,? says doraiswamy.
    (more: does yoga really drive people wild with desire?)
    but while the research is promising, yoga likely won?t be a panacea for mental illness. Nor should patients try to replace their medications with the practice. ?what we are saying is that we still need to do further, large-scale studies before we are ready to conclude that people with mental illnesses can turn to yoga as a first-line treatment,?. ?we are not saying throw away your prozac and turn to yoga. We?re saying it has the promise and potential. If a large national study were done, it could turn out that yoga is just as good and may be a low cost alternative to people with unmet needs.? in the meantime, he says it doesn?t hurt to add yoga to existing treatments so patients can take advantage of any potential benefits.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Stress is the way our bodies and minds react to something which upsets our normal balance in life. Stress is how we feel and how our bodies react when we are fearful or anxious. Some level of stress has some upside to mind and body function to enable us to react in a positive way. Too much stress though, is both harmful to the body and our performance. How much is too much? well, that depends. On you and how you respond.

    It is essential to know how our brain responds to the stimuli which trigger an anxiety response so that you are equipped to deal appropriately with anxiety.

    Let me highlight the key areas of your brain that are involved, and then I will explain what happens inside the brain.

    The thalamus is the central hub for sights and sounds. The thalamus breaks down incoming visual cues by size, shape and colour, and auditory cues by volume and dissonance, and then signals the cortex.

    The cortex then gives raw sights and sounds meaning enabling you to be conscious of what you are seeing and hearing. And i'll mention here that the prefrontal cortex is vital to turning off the anxiety response once the threat has passed.

    The amygdala is the emotional core of the brain whose primary role is to trigger the fear response. Information passing through the amygdala is associated with an emotional significance.

    The bed nucleus of the stria terminals is particularly interesting when we discuss anxiety. While the amygdala sets off an immediate burst of fear whilst the bnst perpetuates the fear response, causing longer term unease typical of anxiety.

    The locus ceruleus receives signals from the amygdala and initiates the classic anxiety response: rapid heartbeat, increased blood pressure, sweating and pupil dilation.

    The hippocampus is your memory centre storing raw information from the senses, along with emotional baggage attached to the data by the amygdala.

    Now we know these key parts, what happens when we are anxious, stressed or fearful?

    Anxiety, stress and, of course, fear are triggered primarily through your senses:

    Sight and sound are first processed by the thalamus, filtering incoming cues and sent directly to the amygdala or the cortex.

    Smells and touch go directly to the amygdala, bypassing the thalamus altogether. (this is why smells often evoke powerful memories or feelings).

    Any cues from your incoming senses that are associated with a threat in the amygdala (real or not, current or not) are immediately processed to trigger the fear response. This is the expressway. It happens before you consciously feel the fear.

    The hippothalmus and pituitary gland cause the adrenal glands to pump out high levels of the stress hormone coritsol. Too much short circuits the cells of the hippocampus making it difficult to organize the memory of a trauma or stressful experience. Memories lose context and become fragmented.

    The body's sympathetic nervous system shifts into overdrive causing the heart to beat faster, blood pressure to rise and the lungs hyperventilate. Perspiration increases and the skin's nerve endings tingle, causing goosebumps.

    Your senses become hyper-alert, freezing you momentarily as you drink in every detail. Adrenaline floods to the muscles preparing you to fight or run away.

    The brain shifts focus away from digestion to focus on potential dangers. Sometimes causing evacuation of the digestive tract thorough urination, defecation or vomiting. Heck, if you are about to be eaten as someone else's dinner why bother digesting your own?

    Only after the fear response has been activated does the conscious mind kick in. Some sensory information, takes a more thoughtful route from the thalamus to the cortex. The cortex decides whether the sensory information warrants a fear response. If the fear is a genuine threat in space and time, the cortex signals the amygdala to continue being on alert.

    Fear is a good, useful response essential to survival. However, anxiety is a fear of something that cannot be located in space and time.

    Most often it is that indefinable something triggered initially by something real that you sense, that in itself is not threatening but it is associated with a fearful memory. And the bed nucleus of the stria terminals perpetuate the fear response. Anxiety is a real fear response for the individual feeling anxious. Anxiety can be debilitating for the sufferer.

    Now that you know how anxiety happens in your brain, we can pay attention to how we can deliberately use our pre-frontal cortex to turn off an inappropriate anxiety response once a threat has passed.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Weakness and fatigue

    If you have generalized weakness and fatigue along with other symptoms, evaluate those symptoms. Home treatment for your other symptoms usually will improve your weakness and fatigue. Mild generalized weakness and fatigue that occur with a viral illness usually improve with the following home treatment measures.

    Get extra rest while you are ill. Let your symptoms be your guide.
    If you have a cold, you may be able to stick to your usual routine and just get some extra sleep.
    If you have the flu, you may need to spend a few days in bed.
    Return to your usual activities slowly to avoid prolonging the fatigue.
    Be sure to drink extra fluids to avoid dehydration.
    If generalized weakness and fatigue are not related to another illness, follow the guidelines in the prevention section and be patient. It may take a while for you to feel energetic again.

    Listen to your body. Alternate rest with exercise. Gradually increasing your exercise may help decrease your fatigue.
    Limit medicines that might contribute to fatigue. Tranquilizers and cold and allergy medicines often cause fatigue.
    Improve your diet. Eating a balanced diet may increase your energy level. Do not skip meals, especially breakfast.
    Reduce your use of alcohol or other drugs, such as caffeine or nicotine, which may contribute to fatigue.
    Cut back on watching television. Spend that time with friends, try new activities, or travel to break the fatigue cycle.
    Get a good night's sleep. This may be the first step toward controlling fatigue.
    Eliminate all sound and light disturbances.
    Do not eat just before you go to bed.
    Use your bed only for sleeping. Do not read or watch tv in bed.
    Get regular exercise but not within 3 to 4 hours of your bedtime.
    For more information, see actionset. Gif insomnia: improving your sleep.

    Symptoms to watch for during home treatment
    Call your doctor if any of the following occur during home treatment:

    New symptoms develop along with the weakness and fatigue.
    Symptoms last longer than 2 weeks.
    Symptoms become more severe or more frequent.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Cocaine Detoxification

    Medical Detoxification is a process that systematically and safely withdraws people from addicting drugs, usually under the care of a physician. Drinking alcohol or using drugs can cause physical dependence over time and stopping them can result in withdrawal symptoms in people with this dependence. The detoxification process is designed to treat the immediate bodily effects of stopping drug use and to remove toxins left in the body as a result of the chemicals found in drugs and/or alcohol.

    While at the present time, no proven pharmacologic therapy for cocaine addiction exists, several kinds of medications have been used in the detoxification of cocaine. Withdrawal from chronic cocaine use produces anxiety, depression and intense cravings for the drug. Several types of medications address these issues in different ways.

    Antidepressant drugs such as desipramine or a combination of phentermine and fenfluramine have been used to reduce cocaine withdrawal symptoms such as anxiety and depression. Benzodiazepines, tranquilizers such as Diazepam, have been used to reverse anxiety induced by cocaine withdrawal. Amantadine, a drug used to treat Parkinson's Disease, may be an effective treatment for cocaine-dependent patients with severe cocaine withdrawal symptoms and may reduce cocaine craving. Bromocriptine, a drug that works on the brain's dopamine system, has been used to decrease the craving for cocaine during detoxification and to reduce mood disturbance.

    Propanolol, a beta-blocker drug used to treat high blood pressure, may be useful for severe cocaine withdrawal symptoms, as it slows down the effects of adrenaline, thereby calming the body's "fight or flight" response to stressful situations. This type of drug has been used to treat general anxiety and anxiety associated with alcohol withdrawal. Propranolol's lessening of symptoms such as palpitations and sweating has helped reduce cocaine craving. Its use, however, is not risk free in patients who have taken cocaine and can be associated with decreased blood flow to the heart and other changes that predispose patients to arrhythmia and a severe increase in blood pressure that can lead to a stroke. Delayed toxic effects are possible. Any use of beta-blockers in this setting requires careful monitoring and caution
  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    How to Improve Your Memory

    Tips and Exercises to Sharpen Your Mind and Boost Brainpower

    Improving Emotional Health
    A strong memory depends on the health and vitality of your brain. Whether you're a student studying for final exams, a working professional interested in doing all you can to stay mentally sharp, or a senior looking to preserve and enhance your grey matter as you age, there are lots of things you can do to improve your memory and mental performance.

    Harnessing the power of your brain

    They say that you can?t teach an old dog new tricks, but when it comes to the brain, scientists have discovered that this old adage simply isn?t true. The human brain has an astonishing ability to adapt and change?even into old age. This ability is known as neuroplasticity. With the right stimulation, your brain can form new neural pathways, alter existing connections, and adapt and react in ever-changing ways.

    The brain?s incredible ability to reshape itself holds true when it comes to learning and memory. You can harness the natural power of neuroplasticity to increase your cognitive abilities, enhance your ability to learn new information, and improve your memory.

    Improving memory tip 1: Don't skimp on exercise or sleep

    Just as an athlete relies on sleep and a nutrition-packed diet to perform his or her best, your ability to remember increases when you nurture your brain with a good diet and other healthy habits.

    When you exercise the body, you exercise the brain

    Treating your body well can enhance your ability to process and recall information. Physical exercise increases oxygen to your brain and reduces the risk for disorders that lead to memory loss, such as diabetes and cardiovascular disease. Exercise may also enhance the effects of helpful brain chemicals and protect brain cells.

    Improve your memory by sleeping on it

    When you?re sleep deprived, your brain can?t operate at full capacity. Creativity, problem-solving abilities, and critical thinking skills are compromised. Whether you?re studying, working, or trying to juggle life?s many demands, sleep deprivation is a recipe for disaster.

    But sleep is critical to learning and memory in an even more fundamental way. Research shows that sleep is necessary for memory consolidation, with the key memory-enhancing activity occurring during the deepest stages of sleep.

    Improving memory tip 2: Make time for friends and fun

    When you think of ways to improve memory, do you think of ?serious? activities such as wrestling with the New York Times crossword puzzle or mastering chess strategy, or do more lighthearted pastimes?hanging out with friends or enjoying a funny movie?come to mind? If you?re like most of us, it?s probably the former. But countless studies show that a life that?s full of friends and fun comes with cognitive benefits.

    Healthy relationships: the ultimate memory booster?

    Humans are highly social animals. We?re not meant to survive, let alone thrive, in isolation. Relationships stimulate our brains?in fact, interacting with others may be the best kind of brain exercise.

    Research shows that having meaningful relationships and a strong support system are vital not only to emotional health, but also to brain health. In one recent study from the Harvard School of Public Health, for example, researchers found that people with the most active social lives had the slowest rate of memory decline.

    There are many ways to start taking advantage of the brain and memory-boosting benefits of socializing. Volunteer, join a club, make it a point to see friends more often, or reach out over the phone. And if a human isn?t handy, don?t overlook the value of a pet?especially the highly-social dog.

    Laughter is good for your brain

    You?ve heard that laughter is the best medicine, and that holds true for the brain and the memory as well as the body. Unlike emotional responses, which are limited to specific areas of the brain, laughter engages multiple regions across the whole brain.

    Furthermore, listening to jokes and working out punch lines activates areas of the brain vital to learning and creativity. As psychologist Daniel Goleman notes in his book Emotional Intelligence, ?laughter?seems to help people think more broadly and associate more freely.?

    Looking for ways to bring more laughter in your life? Start with these basics:

    Laugh at yourself. Share your embarrassing moments. The best way to take ourselves less seriously is to talk about the times when we took ourselves too seriously.
    When you hear laughter, move toward it. Most of the time, people are very happy to share something funny because it gives them an opportunity to laugh again and feed off the humor you find in it. When you hear laughter, seek it out and ask, ?What?s funny??
    Spend time with fun, playful people. These are people who laugh easily?both at themselves and at life?s absurdities?and who routinely find the humor in everyday events. Their playful point of view and laughter are contagious.
    Surround yourself with reminders to lighten up. Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family or friends having fun.
    Pay attention to children and emulate them. They are the experts on playing, taking life lightly, and laughing.
    Improving memory tip 3: Keep stress in check

    Stress is one of the brain?s worst enemies. Over time, if left unchecked, chronic stress destroys brain cells and damages the hippocampus, the region of the brain involved in the formation of new memories and the retrieval of old ones.

    The stress-busting, memory-boosting benefits of meditation

    The scientific evidence for the mental health benefits of meditation continues to pile up. Studies show that meditation helps improve many different types of conditions, including depression, anxiety, chronic pain, diabetes, and high blood pressure. Meditation also can improve focus, concentration, creativity, memory, and learning and reasoning skills.

    Meditation works its ?magic? by changing the actual brain. Brain images show that regular meditators have more activity in the left prefrontal cortex, an area of the brain associated with feelings of joy and equanimity. Meditation also increases the thickness of the cerebral cortex and encourages more connections between brain cells?all of which increases mental sharpness and memory ability.

    Depression and anxiety can also affect memory
    In addition to stress, depression, anxiety, and chronic worrying can also take a heavy toll on the brain. In fact, some of the symptoms of depression and anxiety include difficulty concentrating, making decisions, and remembering things. If you are mentally sluggish because of depression or anxiety, dealing with the problem will make a big difference in your cognitive abilities, including memory.

    Improving memory tip 4: Eat a brain-boosting diet

    Just as the body needs fuel, so does the brain. You probably already know that a diet based on fruits, vegetables, whole grains, ?healthy? fats (such as olive oil, nuts, fish) and lean protein will provide lots of health benefits, but such a diet can also improve memory. But for brain health, it?s not just what you eat?it?s also what you don?t eat. The following nutritional tips will help boost your brainpower and reduce your risk of dementia:

    Get your omega-3s. More and more evidence indicates that omega-3 fatty acids are particularly beneficial for brain health. Fish is a particularly rich source of omega-3, especially cold water ?fatty fish? such as salmon, tuna, halibut, trout, mackerel, sardines, and herring. In addition to boosting brainpower, eating fish may also lower your risk of developing Alzheimer?s disease. If you?re not a fan of seafood, consider non-fish sources of omega-3s such as walnuts, ground flaxseed, flaxseed oil, winter squash, kidney and pinto beans, spinach, broccoli, pumpkin seeds, and soybeans.
    Limit calories and saturated fat. Research shows that diets high in saturated fat (from sources such as red meat, whole milk, butter, cheese, cream, and ice cream) increase your risk of dementia and impair concentration and memory. Eating too many calories in later life can also increase your risk of cognitive impairment. Talk to your doctor or dietician about developing a healthy eating plan.
    Eat more fruit and vegetables. Produce is packed with antioxidants, substances that protect your brain cells from damage. Colorful fruits and vegetables are particularly good antioxidant "superfood" sources. Try leafy green vegetables such as spinach, kale, broccoli, romaine lettuce, chard, and arugula, and fruit such as bananas, apricots, mangoes, cantaloupe, and watermelon.
    Drink green tea. Green tea contains polyphenols, powerful antioxidants that protect against free radicals that can damage brain cells. Among many other benefits, regular consumption of green tea may enhance memory and mental alertness and slow brain aging.
    Drink wine (or grape juice) in moderation. Keeping your alcohol consumption in check is key, since alcohol kills brain cells. But in moderation (around 1 glass a day for women; 2 for men), alcohol may actually improve memory and cognition. Red wine appears to be the best option, as it is rich in resveratrol, a flavonoid that boosts blood flow in the brain and reduces the risk of Alzheimer?s disease. Other resveratrol-packed options include grape juice, cranberry juice, fresh grapes and berries, and peanuts.
    For mental energy, choose complex carbohydrates
    Just as a racecar needs gas, your brain needs fuel to perform at its best. When you need to be at the top of your mental game, carbohydrates can keep you going. But the type of carbs you choose makes all the difference. Carbohydrates fuel your brain, but simple carbs (sugar, white bread, refined grains) give a quick boost followed by an equally rapid crash. There is also evidence to suggest that diets high in simple carbs can greatly increase the risk for cognitive impairment in older adults. For healthy energy that lasts, choose complex carbohydrates such as whole-wheat bread, brown rice, oatmeal, high-fiber cereal, lentils, and whole beans. Avoid processed foods and limit starches (potato, pasta, rice) to no more than one quarter of your plate.

    Improving memory tip 5: Give your brain a workout

    By the time you?ve reached adulthood, your brain has developed millions of neural pathways that help you process and recall information quickly, solve familiar problems, and execute familiar tasks with a minimum of mental effort. But if you always stick to these well-worn paths, you aren?t giving your brain the stimulation it needs to keep growing and developing. You have to shake things up from time to time! Try taking a new route home from work or the grocery store, visiting new places at the weekend, or reading different kinds of books.

    Memory, like muscular strength, requires you to ?use it or lose it.? The more you work out your brain, the better you?ll be able to process and remember information. The best brain exercises break your routine and challenge you to use and develop new brain pathways. Activities that require using your hands are a great way to exercise your brain. Playing a musical instrument, juggling, enjoying a game of ping pong (table tennis), making pottery, knitting, or needlework are activities that exercise the brain by challenging hand-eye coordination, spatial-temporal reasoning, and creativity.

    The brain exercise you choose can be virtually anything, so long as it meets the following three criteria:

    It?s new. No matter how intellectually demanding the activity, if it?s something you?re already good at, it?s not a good brain exercise. The activity needs to be something that?s unfamiliar and out of your comfort zone.
    It?s challenging. Anything that takes some mental effort and expands your knowledge will work. Examples include learning a new language, instrument, or sport, or tackling a challenging crossword or Sudoku puzzle.
    It?s fun. Physical and emotional enjoyment is important in the brain?s learning process. The more interested and engaged you are in the activity, the more likely you?ll be to continue doing it and the greater the benefits you?ll experience. The activity should be challenging, yes, it should also be something that is fun and enjoyable to you. Make an activity more pleasurable by appealing to your senses?playing music while you do it, or rewarding yourself afterwards with a favorite treat, for example.
    Use mnemonic devices to make memorization easier

    Mnemonics (the initial ?m? is silent) are clues of any kind that help us remember something, usually by helping us associate the information we want to remember with a visual image, a sentence, or a word.

    Mnemonic device Example
    Visual image ? Associate a visual image with a word or name to help you remember them better. Positive, pleasant images that are vivid, colorful, and three-dimensional will be easier to remember.
    To remember the name Rosa Parks and what she?s known for, picture a woman sitting on a park bench surrounded by roses, waiting as her bus pulls up.
    Acrostic (or sentence) - Make up a sentence in which the first letter of each word is part of or represents the initial of what you want to remember.
    The sentence ?Every good boy does fine? to memorize the lines of the treble clef, representing the notes E, G, B, D, and F.
    Acronym ? An acronym is a word that is made up by taking the first letters of all the key words or ideas you need to remember and creating a new word out of them.
    The word ?HOMES? to remember the names of the Great Lakes: Huron, Ontario, Michigan, Erie, and Superior.
    Rhymes and alliteration - Rhymes, alliteration (a repeating sound or syllable), and even jokes are a memorable way to remember more mundane facts and figures.
    The rhyme ?Thirty days hath September, April, June, and November? to remember the months of the year with only 30 days in them.
    Chunking ? Chunking breaks a long list of numbers or other types of information into smaller, more manageable chunks.
    Remembering a 10-digit phone number by breaking it down into three sets of numbers: 555-867-5309 (as opposed to5558675309).
    Method of loci ? Imagine placing the items you want to remember along a route you know well or in specific locations in a familiar room or building.
    For a shopping list, imagine bananas in the entryway to your home, a puddle of milk in the middle of the sofa, eggs going up the stairs, and bread on your bed.
    Tips for enhancing memory and learning skills

    Pay attention. You can?t remember something if you never learned it, and you can?t learn something?that is, encode it into your brain?if you don?t pay enough attention to it. It takes about eight seconds of intense focus to process a piece of information into your memory. If you?re easily distracted, pick a quiet place where you won?t be interrupted.
    Involve as many senses as possible. Try to relate information to colors, textures, smells, and tastes. The physical act of rewriting information can help imprint it onto your brain. Even if you?re a visual learner, read out loud what you want to remember. If you can recite it rhythmically, even better.
    Relate information to what you already know. Connect new data to information you already remember, whether it?s new material that builds on previous knowledge, or something as simple as an address of someone who lives on a street where you already know someone.
    For more complex material, focus on understanding basic ideas rather than memorizing isolated details. Practice explaining the ideas to someone else in your own words.
    Rehearse information you?ve already learned. Review what you?ve learned the same day you learn it, and at intervals thereafter. This ?spaced rehearsal? is more effective than cramming, especially for retaining what you?ve learned.
    5 Simple Tricks to Sharpen Thinking and Memory Skills

    Using these memory-enhancing techniques can help improve your ability to learn new information and retain it over time.

    1. Repeat

    One of the golden rules of learning and memory is repeat, repeat, repeat. The brain also responds to novelty so repeating something in a different way or at a different time will make the most of the novelty effect and allow you to build stronger memories. Examples of using repletion include:

    Taking notes.
    Repeating a name after you hear it for the first time.
    Repeating or paraphrasing what someone says to you.
    2. Organize

    A day planner or smart phone calendar can help you keep track of appointments and activities and can also serve as a journal in which you write anything that you would like to remember. Writing down and organizing information reinforces learning.

    Try jotting down conversations, thoughts, experiences.
    Review current and previous day?s entries at breakfast and dinner.
    If you use a planner and not a smart phone, keep it in the same spot at home and take it with you whenever you leave.
    3. Visualize

    Learning faces and names is a particularly hard task for most people. In addition to repeating a person?s name, you can also associate the name with an image. Visualization strengthens the association you are making between the face and the name. For example:

    Link the name Sandy with the image of a beach, and imagine Sandy on the beach.
    4. Cue

    When you are having difficulty recalling a particular word or fact, you can cue yourself by giving related details or ?talking around? the word, name, or fact. Other practical ways to cue include:

    Using alarms or a kitchen timer to remind you of tasks or appointments.
    Placing an object associated with the task you must do in a prominent place at home. For example, if you want to order tickets to a play, leave a newspaper ad for the play near your telephone or computer.
    5. Group

    When you?re trying to remember a long list of items, it can help to group the items in sets of three to five, just as you would to remember a phone number. This strategy capitalizes on organization and building associations, and helps to extend the capacity of our short-term memory by chunking information together instead of trying to remember each piece of information independently. For example:

    If you have a list of 15 things on your grocery list, you can group the items by category, such as dairy, produce, canned goods, and frozen foods.
    Adapted with permission from Harvard Health Letter: July 2014, a special health report published by Harvard Health Publications.

    More help for memory

    Age-Related Memory Loss ? How to Keep Your Memory Sharp as You Age
    Alzheimer's and Dementia Prevention ? How To Reduce Your Risk and Protect Your Brain as You Age
    Understanding Dementia ? Signs, Symptoms, Types, and Treatment
    What?s Causing Your Memory Loss? ? It's Not Necessarily Alzheimer?s
    Healthy Lifestyles

    Easy Ways to Start Exercising ? Making Exercise a Fun Part of Your Everyday Life
    How to Sleep Better ? Tips for Getting a Good Night?s Sleep
    Stress Management ? How to Reduce, Prevent, and Cope with Stress
    Relaxation Techniques for Stress Relief ? Finding the Relaxation Exercises That Work for You
    Healthy Eating ? Easy Tips for Planning a Healthy Diet and Sticking to It
    Staying Healthy As You Age ? How to Feel Young and Live Life to the Fullest
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Pharmacological Treatments to Help Quit Smoking

    Why is it so hard to quit smoking?
    You have probably heard this before: "Smoking is so bad for you. Why do you do it"

    People start smoking for different reasons. They might think it will help calm their nerves, make them look more mature, or maybe at the time it just seemed sort of adventurous. Looking back, it was not the best choice. Many people really want to quit, but why is quitting so hard?

    It is hard to quit smoking because the nicotine in cigarettes, cigars, and other tobacco products gets you hooked and keeps you hooked. Most people try as many as three times to quit before they are able to do so. Look at smoking cessation as a process instead of a one-time event. That way, if you do slip, you can focus on what you can do differently to prevent future slips and relapse. Don?t give up?you will get there.

    You have probably heard a lot about how smoking is harmful, but here are some positive things you can look forward to when you do quit.

    If you quit, you will:

    Prolong your life
    Improve your health
    Feel healthier (Smoking can cause coughing, poor athletic ability, and sore throats.)
    Look better (Smoking can cause face wrinkles, stained teeth, and dull skin.)
    Improve your sense of taste and smell
    Save money (Most smokers spend about $90 a month on cigarettes.)
    Smoking increases complications for those who have diabetes.

    While smoking can increase your chances of getting diabetes, it can also make managing diabetes more difficult for those who already have it. Smoking-related complications of diabetes could include retinopathy (eye disease), heart disease, stroke, vascular disease, kidney disease, nerve damage, and/or foot problems.

    What options do people have?
    Some people try quitting on their own before they go to their doctor, but your doctor can be very helpful. He or she may offer tips and suggest medicines, both prescription and over-the-counter, to help you "kick the habit" It is also important to tell your doctor what types of products you might use or are using to quit smoking. The doctor can make sure that suggested products will not interact with other medicines you are already taking. Remember, there is no "magic bullet" when it comes to quitting smoking. Quitting requires persistent effort.

    Over-the-Counter Medicines
    Nicotine-based medicines
    Over-the-counter medicines that contain nicotine can be very helpful in fighting off cravings. These products will not remove all cravings, but you can use them instead of smoking to reduce your nicotine intake gradually and ease off of its addictive effects.

    When you give your body a steady dose of nicotine all the time and then stop suddenly, you will have more side effects (withdrawal symptoms) that usually make quitting a lot harder. Withdrawal symptoms include irritability, headache, and the craving to smoke. Go slow and lower the dose gradually with nicotine-based products until you feel you are able to resist the cravings on your own. You will still have cravings, but they will be weaker. It is very important to have some form of social support when you decide to quit, no matter if you use products or not. Support can come from your doctor, counselor, support group, close friend, or a family member.

    When considering a nicotine-based product to help you quit, be sure to tell your doctor about any conditions you might have, especially:

    Asthma or breathing problems
    Heart or blood vessel disease
    High blood pressure
    Stomach ulcer
    Diabetes mellitus
    Kidney disease
    Liver disease
    Overactive thyroid
    Pheochromocytoma (PCC)
    Over-the-counter treatments are typically used for up to 12 weeks as part of a smoking cessation program.

    Additional things to consider when taking nicotine-based medicines

    Do not smoke while you are using the nicotine-based medicines. You could risk overdosing on nicotine.
    Tell your doctor about any medicines you are taking or any allergies you have.
    Do not use the nicotine-based medicines if you are breastfeeding, are pregnant, or think you might be pregnant.
    Keep this and all medicines out of the reach of children and pets.
    Common brand names of the nicotine patch, gum, and lozenge include:

    Nicorelief� (gum)
    Nicorette� (gum)
    NicoDerm� CQ� (patch)
    Commit� (lozenge)
    Transdermal nicotine patch
    The patch is worn directly on the skin. Nicotine passes through the skin into your bloodstream. Some brands have patches with different strengths so you can gradually reduce your dosage. Nicotine patches are available without a prescription. If you are not sure what kind of patch to use, ask your doctor.

    Always follow the instructions on the box, but here are some things to remember when using the nicotine patch:

    Patches are supplied in child-resistant pouches; save the pouch for disposal of the patch.
    Find a clean, dry part of the skin to apply it. Somewhere on your upper arm or torso usually works best. Try to find an area that has little hair and is without scars, cuts, burns, or rashes.
    Right before applying the patch, wash your hands and the skin area with plain soap and water and dry completely. Avoid using any soap, lotion, hand cream, tanning lotion or oil, bath oil or insect repellent that contains aloe, lanolin or glycerin as a moisturizer since these agents can leave a moisturizing film on your skin, which can potentially interfere with the adherence of the patch.
    When you have finished applying or removing the patch, wash your hands with water only.
    Do not try to adjust the dosage by cutting the patch into sections.
    Leave the patch on, even while bathing or swimming. If it falls off, do not try to re-apply it. Use a new one
    Remove the patch according to the instructions on the box (usually after 16 to 24 hours).
    Dispose by folding sticky ends of the patch together and putting in pouch.
    When applying a new patch, choose a different place than before. Do not use the patch in the same place for at least a week.
    Do not leave the patch on for longer than directed.
    Remove the patch if you are going to do rigorous exercise. This might cause more nicotine to pass into your bloodstream.
    If you are unsure how to use the product, be sure to ask your doctor or pharmacist to explain.
    Remove the patch if you are having a magnetic resonance imaging (MRI) scan. Nicotine patches contain aluminum.
    If you have vivid dreams or other sleep disturbances, try removing the patch at bedtime and applying a new one in the morning.
    Common side effects of the nicotine patch:

    Increased appetite
    Mild headache
    Irritation at the site of the patch, including itching, burning, or redness
    There are other common or more serious side effects. Please read the information that comes with the product carefully, and be sure to contact your doctor if you have any questions.

    Nicotine gum
    Nicotine gum, like the patch, is a systemic way to receive nicotine. This means that the nicotine in the gum passes from the lining of your mouth right into your bloodstream. Like the patch, you will decrease the dosage during the recommended time (usually 12 weeks or sooner) if you are able to resist cravings on your own. Nicotine gum is sold without a prescription.

    Always follow the instructions on the box, but here are some things to remember when using nicotine gum:

    Use nicotine gum only when you feel the urge to smoke.
    Slowly chew the gum until you begin to taste it or feel a tingling sensation in your mouth. Then stop chewing and park it between your cheek and gum. This helps release the nicotine. When the taste or tingling is almost gone, repeat these two steps for 30 minutes.
    Use only one piece at a time.
    Do not drink beverages (e.G, soft drinks, tea, coffee, and fruit juices) or eat food 15 minutes before or while chewing the gum.
    Gradually decrease the number of pieces of gum you chew per day, until you reach three to six pieces per day. Some people can do this in less than 12 weeks. Do not chew more than twenty-four pieces in 1 day.
    Try to have the nicotine gum handy at all times. You might try hard candy or using regular gum, if the nicotine gum is not available.
    Nicotine gum can be difficult to use if you have dentures.
    Common side effects of nicotine gum:

    Belching (burping), gas, or heartburn
    Increased appetite
    Mild headache
    Watery mouth
    Jaw or muscle pain or fatigue
    Sore mouth or throat
    There are other common or more serious side effects. Please read the information that comes with the product carefully and be sure to contact your doctor if you have any questions.

    Nicotine lozenge
    A nicotine lozenge, like the patch and gum, is a systemic way to receive nicotine. This means that the nicotine in the lozenge passes from the lining of your mouth right into your bloodstream.

    Always follow the instructions on the box, but here are a few things to remember when using the nicotine lozenges:

    Place the lozenge in your mouth; wait until it dissolves completely; and move it around from time to time without chewing. It takes around 20 to 30 minutes to dissolve.
    Do not take more than one lozenge at a time or continuously use one lozenge after the other, this can cause hiccups, heartburn, or nausea.
    Do not eat or drink 15 minutes prior to, during, or after use.
    Do not use more than five lozenges in 6 hours or more than twenty lozenges in 24 hours.
    Prescription Medicines
    Nicotine nasal spray
    Nicotine that can help you stop smoking also comes in the form of a nasal spray, available only by prescription. Like the patch and the gum, the amount taken is gradually decreased during a period of 12 weeks. It is to be used, like the gum and the patch, as part of a program that also includes support, education, and counseling.

    Nicotrol NS� is one brand of nicotine nasal spray.

    Always follow the instructions on the prescription label. Here are some other things to remember when using nicotine nasal spray:

    Blow your nose prior to use.
    You may gradually reduce your dose of nasal spray by skipping doses or using only half the usual amount.
    Writing down the time you take the nasal spray and how much you take might be very useful when reducing your dose.
    Common side effects of nicotine nasal spray:

    Back pain
    Indigestion or nausea
    Runny nose
    Watery eyes
    A burning feeling in the back of the throat or nose
    The nicotine nasal spray is not recommended for people with reactive airway disorders such as asthma. In addition, caution is urged in patients with chronic nasal disorders.

    There are other common or more serious side effects. Please read the information that comes with the product carefully and be sure to contact your doctor if you have any questions.

    Nicotine inhalant
    A nicotine inhalant?available only by prescription?used for up to 6 months (initial treatment period up to 12 weeks followed by gradual reduction period of up to 12 weeks) can be part of a smoking cessation program. When the inhaler is used, nicotine passes from the lining of the mouth and throat (not the lungs) into the bloodstream. Like other nicotine products, you will decrease the dosage during the recommended time (usually several weeks) or until you are able to resist cravings on your own.

    Nicotrol Inhaler� is one brand name of nicotine inhalant.

    Always follow the instructions on the box, but here are some things to remember when using a nicotine inhalant:

    Store the inhaler in a dry area at room temperature not to exceed 77� F or 25� C.
    Write down the time you take the inhalant and how much you take. This might be very useful when reducing your dose.
    The normal first dose is between six and sixteen cartridges per day.
    Common side effects of nicotine inhalants:

    Mouth and throat irritation
    Stuffy nose or runny nose
    There are other common or more serious side effects. Please read the information that comes with the product carefully and be sure to contact your doctor if you have any questions.

    Bupropion is more commonly seen under the brand names of Zyban� or Wellbutrin�. Zyban is specifically indicated for smoking cessation. It is not a nicotine-based medicine; it is an antidepressant that is only available by prescription. It is prescribed along with counseling and support to aid in smoking cessation. Bupropion might also be used to treat major depressive disorders. It usually takes 2 weeks for bupropion to take effect, so plan to quit smoking 2 weeks after beginning the treatment.

    Before considering bupropion, be sure to inform your physician if you have a history of seizure disorder, bulimia, or anorexia nervosa.

    Bupropion comes in tablets that are to be swallowed whole, not crushed, divided, or altered in any other way. Individual prescription strengths might vary, so if you are taking bupropion, be sure to follow the directions on the label. Ask your doctor or pharmacist any questions you have about how to take it, when to take it, any potential side effects, and the duration of treatment.

    Common side effects of bupropion:

    Dry mouth
    Decreased appetite
    There are other common or more serious side effects. Please read the Medication Guide that comes with the product carefully and be sure to contact your doctor if you have any questions.

    Do not take bupropion if you have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days. Monoamine oxidase inhibitors are used to treat depression. Some examples include: tranylcypromine (Parnate�), phenelzine (Nardil�), and isocarboxazid (Marplan�). There are several products that might interact with bupropion, so be sure to tell your doctor about any over-the-counter and/or prescription medicines, as well as any herbal supplements you are taking.

    While taking bupropion, immediately report any psychological changes (e.G, new onset depression) to your doctor.

    Varenicline (Chantix�)
    Varenicline, also known by the brand name Chantix, is a prescription medication that does not contain nicotine. This medicine helps to reduce the reinforcing effects of nicotine and can minimize the withdrawal effects from nicotine. It is recommended to set a quit date 1 week after initiation of varenicline therapy. Typically, this medication is taken for a minimum of 12 weeks accompanied by smoking cessation counseling. If you have stopped smoking, another 12 weeks of varenicline might be prescribed. If you have not stopped smoking after the first 12 weeks, stop taking this medication and return to your doctor for advice. Varenicline should be taken with food and a full glass (8 ounces) of water.

    Varenicline can interact with over-the-counter and prescription medicines especially insulin, blood thinners, and asthma medications as well as with certain herbal supplements; therefore, it would be important to inform your physician of your entire medication regimen.

    Contact your doctor immediately if you experience any psychological changes (e.G, new onset depression) while taking varenicline.

    Common side effects of varenicline:

    Nausea, which may dissipate over time
    There are other common or more serious side effects. Please read the Medication Guide that comes with the product carefully and be sure to contact your doctor if you have any questions.

    How could research benefit smokers who want to quit?
    Researchers are testing a vaccine that could make quitting a lot less difficult. This type of treatment could potentially be used in a program, along with bupropion (Zyban) and counseling, to significantly reduce withdrawal symptoms.

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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Solutions That Can Save a Relationship.


    All relationship problems stem from poor communication, You can't communicate while you're checking your BlackBerry, watching TV, or flipping through the sports section"


    Even partners who love each other can be a mismatch, sexually,lack of sexual self-awareness and education worsens these problems. But having sex is one of the last things you should give up. "Sex" "brings us closer together, releases hormones that help our bodies both physically and mentally, and keeps the chemistry of a healthy couple healthy"

    Problem-solving strategies:

    Plan, plan, plan.


    Money problems can start even before the wedding vows are exchanged. They can stem, for example, from the expenses of courtship or from the high cost of a wedding.

    Problem-solving strategies:

    Be honest about your current financial situation. If things have gone south, continuing the same lifestyle is unrealistic.Don't approach the subject in the heat of battle. Instead, set aside a time that is convenient and non-threatening for both of you.Acknowledge that one partner may be a saver and one a spender, understand there are benefits to both, and agree to learn from each other's tendencies.Don't hide income or debt. Bring financial documents, including a recent credit report, pay stubs, bank statements,policies, debts, and investments to the table.Don't blame.Construct a joint budget that includes savings.Decide which person will be responsible for paying the monthly bills.Allow each person to have independence by setting aside money to be spent at his or her discretion.Decide upon short-term and long-term goals. It's OK to have individual goals, but you should have family goals, too.Talk about caring for your parents as they age and how to appropriately plan for their financial needs if needed.
    Struggles Over Home Chores

    Most partners work outside the home and often at more than one job. So it's important to fairly divide the labor at home.

    Problem-solving strategies:

    Be organized and clear about your respective jobs in the home, "Write all the jobs down and agree on who does what" Be fair so no resentment builds.Be open to other solutions, she says If you both hate housework, maybe you can spring for a cleaning service. If one of you likes housework, the other partner can do the laundry and the yard. You can be creative and take preferences into account -- as long as it feels fair to both of you.

    Not Making Your Relationship a Priority

    If you want to keep your love life going, making your relationship a focal point should not end when you say "I do" "Relationships lose their luster. So make yours a priority.

    Problem-solving strategies:

    Do the things you used to do when you first met. Show appreciation, compliment each other, contact each other through the day, and show interest in each other. Schedule time together on the calendar, Say "thank you"appreciate" It lets your partner know that they matter.


    Occasional conflict is a part of life. . The same lousy situations keep repeating day after day -- it's time to break free of this toxic routine. When you make the effort, you can lessen the anger and take a calm look at underlying issues.

    Problem-solving strategies:

    You and your partner can learn to argue in a more civil, helpful manner . Make these strategies part of who you are in this relationship.

    Realize you are not a victim. It is your choice whether you react and how you react.Be honest with yourself. When you're in the midst of an argument, are your comments geared toward resolving the conflict, or are you looking for payback? If your comments are blaming and hurtful, it's best to take a deep breath and change your strategy.Change it up. If you continue to respond in the way that's brought you pain and unhappiness in the past, you can't expect a different result this time. Just one little shift can make a big difference. If you usually jump right in to defend yourself before your partner is finished speaking, hold off for a moments. You'll be surprised at how such a small shift in tempo can change the whole tone of an argument.Give a little; get a lot. Apologize when you're wrong. Sure it's tough, but just try it and watch something wonderful happen.

    "You can't control anyone else's behavior. "The only one in your charge is you"


    Trust is a key part of a relationship. Do you see certain things that cause you not to trust your partner? Or do you have unresolved issues that prevent you from trusting others?

    Problem-solving strategies:
    Be consistent.Be on time.Do what you say yent.Be sensitive to the other's feelings. You can still disagree, but don't discount how your partner is feeling.Call when you say you will.Call to say you'll be home late.Carry your fair share of the workload.Don't overreact when things go wrong.Never say things you can't take back.Don't dig up old wounds.Respect your partner's boundaries.Don?t be jealous.Be a good listener.

    Even though there are always going to be problems in a relationship you both can do things to minimize marriage problems, if not avoid them altogether.

    First, be realistic. Thinking your mate will meet all your needs -- and will be able to figure them out without your asking -- is a Hollywood fantasy. "Ask for what you need directly"

    Next, use humor -- learn to let things go and enjoy one another more.

    Finally, be willing to work on your relationship and to truly look at what needs to be done. Don't think that things would be better with someone else. Unless you address problems, the same lack of skills that get in the way now will still be there and still cause problems no matter what relationship you're in.

    Good Luck
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    contact me on mobile
    as it is mandatory regulation by international medical standards to get full details before advising to avoid error and serious health misguidance.
    This is a serious matter in the interest of Indian Nationals.
    If your condition is serious or emergency call ambulance or attend nearest Hospital Emergency.
    In case of breach of any human rights contact me.

    Thanking you.

    Dr Aravinda Jawali
    Consultant Physician Psychiatrist

  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Dementia treatment


    Environmental modifications


    Other therapies

    Treating dementia

    Where possible, the underlying cause of dementia should be treated
    In case the disease cannot be cured, the goal of treatment is to improve and/or control the symptoms of
    A combination of psychotherapy, environmental modifications, and medication is the best approach, but this can still be complemented by other therapies
    Treatment of dementia begins with the treatment of the underlying disease, where possible. The underlying causes of nutritional, hormonal, tumour-caused or drug-related dementia may be reversible to some extent. For many other diseases, such as Alzheimer's disease (AD), no cure has yet been discovered. However, improvement of cognitive and behavioural symptoms can be achieved through a
    combination of appropriate medications and other treatments, including psychotherapy.
    The goal of treatment is to slow down the progression of dementia-related impairments and to control behavioural symptoms, which may be treated with a combination of psychotherapy, environmental modifications, and medication
    Psychotherapy, in particular behavioural approaches, can be used to reduce the frequency or severity of problematic behaviours, such as aggression or socially inappropriate conduct. Identifying what might be triggering a problematic behaviour and then devising an intervention that either changes the person's environment or the caregiver's reaction to the behaviour can be effective. Other strategies may include
    breaking down complex tasks, such as dressing, into simpler steps, or reducing the amount of activity in the environment to avoid confusion and agitation.
    Environmental modifications
    Modifying the environment can increase safety and comfort while decreasing agitation. Home modifications for safety include removal or lock-up of hazards such as sharp knives, dangerous chemicals, and tools. Child-proof latches may be used to limit access. Bed rails and bathroom safety rails can be important safety measures as well. Another example is lowering the hot water temperature, which reduces the risk of burning or disabling the stove and/or using stove childproof knobs may be
    necessary to prevent cooking accidents.
    Medication can be prescribed to reduce dementia symptoms. There are a number of drugs available today for improving brain function. Typically, anti-dementia or other psychotropic drugs are prescribed.
    The more recent anti-dementia agents belong to the so-called acetylcholinesterase inhibitors 3.
    Acetylcholine is one of the chemical substances that allow brain cells to communicate with one another, the so-called neurotransmitters. Research suggests that acetylcholine is reduced in the brain of AD patients. These kinds of drugs prevent acetylcholine being eliminated too quickly, prolonging its ability to conduct chemical messages between brain cells. It could be shown in clinical trials that, with these
    kinds of drugs, the deterioration of the disease could be delayed by at least 12 months. Apart from preserving and partially improving mental capacities, and coping with daily activities, a delayed onset of behavioural disturbances and a reduction in caring time could also be demonstrated.
    Psychotropic drugs 4 can be used as a supportive therapy in the treatment of behavioral problems in dementia. For instance, antipsychotic medications (typically used to treat disorders like schizophrenia) can be effective in reducing persistent aggression, and in patients who have been unresponsive to nonpharmacological approaches, and where there is a risk of harm to themselves or others; however, such
    treatments should be used on a short-term up to six weeks rather than a systematic basis 4
    Anti-anxiety medications (typically used to treat anxiety disorders) can also be prescribed to help treating agitation and restlessness. Likewise, antidepressant medication can be prescribed to alleviate symptoms of depression. Treating depression symptoms is particularly important, as depression makes it harder for a person with dementia to remember things and enjoy life. It also adds to the difficulty of caring for someone with dementia. Significant improvements can be made by treating depression, as the patient's mood and their ability to participate in activities may be improved 5.
    In general, medications should be administered very cautiously to patients with dementia and in the lowest possible effective doses, to minimize side effects. Supervision of taking medications is generally required. With each of these medications, there are associated side effects and risks. Therefore, a careful risk-benefit evaluation should be conducted before treatment initiation and on a regular basis throughout treatment. However, one must bear in mind that these medications do not cure dementia or reverse someone's symptoms. There is no evidence that life is prolonged by taking medications. Rather, these medications can help some patients functioning better for a longer period of time.
    Psychosocial intervention for Alzheimer's disease patients
    Psychosocial interventions can be beneficial to patients suffering from AD. Such treatments generally fall under four categories:
    Behavior-oriented therapies are used most often with patients who exhibit behaviours that are difficult to manage. The therapies consist of changing environmental factors thought to affect the patients and to reduce the patients' behavioral problems. There is some evidence for the benefits of such therapies, but additional clinical trials are necessary.
    Emotion-oriented therapies include options like psychotherapy. They are often used to address issues of memory loss and to improve mood and behavior.
    Cognition-oriented therapies include reality orientation, cognitive retraining and skills focusing on cognitive deficits. This type of treatment provides some improvements, but they are generally short term.
    Stimulation-oriented therapy includes therapies related to pleasurable activities, such as art, music or exercise. Some data demonstrates its relative effectiveness in reducing behavioural problems.
    Other therapies 7
    Other therapies may also help persons with dementia with activities of daily living. Physical therapy may improve mobility by teaching patients to use canes or walkers properly and showing them how to get in and out of chairs or beds. Aroma, music, reminiscence, or occupational therapy, as well as art activities, may be beneficial and have a calming or rewarding effect for the person with dementia.
    Finally, a growing number of herbal remedies, vitamins and other dietary supplements are promoted as treatments for AD and related diseases. They can be appealing to some people as they come from natural ingredients. Although many of these remedies may be possible treatment options, using these drugs as an alternative to or in addition to physician-prescribed therapy raise legitimate concerns. For
    instance, the efficacy, tolerability and safety of these products are not established and need to undergo further scientific testing. Further, they may not be manufactured consistently by all vendors or always contain the ingredients listed on the label. Moreover, herbal and nutritional supplements can interact with prescribed medications in harmful ways. Therefore, no supplement should be taken without first
    consulting a physician or informing the doctor treating the dementia patient.
    Apart from treating the specific symptoms of dementia, it is important to observe the general state of health because a good general condition improves the feeling of well-being and might prevent or delay the onset of the disease.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    The 5 Stages of Loss and Grief

    The 5 Stages of Loss and Grief The stages of mourning and grief are universal and are experienced by people from all walks of life. Mourning occurs in response to an individual’s own terminal illness, the loss of a close relationship, or to the death of a valued being, human or animal.
    In our bereavement, we spend different lengths of time working through each step and express each stage with different levels of intensity. The five stages do not necessarily occur in any specific order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief.

    The death of your loved one might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges: As long as there is life, there is hope. As long as there is hope, there is life.

    Many people do not experience the stages in the order listed below, which is okay. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, it’s more helpful to look at them as guides in the grieving process — it helps you understand and put into context where you are.

    All, keep in mind — all people grieve differently. Some people will wear their emotions on their sleeve and be outwardly emotional. Others will experience their grief more internally, and may not cry. You should try and not judge how a person experiences their grief, as each person will experience it differently.

    1. Denial and Isolation

    The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.

    2. Anger

    As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

    Remember, grieving is a personal process that has no time limit, nor one “right” way to do it.
    The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.

    Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved one’s illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time.

    3. Bargaining

    The normal reaction to feelings of helplessness and vulnerability is often a need to regain control–

    If only we had sought medical attention sooner…
    If only we got a second opinion from another doctor…
    If only we had tried to be a better person toward them…
    Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.

    4. Depression

    Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.

    5. Acceptance

    Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

    Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.

    Coping with loss is a ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolon
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS

    Hyperhidrosis is the condition characterized by abnormally increased sweating/perspiration, in excess of that required for regulation of body temperature. It is associated with a significant quality of life burden from a psychological, emotional, and social perspective. As such, it has been referred to as the 'silent handicap'
    Hyperhidrosis may also be divided into palmoplantar (symptomatic sweating of primarily the hands or feet),


    The cause of primary hyperhidrosis is unknown, although some surgeons claim it is caused by sympathetic over-activity. Nervousness or excitement can exacerbate the situation for many sufferers. Other factors can play a role; certain foods and drinks, nicotine, caffeine, and smells can trigger a response.

    Humectants such as glycerin, lecithin, and propylene glycol, draw water into the outer layer of skin. Glycerin, lecithin, and propylene glycol are found in Vaseline. Hypothetically excessive use of vaseline over time may be one cause of palmar hyperhidrosis, however research needs to be conducted to provide evidence.

    A common complaint of patients is they get nervous because they sweat, then sweat more because they are nervous.
    Aluminium chloride is used in regular antiperspirants. However, hyperhydrosis sufferers need solutions or gels with a much higher concentration to effectively treat the symptoms of the condition. These antiperspirant solutions or hyperhydrosis gels are especially effective for treatment of axillary or underarm regions. Normally it takes around three to five days to see the results. The main secondary effect is irritation of the skin. For severe cases of plantar and palmar hyperhydrosis, there is some success using conservative measures such as higher strength aluminium chloride antiperspirants.[5] Treatment algorithms for hyperhidrosis recommend topical antiperspirants as the first line of therapy for hyperhidrosis. Both the International Hyperhidrosis Society (http://www.Sweathelp.Org) and the Canadian Hyperhidrosis Advisory Committee have published treatment guidelines for focal hyperhidrosis based on evidence based clinical support.

    Injections of botulinum toxin type A, (Botox, Dysport) are used to block neural control of sweat glands.[5][6] The effects can last from 3?9 months depending on the site of injections.[7] This procedure used for underarm sweating has been approved by the U.S. Food and Drug Administration (FDA).[8]

    Prescription medications called anticholinergics, taken by mouth (orally), may be used to treat either generalized or focal hyperhidrosis.Anticholinergics used for hyperhidrosis include propantheline, glycopyrronium bromide, oxybutynin, methantheline, and benztropine. Use of these drugs can be limited, however, by the common side effects of the anticholinergic class?dry mouth, urinary retention, constipation, and visual disturbances such as mydriasis and cycloplegia. Additionally, many of the medications used to treat excessive sweating are not FDA approved for that purpose and are, rather, being used "off label" For people who find their hyperhidrosis is made worse by anxiety-provoking situations (public speaking, stage performances, special events such as weddings, etc.) and want temporary, short-term treatment for the duration of the event, an oral medication/anticholinergic can be of assistance. (Reference: Böni R. Generalized hyperhidrosis and its systemic treatment.

    Several anticholinergic drugs reduce hyperhidrosis. Oxybutynin (brand name Ditropan) is one that has shown promise,[5][10] although it has important side effects, which include drowsiness, visual symptoms and dryness in the mouth and other mucous membranes. A time release version of the drug is also available (Ditropan XL), with purportedly reduced effectiveness. Glycopyrrolate (Robinul) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin and has similar side-effects. Other anticholinergic agents that have tried to include propantheline bromide (Probanthine) and benztropine (Cogentin).

    Non-surgical treatments:
    Iontophoresis was originally described in the 1950s, although the exact mode of action remains elusive
    of 2014,
    the hyperhidrosis treatment device is available in North America, Asia Pacific, and Europe. Treatment with this device is given in a physician's office and results in the thermolysis (destruction by heat) of the sweat glands beneath the underarm skin.

    Hyperhidrosis can have physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin. Hyperhidrosis can also have devastating emotional effects on one?s individual life.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Essential Tremor

    Essential tremor is when you have uncontrolled shaking movements in parts of your body - most commonly the arms and hands. It is more common with increasing age. It tends to occur in families. It is mild in some people but can become severe and disruptive to daily activities in others. There is good treatment available in the form of medication and occasionally surgery.

    What is tremor?
    A tremor is a repetitive movement of a part of the body. It is involuntary. This means that it is generally not controllable and happens without you deciding to move that body part. It is often felt as a trembling or shaking sensation.

    A slight tremor is present in all people. That is called physiological tremor. It may not be noticeable. Certain things will make a physiological tremor more noticeable such as caffeine (in coffee, tea and cola), anxiety or tiredness.

    What is essential tremor?
    Essential tremor is also called familial essential tremor. It is different from physiological tremor described above. It usually starts in the hands and arms. It can sometimes become quite severe so that everyday activities like holding a cup can be difficult. The tremor is usually not there at rest but becomes noticeable when the affected body part is held in a position, or with movement.

    The term 'essential' means that there is no associated disease that causes the tremor.

    What causes essential tremor?
    Essential tremor is known to be familial condition, meaning that it runs in families. At least 5-7 out of 10 people with essential tremor have other members of the family with the same condition. Genes are passed on to a child from each parent and determine what we look like, how our body functions and even what diseases we get. Particular genes have been shown to have certain changes present in families with essential tremor.

    It is not clearly understood how this genetic change leads to essential tremor. However, it is likely that it somehow affects some parts of the brain that are responsible for controlling movement.

    Who has essential tremor?
    Studies have shown different rates of essential tremor. Some have shown it to be present in 3 in 1,000 people, whereas other studies have shown it may affect as many as 5 in 100 people. It is equally common in men and women and is more common with increasing age. Most people who develop essential tremor are aged over 35, but it can occur in younger people.

    What are the symptoms?
    The only symptom in essential tremor is tremor. If you have other symptoms, then you may have a different condition. (For example, tremor can be a symptom of various conditions such as Parkinson's disease. In these other conditions, tremor is just one of several other symptoms.)

    In essential tremor, the tremor usually begins in one arm or hand. Within 1-2 years, the other arm is likely to be affected. Very occasionally, it may also spread to involve the legs. Three in ten people with essential tremor have a tremor of the head. The voice, jaw or face may also be involved.

    At first, the tremor may not be present all the time. Eventually it will be present all the time when the affected body part is held in a position or with certain movements. It may be worse with stress, tiredness, hunger or certain emotions such as anger. Extremes in temperature may also make the tremor more severe.

    You may be able to control the tremor to an extent. It may be less noticeable when you are working with the affected body part. For example, when you use your hand the tremor may ease off. It is not present when you are resting or sleeping.

    Up to 7 in 10 people with essential tremor find that the tremor reduces after drinking some alcohol.

    How is essential tremor diagnosed?
    There is no test to diagnose essential tremor. Your doctor can usually diagnose essential tremor based on your explanation of the tremor and an examination. It is important for the doctor to make sure that there are no other conditions present that are causing tremor. In some cases, this may mean that you need to have some tests to rule out other conditions. For example, blood tests or a brain scan. You may also be referred to a neurologist (a doctor with a special interest and expertise in the brain and nerves).

    Other conditions that can cause tremor and need to be ruled out include: a side-effect from some prescribed medicines, anxiety, caffeine, some poisons, kidney and liver disease, thyroid disease, Parkinson's disease and other movement disorders.

    What is the treatment for essential tremor?
    Essential tremor cannot be cured. Treatment reduces the severity of the tremor, sometimes greatly. There are various treatments that are used.

    No treatment is an option
    If your tremor is mild, you may not need any treatment.

    There are two medicines used initially for essential tremor - propranolol and primidone. These medicines have been shown to ease the tremor in up to 8 in 10 affected people.

    Propranolol - this is a medicine that is usually used in heart disease. It is in a class of medicines called beta-blockers. It has also been shown to be effective in essential tremor. This medicine should be used with care if you have a heart conduction problem or a lung disease such as asthma. The most common side-effects with propranolol are dizziness, tiredness and nausea (feeling sick).

    Primidone - this is a medicine that is primarily used for epilepsy, but it also works very well in essential tremor. The most common side-effects are sleepiness, dizziness and nausea. These may improve if you continue to take this medicine.

    When the diagnosis of essential tremor is made, you may be offered one of these medicines. A low dose is usually started at first, and gradually increased until your tremor is eased. If you reach the maximum dose without a satisfactory improvement, then the other medicine can be tried. If that also doesn't work, you can try them together. Other medicines can be tried if these two are not effective. A wide range of medicines have been shown to have some effect on reducing the severity of the tremor.

    If medicine treatment is not effective, and the tremor is severe, then a surgical procedure may be an option. There are two main surgical procedures that may be considered - thalamotomy and thalamic deep brain stimulation. They both involve the thalamus. This is a deep part of the brain that organises messages travelling between the body and brain.

    Thalamotomy - in this procedure, the thalamus on one side of the brain is destroyed. It has been shown to be very effective. It stops or greatly reduces the tremor in up to 9 out of 10 people with essential tremor. There are risks involved such as a bleed into the brain. Potential side-effects include muscle weakness, speech problems and memory loss. If the thalamus on both sides of the brain is destroyed, there is a higher chance of side-effects. This is not usually recommended.

    Thalamic deep brain stimulation - this procedure involves placing an electrode (fine wire) into the thalamus on one or both sides of the brain. The electrode is connected to a device called a stimulator. The electrode and stimulator stay in the body. (The stimulator is placed under the skin at the top of the chest.) The simulator sends electrical impulses down the electrode to the thalamus. It is not known exactly why this device works. It seems to interrupt or block the nerve signals coming through the thalamus that cause the tremor. If you have this procedure, you will need to have regular reviews to make sure that the stimulator setting is correct. This aims to minimise side-effects and maximise benefit. It may produce a good response in up to 9 out of 10 affected people. Again, there is a small risk that the procedure may cause a bleed into the brain. Side-effects include loss of sensation, speech problems and weakness. These usually resolve when the stimulator settings are adjusted.

    Botulinum toxin injections (Botox®)
    There is some evidence that Botox® injections are helpful in reducing certain tremors. Unfortunately, a Botox® injection into the arm also produces weakness of the arm. This is usually not tolerated. It is mainly useful when essential tremor affects the head and neck.

    Many people find that alcohol is helpful in reducing their tremor. It needs to be used with caution to avoid developing an alcohol problem. It is not advisable to drink more than the normal recommended amount of alcohol. That is: men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week. Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week. Pregnant women, and women trying to become pregnant, should not drink alcohol at all. One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.

    Intermittent treatment
    Some people with essential tremor only wish to have treatment for specific times. For example, prior to going to a social engagement or before a particularly important meeting. In these situations a single dose of propranolol or an alcoholic drink may ease the tremor satisfactorily for the occasion.

    What is the outlook?
    Essential tremor is called a progressive disease. This means that it tends to gets worse over time. It does not shorten expected lifespan and does not lead on to any more serious brain disorders. Some people have a mild tremor which does not affect daily life very much. If your tremor is more severe, it may significantly disrupt your ability to carry out normal activities such as drinking from a cup.

    However, treatments work well to ease the severity of the tremor in most people with essential tremor.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Organic brain syndrome (OBS),

    also known as organic brain disease (OBD) Organic mental disorders organic brain disorder, is an older and nearly obsolete general term from psychiatry, referring to many physical disorders that cause impaired mental function. It does not include psychiatric disorders. Originally, the term was created to distinguish physical (termed "organic") causes of mental impairment from psychiatric (termed "functional") disorders.

    Acute organic brain syndrome is (by definition) a recently appearing state of mental impairment, as a result of intoxication, drug overdose, infection, pain, and many other physical problems affecting mental status. In medical contexts, "acute" means "of recent onset. As is the case with most acute disease problems, acute organic brain syndrome is often temporary?however this is not guaranteed (a recent-onset problem may continue to be chronic or long term). A more specific medical term for the acute subset of organic brain syndromes is delirium
    Chronic organic brain syndrome is long-term. For example, some forms of chronic drug or alcohol dependence can cause organic brain syndrome due to their long-lasting or permanent toxic effects on brain function.[3] Other common causes of chronic organic brain syndrome sometimes listed are the various types of dementia, which result from permanent brain damage due to strokes, Alzheimer's disease, or other damaging causes which are not reversible.

    Though OBS was once a common diagnosis in the elderly, until the understanding of the various types of dementias it is related to a disease process and is not an inevitable part of aging. In some of the older literature, there was an attempt to separate organic brain syndrome from dementia, but this was related to an older world view in which dementia was thought to be a part of normal aging, and thus did not represent a special disease process. The later identification of various dementias as clear pathologies is an example of the types of pathological problems discovered to be associated with mental states, and is one of the areas which led to abandonment of all further attempts to clearly define and use OBS as a term.

    1 Associated conditions
    2 Symptoms
    3 Treatment
    4 Other names
    5 References
    6 External links
    Associated conditions
    Disorders that cause injury or damage to the brain and contribute to OBS include, but are not limited to:

    Alzheimer's Disease
    Attention deficit/hyperactivity disorder
    Fetal alcohol syndrome
    Parkinson's disease
    Intoxication/overdose caused by drug abuse including alcoholism
    Sedative hypnotic dependence and drug abuse[3]
    Intracranial hemorrhage/trauma
    Korsakoff Syndrome
    Psychoorganic syndrome
    Stroke/transient ischemic attack (TIA)
    Withdrawal from drugs, especially sedative hypnotics, e.G. Alcohol or benzodiazepines
    Other conditions that may be related to organic brain syndrome include: clinical depression, neuroses, and psychoses, which may occur simultaneously with the OBS.

    Symptoms of OBS vary with the disease that is responsible. However, the more common symptoms of OBS are confusion; impairment of memory, judgment, and intellectual function; and agitation. Often these symptoms are attributed to psychiatric illness, which causes a difficulty in diagnosis.

    Treatment of OBS varies with the causative disorder or disease. It is important to note that it is not a primary diagnosis and a cause needs to be sought out and treated.

    Other names
    Chronic organic brain syndrome
    Organic mental disorders
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Irritable Bowel Syndrome Treatment

    The medical community has not yet determined the cause for Irritable Bowel Syndrome. A combination of treatments may help a sufferer cope with the symptoms; however given the diverse symptoms of IBS sufferers; diarrhea, constipation, pain, bloating, etc, and it's chronic nature, none of these treatments at present will ultimately cure IBS.
    IBS is a non-life threatening illness. It does not progress or increase your risk of developing Inflammatory Bowel Disease or Cancer. Treatment focuses on the relief of symptoms so you can live your life as normally as possible.

    There is much anecdotal information on the internet as to what may relieve IBS symptoms. We recommend that before starting any new dietary, medical food or over the counter (OTC) remedy, that you consult with your physian. Physician's rely on risk and benefit decisions based on reproducible research data when they suggest a treatment for someone suffering from IBS.

    Based on your physician's diagnosis after the appropriate medical tests, treatment, in our opinion, may be different for those suffering from mild, moderate or severe symptoms; however, they may be summarized as follows.

    Mild: manage stress and make changes to your diet and lifestyle
    Moderate: As per Mild + fiber supplements, over-the-counter (OTC), anticholinergic, or like, medications.
    Severe: As per Moderate + tricyclic or SSRI antidepressants, or 5-HT3 or 5-HT4 or Chloride channel activator or guanylate cyclase-C (GC-C) agonist medication.

    Your physician may recommend one or more or none of these treatments. See your physician for all recommendations for treatment. It is very important to follow-up with your physician. Refer to the medication page for an overview of medications for IBS.

    Role of stress and visceral hypersensitivity
    Role of diet
    Self Care
    Coping Skills
    Alternative Medicine
    Prescription Medical Food

    Specific Treatments Now and the Future:
    Cognitive Behavioral Therapy (CBT) and Hypnosis: There is research evidence that IBS symptoms respond favorably to other therapeutic approaches such as cognitive behavioral therapy (CBT) and hypnosis. As IBS is a chronic condition, with an ongoing fluctuating course, these treatments may help the individual to develop skills for managing the condition over the long haul. Many people with IBS also have a co-existing anxiety or depressive disorder, the symptoms of which also benefit from these types of treatments.
    Probiotics: Probiotics (good bacteria) which contain the strain bifidobacterium infantis 35624 have been shown to relieve abdominal pain, bloating, urgency, constipation or diarrhea. Align and VSL#3 are marketed over-the-counter (OTC) with this strain.
    5-HT3 antagonist: Lotronex (alosetron), is used for the control of pain and diarrhea associated with IBS in women (IBS-D). It was removed from the market at the recommendation of the United States FDA in Nov. 2000 and re-introduced in June 2002.
    5-HT4 receptor agonist: These medications help relieve the symptoms of constipation and pain associated with IBS and constipation (IBS-C), and chronic idiopathic constipation in women. Zelnorm/Zelmac (tegaserod) was approved by the FDA in the United States. Effective April 2, 2008 Zelnorm is only available to patients in the U.S. Under emergency situations.
    Chloride channel activator: These medications help relieve the symptoms of constipation and pain. Amitiza (lubiprostone) was approved by the FDA in the United States for IBS with constipation and chronic idiopathic constipation.
    Guanylate cyclase-C (GC-C) agonist: These medications help relieve the symptons of constipation and abdominal pain. Linzess (linaclotide) was approved by the FDA in the United States for IBS with constipation and chronic idiopathic constipation.
    Antibiotics: There is some research evidence suggesting that IBS symptoms may be caused in part by an abnormal growth of bacteria in the small intestine, referred to as Small Intestinal Bacterial Overgrowth (SIBO). A specific regiment of antibiotics, namely Rifaximin (xifaxan), have been investigated to treat this condition.
    Prescription Medical Food: These products are regulated by the FDA under the Orphan Drug Act and are meant to be used under physician supervision. One prescription medical food is indicated for the clinical dietary management of IBS-D under physician supervision as part of ongoing medical care for a specific condition or disease. Some patients due to chronic conditions, diseases or specific drug therapies have an impaired ability to ingest, digest, absorb, or metabolize food and certain nutrients. This medical food product is prescribed to help people manage their bowel problem.
       7 Thanks
  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Signs and Symptoms Reported by Patients with Chronic Fatigue Syndrome

    Fatigue or exhaustion Double vision
    Headache Sensitivity to bright lights
    Malaise Numbness and/or tingling in extremities
    Short-term memory loss
    Muscle pain Fainting spells
    Difficulty concentrating Light-headedness
    Joint pain Dizziness
    Depression Clumsiness
    Abdominal pain Insomnia
    Lymph node pain Fever or sensation of fever
    Sore throat Chills
    Lack of restful sleep Night sweats
    Muscle weakness Weight gain
    Bitter or metallic taste Allergies
    Balance disturbance Chemical sensitivities
    Diarrhea Palpitations
    Constipation Shortness of breath
    Bloating Flushing rash of the face and cheeks
    Panic attacks Swelling of the extremities or eyelids
    Eye pain Burning on urination
    Scratchiness in eyes Sexual dysfunction
    Blurring of vision Hair loss
  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Understanding the Brainband Mental Illnessbhelping families & friends find better ways
    The biological basis of mental illness
    Mental illness is, in part, an illness of the brain. Learning about the brain can:
    ? give information from a biological and medical perspective (and some idea of its complexity)
    ? help you understand and support treatment
    ? assist you in dealing with the stigmas of mental illness
    ? support the realisation that no one is to blame for the onset of mental illness.
    About brain research
    A lot of what the community commonly thinks and knows about mental illness is based on previous experience and social stigma. It is often information that is out of date and leaves us with an impression of hopelessness. In fact:
    ? Over half of what we know about the brain in relation to mental illness we have learnt in the last 10 years. As a consequence, medications and treatments have improved significantly and people who are now being diagnosed with mental illness have a better prognosis than people diagnosed before that time.
    ? New imaging technology allows the brain to be examined while the person is experiencing mental illness, whereas before we relied on autopsy information.
    ? Research indicates that physical changes commonly occur within the brain in
    mental illness.
    ? The brain pathways responsible for ?higher? mental functioning (feeling emotions, interpreting information) are affected.
    ? The linking of an illness to particular changes in the brain is extremely difficult. (Brain scanning techniques are used alongside assessment of behaviour and symptoms.)
    ? Brain research has already achieved much, and has further capacity to improve medications and other physical treatments.
    What changes in the brain when mental illness is present?
    Like other body parts, the brain is susceptible to injury and change.
    Both the chemical messaging system and the physical structures of the brain can be
    altered in mental illness.
    The chemical, or neurotransmission system in the brain Neurons.The brain is made up of billions of cells called neurons. Each neuron is a link in a chain and can have thousands of connections to other neurons. These connections of neurons form chains through which messages are relayed in the brain.
    The synapse is the meeting point of two neurons. A signal must be transmitted from one neuron across the synapse to the other neuron. These events occur within
    ? Neurotransmitters are the chemicals that conduct the messages across the
    ? When a signal arrives at the end of a neuron, the neurotransmitter spills into the gap and crosses the gap.
    ? Scientists have identified over 50 neurotransmitters that are messengers communicating information from one part of the brain to another, and to all
    parts of the body.
    ? From this simple system, complicated brains are built. And this system seems
    affected in many mental illnesses.
    Neurotransmitter malfunctions can occur because there is:
    ? not enough neurotransmitter
    ? too much neurotransmitter
    ? malabsorption of the neurotransmitter.
    Some important neurotransmitters and their roles are:
    ? dopamine: activation level, mood, movement Understanding the Brain and
    Mental Illness continued.
    ? norepinephrine: mood, activation level
    ? serotonin: mood, sleep, appetite, aggression
    ? acetylcholine: mood, autonomic nervous system.
    Malfunction in these neurotransmitters is found in many forms of mental illness. It is possible that, in biologically vulnerable individuals, high stress levels ?trigger? malfunctioning in neurotransmitters (e.G. Production of neurotransmitters cannot
    keep up with the body?s demands or the neurotransmitters are
    not effectively removed from the system).
    Brain structures
    There is evidence to strongly suggest that some brain structures are altered or damaged in mental illness. It is clear, however, that many parts of the brain are affected by mental illness, including the following:
    Frontal lobe
    The main purpose of the frontal lobe is control of movement
    It is also thought to be responsible for behaviour, character, emotional state, short-term memory and planning.
    Think of the behaviours that are often displayed when someone is psychotic. They often have poor concentration, they can be emotional or lack emotion and display odd behaviours.
    Movement can also be random and disjointed.
    Parietal lobe
    The parietal lobe is involved in:
    ? long-term memory
    ? obtaining and retaining accurate knowledge of objects
    ? sensory speech (responsible for perceiving the spoken word).
    When a person develops certain mental illnesses, these pathways/speech may be affected. Hence someone with schizophrenia, when psychotic, may develop a language of their own or words of their own, called neologisms. Often people?s
    ability to retain information is limited.
    Temporal lobe
    Roles of the temporal lobe include:
    ? auditory (hearing), the area that receives and interprets
    impulses from the inner ear
    ? olfactory (smell), the area that receives and interprets
    impulses from the nose
    ? taste, the area that interprets nerve impulses from the tongue.
    The cells in this area receive and interpret impulses from the various parts of the body, i.E. Nose, taste buds and ear. When someone is psychotic they may be hearing voices, but the parts of the ear usually involved in hearing (the anvil hammer, etc.)
    are not physically moving from sound waves. However, the impulses in the brain are working and sending messages, as if the person is hearing. This also occurs in relation to smell and taste ? people may think the food is being poisoned because it
    tastes different.
    Message Occipital lobe
    The occipital lobe receives impulses from the eye and interprets them as visual impressions. The eyes do not actually do the seeing ? it is the brain that receives the impulses from the eyes and interprets them. When someone experiences visual
    hallucinations, the occipital lobe is seen to be very active ? impulses are interpreted and processed ? thus the person sees objects that may not be present.
    Basal ganglia
    Thought to influence muscle tone ? if control is inadequate, movements are uncoordinated.
    Receives impulses from the body?s sensory nerves associated with pain, temperature, pressure and touch. Here crude, uncritical sensations reach consciousness (e.G. Awareness of pain but not the ability to identify the body part involved). People with schizophrenia may wear lots of clothes on hot days because
    this part of their brain is affected by the illness.
    Involved in the pituitary gland?s orchestration of hormone release and in the autonomic nervous system (hunger, thirst, body temperature, heart and blood vessels, and defensive reactions such as fear and rage).
    The cerebellum
    ? Controls and co-ordinates the movements of various muscle groups to ensure smooth, even and precise actions.
    ? Maintains balance and equilibrium of the body.
    ? Jerky, unco-ordinated movements indicate the involvement of the cerebellum in mental illness.
    The limbic system
    ? Is more a functional than an anatomical entity.
    ? Involves parts of the brain essential for organising emotional responses and processing information.
    ? Is involved in schizophrenia, which affects the emotions of the person and their ability to process information.
    Applying the knowledge ? theories about what happens in the brain relating to
    schizophrenia, depression and obsessive compulsive disorder
    Current research indicates the following theories about what is happening in the brain in relation to schizophrenia:
    There is an excess of the neurotransmitter dopamine. Dopamine is involved in regulating thoughts and feelings, both of which are disturbed in schizophrenia. It is also thought that high dopamine levels make someone more sensitive to stress.
    Research indicates that some people with schizophrenia appear to have larger ventricles. Research also indicates that some people experiencing schizophrenia seem to have a loss of tissue in the anterior hippocampus, which may account for memory problems and irrationality. Recent research carried out in Melbourne seems
    to indicate some people have this tissue reduction before the onset of psychosis, which leads to the hope that results of
    Magnetic Resonance Imaging (MRI) can be used as a predictor
    of schizophrenia.
    In depression, not enough neurotransmitter appears to be released into the gap between neurons, or too much of it is removed before it has completed its function.
    When antidepressants are used, there is more neurotransmitter is available in the gap between neurons, which eases a depressed mood.
    Obsessive compulsive disorder
    Researchers think obsessive compulsive disorder (OCD) may be linked to parts of the basal ganglia involved in fixed patterns of behaviour resulting in an imbalance among a variety of neurotransmitters.
    One hypothesis is that the brain signals for a contaminant (like dirty hands) cause the cortex to send signals to preprogrammed cells in an area of the basal ganglia that produce the neurotransmitter serotonin, with other neurotransmitters also involved.


    In short, we provide this basic information about the brain and mental illness for the following reasons:
    To increase your familiarity with the terms so that when they are described by people in the treating profession, you might recognise them and be able to engage in a discussion that is fruitful for you.
    For you to understand more about some of the behaviours associated with mental illness and their origins.
    Because our experience is that many families when they first come into contact with mental illness believe that it is due solely to a negative psychological experience early in life (that the family may have caused). More information about the biological origins of mental illness gives you an opportunity to revisit these ideas. Mental Illness Fellowship Victoria - for people with mental illness, their families and friends

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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Stop smoking and drinking.
    Cardiovascular risk reduction Programme.
    Do Power Yoga.
    Be natural
    you can avoid medication.
    Diet is drug/Water is medicine.
    Maintain Mental Health by Cleaning your thought.
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  • BHARAT JYOTI, MRACGP, INCEPTOR, MD-PhD, MD - Psychiatry, FIPS, Fellow of Academy of General Education (FAGE), DPM, MBBS
    Keep the passion alive
    Like other parts of your relationship, your sex life needs care and attention if you want to keep it in good condition. Psychosexual therapist Denise Knowles offers some tips on keeping the passion and lust alive in your sexual relationship.
    In the early days of a relationship, sex is full of discovery, intimacy and fun. But as your relationship develops, and you perhaps move in together or have children, other demands of life can mean that your sex life is neglected.
    ?This doesn?t mean you can?t still have a fulfilling and desirable sex life,? ?It just means you need to recognise that this is natural, and that your relationship is changing.?
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