Dr. Manish Jain

While many of us may feel the pressure of appearing in large social gatherings, there are those who feel positively crippled at the very thought of showing up and interacting with many people at a time. There is a difference between the two scenarios where one may down to an introverted nature, and the other may be a symptom of a greater problem like social anxiety disorder. So what exactly is this condition all about? Here is everything you need to know!

Definition: By definition, social anxiety disorder is marked with many issues including the feeling of pressing self-consciousness, as well as anxiety, fear and embarrassment. All of these may be caused in the natural course of everyday interactions as well. It is a condition where the patient cannot cope with normal interactions without the support of medication and therapy.

Symptoms: There are a number of symptoms which can help in recognizing this condition. Constant worry and concern that one may end up humiliated on a public platform or while having the most mundane discussions at work or at a party, is one of the most pressing symptoms of this condition. Further, the patient will also be fearful of offending people he or she may be interacting with. Also, after an interaction or presence at a gathering, one may sit down to analyze the performance in great detail and be constantly critical of the same. Anxiety may also make the patient avoid any kind of social situation in extreme cases.

Causes: There are a number of things that may cause such a condition. The genetic makeup of the patient may make this an inherited condition that may happen if there were one or more people in the direct family who were suffering from this condition. Also, it may be caused due to changes in the amygdala, which is the part of the brain that controls one’s responses to fear. A person with an overactive amygdala may end up feeling more scared than normal of the most everyday things. Social anxiety disorder can also be a learned behaviour which may come up due to environmental issues like being reared by parents who have been severely overprotective of their children.

Treatment: There are many ways of treating this condition. To begin with, one can turn to psychotherapy. With the help of such therapy, the symptoms can be handled with the help of proper discussions and the programming of new ideas into the brain so that the fear and anxiety gradually recede. Cognitive behavioural therapy is one of the most favoured forms of therapy that psychiatrists consider in such cases. Medication like norepinephrine reuptake inhibitors may also be prescribed for the patient so as to control the amygdala. Further, one may also have to sue antidepressants prescribed by a medical practitioner so as to deal with the anxiety and fear on an everyday basis. Also, one may use beta blockers that affect the way adrenaline functions, by curbing the excess production of the same. If you wish to discuss about any specific problem, you can consult a Psychiatrist.

ADHD is one of the commonest behavioral disorders that are found in mostly school going kids. In fact, this kind of trouble might affect kid's ability quite adversely. There are a few signs with the help of which ADHD in kids can be easily detected and some of the commonest ones are emotional turmoil, unfinished tasks, squirm and fidget, low focus careless mistakes and other related ones. 

Both interpersonal relationship and schooling success can be hampered to a great extent with this kind of mental disorder. This is why the kids facing the mentioned signs need to be thoroughly diagnosed medically so that the doctors can recommend best treatments that can provide fastest recovery and that too safely and easily. 

Best tips for tackling ADHD in kids:

1. Setting behavior limits: If you make your kids learn how to lead a disciplined life, then appropriate behavioral limits are established. Arrogant child is mostly exposed towards ADHD. 
2. Staying calm: Child anger should be efficiently controlled otherwise. ADHD cannot be cured. If the kids remain calm and quiet, then only their concentration level will increase, and they can show productive outcomes. 
3. Setting pressure free structure: Sensible routines and scheduled charts are to be prepared so that unwanted risks can be easily avoided. If the kids are under tremendous pressure, then they might face different kinds of behavioral troubles. 
4. Allow kids to make wise choices: If you let your kids free, then only they will be able to take right decisions. Kids with a cool mind can take wise decisions that are very much appropriate for upgrading their performances. 
5. Advocating child: Child advocating is highly needed for maintaining a good and healthy balance. But too much strictness should be avoided so that your kids' behavior can be controlled with ease.  This should be done either by parents or tutors so that they can choose the best direction in life. 
6. Avoid muting any headstrong child: Communicate with your child so that a proper interaction can be maintained. If your child remains silent for too long, then they might face different behavioral troubles. 
7. Acquiring knowledge about ADHD: Both parents and kids should have equal knowledge about ADHD and then only the probable signs can be easily avoided, and the necessary treatments can be known. 
8. Being persistent: Persistent behavior is to be maintained, and if you find any deviation in your kids, then you should take them to a doctor. If you wish to discuss about any specific problem, you can consult a psychiatrist.

Manic depression, also known as bipolar disorder in recent days, is a major mood disorder characterized by hypomanic or manic episodes (deviation from one's usual mood along with abnormally high energy levels). Mania involves sleeplessness, along with psychosis, hallucinations, rage, grandiose delusions or paranoia. Mania or hypomania isn’t usually harmful to the patient and they might exhibit increased capacity for work and creativity. Depressive episodes however, can be debilitating and often life threatening as the person becomes self-destructive and suicidal in many instances. 

The extent of mood swings can vary from extreme to very mild. They can occur progressively or suddenly and might last for few days to weeks. Patients affected by bipolar disorder may experience disturbances in thinking apart from depressive or manic episodes. Distortions of perception and impaired social functioning are also not uncommon. The cause of bipolar disorder is not fully understood like most mental health conditions and is often thought to be hereditary.

The extent of the seriousness of the bipolar symptoms varies from person to person. In some people, the disorder is not full blown and they don’t exhibit all the symptoms. Others who aren’t that lucky might have to be hospitalized multiple times in their lives as the symptoms creep into their work and personal life and make living a normal life a tough challenge. 

Psychotic symptoms such as disorganized thinking, hallucinations and delusions might make a person do things that demand the urgency of hospitalization to keep them safe from their suicidal impulses. These symptoms might need to be urgently addressed by a psychiatrist and with the help of medications, the person might be able to regain control of their lives.

The symptoms of bipolar disorder are many and can be mainly categorized into two (sometimes overlapping) categories of mania or hypomania and depression:

Manic symptoms include: 

1. Grandiose delusions (delusion of grandeur) 
2. Racing thoughts which are often disconnected
3. Sense of euphoria or false elation
4. Irritability without cause
5. Hampered social functioning
6. Increased sexual inclination and risky sexual behavior
7. Hyperactivity
8. Increase in talking volume or speed
9. Impaired judgment
10. Reduced sleep requirements owing to extra energy levels
11. Increased productivity and creativity

Depressive symptoms include:

1. Abnormal eating patterns like over or under-eating to the extent of severe medical complications accompanied by drastic changes in weight
2. Difficulty in concentration, making decisions and remembering
3. Lack of energy or fatigue 
4. Contemplating about death for prolonged periods of time and suicidal behavior
5. Oversleeping, insomnia or early awakening
6. Persistent pessimism 
7. Irritability and restlessness
8. Feeling of hopeless and negative attitude

Mood stabilizers, such as lithium are commonly employed to treat bipolar disorder. Anticonvulsants, benzodiazepines and anti psychotics can also be used in the treatment. Along with medications, support from family and friends is of the utmost importance as they need to help provide all the support required in making the person functional and healthy. If you wish to discuss about any specific problem, you can consult a psychiatrist.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. A person’s mood and emotions can be altered drastically due to bipolar disorder, but they do not have more than one personality. Split personalities problem is more commonly seen in those with personality/dissociative disorders. 

There are four basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior (known as manic episodes) to very sad, “down,” or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

1. Bipolar I Disorder: Defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
2. Bipolar II Disorder: Defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
3. Cyclothymic Disorder (also called cyclothymia): Defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.
4. Other Specified and Unspecified Bipolar and Related Disorders: Defined by bipolar disorder symptoms that do not match the three categories listed above.

The disorder has two strong phases: 1) Bipolar Mania and 2) Depression.

Mania

Mania is a state of heightened energy and euphoria - an elevation of mood. It is in direct contrast to depression. Mania can vary in severity from hypomania, where, in addition to mood and energy elevation, the person shows mild impairment of judgement and insight, to severe mania with delusions and a level of manic excitement that can be so exhausting that hospitalisation is required to control the episode.

The mood, energy and other related symptoms define both mania and hypomania, with psychotic features being an 'add on' component experienced by a sub-set of individuals. 

You have an intense sense of well-being, energy and optimism. It can be so strong that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and - occasionally - dangerous ways.
 
Like depression, it can make it difficult or impossible to deal with day-to-day life. Mania can badly affect both, your relationships and work. When it isn't so extreme, it is called 'hypomania'. In case a person has become maniac, you may notice the following things:

Emotional

• Very happy and excited
• Irritated with other people who don't share your optimistic outlook
• Feeling more important than usual. 

Thinking

• Full of new and exciting ideas
• Moving quickly from one idea to another
• Hearing voices that other people can't hear.

Physical

• Full of energy
• Unable or unwilling to sleep
• More interested in sex

Behaviour

• Making plans that are grandiose and unrealistic
• Very active, moving around very quickly
• Behaving unusually
• Talking very quickly - other people may find it hard to understand what you are talking about
• Making odd decisions on the spur of the moment, sometimes with disastrous consequences
• Recklessly spending your money
• Over-familiar or recklessly critical with other people
• Less inhibited in general.

If you are in the middle of a manic episode for the first time, you may not realise that there is anything wrong, although your friends, family or colleagues will. You may even feel annoyed if someone tries to point this out to you. You increasingly lose touch with day-to-day issues and with other people's feelings. 

Depression

The feeling of depression is something we all experience from time to time. It can even help us to recognise and deal with problems in our lives. In clinical depression or bipolar disorder, the feeling of depression is much worse. It goes on for longer and makes it difficult or impossible to deal with the normal things of life. If you become depressed, you will notice some of these changes:

Emotional

• Feelings of unhappiness that don't go away
• Feeling that you want to burst into tears for no reason
• Losing interest in things
• Being unable to enjoy things
• Feeling restless and agitated
• Loss of self-confidence
• Feeling useless, inadequate and hopeless
• Feeling more irritable than usual
• Thinking of suicide.  

Thinking

• Can’t think positively or hopefully
• Finding it hard to make even simple decisions
• Difficulty in concentrating. 

Physical

• Losing appetite and weight
• Difficulty in getting to sleep
• Waking earlier than usual
• Feeling utterly tired
• Constipation
• Going off sex

Behaviour

• Difficulty in starting or completing things, even everyday chores
• Crying a lot or feeling like you want to cry, but not being able to
• Avoiding contact with other people.

Causes

1. Biological Causes: Experts say that patients with bipolar disorder often show physical changes in their brains. Nobody is sure why the changes lead to the disorder.
2. Genetic Traits: Researchers are involved in finding out whether or not the causes of bipolar disorder arise out of genes and other hereditary factors. If you have a first-degree relative or a sibling who is/was affected by this condition, you would probably have it too.
3. Neurotransmitters: Mood swing disorder is caused by an imbalance in brain chemicals known as ‘neurotransmitters’.

Treatment Methods

1. Initial Treatment: The initial treatment method is to take medications to balance and control the mood swings. After the symptoms are in control, one has to start working with his/her trusted doctor for chalking out an effective and practical long-term treatment procedure.

2. Recovery from substance abuse: Problems related to excessive alcohol and drug abuse are solved by this therapy. Failing this step, this disorder can be unmanageable.

3. Day care treatment: Day care treatment programs can be recommended by your doctor. This treatment method includes counseling and support which keep the bipolar traits under control.

4. Hospitalization: Hospitalization or immediate medical support is recommended in case of suicidal thoughts or when a person starts exhibiting erratic behavior (being psychotic).

5. Medications: Medications include the administration of antipsychotics (such as ziprasidone, olanzapine), antidepressants (usually in combination with a mood stabilizer or an anti-psychotic), mood stabilizers (such as valproic acid, lithium, divalproex sodium) and anti-anxiety medications. If you wish to discuss about any specific problem, you can consult a psychiatrist and ask a free question.

Panic disorder is a serious condition that can strike without any reason or warning and the symptoms last for about 10 minutes, such as; a fear for imminent death or losing control, chills, numbness of toes or fingers, stomach ache problem or nausea, trembling, dizziness, chest pain, shortness of breath and difficulty in breathing.

Over time, a person with panic disorder develops a constant fear of having another panic attack, which can affect daily functioning and general quality of life.

Is it a heart attack or a panic attack?

Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that people think they are having a heart attack. In fact, many people suffering from panic attacks make repeated trips to the doctor or the emergency room in an attempt to get treatment for what they believe is a life-threatening medical problem. While it’s important to rule out possible medical causes of symptoms such as chest pain, heart palpitations, or difficulty breathing, it’s often panic that is overlooked as a potential cause—not the other way around.

What are the causes behind Panic Disorder?

Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger a panic attack.

Panic attacks can also be caused by medical conditions and other physical causes. Panic Disorder usually begins during late adolescence and early adulthood and is twice as common with women as compared to men.

How can Panic Disorder be treated?

1. Psychotherapy- It is a type of counseling wherein trained professionals assist people by discussing strategies for comprehending and stabilizing this disorder.

2. Cognitive Behavioral Theory- Cognitive behavioral theory aims at identifying possible triggers of panic attacks and helps one recognize and change their thought patterns and behaviors that stimulate such behavior.

3. Medication- Anti-depressant medicines are used to cure panic disorders, such as Selective Serotonin Reuptake Inhibitors (SSRI), medications for reducing anxiety and certain cardiovascular medications such as beta-blockers to cope with situational anxiety.

Self-help Tips-

When it comes to panic attacks, professional treatment and therapy can make a big difference. But there are many things you can do to help yourself, too:

1. Learn about panic, read up on anxiety, panic disorder, and the fight-or-flight response experienced during a panic attack.  

2. Avoid smoking and caffeine.

3. Learn how to control your breathing.

4. Practice relaxation techniques regularly like Yoga and meditation.

OCD or obsessive compulsive disorder is a mental condition, which traps people in a cycle of repetitive thoughts that push them to do repetitive behaviors. As the name states, the obsession over certain things compels them to do it over and over again. These actions will only help you feel relieved for a short time and soon the cycle starts back again.

Symptoms of OCD: 

The symptoms of OCD are classified into two groups, one for the obsessive behavior and the other for compulsive behavior. Some of the common symptoms for these are mentioned below:

Obsessive behaviors:

As the name states this means obsessing over certain things, which varies from person to person. Some of the things could be:

1. Being scared about making mistakes
2. The fear of being embarrassed in public situations
3. Constantly being scared about contamination by germs, microbes or dirt
4. Doubts about sure and simple situations and the need to be constantly reassured about them

Compulsive behaviors

The obsessions usually results in compulsive behaviors, which you may need to perform to reassure and relieve yourself of the anxiety temporarily. Some of these may include:

1. Trying to constantly arrange things in a certain way and still not being satisfied
2. Thoughts, words and images being stuck in your head throughout the day that may keep you disturbed and cause to lose sleep
3. You may even repeat specific words or actions multiple times as a measure of self reassurance.
4. Hoarding of items, which have no value

Causes of OCD:

Biological factors: Certain chemical imbalances in the brain may lead to OCD, which may happen due to hormonal or biological changes. In fact certain infections are also known to trigger OCD in people.

Environmental factors: Certain types of mental trauma have been known to trigger OCD as well, such as

1. Office, school, college or other work related stresses over a long period of time
2. The passing away of a near and dear one
3. Relationship problems
4. Repressed abuses from earlier in life

Treatments: 

Most treatments of OCD are categorized into two types:

1. Cognitive behavioral therapy: This is a counseling based therapy where you may be slowly asked to face your fears and overcome them over a period of time.
2. Medications: Antidepressants, inhibitors, or antipsychotic drugs or relaxants in various combinations may be used to treat OCD.
3. Electroconvulsive therapy: Only in the rarest of cases would doctors consider electroconvulsive therapy, if the patient is a danger to themselves or others around them.