I am Dr. Prasad Shetty here. I am a practicing psychiatrist for the past 20 years and a director of Mumbai Psychiatry Clinics, which is based in Bombay.
Today I will be talking to you two about the concept of a functioning alcoholic, mind you this terminology is not a codable disorder it finds its reference in certain articles on alcoholism. So I'll tell you what do you mean by functional alcoholism or a functional alcoholic.
Normally we use words like alcohol dependence where the patient is dependent on alcohol and without alcohol, his day to day life is a big problem and after stopping alcohol he goes into withdrawal and he goes into delirium tremens and the classical pattern which we see of a patient of alcoholism.
Now there is something known as a functional alcoholic, these are basically people who are working, who are managing their house, they're managing the job well and initially they start with weekend drinking like parties or get-togethers or a social gathering. However over a period of time because of the stressors of day-to-day life or any personal reasons slowly their alcoholism increases. The intake of alcohol increases so instead of weekends they may start taking on weekdays also and most of the times they justify it by saying that I'm stressed out, I have job pressures, I have personal problems, so I am taking some alcohol to relax. They may not drink daily, they may take two or three times a week and sometimes they drink a lot over the weekend then they don't have to go to work.
When confronted they will say that I am earning well, I am going to work daily, I am not bunking my job and I am performing well so if I am functioning well why do you think alcohol is a problem, but when you speak to the relative like their wife or a reliable objective data as we call it, we will come to know that because of his drinking pattern there are certain minor changes in him which he himself does not realize, like for example a little bit of irritability comes in, a little bit of anger comes in.
In Bombay life I can typically give an example if he is driving to work previously if there had been a traffic jam or if someone had tried to overtake him he would not be angry, but nowadays if there is a traffic jam he is not able to wait in the traffic jam or someone shouts he is not able to control his anger so this threshold goes down he starts reacting more and if spoken to his manager, his colleague they will say that he slightly changed, he is functioning at work he is delivering his projects on time, he is doing everything well but he's become a bit snappy and irritable and over a period of time we see that there are changes in his personality both the physical personality and the psychological personality, which he will attribute to stress and work but he will not attribute it to alcohol.
So the biggest problem of a functioning alcoholic is denial. They will not accept that their alcohol has increased and it is overtaking them, they won't say that they're addicted and if told them they will say that I am drinking good scotch liquor, I am doing good whiskey, I am not drinking daily, I am not drinking and falling down, you see the alcoholics around they are creating a commotion, they are beating their wives, they are not going to work, I am a much better person and I know how to handle my personal life and that is the biggest problem with these people who drink and function, but when we do their blood tests at times, when we do their liver function test i.e.LFT, there is a parameter known as the GGPT, the gamma-glutamyl pyruvate transaminase which is an indicator of acute liver damage.
Many a time in these people we need to get the CBC done that is a normal blood count and the other parameters and LFT done with the GGPT and you come to know that the liver is silently suffering some damage. The point is, making these people aware and when they are not convinced through your counseling or talking the blood tests may help you in convincing such people and believing most of these people are very intelligent people that is why they are functioning well at work and they have a good amount of intelligence, they are high-performing guys, so it is very difficult to convince them that they have a disorder.
The biggest danger in functional alcoholics is they may anytime slip over to dependence, like for example at job they have a big setback, they may take to drinking alcohol every day, if there is a death of a dear one in the family they may go to switching to alcohol every day, they suffer a major loss, suppose a major loss in share market or a major loss in investment, they may slip anytime to full-time alcoholism, the only thing they don't realize that they are on the edge. The moment stress or some tension overtakes them they straightaway shift into complete alcoholism and they start drinking daily and that is the time very difficult to control them because like I said they are very intelligent people, they are more intellectual and they are in denial.
So functional alcoholism finds its place, not in textbooks per se and not in this powered textbook of disorders, but it is very well known and this is something which we need to be sensitive about and if you have people around you, I would recommend you to speak to them and tell them to stop it before it becomes a problem, don't wait for it to become a problem.
If you want to know more about this particular topic, if you want to know more about Dr. Prasad Shetty and if you want to know more about Mumbai psychiatric clinics and how to contact us for further knowledge or for further help you can definitely contact us, you can contact us through the Lybrate helpline, there is a Lybrate website so you could definitely approach Lybrate.
I am Dr. Prasad Shetty here. Today I'll try to throw some insights into obsessive-compulsive disorder, a very common disorder in our population but not many people go to the psychiatrist for its treatment. People know about depression, people talk about anxiety, people talk about psychosis, but no one actually knows much about obsessive-compulsive disorder.
This is a disorder which has two components which are obsessions and compulsions, obsessions are thoughts and compulsions is action so what do you mean by obsessions? We all talk about obsessions, we say we are obsessed about things say we are obsessed about objects, but obsessions mean repetitive recurrent intrusive thoughts which come into your mind against your will and it increases in spite of trying to control it.
So what does typically happens with OCD patient is, when he has obsessions he tries to control his obsessions by compulsions like for example he touches his hand on something, some object, he feels his hands are dirty so the feeling is an obsession and cleaning of the hand is compulsions.
So I have told you a very simple thing that your hands are dirty and you are washing it, so what is the disorder, the disorder here is in spite of washing his hands multiple times the patient is not convinced that his hands are clean, so he has to go on doing it repeatedly and he goes on and on and there are people who wash their hands for hours together or wash or clean their personal objects for hours together.
Obsessions are of different types but predominantly it has to do with cleanliness, it has to do with symmetry, it has certain rituals and there are obsessions about sex and obsessions basically about activities around you and the worst obsessions when the patient feels very guilty is an obsession about sex and religion.
So whenever he is praying to god all of a sudden a bad word comes in his mind or he sees someone near to him, he thinks about sexual activity about that person. So these are the Obsessions which person feels very guilty about and the major drawback in this treatment is patient feels so guilty about it that they never go to seek help, they feel so guilty, they feel so bad they don't go to a psychiatrist for help and that is why most of them are untreated and most of them don't come to therapist.
The treatment of the obsessive-compulsive disorder is long and drawn out, it's simple in that context but it has to go on for a long time and in obsessive-compulsive disorder, both medicines and counselling are very important. People feel that medicines are not useful, medicine is very much useful because obsessive-compulsive disorder is due to deficiency of the chemical in the brain by the name of serotonin because of which you get those thoughts and giving medicines, the intensity, the frequency of the thoughts come down and when your thoughts come down automatically your compulsions or the actions also come down.
OCD is not a sign of madness, people of obsessive-compulsive disorder are in touch with reality that's why they feel bad and guilty about it. In counseling most important therapy is CBT which is cognitive behaviour therapy where the patient knows and we teach the patient to deal with his obsessions and compulsions.
There is also other treatment like the aversion therapy, the inclusion therapy, these are all very scientific terms but what I am trying to say here is that with these therapies patients can come to control obsessions and compulsions. There is no fixed duration of treatment, it can go on for a long time or it can go on for a short time, it depends upon the patient’s personality, his family background, his family support and his insight into the problem.
So OCD, obsessive-compulsive disorder is a very treatable problem and if someone tomorrow tells you, you are a very obsessive personality that does not mean you have a disorder so before I wind up, I just tell you what a disorder is? a disorder in psychiatry is when it's more than normal that means it goes on for months and years, it is difficult to control in spite of all efforts you are not able to control the thoughts and the 3rd criteria is because of this it causes socioccupation deterioration that means because of your OCD, you are not able to lead a normal life and it affects your personal, social and occupational life.
This is OCD in short for you. Hope I could give some insight for you to understand this illness better.
I am Dr. Devendra Save, Psychiatrist, practicing in Mumbai for the last 20 years. Today I will talk about bipolar disorder. It comprises of 2 parts out of which one is almost known to all of us which is called depression. Depression means feeling sad, problems in life, something is going wrong and when we use this word, we use this loosely. In this sometimes because of reason or sometimes without the reason, the person starts feeling sad most of the days. Most f the days, for at least 2 weeks. He loses interest from everything. He is not able to experience his happiness. It starts affecting sleep, appetite. Sometimes, we may also see an increase in sleep and appetite also. There is a feeling of lethargy in the body, dull feeling. Not feeling like doing anything. Thinking process becomes negative. Small things start becoming big, a burden. Simple things are now difficult to be done.
And the person starts feeling very low. Many a time people even think about committing suicide also. t becomes so prominent which others may not understand, for that person this sort of life without any happiness, enthusiasm, motivation, without any sort of positivity becomes a burden and many a time people commit suicide. Now, this depressive disorder is something in simple words is a state where certain neurochemicals which keeps our mind active and fresh, they go down. I will explain it to you with the help of 3 neurochemicals. One is serotonin in which it goes down, the control on our thoughts goes down. Same thought in mind goes for a longer time. We just cannot let go of it. And thoughts turs negative. Another neurochemical called dopamine which is to increase your happiness and motivation. So, when it goes down, you are not experiencing happiness, pleasure.
3rd is known as norepinephrine which is for the energetics. We have got treatment to treat this and bring it up. Very nice treatments are there with the help of medications. If at all this depression comes in, you should consult a mental health professional immediately to see whether it is level of being treated or to be counseled. Now why I explained particularly this disorder is because it is very common and a large population suffers from it. Almost around 13% of population is likely to suffer at some point or the other. It can happen to small children, adults, elder, old people also. Many a time you don't require reason. When you are not depressed, all stress in life is okay. And when you depressed, all stress seems to be very difficult. To get them up, there are a lot of methods including therapies, medications, yoga but when it is serious or even moderate, the best thing is to visit a doctor and understand where it requires the treatment. In another phase, the person starts feeling very energetic. He thinks he has got all the power in this world. He starts making a plan, spending money, he thinks everything is achievable for him.
In spite of not sleeping, the person feels very fresh. The person may feel irritable, starts getting angry, aggressive at times, there is a lot of spending. Flight of ideas are there like one idea and then the other. People start making the planning of the business. This can last for a week, 15 days, 2 months together. Sometimes, this mania has a smaller variant which is called hypomania or smaller mania where the person is over-energetic. This is something which goes unnoticed. It has to come to an end and followed by the depression. Bipolar disorder is the disorder of the mood. As I told the treatment for depression is the increase of the chemicals where we have medication to stabilize the system. If bipolar is severe, we have to continue the treatment may be for lifelong because it may cause a lot of harm to the person as well as family and near and dear ones. Bipolar patients are more prone to suicide. I hope you have understood about this disorder and in case if you have any other query, you can connect with me through lybrate.com.
Thank You!read more
I am Dr. Devendra Save, Psychiatrist, practicing in Mumbai for the last 20 years. Today I will talk about a very common thing which we use almost every day called stress. When I used to sit in a group and asked about who all are under stress, maybe around 10% hand will go up. But now when I ask the same question, almost everybody's hand will go up. Even small children and 4 years of kids have learned this phase. A few days back a friend of mine told that his 4 years kid was stressed out because the net was slow and he could not play games properly. Now what exactly the definition of stress? Good things happen in life like promotion, do you think is it stress? Getting married, somebody got a girlfriend or boyfriend, buying a new house, are these all a stress. Yes, it is. Getting anything new which changes your life at a physical or a mental level is stress. Negative things like losing a job, death of someone close to you, monitory stress.
For a human something which really happens is stress and what he imagines is also equal to stress. You lose your job, it is a stress. Suppose you are not doing well in your office or your office is not doing well in the market, your boss gets upset on you are stress. It stays for a long because the imagination and fear stay for long. Thinking itself is a big stress for most of us. Leaving this aside, what exactly stress do to your body? Earlier the stress only used to be on the body like some physical harm coming to you, somebody coming to fight with you, hunting of animals or vice versa. Now, these things are body learned to react. Now nothing is going to happen physically like a tiger is not going to come to hunt you but the mind is creating these tigers and enemies. Or something which is stressful in the mind, the body reacts in the same way. What does it do? It releases a hormone called adrenaline. The heart starts beating faster because it needs more blood. Your pupil dilates and the body starts sweating a little bit because you are going to fight somebody and you require to be cool down.
Muscles become tensed up, breathing becomes longer because you require more oxygen. Muscles become tense so that you can hit and run. This is what we call as flight or fight response. Now actually speaking there is nobody in front of you to fight with but this is happening so that you feel is that something happening in the body and something is going to go bad and you get a panic attack. It is called an anxiety attack and you rush to a doctor. Suppose stress goes on then what does the body say? I have to run for a longer time. So, just think logically what is required. Do you require a higher level of sugar so the body regulates your sugar to come up and what does it cause, diabetes? The body says if I have to run for a longer time, my heart requires to beat for a longer time. My pressure of blood also require to be high. And what does it cause, blood pressure?
If someone is ill, the doctor used to prescribe steroids which make a person alright very fast. This also reduces your immunity level of the body and you start getting the infection again and again. People under stress are prone to get TB. It is also very well known that stress can also lead to cancer. Stress causes depression, anxiety, psychosis, panic attack, and other mental disorder. People are very prone to mental disorders as in reaction to stress. What you can see that stress is not only going to cause depression but it can cause all sort of physical, mental disorders and also can make you prone to infections, injuries. Your concentration goes away, accidents happen frequently. It is going to completely affect your body and mind. Now in short, how to deal with stress? You will be least under stress when you were a child. What is childhood? If you are able to understand, it will be very easy for you to deal with stress. A child is somebody who spends time playing, sports, staying active, jumping, running around. So, are we doing that and keeping our body healthy? A simple thing that we need to keep ourselves happy, active, play some sports and jump around, run around.
The child is somebody who thinks on that day. Does not think too much about the future, he forgives people. Do you do that today? If somebody says anything to you, leave the fight but you remember some taunts, and fight for days and keep the grudges. You need to keep the power of forgiveness again. The child always stays in the present. He lives for the day, happiness for the small things. Now happiness is only going to come when I am going to get the promotion or I am going to get the best cell phone, best car, the biggest house. Small things like coffee, tea, the weather have stopped mattering to us. So, keep yourself happy so that it will minimize the stress level. So, do small things like a child but in a mature way who knows how to work well, maintain the relationships well. If you have further queries, you can get back to me through Lybrate.
Thank You!read more
I am Dr. Chinmay Kulkarni, Psychiatrist. Today I will talk about how to stop smoking. So, as we all know that smoking is a very dangerous thing and if you look at the statistics, almost 8300 people die every day in India only because of the illness due to cigarettes or tobacco. It is a very dangerous thing and even on the packets also written that smoking kills. But it is very difficult for people to stop smoking. And why is it so? So the important mechanism behind this is tobacco and the nicotine is a very addictive substance So, there are some biological reasons why people get addicted to it? Our brain has a neuron circuit which is called a reward pathway. And in that reward pathway, it releases goo substance whenever we do something good. And same with this addictive substance that people feel good after taking them. In due course of time, a person requires to smoke more and more to get the pleasure. And that is why a person gets addicted to smoking. Now tobacco is one of the most addictive substances. It is more addictive than alcohol and other substances.
Some studies have shown that 10% of the people who gets addicted to smoking, gets addicted to smoking when they smoke their first cigarette. Now there are 2 things which stops a person. Behavioral changes and medications. I first talk about some behavioral changes which a person can make his life to stop smoking. So, the first thing a person can do is not to keep the packets with themselves, office and home. 2nd thing you have to decide one shop which is 5 mins away from your place and you should smoke only 1 cigarette. In this all the unnecessary cigarettes a person would be able to stop. Another thing is you need to make a chart of cigarettes which you smoke. Suppose, you are smoking 14 cigarettes in a day, so mention the same in the chart with time and number of cigarettes and so on. 3rd thing you need to decide a quit date. So, this day also should not be very far away from the day you start the technique. It should be within 1-2 weeks. And on the final day, you have to stop smoking completely. One day before the quit date, you have to discard all the things related to smoking like litters, ashtray.
If you still have a craving after the quit date then you have to do a nicotine replacement. There are many nicotine therapies are available at the pharmacy which is available at the pharmacy or over the counter. Nicotine chewing gums and packages are there. So, you have to take these therapies rather than smoking after the quit date. A few of the people have the habits of smoking before going to the morning toilet. They feel that they won't be able to pass the motions if they don't smoke or consume tobacco. But it is a myth as tobacco has no relation with your motions. It happens because your brain has got this habit. So, now you have to replace these habits with some other habits which are a healthy habit like drinking a lukewarm glass of water.
In this way, you can replace your bad habit with a healthy habit. Now you have to figure out the things which can make you a smoker like a fight with someone. Instead of doing this, you can drink a cold glass of water, eating an ice-cream, chocolate. So, you have to anticipate relapse. Even after trying all these things, you are not able to stop smoking then you can go to a psychiatrist and talk to them about your condition. We can give you good medications which can help you in getting rid of this problem. You have to understand that it is difficult to stop smoking but millions of people have managed in stopping smoking with the help of anti-craving substance, nicotine as well as behavioral changes. I wish you all the best and good luck.
Thank You!read more