Fortis Hospital

HI,

I am Dr. Kedar Tilwe, a consultant psychiatrist and we shall be discussing this condition very common and yet very very underreported. Agoraphobia is the fear of a situation turning unsafe or from a situation where escape may not be possible. Do you feel scared of public transport, petrified of traveling across bridges, get terrified when you are in traffic jams for no possible reason; well this could be signs of Agoraphobia. A very peculiar phobia which affects about 1-2% of the people during their lifetime. Also, by its corollary, it encompasses situations in which help might not be available. So, agoraphobia is a very very common condition like I said up to 2% of the general population. So how do you handle this?

Well first you need to know the signs and symptoms. Typically, a panic attack occurs when in a situation where help might not be available this can include like we had mentioned bridges, public transport, open spaces, social gatherings, cinema halls, crowded spaces, it can also sometimes occur when you are trying to fly. There is no particular reason or precipitant but an uneasy sensation occurs. Panic attack typically consists of 15 minutes of building up, 15 minutes of maintaining and 15 minutes of disappearance of intense symptoms of ghabrahat, palpitations, coldness of the extremities, feelings as if someone is choking you, shortness of breath, giddiness; four out of all of these symptoms are acquired and they disappear without any provocation also but when they do occur it's extremely intense. Now because of these symptoms, a person starts to fear and avoid situations which could lead to a panic attack or where the agoraphobia may be precipitated. It can also lead to situations where a person might feel there will be a social embarrassment and so he will avoid or she will avoid stepping out of the house for the simple fear of social embarrassment or a panic attack occurring.

While a very very common condition, a very easily treatable condition, this causes a lot of morbidities. So, what do we do if these are the symptoms you have? Well, remember that these symptoms need to last for at least 6 months before treatment and before diagnosis. However, if the symptoms are very very debilitating we do not have to wait for that span. How do you manage it? Well, everything has to be classified, so we'll classify the treatment also.

The first thing is lifestyle alterations. Then comes things that you can do at your home, this includes relaxation exercises. We will talk about CBT and finally about medicines. Lifestyle altercations which they have to be factored in when you try and handle agoraphobia include reducing coffee intake, stopping the alcohol remember self-medicating with alcohol does not help over a long run it just disarrays your symptoms completely, avoid cigarettes and that's about it. Relaxation exercises help, known panicogens have to be avoided. Therapy including CBT and REBT can have a beneficial effect however the symptoms if they are pronounced they may require treatment with SSRIs, SNRIs and sometimes SOS treatment with benzodiazepines. So if you feel these symptoms, do reach out to a psychiatrist near you. They'll be happy to help.

Thank you.

Of all the mental illnesses, the most common and prevalent one is perhaps depression and anxiety, known to affect one in four people. This is a big problem that is facing the entire human population as a whole. We all know that depression is the rough equivalent of sadness of mood and it is something that is very very quickly associated with suicide. However, you will be surprised to learn that most people don't actually realise that they have a sadness of mood which is pervasive till well into depression. I am Dr Kedar Tilwe and we shall be discussing depressive equivalents.

Depression is a syndrome which is accounting for 5 out of 9 symptoms have to be present for at least two weeks of time before you call it as clinical depression. Of this, two of the most obvious ones which have to be present are the sadness of mood and get this decreased interest in previously pleasurable activities, which means that you may not actually have a situation in which sadness of mood becomes obvious. What it means is that you could experience depression just by realizing that you are not really enjoying your favorite TV serial anymore, not just because of the season change but because it does not seem to entertain you. A hobby which relieved you or a movie star that you liked, does not seem to hold on to your attention anymore and doesn't give you the reprieve that it did earlier.

So, what do we do about this? Well, remember, that there have to be other symptoms present along with the sadness of mood and decreased interest in pleasurable activities that I just discussed. There is also decreased appetite when not dieting, decreased sleep or increased sleep for more than 2 hours either way. Most obviously it is often in the complaint that people can't sleep because when they try to sleep worrying thoughts coming to their head and the sleep pattern gets prolonged a bit. This could be a presenting symptom, something that you need to watch out for. But if you are gonna talk about depressive equivalents, we have to remember that the other ways of expressing sadness and depression which are sometimes clinically known, sometimes they are just a way a person chooses to express sadness.

The most prominent among this culturally recognized as an idiom of distress is perhaps pain. Pain which can't be explained medically, which can't be explained without trauma, which can't be explained due to any particular reason can sometimes be psychological pain, very vague, very generalized and one of the somatic equivalents of depression. Some people may not actually realize that they are depressed because they are trying to fight this depression all along. But it causes tearfulness, it causes a person to break down and this is known as smiling depression. Usually, the sleep pattern changes, concentration difficulties, ideas of helplessness, hopelessness, worthlessness are the most common ones that you see.

Even more important than this irritability on minimal provocation or anger outburst or tendency to lose your temper quickly is something that can be seen if you are depressed. It is not necessary that it has to be done with anger management. The answer could lie in looking into yourself, introspecting a bit and realizing that you have the other symptoms. That is something you need to watch out for. Beyond this, substance use in the form of alcohol to self-medicate depression or Cannabis or cocaine has been well known and well documented and we try and search for cures to alcohol and cocaine without realizing that it was self-medication all along. Why am I discussing this? Well because these are presenting complaints, that would be the most obvious cause for clinical attention. The reason why you end up going to a doctor or a mental health professional in the first place.

Also, in high functioning executives or high functioning individuals who have reached a certain level of education, it is quite often noticed that concentration difficulties and focusing difficulties and not getting the same drive out of your work is sometimes a depressive equivalent which can cause in person to present. So, if you have any of these symptoms which are unanswered, you should reach out to mental health professional nearest to you. Remember that depression, like most mental illnesses, has a biological explanation, caused by the receptor systems in your brain and we have a legitimate medical treatment available for this. So, if you know of someone or if you find yourself suffering from the symptoms, remember that we can help and that you don't have to suffer this illness alone. So, do reach out at Tilwe Nursing Home, that's where I sit or any mental health professional close to you will be happy to help.

Hi, I am Dr. Kedar Tilwe, consultant psychiatrist and I will be talking about pain along with my sister Dr. Amrita Ajay Tilwe, who has done a fellowship in chronic pain management. Pain is one of the clear sign of the stress involved in our body and something needs the focus of our attention. However, sometimes this pain persists despite all medical tests and treatments and takes the form of a chronic situation which seldom seems to respond to any treatment. Dr. Amrita would explain to us how pain works and why it occurs. Hello everyone, this is Dr. Amrita Tilwe. I am anesthesiologist in pain physician. Now, what is pain? Pain is an unpleasant sensory or emotional experience, that is caused due to tissue damage or probable tissue damage. Now pain can be of different types. It can be an acute pain which is in often immediate setting and chronic pain which comes from 3 to 6 months and lasts long. Pain can be felt like a normal dull aching pain to a sharp pain to tingling sensations or just a dull visceral pain. Pain can be of variety of types. But we have to know that we don’t have to live with this kind of pain.

Nowadays we have lots of medicines, procedures, and therapy by which we can avoid this pain. Now, what does pain do? Pain restricts your lifestyle. You can’t experience all the pleasures of your life, you can’t do everything. You get restricted. It might be as simple as a small backache because of a backache you might not able to watch your movie or go to any theatre and watch a play. Just a simple backache might restrict you from your activities or it might be something difficult like trigeminal neuralgia were even washing your face or where even driving might cause such severe pain in your face that you might just give up on everything. You don’t have to live with this pain. You can just be comfortable. And the procedures, the medicines they are simple. Just remember that you don’t have to live with the pain. In here, we take you in, we take a nice detailed history of you so that we understand what type of pain you have. We try to find out what is causing that pain and when we understand what is causing the pain, what type of pain you have, then further we manage.

For example, if you have small muscle pain like you have a muscle pull, then we can have physiotherapy and we can have something like acupuncture, which helps to release the muscle tension. On the other hand, if you are having a backache which is radiating to one side say one of your leg pains or it gives a sharp shooting sensation in the night or intermittently during the day which has restricted your activity, we can give you simple procedure like Transforaminal Epidural Steroid Injection. This will help you to the next extreme is cancer pain. There are cancer survivors who say we are fine with cancers but we don’t want that pain. For such people also we have to tell that you need not suffer through the pain. There are simple blocks like lumbar sympathetic block or celiac plexus block which will help you recover and these things are done at Dr. Tilwe nursing home. The physical causes of pain apart as in psychiatrist, I see many cases in whom the pain doesn’t seem to have a physiological basis or is often experienced in a degree much worse than anticipated or expected.

This is known as a condition of somatic symptom disorder with predominant pain. More often than normal doctors would not be able to explain the cause of why it occurs, why it persists for so long or what to do about it. It is at these times when there seems to be no other help readily available that we can consider the possibility of one of my medicines or therapies helping. It is worth noting that up to 12 percent of people during their lifetime may experience something similar to somatic symptom disorder with predominant pain in which no explanation is possible. It is also worth remembering that more often than no medical basis for this. While the causes can be psychological and in some cases a biological predisposition causing more acute presentation of symptoms. There just seems to be no treatment in sight. So what do we do about these?

Well we have the options of medicines in the form of pharmacotherapy such as antidepressants like SSRIs, tricyclic antidepressant or SNRIs in the form of mood stabilizers which have shown to reduce the amount of pain endured and sometimes in therapy in the form of CBT or other forms of therapy which will help reduce the pain that you have experienced. Remember the idea is to experience your life to the fullest and not the pain. So if for any reason you find yourself in a situation in which the pain persists and physical treatment has not seemed to take full effect then there are other alternatives that can be considered. So to reach out, one of us may be able to help.

Thank you.

So let's define stress before we move to stress management. Stress is defined as an adverse reaction to external pressures or an environment which produces an unwanted and difficult response in a person is usually and agent biological chemical environmental psychological or social which will produce stress in an organisation or an individual the types of stresses change from person to person this is very important to understand what may be stressful to you and me we not necessarily be stressful to another person. it is ok to be stressed out about your exams about your work, about how you are going to deal with things and it's also ok to be stressed out about what it is going to rain like and whether you want to be able to catch the local home or not so why am I talking to you about this and what is it was there and you tell you will frankly the twist is this we all have stress.

As adults we are stressed out about job responsibilities spouses are getting one is required as working women we have stress and the thought of stress that you is pretty hard as executive with 5 day week also the sort of decisions that would take and the sort of people that you respond to and the degree of decisions that you take can produce stress with Hindi. So beyond this just remember if nothing else we tend to live in Bombay and in Metro areas so if you do anything like living in a metro area you are going to have enough amount of stresses whether you got that the 929 train 19031 train makes a huge difference to when you reach home and when you reach office that itself is quite the belligerent enough to produce stress.

In any person now how important is this when it is important because you need to understand that stress is pretty much going to be an part of your life stress is going to be present and it is not always one particular stress which produces the adverse reaction it can vary from person to person and more importantly stress is going to be multifactorial. So your response to does not have to be limited to correcting the one absolutely correct your core open mechanism and you will rectify the amount of stress you are able to you and handle before you move on allow me to get a little bit technical stress is a biological phenomenon and it is a part of your response system there is a stress response system in your brain which is activated through your brain through the cortisol through the adrenal glands and it is essential to your survival so remember this stress is not something that you take but pretty much a response system inbuilt in your body.

The trick is trying to manage so that it doesn't overwhelm you so what are the red flags of stress and why do we need to worry about it if I had to convey this in a short and sweet manner let me be very clear all biological elements are now linked to excessive stress. I am not saying that caused by I am saying they can be increased or your response to the treatment can be yourself because of it to you need to handle stress properly when it comes to biological or medical illnesses as far as psychiatric illness is concerned. I think the Jury is out on that the stress that is a model of how stress occurs pretty much states that in the window of tollens opportunity. If you have excessive stress and you are not able to adapt to add then you would actually and having talked about post matric stress disorders.

All of these are produced by stress but most importantly and most worryingly the commonest response to stress is actually substance used start with the beer because you are not sure that you are able to sleep at night and that happened because of the stress that you have the beer, most vodka, whisky soon enough you are holding it and it is causing a lot of problems in the morning and you can't live without the drink substance used because of and stress which was not any is a very common precipitated factor you need to be careful of this beyond that do remember that it is quite possible to have other signs of stress something that would normally call as Red flags.

So what are the red flags of stress which one you that may be things are not quite right as to start of these are the technical words the ones that your Bond irritability on minimum provocation if you are not able to sleep at night if there are situations in which you are becoming more and more intolerant of normal things if there are times when you are just passing through your entire day in a mundane manner of the subtler signs before that have to Warn you that a person breaking down crying for having an aggressive outburst is usually the last step in stress response before that you will get the signs that I am telling you about what are the signs of stress well here they are you are not able to finish your normal day to day activities you are forgetting what things made you smile and why you are telling to watch the clock before it finishes you are attending to try and avoid getting up from bed yourself care has worsened and you are starting to become more and more than it will be our red flags of stress and remember like anything these flags will be better seen by other people sweet quite possible that someone else might help you understand this better or someone else might point out to you.

Don’t take it as offence remember someone meaning actually concerned about your well that's so if I had to tell you one thing it would be this always Peculiar to the place you work. for instance software professionals usually understand in distress when they tend to break the enter and the space bar in the keyboard people working at places which require them to do Road activities generally tend to stick to the rules before they start to realize that the stress they become more and more protocol apart from this how do we handle stress. Why because it required hand where it can happen anywhere when at any time and how with whatever you have available usual stress management techniques are there and I am not going to focus too much on it because they are all something that we are aware of things like maintaining a good work-life balance and sure that you deal with problems openly acknowledge your problems.

Learn how to say no maintain sleep hygiene and sure that you are not too anxious about it and you are saying no in a proper manner that should not get if I try and set goals and achieve them anticipate problems that is something that we all do if you are not doing it where you have to here's the thing remember the most important idiom in handling stress is don't bring your work home or your home to work maintain those balances. But really talking this because I just told you that it is quite possible that stress can be looked upon in different man so here I am going to tell you about what to do to not stress you are already doing what I am going to tell you is how to manage stress when things go horribly wrong.

It happens without warning it can happen on any random at any time and could happen because of you can't do anything about it but you have to get those that my dear friends when you require that intervention something that would help you adopt to the amount of stress which would be problematic for anything during this time normal techniques don't help and you have to have and contingency plan what do you do next 4 upontechniques are going to sound little whimsical 1st is acknowledging the fact that you are overwhelmed and are asking for help whenever you can,96 remember there is no it is usually new manifestation of old problem.

Which means someone else has gone through before so you can avail of the opportunity and help if you ask for it second this is very good when things go very very horribly wrong remember the wave example remember that you are emotions like waves always have a fixed time that they can respond to it doesn't matter if its or it's Tsunami it's good to go off within half an hour which means if you joy if it is fantastic happiness if it is escatcy or sadness or grief or just and invariable sense of feeling that the earth is gobble you up you have to learn how to handle the next half an hour when you get earth shattering situation which is very horribly wrong.

The weight and height existence only half an hour why is it important well because you have to remember that light waves reference tsunami or even a very-very flooded Marine Drive recedes within half an hour which means that even if the things which went fantastic which caused euphoria ecstasy happiness or extreme sadness grief for the gut wrenching feeling which you feel like the earth should gobble you up would only last for half an hour remember waves and emotions tend to coexist it is very very similar.

So if you take out the half your training your combination your mindset will set in and you will be able to handle things better it is as true for you as it is for the people from next time you have that horrible thing going wonderful happy or horrendously don't remember take out the next half an hour in the words of Winston Churchill if you going through hell keep on taking out the time it requires to adjust and manage to whatever problem should help you music to the next mobile price happiness is generally people that the person who coordinates with happiness should be entitled to the next Nobel Prize and the reason for this is simple any music which makes you smile will work as a stress buster.

Why am I saying this river and not saying a soft instrumental music I am saying music which makes you smile so you have the mobile phones just listen to them and ensure that you have a playlist of the songs which make you smile those random songs which you hear on the radio and you just can't be angry it will vary from person to person, 1980 so the song which makes me smile pehla nasha people born in 90s tell me this and that anything on this is always Kuch Kuch Hota Hai people born after 2010 however should be cautioned you cant tell people the song which makes you smile is zalima.

It doesn't work. It has to be group of 10 songs which make you smile and there is no restriction it can be soft instrumental. It can be patriotic songs for it could be rock and death metal it could be a random mix as - but you need to have those 10 songs which will make you smile and take the stress away just have that playlist that there are 3 exercises relaxation exercises that can be done if I had to fork and exercises that can be done while you are sitting.

I am not certain if you can't hear the surroundings right now but if I had to focus and 2 and exercise right now I would focus my mind not on my breathing but on the sound of the AC the among the AC or the sum of the sound of the drilling machine which you can hear outside their synchronous motor the sound they will help you focus your attention and once you have focused on that sound for 30 seconds you will realise that you are aware of your breathing and all you have to do is just know your breathing down for the next 8 minutes and we'll up suddenly you have manage to have stress management relaxation exercise done while sitting on your desk finally because I said 4 so I'll tell 4 but 5th piece of advice is equally important.

And its this remember that a diamond is just a piece of charcoal which handle stress very very well you are only going to find what you're made of if you go through the adverse circumstances and in the words of the great sir Albus Dumbledore maybe not sir jus albus Dumbledore help will always be provided at Hogwarts to those who ask for it to those who ask for it so if you feel the need to reach out or connect of you feel the need to make other people reach out of connect ensure that you talk with son if you want to talk with me you can reach me and doctor they were nursing home is where are usually set so do feel free to reach out any queries you can address then I will try my best to answer.

Thank you.