Psychiatry and Society

References to wisdom and to the wise have been found in almost all ancient civilisations, mythologies, religions, and philosophy. Philosophy (philo-sophia) literally means the love of wisdom. It has often been referred to as the ‘father of all virtues’, suggesting that wisdom was considered to be the ideal of human development, even of divinity - attained only by a few. Many millennia later, we are yet to understand or even define wisdom.  Wisdom is often assumed to be the sum of one’s knowledge and experience. Thinking patterns that are associated with wisdom - the ability to contemplate and think introspectively, to consider multiple perspectives and to have insight into individual and cultural differences develops only in late adulthood, as does practical knowledge of the world. However, age, by itself, does not bring wisdom – some studies have found that many of us tend to become more rigid and live more constricted lives as we grow older, while openness to learning and exper...

Caregivers living with persons having Alzheimer's Disease face specific problem behaviours. These behavioural problems result from memory loss that is the hallmark symptom of Alzheimer's. We have previously discussed resources giving hope for dementia caregivers . Caregiver  do's and dont's for mental illnesses  in general have also been highlighted. Living with Alzheimer's Disease is the theme for World Alzheimer's Day 2012. In this post we specify methods to help caregivers living with persons having Alzheimer's handle problems related to memory loss and reduce the burden of  care at home. Caregiver techniques for Alzheimer's Regular routine enables basic activities of daily living for a longer period of time. Make a visual time-table and regularly remind the person with Alzheimers to consult it so it becomes a habit. Keep large clocks in each room and remind them of the time at every opportunity. A personalised calendar wit...

Alzheimers dementia is usually diagnosed when memory loss and behavioural symptoms are readily apparent to their caregivers. At this stage the primary concern is to slow further deterioration. Caregivers at the clinic have often wished they could have looked into the future. Many have a history of Alzheimers disease in their elderly and wondered whether there was an earlier way of knowing. New knowledge gives us hope in this direction. Alzheimers disease before memory loss We now have the beginnings of a time line in the countdown to dementia. It is now possible to trace the beginnings of Alzheimers Dementia up to 20 years before its manifestation with memory loss and impaired function. 20 Beta-amyloid levels in the cerebrospinal fluid (CSF)   begin to drop 20 years before the onset of dementia. Alzheimer's Disease is characterized by toxic deposition of specific beta-amyloid (Aβ1-42) plaques around the brain cells. In normal aging beta-amyloid...

Training for caregivers of persons with Alzheimer's disease  helps address the distressing behaviours that arise in the affected person. Caregiver training also promotes wellness in caregivers by giving them the skills to  handle the relentless stress. Unfortunately most caregivers are unaware of the need or the availability of resources. The Alzheimer’s and Related Disorders Society of India (ARDSI) held its 16th conference in Nov 2011 at Pune. This significant event marked Pune’s arrival on the national dementia caregiver stage. Pune is now the 16th Indian city with an ARDSI chapter of its own. How does this help people with dementia (PwD) and their caregivers? The ARDSI Pune chapter “develops, coordinates and renders services in the field of dementia care, support, and training”. The training aspect is particularly interesting . Conversations with caregivers at the clinic usually swing around to the day-to-day nitty-gritty of dealing with dementia, the impa...

Microscopic picture of the brain showing amyloid plaques and  neurofibrillary tangles first seen by Alois Alzheimer in 1907 The diagnosis of Alzheimer's disease became headline news when the defence counsel of a prominent citizen of  Pune stated they were awaiting results of his brain MRI to finalise the diagnosis of dementia. Recently a patient's medication was stopped when his neuro-physician declared there were 'no plaques on MRI so it is not a case of Alzheimers'. The caregivers returned to me when his behaviour problems recurred. Dementia including that of the Alzheimer's type is a clinical diagnosis (Grand 2011). Dementia is characterised by a triad of Progressive deterioration of mental processes ( cognitive abilities ) Behavioural and psychological symptoms of dementia ( BPSD ) Difficulties carrying out day-to-day activities ( activities of daily living or ADL).   Alzheimer's Disease is commonest dementia after 65 years of age Alzheime...

Caregivers of persons with chronic mental illness are usually family members, 'individuals whose own happiness is entwined with the well-being of people who are dear to them'. The burden of care is associated with significant stress. For one family the stress was unbearable. They abandoned their mentally ill daughter in a hospital . This story is repeated often enough in urban areas like Pune. How can a caregiver help a relative with mental illness? DOs Follow the treatment See to it that the person takes the prescribed dosage of medication regularly. Failure to keep to the dosage may lead to a relapse of the illness. Watch for a relapse A person in your care may suffer a relapse for no obvious reason. Watch out for early signs such as sleeplessness, restlessness, and irritability. Take the person immediately to a psychiatrist, so that medication may be adjusted. Take interest and appreciate Talk to the person. Show an interest in what he or she is doing. Apprec...