Monday, December 29, 2008

Borderline Personality Disorder;Patient and Family Problems

There are problems in recognising this disorder.The family undergoes severe stress and the patient suffers as she or he does not recieve treatment and help for quite sometime.As the incidence of personality disorders is very high,although not documented(there is no registry for psychiatric diseases and disorders) a major portion of our population remains untreated .The mortality rate must be high too. It is of utmost importance that this disorder is recognised earliest a nd the patient helped.A major group who may be targetted for awareness campaign must be teachers and school staff.The behaviour irregularity if earlier recognised and reported may help the patient as a life saver. Fellow students especially of higher grades may also be inducted in a sort of observer troops such as monitors.
There is agood literature available on web Md which immensly helps to understand this disorder.The following symptoms are apparent;
  • intense mood swings;these maybe so intense and sudden that the family cannot actually physically or emotionally take it.They may need psychiatric support themselves.
  • impulsive behaviours;these may land the patient,and others in severe trouble,accidents and missing persons.(the movie "Killer Movie" amply depicts this sort of behavioural problems.)
  • Problems with relationships;as most of the family and freinds are neither aware of the disorder and are not trained to handle the situations, often flare ups and reactionary behaviour may worsen both the patients symptoms and responses by the family and freinds.Such patients need immense understanding and support to make it through this long and often hopeless situation.
  • low self worth is one of the major hinderance in getting better.The attitude often of intolerance and judgemental of peers,older people and teachers may compound this problem.
  • Other disease such as depression,eating disorders,substance abuse may occur simultaneously and themselves compound the problem.

The symptoms start in early childhood and if recognised and treated may improve over a long period.Most patients with severe symptoms get better over time.

Symptom recognition by patients themselves may help;such as

  • Intense emotions and mood swings.
  • impulsive often disruptive behaviours.
  • temper tantrums.
  • Aggressive behaviour.
  • Feeling of emptiness inside.
  • hurting yourself such as cutting or burning.
  • suicidal attempts;this maybe confused as attention seeking behaviour and not bieng taken seriously by the family.
  • Low self worth;patient may enter illogical relationships and freindships where they maybe taken advantage of or even raped or sexually abused as with older persons.
  • a frantic fear of bieng left alone ,abandoned,this may put personin disadvantaged relationships again.
  • Feeling suspicious of others for no reason;this may include immediate family and kin;This is a tricky situation as if a child is in an abusive environment then his behaviour may appear mistrustful to either parent and he maybe suffering abuse also but not bieng able to report it.

The diagnosis of this disorder is only done by a trained and experienced physician as this maybe confused with anti social peersonality disorder,bipolar disorder.The cause of this disorder are not really known.Genetic or familial history plays a part.Often childhood trauma,abuse,parental seperation,neglect brings about the symptoms to the fore.Treatment is both by medicines and behavioral and analytical psychotherapy.This is very helpful though long and tedious journey but there is no other choice .Relapse and recurrence is a major feature and both support for the immediate caregiver and patient is essential.

Wednesday, December 17, 2008

Awareness of Health Issues in Pakistani Youth and Adolescents

A large chunk of our population will be young adults and adolescents.About 50 % will be females.Literacy rate is very low,therefore in order to raise awareness about health issues media such as television and radio is very important.Amongst the educated mostly urban populace,also health topics are neither the part of regular school education program nor are the school teachers and management aware of its importance.In order to make everyone including parents more receptive to the idea of awareness in prevention of diseases the TV and radio is bieng used effectively by the numerous channels and fewer television anchors with a health background.Internet population has also increased and it needs to be used more as tool to reach out to a large Pakistani youth to create awareness in prevention of diseases such as sexually transmitted disease,AIDS/HIV,infectious diseases such as tuberculosis,hepatitis,etc,.The incidence of teenage and unwanted pregnancies is a lso very high amongst our youth and thanks to the tyrannical and ostrich like behaviour of even our urban populace these issues are not addressed in a fair and balanced manner.As morbidity due to wrong treatment and mortality due to cruelty and indifference rises,a major problem is a health and social burden,This issue also highlights gender inequality and bias towards a polarised and divided society.Awareness raising of youth will eventually defeat the prejudices in addressing health issues and promote a healthier society.

Friday, December 12, 2008

Mothers dilemma in search for a mental disability diagnosis

A mother presented with not bieng able to understand her child,s mental disorder and not bieng aware of the diagnosis.She was suffering from acute anxiety so much so that she very nearly collapsed.This is a common phenomenon.Mental disorders are a major health issue in Pakistan.Their detection,diagnosis and proper treatment is a long anguishing and costly procedure for average person.In the due process the family especially mother suffers a lot as she not only has to undergo her personal pain ,she is also ostracised and abused,tortured for bringing up the child badly.The attitudes need to be changed effectively and swiftly.For this small well informed support groups need to be made among teachers,social workers,and other persons in contact with children.This has to be done on emergency basis.You can start with this activity youself start reading more about these disorders on WEBMD or sites such as,etc.In reading and understanding the disorders and mental diseases,your own perception and attitude will change.This may help you to help others.
The mental disorders are not only undiagnosed but also the teaching is affected as the child is unable to learn according to his needs.The schools try to shove out such children to keep their results at top levels.They not only hurt and damage the child in the process,but also the family and society on the whole.We need to make scools aware for the need to understand and help such children.Canadian society has already incorporated such developments in their school system.
A book entitled If your adolescent has Depression or bipolar disorders by Dwight L Evans,and Linda Wasmer Andrews is a must read .

Sunday, December 7, 2008

Urinary Bladder Exostophy And Epispadiasis In A Child

A young father with limited financial resources presented with complaints of his child bieng operated several times for repair of his bladder and genitilial malformations.The dilemma here is how to provide adequate information and satisfy the guardian as a third party support person.As I am a trained family physician with vast experience in support counselling and referral,I could handle the situation.It is difficult for surgeons working in poor countries with vast populations with limited time and resources to provide adequate information and support to such people.For people with complicated surgeries it is imperative that a whole lot of information on Procedure,Type of Surgery,Expected or desired Results,Financial liabilities,Other costs be provided.A good website is provided on Boston Children Hospital for this necessary information.For people without access to internet it is the local family physician who is the best support person.Children with urinary bladder exostophy or bladder bieng outside abdomen several operations maybe needed depending on the extent of malformation.As usually the genitilia is also not formed properly, its repair is also an issue.The long term use of medicines is also required.The operating surgeon should discuss all these aspects in detail before starting treatment.In this case a long duration treatment by the mother using NSAIDS for joint pain during early pregnancy was most likely cause.It is essential that people be aware of using any drugs without prescription and also the physician should not provide long usage prescriptions to females of childbearing age.As a precaution all family physicians should use vigilance criteria checklists for all their patients using a groups and drugs with interactions in mind.A religious use of these checklists will ensure prevention of such morbidity and health burden.