A ticking time bomb
A lady in her early fifties walked in to my OPD cheerfully one day. She was my regular patient with a prior history of asthma, now well under control. Her husband had recently taken voluntary retirement from his job and the couple were really excited about their post retirement innings as full time grand parents of two beautiful twins. She was very happy. The purpose of the visit was to get my go ahead for a month long trip across North India. I examined her and told her she was fit enough for a world tour!
She was back after nearly six months. She complained of fever, cough and weaknees. It looked like some viral flu. I treated her symptomatically and reassured her that she will be fine. Third day she is back again - this time the fever and cough had decreased but now she had developed a purple colored lesion on her thigh and she was absolutely terrified. It looked like a bruise to me and for some reason it seemed like she had injured herself. I asked her repeatedly if she remembered how it could have happened and after some time she finally recalled that she had accidentally hit on a tap in the bathroom and had forgotten all about it. Well, at least there was an explanation so I just prescribed some medicines and again reassured her that she will be absolutely fine.
Guess what, she was back again within two days. She said she was feeling very low and weak. Now, I was beginning to wonder if I was missing something. She was certainly looking very dull and not at all her usual self. Clinically there was nothing wrong with her. I suggested that we run a battery of tests to get an idea of what is wrong. The family readily agreed. At this stage, I didn't have a diagnosis - much less a differential diagnosis.
This patient's mother (a pretty old lady) was also present in the room. I sensed that she was trying to communicate something to me. I asked the patient to step out for a minute and maybe grab a coffee if she was in the mood. Immediately after the patient stepped out, the mother started talking. She told me that very morning her daughter (my patient) had tried to end her life. She was about to consume a lot of pills and was stopped in the nick of time. The mother started crying inconsolably. She was really worried about her daughter and begged me to do something.
This hit me hard. I had obviously missed the elephant in the room. I was trying to solve the wrong problem all along! My patient was trying to seek my help and she was coming back to me again and again hoping that I will ask her the most important question - What is wrong with you? I was obsessed with her physical health but didn't pay much thought that a once cheerful lady had lost her enthusiasm in life. She was now anxious and looking lost - and it was not her body that was causing it.
I had to act real quick, suicidal tendency is a medical emergency. It is definitely not a normal response to stress. It indicates an underlying mental health disorder.
A decade ago as a very young intern, I was posted to one of the primary health centers in rural Karnataka. I got a chance to participate in a psychiatry health camp. The usually deserted health center was teeming with people for the camp. The crowd was in thousands - cases ranging from acute psychosis,substance abuse, schizophrenia and many many more conditions. 3 psychiatrists and 2 interns to tackle all the patients. Till this day I remember the stories of the patients and how the society around them has treated them as mad people.It was an overwhelming experience as an intern who had no clue about how to manage these patients. After a decade I don't think numbers will be any different.
As medical professionals even for us it is so tough to recognise what really is a mental disorder, sometimes it is very clear and sometimes it isn't so obvious. Many a time the signs and symptoms could suggest a physical disorder too but most importantly we have to be aware of possibility of mental disease.
Every day newspapers are filled with horrifying stories of suicides. Some from my own fraternity. What could drive a person to give up the most precious thing they could possibly have - their own life?
A Lancet study published in May 2016, said mental illness is India's ticking time bomb, only 1 in 10 are treated.There are 0·3 psychiatrists per 100,000 people in India. The numbers are absolutely dismal. The onus to spread awareness about mental health disorders and treatment available is on each one of the practitioner. Many people who have mental health conditions consider their signs and symptoms a normal part of life or avoid treatment out of shame or fear. If you're concerned about your mental health, don't hesitate to seek advice. With appropriate support, you can identify mental health conditions and explore treatment options, such as medications or counselling. I think in the current fast paced world, we are seeing a significant rise in the mental disorders. I have seen many number of youngsters who are already victims of substance abuse.
As for my patient, she was referred to a psychiatrist and was diagnosed to have "Major Depressive Disorder". She was stressed out taking care of her two young kids and also had some tiff with her daughter-in-law. She was put on medications and the last time I saw her she was back to her usual cheerful self.
As a physician I almost always want to have a diagnosis or rather don't want to miss one. After this experience, I no longer hesitate to ask patients about their behaviour/mood/emotions/perceptions/thoughts. If I sense deep trouble, I refer to a psychiatrist at the earliest. It does take longer consult times when we get into it but perhaps worth a precious life who are seeking help.
She was back after nearly six months. She complained of fever, cough and weaknees. It looked like some viral flu. I treated her symptomatically and reassured her that she will be fine. Third day she is back again - this time the fever and cough had decreased but now she had developed a purple colored lesion on her thigh and she was absolutely terrified. It looked like a bruise to me and for some reason it seemed like she had injured herself. I asked her repeatedly if she remembered how it could have happened and after some time she finally recalled that she had accidentally hit on a tap in the bathroom and had forgotten all about it. Well, at least there was an explanation so I just prescribed some medicines and again reassured her that she will be absolutely fine.
Guess what, she was back again within two days. She said she was feeling very low and weak. Now, I was beginning to wonder if I was missing something. She was certainly looking very dull and not at all her usual self. Clinically there was nothing wrong with her. I suggested that we run a battery of tests to get an idea of what is wrong. The family readily agreed. At this stage, I didn't have a diagnosis - much less a differential diagnosis.
This patient's mother (a pretty old lady) was also present in the room. I sensed that she was trying to communicate something to me. I asked the patient to step out for a minute and maybe grab a coffee if she was in the mood. Immediately after the patient stepped out, the mother started talking. She told me that very morning her daughter (my patient) had tried to end her life. She was about to consume a lot of pills and was stopped in the nick of time. The mother started crying inconsolably. She was really worried about her daughter and begged me to do something.
This hit me hard. I had obviously missed the elephant in the room. I was trying to solve the wrong problem all along! My patient was trying to seek my help and she was coming back to me again and again hoping that I will ask her the most important question - What is wrong with you? I was obsessed with her physical health but didn't pay much thought that a once cheerful lady had lost her enthusiasm in life. She was now anxious and looking lost - and it was not her body that was causing it.
I had to act real quick, suicidal tendency is a medical emergency. It is definitely not a normal response to stress. It indicates an underlying mental health disorder.
A decade ago as a very young intern, I was posted to one of the primary health centers in rural Karnataka. I got a chance to participate in a psychiatry health camp. The usually deserted health center was teeming with people for the camp. The crowd was in thousands - cases ranging from acute psychosis,substance abuse, schizophrenia and many many more conditions. 3 psychiatrists and 2 interns to tackle all the patients. Till this day I remember the stories of the patients and how the society around them has treated them as mad people.It was an overwhelming experience as an intern who had no clue about how to manage these patients. After a decade I don't think numbers will be any different.
As medical professionals even for us it is so tough to recognise what really is a mental disorder, sometimes it is very clear and sometimes it isn't so obvious. Many a time the signs and symptoms could suggest a physical disorder too but most importantly we have to be aware of possibility of mental disease.
Every day newspapers are filled with horrifying stories of suicides. Some from my own fraternity. What could drive a person to give up the most precious thing they could possibly have - their own life?
A Lancet study published in May 2016, said mental illness is India's ticking time bomb, only 1 in 10 are treated.There are 0·3 psychiatrists per 100,000 people in India. The numbers are absolutely dismal. The onus to spread awareness about mental health disorders and treatment available is on each one of the practitioner. Many people who have mental health conditions consider their signs and symptoms a normal part of life or avoid treatment out of shame or fear. If you're concerned about your mental health, don't hesitate to seek advice. With appropriate support, you can identify mental health conditions and explore treatment options, such as medications or counselling. I think in the current fast paced world, we are seeing a significant rise in the mental disorders. I have seen many number of youngsters who are already victims of substance abuse.
As for my patient, she was referred to a psychiatrist and was diagnosed to have "Major Depressive Disorder". She was stressed out taking care of her two young kids and also had some tiff with her daughter-in-law. She was put on medications and the last time I saw her she was back to her usual cheerful self.
As a physician I almost always want to have a diagnosis or rather don't want to miss one. After this experience, I no longer hesitate to ask patients about their behaviour/mood/emotions/perceptions/thoughts. If I sense deep trouble, I refer to a psychiatrist at the earliest. It does take longer consult times when we get into it but perhaps worth a precious life who are seeking help.