Mind matters

If you were walking in the woods, and you heard a crackling sound beneath your feet, would you treat it as a snake or a stick?

This hypothetical situation at the Conference on Mood and Anxiety Treatments (CANMAT) held in Dubai last weekend was one example given to illustrate the association between sound and shock, besides throwing light on other psychiatric disorders.

As explained by Dr Jitender Sareen the Director of Research and Professor of Psychiatry at the University of Manitoba, Canada, referencing the human need to self-protect, “it is better to treat the stick as a snake than the other way round.”

Anxiety

One piece of good news was that “anxiety is very, very common, and people will have a few symptoms.” But talking about the difference between normal and abnormal anxiety, Dr Sareen spoke of the five key distinguishers: Negative thinking, poor relationships, repeated avoidance of issues, unemployment and psychological symptoms (such as heart racing).

The revelation was that there is good anxiety and bad anxiety. “Anxiety can be very useful,” he said, likening ‘limited symptom panic attacks’ to a body’s “smoke detector that turns on at the first signal of danger.”

In fact, it is a matter of concern if the body has no pain detectors. That’s dangerous. For example, students cramming for exams are benefitted by a degree of anxiety so that they sit down to study. Sareen explained: “If you have no anxiety, you’re not going to study — the trick is to find that bell curve”. The conference attracted over 320 participants from more than 18 countries, including the US, the UK, Canada, Turkey, Greece, India, Pakistan, Egypt, Saudi Arabia, Kuwait, Qatar, Lebanon, Syria, Jordan and Iraq.

Prof Hany Shafey, founder and chair of MENMAT, told Khaleej Times that here, in the Middle East, incidentally, medical insurance doesn’t cover mental ailments and people may be seeking help for problems much less than in other parts of the world, though the problems are no less.

Hany described the congress as the ‘birth of a dream that began two years ago’ following a casual discussion with Prof Sidney Kennedy, leading international psychiatrist. He said the congress will lay the foundation for creating guidelines for meeting the peculiar needs of the region, which is marked by unique genetic and cultural differences.

How to identify Depression is an oft-misused word. The checklist for depression is as follows: A consistent down mood; Consistent is the key. Bad days don’t constitute depression. But an inability to enjoy things you used to enjoy earlier for at least a two-week period is a symptom. Loss of appetite Lack of sleep A studden burst of anxiety Accompanied with a bunch of physical symptoms such as shortness of breath and chest pain Importantly, a feeling that you have to escape A Panic Attack meanwhile is just

Prof Kennedy, founding chair of CANMAT, while delivering a presentation of challenges facing treatment of depression disorders, remarked that the Middle East region lags behind in the number of psychiatrists proportionate to the population: “While Canada has nearly 14 psychiatrists per 100,000 population, in the Middle East it ranged from 0.7 to 5 per 100,000.”

He said more intensive research was required to treat depression, which he described as a disease of the brain and body.

The important thing to know is that both depression and anxiety — more common among people who have a family history — are treatable with medication, provided patients follow the doctor’s orders. Noting that it is a real problem, Prof Fareed Aslam Minhas, Head of Institute of Psychiatry, Rawalpindi Medical College, Pakistan, said: “Non adherence is the primary cause of treatment failure.”

Dr Minhas spoke of how patients, even when they are correctly diagnosed, have a problem adhering to the treatment. Basing his study in the context of Pakistan, he pointed out how some patients would rather see faith healers, a less socially suspect alternative in Pakistan, than going to a psychiatrist. Although in some cases, Dr Minhas agreed, faith healers rely on common sense and perhaps thus retain their popularity. He gave an example of one lady who was having marital problems and decided to go to a faith healer to seek help.

The faith healer gave the lady a tabeez (an amulet) to keep in her mouth for 15 minutes when her husband got home from work.

After a fortnight, the woman’s marital problems had lessened, as with her mouth held shut, she couldn’t get into arguments.

Depression

Gone are the days when you could talk of depression in isolation. This was one of the consensuses reached at the meet.

Nowadays, according to medical findings, depression is tied up with a whole host of other complications. Comorbidity was a frequently cited word in the conference, meaning there is something of a package deal with mental illnesses. If a person is depressed, there are also high risks of hypertension and diabetes. Add to which, 50 per cent of clients (Dr Minhas’ findings) don’t take their medication.

“Adherence on the whole is poor,” he said of the non-compliant clients.

A worrisome state of affairs in societies such as Pakistan — where every year 40 out of 100 medical students dropout within a year. The message is clear: there is no shame seeking help, and the sooner it is sought, the speedier the recovery. - nivriti@khaleejtimes.com

Depressed and anxious: two case studies CASE 1: Anxiety and OCD *Shakila Ahmed, 31, has been married two years to an investment banker, who moved to Dubai from Hyderabad, India, in January 2010. It was an arranged marriage. Shakila’s parents knew the groom’s parents since childhood and the wedding took place in November, 2008. Last year, Shakila began an extra-marital relationship with a college lover whom she couldn’t wed. The affair came to a conclusion when her fears outran her excuses to get out of the house. She has secretly since been to a psychiatrist on a recommendation of a female friend, as Shakila believes she might be carrying HIV. Her life has been hell, as she has anxiety, and obsessive compulsive disorder to check symptoms online daily, compounded with an irrational fear of syringes. She will not get tested, but is convinced that she is carrying the deadly disease. Her husband doesn’t know. And the doctors are working on counseling her to both get the blood test done and tell her husband, regardless of repercussions. The doctors say there is more fear in the patient of revealing the truth to her husband than facing the possible reality of being infected and ruining more than one life. CASE 2: Depression It took Dubai resident *Mrinalin, 53, mother to two girls, three months to unpack her suitcases from a trip to Italy with her husband and younger daughter. The trip was in December, over the youngest child’s Christmas holidays. Mrinalini didn’t want to go on the trip and wished to be left behind while the rest of the family vacationed. On the insistence of the family, she went along but throughout, stayed in her hotel room while father and daughter went for outings. There are no holiday pictures with the whole family. The eldest daughter, away at college in Paris joined her father and sister. Mrinalini, since October 2012, has not stepped out of her home except to drive one kilometre to pick up her youngest from art class every Thursday and piano lessons on Monday. She didn’t shop at all on holiday and all her meals were ordered from room service. The family has found ways to cope but it hasn’t been easy. The youngest daughter who used to have a surrogate mother in her eldest sibling, is left to cope. Mrinalini has been on medication, but her condition has become progressively worse. Her diagnosis is seasonal depression. Some months, she is a regular parent and wife, participating in the progress and development of her family. Most days though, the husband gives the maid orders for what to make for dinner. Socialising is intermittent. Plans are usually exclusive of Mrinalini, whose condition is compounded with bad migraines, meaning she lives for months at a stretch in an upstairs bedroom in a villa in Dubai, with the curtains drawn. Upon return from vacation, she refused to answer calls. The live-in cook has, out of practice, learned to tell callers on the telephone that “Madam is unwell”. What used to be bleak phases that lasted three to four weeks have stretched into dark months for the rest of the family. The elder daughter’s college essay had a melancholic tone the subject? ‘Growing up with an absent mother’, detailing the ever-sombre silence in the house, all day long. Despite the father’s extra compensatory love, and the bi-annual presence of grandparents, there is a hole in the lives of daughters and husband. *Names have been changed to protect identity.