Saturday, November 26, 2005

Sindhai Sidharal - 5

பூவெறுகோனும்--நாயேனைப் பாடலின் பொருளை இங்கு காண்க
Anbe Sivam
Family care is the important thing in case of mental illness. I strongly feel that the festivals, occasions and the environment created by the Indian culture would really help people in getting out of any sort of depression. But now a days, the nuclear family life and extremely busy city life have resulted in reduction in the quality time spent at home with people. And, the things of interest of parents, brothers and us do not lie closer unlike olden days where people did things together. Now a days, people don’t tend to share things with family which is totally understandable to an extent and friends do play a part in people’s life.. Enna maari ore kidkku life ellam friends dhaan . Still, family care is something that would help you get out of any problem as they are the people who play a vital role in deciding things on patient’s life.

I met a lady in the train during my last visit to India when I travelled from Bombay to Chennai. She is a tamilian from chennai. She was pretty smiling, young but obese. She was so nice. But she was pretty slow in thinking/ talking must be around 27 /28 year old !! Her family asked me to take care of her when they dropped her in station which sounded odd and unusual as I look much puny ( like a to-be taken care person) . Infact I thought that I have got a great matured look after I joined Ph.D. During the journey, she asked me what is my discipline etc. and when I said 'pharmacy Bachelors', she opened up asking that whether the medicines taken by her are exactly good or what is that for?? She was actually having olanzipine a drug that is given for psychosis. It seems that her parents took her to a psychiatrist when she was in 10th class because she was not active / fast in picking up!! Then she was always mocked by her family for dumbness (dhadhi- thats what they call her ). She started taking regular psychiatric medicine. She had brothers and sisters.

And when she was ready for marriage , she told the paiyan (alliance) that she takes some medicines inspite of her parents asking her to hide . The guy's families, ofcourse said a ' no'. The parents started looking at her as a problem and felt that she is a hindrance to marriage of other daughters. The feeling of being rejected increased her depression . God knows what happened that made the doctor put her into a proper psychosis treatment (olanzipine) ( which I don’t understand)!!! As I said before, the psychiatry drugs have a severe side effect profile. It is necessary to consider the age/state of the patient before giving any medicine. In general, doctors give mild effcicacy drug with less side effect profile for girls of young marriageable age so that it may not cause obesity or in case if prescribed, the docs ask them to work out regurlarly . Nothing was told to her !! I felt sorry for her. ( Here is where I see the role of reps. There are some docs who generate prescriptions based on the gifts you give and there are some docs whose prescriptions never changes based on others and who are sensible enough to understand that they should not play with people’s mind.) And, all she needs is love and care and not olanzipine!! Parents hate her because she has younger sisters to get married!! She is smart enough to understand that she has some problem. she accepts it which many don’t and explains me pretty sensibly and asked me to suggest a better doctor. She says that her parents wont be listening to her as well.. I suggested someone better. Aanaa Manasu romba kashta patten!!

My suggestion to anybody would be this- dont go to a psychiatrist unless u think there is a dire need. Most of the times it is a situational reaction. If gone, otherwise they make it worse due to poor diagnosis/ treatment!! Not that they are always bad but the field of treating mental disorders is so poorly understood. I am not coming to such conclusion based on just one case!! Infact I have seen many doctors who have helped people in getting better but the credit is totally to the family who ARE the people who make it better!!!

I agree that every body reacts to the pressure they face!! Parents/ relatives have their own frustrations in these days and it needs lot of time and care to treat mental illness. Parents / friends have to really know the way/ tactics to get them out. Even if they are out of illness, they can get better but we can never say that they will not get back to such pathetic state unless taken care… things do repeat in patients life!!! Infact, mental health is like a see-saa when it goes low, it is not good but when it goes high, again it is not suitable because going high will lead to going low.. Staying balanced is what is needed and when it is even tough for people who has never been affected , it is tough for somebody who has experienced something bitter..
In my opinion, when somebody is depressed say like a loss of their dearest people / love failure / emotionally hurt , there is nothing we can do directly unless they realize that themselves that they have to get going in life. All we can do is, be a tool/ aid to help them realize that/ prevent them from becoming a mentally ill person/ make them feel better when they are improving.. There is no rule like this is the tactics to make them but we can do something about it. All we need to have is patience and perseverance with them !! I agree that it becomes unbearable for us sometimes. But certain things what we do shall help others!! I will talk about that in the next (final ) post!

Makkale, God has given many things to us when compared to such people - 'Thammin meilyaarai nokki thamadudamai 'amma perithendru' agamakizhndhu kol' nnu solli irukkanga . All of us get upset and can’t accept some things in life. There is somebody who is there for us to make us feel better. We get better and so, it would be nice if we make somebody’s life better.

Saturday, November 19, 2005

Sindhai Sidharal - 4

'நானும் என் சிந்தையும்' பாடலின் பொருளை இங்கு காண்க !!
In the initial days of my work, I used to be scared of psychiatric patients as I considered them to be 'specimens'. As I started getting slightly matured, I realised that they are just normal people and why should somebody abuse them (as paithiyam). I understood this only after getting in close touch with them. You may ask “ Priya, don't you see abnormal behaviour in them? Don't you think their movements are unusual". Yeh, I agree. Let me talk about each of them as I think they are different things.

Behavioral abnormaties do occur in common people when they are extremely emotional/ sensitive but such behavior remain unnoticed in normal situations. But when we brand somebody as mad, many of us tend to extrapolate every activity of them to abnormality. I do agree that psychiatric patients do have hallucinations, delusions and obsessive compulsion but we, supposedly the better individuals, should be rational enough to identify which is normal and which is not normal behaviour. This would help the slightly depressed/ improving patients to recover faster as everylook of ours would play a role in their recovery.

The abnormal postural movements you see in patients who are branded as paithiyam/ mentally ill say like what you see in ' sethu - chiyaan vikram' are not due to their illness. It is a clear misconception that abnormal postures/ movement (of head / face/ body) are mostly due to mental illness (though dullness and dumbness are due to the illness). It is the mostly the side effect of the antipsychotic drugs !! Such movements are called Tardive dyskinesia( dys- abnormal kinesia- movement) [ Details: These drugs used for treating psychosis reduces the increased dopamine levels by blocking their receptors. But this causes super sensitivity’ of the dopamine receiving receptors(as their dont receive due to this blocking nature)]

Dopamine transmission through basal ganglia region responsible for movement and when its transmission is reduced at a sudden rate, it cause abnormality in the movement causing facial/ other movement disorders. If you see somebody with such abonormal posture/ movement it means that they are getting treated and they can't avoid such movements. In U.S doctors do tell the patients about such abnormal movement which would occur due to treatment and are asked to choose the drug sometimes- either a slow acting drug with less abnormality in movements / or quick acting drug with high abonormality in movements.

Idha therinjuukkama many of us would have looked and abused somebody as 'adhu paithyam!! '. (Ofcourse there many other abnormality disorders occuring even in the absence of treatment in psychiatric and non psychiatric cases). I was/get extremely disturbed when I learn such truths in my classes. Such misconceptions should go away from people's mind so that recovering patients would feel much better. Some friends have heard volumes from me about this.. inga blogla ungalayum torture pannalaamnnu vandhen!!!
I think it's too much of science in a post!!! Let me stop here now!

Wednesday, November 16, 2005

Sindhai Sidharal - 3

சித்த விகாரக் கலக்கம் தெளிவித்தவரின் சிறப்பை இங்கு காண்க !!

Apart from the fun, I started reading literature- doctors kitta pesanume!!! I have to convince doctors who don't believe on a drug's profile, to write prescriptions for that drug. Incase, if he writes prescritions for the same drug but not my brand, then I have to convince to write my company's. Always wondered how can I convince a doctor when I cannot even convince my kith and kin!! So,I started reading!! (But, later, I found that neriya doctorsa convince panna literature vendaam - giftse pothummnnu.)

In a while, I could see that the subject knowledge had made me a better person. I seriously understood what am I talking about (apart from marketing) ; what is needed for the society and What I am doing for it ?

From marketing to research !!!

sari.. matterukuu varuvom!!

In my opinion, as I said before, psychiatry is a field where there is no specific medicine(I will call it 'drug' here after) to cure for any specific disorder. If the efficacy profile of a drug is good, the side effect of the drug is also severe! The conditions and symptoms of many illness are pretty much interrelated that we don't have a specific drug to treat for a particular cause!!

Scientifically, we have to understand that psychosis/ any mental illness is biological. Increase / decrease from the normal levels of neurotransmision of neurotrasmitters (via different routes) in the brain are the cause for any psychiatric illness. These neurotransmitters take up different routes in brain which are responsible for different functions. Abnormalities in its levels may affect a specific function or a combination of functions. Let us take the the neurotransmitter Dopamine. Dopamine plays a vital role in regulating our pleasure and pain (via pleasure pain pathway), neurocognitive functions like problem solving, memory etc (at frontal cortex) and also in movement . When its level go down/ up at a specific route , that particular function is affected say it may cause movement disorders / memory loss/ problems in recognizing pleasure and pain

Asking me what causes such changes??? Changes in such neurotransmitters levels are affected due to factors like Stress / emotional disturbances / genetic reasons/ Drugs (medications).

Let us look at the effect of drugs in causing such illness first. Even medicines that are taken chronically for some other illness like diabetes would have a side effect of increasing the level of neurotransmission. I terribly worry about taking any medicine as such for a long time as it may affect our nervous system. Have you seen grandmas/ people who had been treated chronically for diabetes / thyroid for years and have you noticed them to have lots of worries / complaints/ hallucinations/ depression ? We would just tend to think granny is conservative / old / getting mad whatever and that's why she fights against the daughter in laws/people around her and says things which she would never do before. Most of such cases where there is no problem at the relatives's / at the granny’s side (except the complaints) would be due to some side effects of a drug that she had been chronically having for treating some other ailment. All she hallucinates / assumes/ complaints against the people would be just out of her chronic treatment medicine!! Believe me, its true. Many of us take medicines assuming that medicine would just work to heal our illness. It does something silently too!! I strongly think that we shouldn't be looking at them as cunning / conservative / narrowminded individuals always and many a times We are the people who introduced such chronic english medicine treatment to them!!!
There are literatures coming up on the side effect profiles. But who cares in India?? Atleast U.Sla we get patient information sheet which updates us with some info.

Many mental illness conditions occuring via different routes of brain may have closely similar symptoms say like dullness, suicidal feel, delusions, anger etc . So, its pretty tough to diagnize the illness as such!! So, different drugs may appear to work for many different illness but it may actually not be treating the exact cause. Gradually, I found some papers talking about the usage of drugs for illness. Though Indian doctors have great experience than people here and can diagnize much better than anywhere, I happen to find during work that many doctors in India after diagnosis treat with drugs with doses/ ways which do not seem to be sensible..

And also there are many side effects for such drugs which are not mentioned to those patients at all.. I also will blame the society for this as I find that people will not go to the same doctor if he says that ' this medicine is very effective but it will cause stomach upset everynow and then'.

That was a shock... man!!! Patients take medicine without knowing their side effect profile!!! Above all, I found that the same drug is marketed for 2 different illness (though they share some common symptoms, their origin/cause is different right !!) by different companies. Each of them have articles/ case studies to defend but no body is sure that if they are eactly treating the cause. It was the first time I felt that I am a part of the group (marketing people and doctors) that tries to play with the minds of others which is absolutely a sin. Romba varutham.. Could not control my sadness!!!

I think everybody has to know if our brain(/ our close people's) is being manipulated by some drug.‘Doctor kuduthaa ellam sari dhaan’ thought will not work in case of mental illness as you don't/ can't see its side effect explicity as like a wrong dosage causing irritation / stomach upset.

Have thought many a times why there is marketing in the field of neuropsychiatry which is absolutely a non sense in my opinion!!

to be cntd.

Monday, November 14, 2005

Sindhai Sidharal -2

Well, apart from roaming out in Chennai, I have had interesting things happening at the work spot as well!! As you all might be aware that there are many neuro psychiatric disorders such as Schizophrenia, depression (mild/moderate/severe), Bipolar disorder (Mania/Depression), psychosis. These illness may be genetic but mostly, it is due to environmental surroundings. Precisely, it (illness/ biological changes) occurs /aggravates / weakens to a greater extent based on how somebody reacts to public and how public reacts to the person. I say this statement with wide connotations – I mean that it can be viewed in both serious and funny aspects. The funny aspect I refer is what experiences I have had with the patient and my boss (my manager) and the serious aspect I refer is how the patients develop such psychiatric illness about which I will talk later.

My Manager H is a wonderful man but he takes so much rights and care for the job that he would correct my mistakes bluntly right on my face!! He is pretty professional that he would tell how much time before one should come to a spot based on the people you meet. Say for example, if you are waiting for your manager, you should be at the spot before 15min ahead of the time . If its a friend, it should be 2-3 minutes. If its an interview its 5 minutes etc.. And so he has so much ethics set up for him and his subordinates as well. He likes me/ my work but never ever appreciates me as I know he wants me to be the best.

There are some ethics which we have to follow when we go to mental hospitals. When I meet patients, I am not supposed to make any conversation with them. Infact, not even smile because a patient with 'hallucination' may think that I am there to hit him/ do something to him. Ennaku smile naturallaa varum neriya vaati.. but ' chumma iru priya'nnu nenachupen!! When he comes on rounds with me, it's a terror period! Ipdi irukadha apdi irukaadha etc. When some patient/ wardboy/ attendant comes and talks to me, I tend to answer them pleasingly and continue with the conversation for a while atleast. I always think somebody opposite to you may be smart enough to understand if I make conversations oppurtunistically. Infact I feel I should not do it. But H will give all D looks. After they leave, he will just tell right on my face ' unakku aarvakoolaru romba adigam...adanga maateye nee'. For me, who have never heard local chennai bashai like this, it would sound insulting and I would get broken into pieces. Avar kooda irundhu irundhu soranai ellam koranju pochu!!!!

When I am there waiting for my turn to meet the doctor, I get to meet many patients during that time. One thing I observed was this: Very poor / very rich patients dare to start a conversation. Poor patients ask for free sample medicine and share their symptoms and their treatment details. I kindaa verify to myself if the doctor is on his right way in treatment. ( Please do not think that I am proudly saying that I know things.Psychiatry is a field where things are not definite. All what many doctors know is from the references the reps and executives quote. And there is no medicine like thalavalinna tylenol, fevernna ibuprofennnu !! Its all trial and error situation for psychiatrist about which I will talk in depth. let me leave this now).
Very rich patients do not consider illness to be a sin and they forget their illness. There is one inpatient clinic in nungambakkam opposite to the L college where there are/ can be only rich patients. The expenditure for their stay is like 10,000 rupees per person in 2001. Some are Ph.D students (makkalee..romba padikaantheenga!!! ) / Ph.D candidates / Job holders from U.S who couldn't bear the pressures . But, now, they look so cool and once, I was amazed at a chemistry student(patient) who casually with great english accent came up to me and called me for playing TT .

Well, the middle class are those who scare to death and do nonsense about their illness. Patient's caretakers are the pillars for such patients. Avanga epdi nadakaraangalo that is reflected on patients of this category very much. Adhai pathi aprom pesalaam. But indha patient's caretakers' thollai thaangaadhu'!!! Patientsoda family members ask me for cold/ cough/other illness medicine and when I say ' I have only psychiatric medicine' they give me a kevalam look that I feel so embarrassed. My sample medicines go just to doctor and I rarely give to patients that too only after knowing that they take the same drug, same dose!

Other reps of other non psycho division would be distributing to all perimma, chithi.. etc. Enna seiyya -- 'avvaiyar' kalvi pathi solra maari, naanum solven – en maathiraigal 'kollathaan mudiyaathu; kuduthaalum (vyaadhi) neraivozhiya kuraipadaathu'. Avlo sample mathrai bag bagaa irukkum !! 'Thookamathrai' leirundhu - obsessive compulsive disorder varaikkum ella psycho medicineum enkitta irukkum!! aana use panna mudiyaadhu!!
Lexingtonnukku eduthukittu vandhu naalu perukku kuduthu udavi irukalaam :)-
To be contd.

Friday, November 11, 2005

Sindhai Sidharal - 1

Hey there!!
Have you thought of this... What can be the most horrible illness one can get?-- Cancer? Diabetes? Thyroid problem? Lactose intolerance? Gout disease? Arthritis? - yeh... these are chronic and they will cause trouble all throughout the life. According to me, the one that is most severe/ 'unbearable kodumai' is the Neuropsychiatric illness. It does not only affect one's brain/thought process but also the people around them.

Well, I want to ask you this... Have you guys had a chance to visit any mental hospital / psychiatry clinic??? If not, ask me.. I have lllots of stories to tell - the fun part and the learning part as well. I really have something to discuss and share with you all and though I am starting here with my experiences, I have something which I want to share important in the next posts..

Sari, getting back to the story..Yeh, I had the oppurtunity to visit almost all the mental hospitals/neuropsychiatry divisions at chennai right from MMC, Ramachandra (SRMC), Vadapalani Vijaya, Soorya and many kutti clinics and infact I have been to the biggest and one of the best mental hospitals - Vellore bagayam!!! Enna daa, ivlo naal oru loose ezhuthardhaya padichomnnu nenachu bayapadaatheenga!! coolap podunga!! I went there as a part of my job & not as a patient.

I took up a job in psychiatric division of a reputed company in chennai in 2001 which demanded me to meet psychiatrist and neurologists and talk about our products/ patients illness etc. - more like a Rep. but, as its a separate division, I didn't have to visit general physicians..koncham mariyaathai undu..onnum therilanaa kooda BITSnra per 'kai' kuduthu udavichu:)- and also koncham sales velai irukkum- visit pharmacies and enquire about the competetor brand, what they sell, how they do it etc.!! Sama different exposure!!! I took it up inspite of knowing that I dont know anything abt marketing / sales because I wanted to explore chennai.. All I knew was the route from Luz aanjaneyar temple( near which we lived during schooling) to gopalapuram D.A.V. Maximum 'kabaleeshwarar kovil' theriyum avlodhaan. satyam theatreukku 11th std kooda poga theriyaadhu!!

But then, my parents moved to pammal during my college days. So, I had to ride my scooty atleast 90kms / day for my job. As its psychiatry, the doctors and clinics are few and scattered. I had to meet a doctor at MMC in the morning at 8.00am, be at vadapalani vijaya at 11.00am, at surya around 12.15, then to ramachandra around 1.00(i had to rush..SRMC Canteen saapada adichuka mudiyaadhu!!), get back to best hospital choolaimedu at 3.00pm and visit some clinics at triplicane till 9.00pm and come back to my home at pammal all the way through GST road.(wow.. enna sugama kathu adikum vandi ottinaa!!!) The next day, it will be a pretty different route starting with KK nagar, T.nagar etc...though the life was tough, I enjoyed being busy to the core as that was the time I learned things like
moving out myself, eating alone in a hotel/ road side kadai (when so many 'bayangarama looking' guys stand near me) and things like initiating a conversation etc.
to be cntd..