ELECTRO CONVULSIVE THERAPY=ECT
Definition=
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.
Much of the stigma attached to electroconvulsive therapy is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
Electroconvulsive therapy is much safer today. Although electroconvulsive therapy still causes some side effects, it now uses electrical currents given in a controlled setting to achieve the most benefit with the fewest possible risks.
Indications=
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of a number of mental health conditions. It may be an effective treatment in someone who is suicidal, for instance, or end an episode of severe mania.
ECT is used to treat:
Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
Treatment-resistant depression, long-term depression that doesn't improve with medications or other treatments.
Schizophrenia, particularly when accompanied by psychosis, a desire to commit suicide or hurt someone else, or refusal to eat.
Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision making, impulsive or risky behavior, substance abuse and psychosis.
Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It's associated with schizophrenia and some other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
Electroconvulsive therapy is sometimes used as a last-resort treatment for:
Treatment-resistant obsessive compulsive disorder, severe obsessive compulsive disorder that doesn't improve with medications or other treatments
Parkinson's disease, epilepsy, and certain other conditions that cause movement problems or seizures
Tourette syndrome that doesn't improve with medications or other treatments
ECT may be a good treatment option when medications aren't tolerated or other forms of therapy haven't worked. In some cases ECT is used:
• During pregnancy, when medications can't be taken because they might harm the developing fetus
• In older adults who can't tolerate drug side effects
• In people who prefer ECT treatments over taking medications
• When ECT has been successful in the past
CONTRADICTION=
RECENT MI OR CARDIAC SURGERY
CERVICAL SPINE FRACTURE
Risks
Although ECT is generally safe, there are known risks and side effects. These include:
Confusion. Immediately after an ECT treatment, you may experience a period of confusion. You may not know where you are or why you're there. This confusion may last from a few minutes to several hours. You may be able to return to work and normal activities right away; or, you may need to rest for several hours after treatment. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
Memory loss. ECT can affect memory in several ways. You may have trouble remembering events that occurred before treatment began, a condition known as retrograde amnesia. It may be hard to remember things in the weeks or months leading up to treatment, although some people do have problems with memories from years previous, as well. You may also have trouble recalling events that occurred during the weeks of your treatment. And some people have trouble with memory of events that occur even after ECT has stopped. These memory problems usually improve within a couple of months.
Physical side effects. On the days you have an ECT treatment, you may experience nausea, vomiting, headache, jaw pain, muscle ache or muscle spasms. These are common and generally can be treated with medications.
Medical complications. As with any type of medical procedure, especially one in which anesthesia is used, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.
Pre ECT Evaluation
A pre-ECT evaluation usually includes:
• A medical history
• A physical examination
• Basic blood tests
• An electrocardiogram (ECG) to check your heart health
Procedure=
The ECT procedure takes about 10 or 15 minutes, with added time for preparation and recovery. ECT may be performed while you're hospitalized or as an outpatient procedure. In either case, it's done under general anesthesia, which means you'll be unconscious during the procedure. Your health care team will tell you how long you must avoid food and drinks before ECT treatment.
When it's time for the procedure, you may have a brief physical exam to check your heart and lungs. An intravenous (IV) catheter is inserted in your arm or hand through which medications or fluids can be given. During the procedure, monitors constantly check your heart, blood pressure and oxygen use. You may be given oxygen through an oxygen mask.
Doctors place electrode pads, each about the size of a silver dollar, on your head. ECT can be unilateral, in which only one side of the brain is subject to electricity, or bilateral, in which both sides of the brain receive electrical currents.
Anesthesia and medications
An anesthetic is injected in the IV to make you unconscious and unaware of the procedure. A muscle relaxant also is injected to help prevent your body from convulsing violently during the seizure. A blood pressure cuff is placed around your forearm or ankle area, preventing the muscle relaxant from paralyzing those particular muscles. When the procedure begins, the doctor can make sure you're actually having a seizure by watching for movement in that one hand or foot.
In addition to the anesthetic and muscle relaxant, you may be given other medications, depending on any health conditions you have or your previous reactions to ECT. You may also be given a mouth guard to help protect your teeth and tongue from injury.
Inducing a seizure
When you're asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electrical current to pass through the electrodes to your brain, producing a seizure that usually lasts 30 to 60 seconds.
Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you're experiencing a seizure may be a rhythmic movement of a foot or a hand. But internally, activity in your brain increases dramatically. This is recorded by an electroencephalogram (EEG) in much the same way as an ECG measures your heart's activity. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You're taken to a recovery area, where you're monitored for problems. Upon awakening, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
In the United States, ECT treatments are generally given three times weekly for two to four weeks — for a total of six to twelve treatments. The number of treatments you will need depends on the severity of your symptoms and how rapidly they improve.
Results
Many people begin to notice an improvement in their symptoms after two or three treatments with electroconvulsive therapy. Full improvement may take longer, though. Response to antidepressant medications, in comparison, can take several weeks or more.
No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses.
That's why ECT is most effective with multiple treatments. Most people who receive ECT have treatments three times a week, usually for two to four weeks. ECT is effective in most people who receive the full course.
Even after your symptoms improve, you likely will need ongoing treatment to prevent a recurrence. That ongoing treatment, known as maintenance therapy, doesn't have to be ECT, but it can be. More often, it includes antidepressants or other medications or psychological counseling (psychotherapy).
27 January 2012
19 January 2012
Behavioural and conduct problems
Behavioural and conduct problems
Factsheet for parents and teachers
Introduction
It takes time for children to learn how to behave properly. With help and encouragement from parents and teachers, most of them will learn quickly. All children will sometimes disobey adults. Occasionally, a child will have a temper tantrum, or an outburst of aggressive or destructive behaviour but this is nothing to worry about.
Behavioural problems – the signs
Behavioural problems can occur in children of all ages. Very often they start in early life. Toddlers and young children may refuse to do as they are asked by adults, in spite of being asked many times. They can be rude, swear and have tantrums. Hitting and kicking of other people is common. times..
So is breaking or spoiling things that matter to others.
Some children have serious behavioural problems.
The signs of this to look out for are:
• if the child continues to behave badly for several months or longer, is repeatedly being disobedient, cheeky and aggressive
• if their behaviour is out of the ordinary, and seriously breaks the rules accepted in their family and community, this is much more than ordinary childish mischief or adolescent rebelliousness.
This sort of behaviour can affect a child’s development, and can interfere with their ability to lead a normal life. When behaviour is this much of a problem, it is called a conduct disorder.
What does this mean?
Children with a conduct disorder may get involved in more violent physical fights, and may steal or lie, without any sign of remorse or guilt when they are found out. They refuse to follow rules and may start to break the law. They may start to stay out all night and truant from school during the day. Teenagers with conduct disorder may also take risks with their health and safety by taking illegal drugs or having unprotected sexual intercourse.
What effect can this have?
This kind of behaviour puts a huge strain on the family. Children who behave like this will often find it difficult to make friends. Even though they might be quite bright, they don’t do well at school and are often near the bottom of the class. On the inside, the young person may be feeling that they are worthless and that they just can’t do anything right. It is common for them to blame others for their difficulties if they do not know how to change for the better.
What causes oppositional defiant disorder/conduct disorder?
A child is more likely to develop an oppositional defiant disorder/conduct disorder if they:
• have a difficult temperament;
• have learning or reading difficulties – these make it difficult for them to understand and take part in lessons. It is then easy for them to get bored, feel stupid and misbehave;
• are depressed;
• have been bullied or abused;
•are ‘hyperactive’ – this causes difficulties with self-control, paying attention and
following rules .
Parents themselves can sometimes unknowingly make things worse by giving too little attention to good behaviour, always being too quick to criticise, or by being too flexible about the rules and not supervising their children adequately. This often happens if a parent is depressed, exhausted or overwhelmed.
Giving too little attention to good behaviour
As a parent, it can be easy to ignore your child when they are being good, and only pay attention to them when they are behaving badly. Over time, the child learns that they only get attention when they are breaking rules. Most children, including teenagers, need a lot of attention from their parents, and will do whatever it takes to get it. Perhaps surprisingly, they seem to prefer angry or critical attention to being ignored. It’s easy to
see how, over time, a ‘vicious cycle’ is set up. Being too flexible about the rules Children need to learn that rules are important and that ‘no’ means ‘no’. Keeping this up is hard work for parents. It can be tempting to give in ‘for a quiet life’. The trouble is that this teaches the child to push the limits until they get what they want. Teenagers need to know that their parents care about them. They must also understand that rules are needed to protect their safety and that they must learn to live within these rules.
Where can I get help?
Parents can do a lot. It helps if discipline is fair and consistent, and it is crucial for both parents to agree on how to handle their child’s behaviour .All young people need praise and rewards when they improve their behaviour. This can be hard. Remember to praise even the small, everyday things, and let them know that you love and appreciate them.
It is worth asking the school about whether they are also worried about your child’s
behaviour. It is helpful if parents and teachers can .behaviour. It is helpful if parents and teachers can work together. Extra teaching may be necessary. You can seek advice from the school teachers or from an educational psychologist. If serious problems continue for more than 3 months, it is worth asking your health visitor or general practitioner for advice. If more specialist help is needed, they will be able to make a referral to your local child and adolescent Psychiatrist. Specialists can help by finding out what is causing the problem, and also by suggesting practical way of improving the difficult behaviour.
Factsheet for parents and teachers
Introduction
It takes time for children to learn how to behave properly. With help and encouragement from parents and teachers, most of them will learn quickly. All children will sometimes disobey adults. Occasionally, a child will have a temper tantrum, or an outburst of aggressive or destructive behaviour but this is nothing to worry about.
Behavioural problems – the signs
Behavioural problems can occur in children of all ages. Very often they start in early life. Toddlers and young children may refuse to do as they are asked by adults, in spite of being asked many times. They can be rude, swear and have tantrums. Hitting and kicking of other people is common. times..
So is breaking or spoiling things that matter to others.
Some children have serious behavioural problems.
The signs of this to look out for are:
• if the child continues to behave badly for several months or longer, is repeatedly being disobedient, cheeky and aggressive
• if their behaviour is out of the ordinary, and seriously breaks the rules accepted in their family and community, this is much more than ordinary childish mischief or adolescent rebelliousness.
This sort of behaviour can affect a child’s development, and can interfere with their ability to lead a normal life. When behaviour is this much of a problem, it is called a conduct disorder.
What does this mean?
Children with a conduct disorder may get involved in more violent physical fights, and may steal or lie, without any sign of remorse or guilt when they are found out. They refuse to follow rules and may start to break the law. They may start to stay out all night and truant from school during the day. Teenagers with conduct disorder may also take risks with their health and safety by taking illegal drugs or having unprotected sexual intercourse.
What effect can this have?
This kind of behaviour puts a huge strain on the family. Children who behave like this will often find it difficult to make friends. Even though they might be quite bright, they don’t do well at school and are often near the bottom of the class. On the inside, the young person may be feeling that they are worthless and that they just can’t do anything right. It is common for them to blame others for their difficulties if they do not know how to change for the better.
What causes oppositional defiant disorder/conduct disorder?
A child is more likely to develop an oppositional defiant disorder/conduct disorder if they:
• have a difficult temperament;
• have learning or reading difficulties – these make it difficult for them to understand and take part in lessons. It is then easy for them to get bored, feel stupid and misbehave;
• are depressed;
• have been bullied or abused;
•are ‘hyperactive’ – this causes difficulties with self-control, paying attention and
following rules .
Parents themselves can sometimes unknowingly make things worse by giving too little attention to good behaviour, always being too quick to criticise, or by being too flexible about the rules and not supervising their children adequately. This often happens if a parent is depressed, exhausted or overwhelmed.
Giving too little attention to good behaviour
As a parent, it can be easy to ignore your child when they are being good, and only pay attention to them when they are behaving badly. Over time, the child learns that they only get attention when they are breaking rules. Most children, including teenagers, need a lot of attention from their parents, and will do whatever it takes to get it. Perhaps surprisingly, they seem to prefer angry or critical attention to being ignored. It’s easy to
see how, over time, a ‘vicious cycle’ is set up. Being too flexible about the rules Children need to learn that rules are important and that ‘no’ means ‘no’. Keeping this up is hard work for parents. It can be tempting to give in ‘for a quiet life’. The trouble is that this teaches the child to push the limits until they get what they want. Teenagers need to know that their parents care about them. They must also understand that rules are needed to protect their safety and that they must learn to live within these rules.
Where can I get help?
Parents can do a lot. It helps if discipline is fair and consistent, and it is crucial for both parents to agree on how to handle their child’s behaviour .All young people need praise and rewards when they improve their behaviour. This can be hard. Remember to praise even the small, everyday things, and let them know that you love and appreciate them.
It is worth asking the school about whether they are also worried about your child’s
behaviour. It is helpful if parents and teachers can .behaviour. It is helpful if parents and teachers can work together. Extra teaching may be necessary. You can seek advice from the school teachers or from an educational psychologist. If serious problems continue for more than 3 months, it is worth asking your health visitor or general practitioner for advice. If more specialist help is needed, they will be able to make a referral to your local child and adolescent Psychiatrist. Specialists can help by finding out what is causing the problem, and also by suggesting practical way of improving the difficult behaviour.
17 January 2012
Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD)
Introduction
In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, the victim of an assault, or see an accident. Police, fire brigade or ambulance workers are more likely to have such experiences - they often have to deal with horrifying scenes. Soldiers may be shot or blown up, and see friends killed or injured.
Most people, in time, get over experiences like this without needing help. In some people, though, traumatic experiences set off a reaction that can last for many months or years. This is called Post-Traumatic Stress Disorder, or PTSD for short.
How does PTSD start?
PTSD can start after any traumatic event. A traumatic event is one where we can see that we are in danger, our life is threatened, or where we see other people dying or being injured. Some typical traumatic events would be:
serious road accidents
military combat
violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
being taken hostage
terrorist attack
being a prisoner-of-war
natural or man-made disasters
being diagnosed with a life-threatening illness.
Even hearing about an the unexpected injury or violent death of a family member or close friend can start PTSD.
When does PTSD start?
The symptoms of PTSD can start after a delay of weeks, or even months. They usually appear within 6 months of a traumatic event.
What does PTSD feel like?
Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms produced by such an experience:
1. Flashbacks & Nightmares
You find yourself re-living the event, again and again. This can happen both as a "flashback" in the day, and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened - fear, sweating, smells, sounds, pain.
Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.
2. Avoidance & Numbing
It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crossword or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it.
You may deal with the pain of your feelings by trying to feel nothing at all - by becoming emotionally numb. You communicate less with other people, who then find it hard to live or work with you.
3. Being "On Guard"
You find that you stay alert all the time, as if you are looking out for danger. You can't relax. This is called "hypervigilance". You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.
Other Symptoms
Emotional reactions to stress are often accompanied by:
muscle aches and pains
diarrhoea
irregular heartbeats
headaches
feelings of panic and fear
depression
drinking too much alcohol
using drugs (including painkillers).
Why are traumatic events so shocking?
They undermine our sense that life is fair, reasonably safe, and that we are secure. A traumatic experience makes it very clear that we can die at any time. The symptoms of PTSD are part of a normal reaction to narrowly avoided death.
Does everyone get PTSD after a traumatic experience?
No. But nearly everyone will have the symptoms of post traumatic stress for the first month or so. This is because they help to keep you going, and help you to understand the experience you have been through. This is an "acute stress reaction". Over a few weeks, most people slowly come to terms with what has happened, and their stress symptoms start to disappear.
Not everyone is so lucky. About 1 in 3 people will find that their symptoms just carry on and that they can't come to terms with what has happened. It is as though the process has got stuck. The symptoms of post traumatic stress, although normal in themselves, become a problem - or Post Traumatic Stress Disorder - when they go on for too long.
What makes PTSD worse?
The more disturbing the experience, the more likely you are to develop PTSD. The most traumatic events:
are sudden and unexpected
go on for a long time
you are trapped and can't get away
are man-made
cause many deaths
cause mutilation and loss of arms or legs
involve children.
What about ordinary "stress"?
Everybody feels stressed from time to time. Unfortunately, the word "stress" is used to mean two rather different things:
our inner sense of worry, feeling tense or feeling burdened.
or
the problems in our life that are giving us these feelings. This could be work, relationships, maybe just trying to get by without much money.
Unlike PTSD, these things are with us, day in and day out. They are part of normal, everyday life, but can produce anxiety, depression, tiredness, and headaches. They can also make some physical problems worse, such as stomach ulcers and skin problems. These are certainly troublesome, but they are not the same as PTSD.
Why does PTSD happen?
We don't know for certain. There are a several possible explanations for why PTSD occurs.
Psychological
When we are frightened, we remember things very clearly. Although it can be distressing to remember these things, it can help us to understand what happened and, in the long run, help us to survive.
The flashbacks, or replays, force us to think about what has happened. We can decide what to do if it happens again. After a while, we learn to think about it without becoming upset.
It is tiring and distressing to remember a trauma. Avoidance and numbing keep the number of replays down to a manageable level.
Being "on guard" means that we can react quickly if another crisis happens. We sometimes see this happening with survivors of an earthquake, when there may be second or third shocks. It can also give us the energy for the work that's needed after an accident or crisis.
But we don't want to spend the rest of our life going over it. We only want to think about it when we have to - if we find ourselves in a similar situation.
Physical
Adrenaline is a hormone our bodies produce when we are under stress. It "pumps up" the body to prepare it for action. When the stress disappears, the level of adrenaline should go back to normal. In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well.
The hippocampus is a part of the brain that processes memories. High levels of stress hormones, like adrenaline, can stop it from working properly - like "blowing a fuse". This means that flashbacks and nightmares continue because the memories of the trauma can't be processed. If the stress goes away and the adrenaline levels get back to normal, the brain is able to repair the damage itself, like other natural healing processes in the body. The disturbing memories can then be processed and the flashbacks and nightmares will slowly disappear.
How do I know when I've got over a traumatic experience?
When you can:
think about it without becoming distressed
not feel constantly under threat
not think about it at inappropriate times.
Why is PTSD often not recognised? None of us like to talk about upsetting events and feelings.
We may not want to admit to having symptoms, because we don't want to be thought of as weak or mentally unstable.
Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events.
People with PTSD often find it easier to talk about the other problems that go along with it - headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.
How can I tell if I have PTSD?
Have you have experienced a traumatic event of the sort described at the start of this article?
If you have, do you:
have vivid memories, flashbacks or nightmares?
avoid things that remind you of the event?
feel emotionally numb at times?
feel irritable and constantly on edge but can't see why?
eat more than usual, or use more drink or drugs than usual?
feel out of control of your mood?
find it more difficult to get on with other people?
have to keep very busy to cope?
feel depressed or exhausted?
If it is less that 6 weeks since the traumatic event, and these experiences are slowly improving, they may be part of the normal process of adjustment.
If it is more than 6 weeks since the event, and these experiences don't seem to be getting better, it is worth talking it over with your doctor.
Children and PTSD
PTSD can develop at any age.
Younger children may have upsetting dreams of the actual trauma, which then change into nightmares of monsters. They often re-live the trauma in their play. For example, a child involved in a serious road traffic accident might re-enact the crash with toy cars, over and over again.
They may lose interest in things they used to enjoy. They may find it hard to believe that they will live long enough to grow up.
They often complain of stomach aches and headaches.
How can PTSD be helped?
Helping yourself
Do ......... keep life as normal as possible
get back to your usual routine
talk about what happened to someone you trust
try relaxation exercises
go back to work
eat and exercise regularly
go back to where the traumatic event happened
take time to be with family and friends
drive with care - your concentration may be poor
be more careful generally - accidents are more likely at this time
speak to a doctor
expect to get better.
Don't ........
beat yourself up about it - PTSD symptoms are not a sign of weakness. They are a normal reaction, of normal people, to terrifying experiences
bottle up your feelings. If you have developed PTSD symptoms, don't keep it to yourself because treatment is usually very successful.
avoid talking about it.
expect the memories to go away immediately, they may be with you for quite some time.
expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
stay away from other people.
drink lots of alcohol or coffee or smoke more.
get overtired.
miss meals.
take holidays on your own.
What can interfere with getting better?
You may find that other people will:
not let you talk about it
avoid you
be angry with you
think of you as weak
blame you
These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won't help you because it doesn't give you the chance to talk over what has happened to you.
You may not be able to talk easily about it. A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can't remember what happened, can't put it into words, or can't make sense of it.
Treatment
Just as there are both physical and psychological aspects to PTSD, so there are both physical and psychological treatments for it.
Psychotherapy
All the effective psychotherapies for PTSD focus on the traumatic experiences that have produced your symptoms rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life.
You need to be able to remember what happened, as fully as possible, without being overwhelmed by fear and distress. These therapies help you to put words to the traumatic experiences that you have had. By remembering the event, going over it and making sense of it, your mind can do its normal job, of storing the memories away and moving on to other things.
If you can start to feel safe again and in control of your feelings, you won't need to avoid the memories as much. Indeed, you can gain more control over your memories so that you only think about them when you want to, rather than having them erupt into your mind spontaneously.
All these treatments should all be given by specialists in the treatment of PTSD. The sessions should be at least weekly, every week, with the same therapist, and should usually continue for 8-12 weeks. Although sessions will usually last around an hour, they may sometimes last up to 90 minutes.
Cognitive Behavioural Therapy (CBT) is a way of helping you to think differently about your memories, so that they become less distressing and more manageable. It will usually also involve some relaxation work to help you tolerate the discomfort of thinking about the traumatic events. For further information, see our factsheet on CBT.
EMDR (Eye Movement Desensitisation & Reprocessing) is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience. It may sound odd, but it has been shown to work.
Group therapy involves meeting with a group of other people who have been through the same, or a similar traumatic event. The fact that other people in the group do have some idea of what you have been through can make it much easier to talk about what has happened.
Medication
SSRI antidepressant tablets will both reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.
This type of medication should not make you sleepy, although they all have some side-effects in some people. They may also produce unpleasant symptoms if stopped quickly, so the dose should usually be reduced gradually. If they are helpful, you should carry on taking them for around 12 months. Soon after starting an antidepressany, some people may find that they feel more:
anxious
restless
suicidal
These feelings usually pass in a few days, but you should see your doctor regularly.
If these don't work for you, tricyclic or MAOI antidepressant tablets may still be helpful. For more information, see our factsheet on antidepressants.
Occasionally, if someone is so distressed that they cannot sleep or think clearly, anxiety-reducing medication may be necessary. These tablets should usually not be prescribed for more than 10 days or so.
Body-focussed Therapies
These can help to control the distress of PTSD. They can also reduce hyperarousal, or the feeling of being "on guard" all the time. These therapies include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They all help you to develop ways of relaxing and managing stress.
Effectiveness of Treatments
At present, there is evidence that EMDR, psychotherapy, cognitive behavioural therapy and antidepressants are all effective. There is not enough information for us to say that one of these treatments is better than another. There is no evidence that other forms of psychotherapy or counselling are helpful to PTSD.
Which treatments first?
The National Institute for Clinical Excellence (NICE) guidelines suggest that trauma-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.
For friends, relatives & colleagues
Do .......
watch out for any changes in behaviour - poor performance at work, lateness, taking sick leave, minor accidents
watch for anger, irritability, depression, lack of interest, lack of concentration
take time to allow a trauma survivor to tell their story
ask general questions
let them talk, don't interrupt the flow or come back with your own experiences.
Don't ....... tell a survivor you know how they feel - you don't
tell a survivor they're lucky to be alive - they'll get angry
minimise their experience - "it's not that bad, surely ..."
suggest that they just need to 'pull themselves together'.
Introduction
In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, the victim of an assault, or see an accident. Police, fire brigade or ambulance workers are more likely to have such experiences - they often have to deal with horrifying scenes. Soldiers may be shot or blown up, and see friends killed or injured.
Most people, in time, get over experiences like this without needing help. In some people, though, traumatic experiences set off a reaction that can last for many months or years. This is called Post-Traumatic Stress Disorder, or PTSD for short.
How does PTSD start?
PTSD can start after any traumatic event. A traumatic event is one where we can see that we are in danger, our life is threatened, or where we see other people dying or being injured. Some typical traumatic events would be:
serious road accidents
military combat
violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
being taken hostage
terrorist attack
being a prisoner-of-war
natural or man-made disasters
being diagnosed with a life-threatening illness.
Even hearing about an the unexpected injury or violent death of a family member or close friend can start PTSD.
When does PTSD start?
The symptoms of PTSD can start after a delay of weeks, or even months. They usually appear within 6 months of a traumatic event.
What does PTSD feel like?
Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms produced by such an experience:
1. Flashbacks & Nightmares
You find yourself re-living the event, again and again. This can happen both as a "flashback" in the day, and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened - fear, sweating, smells, sounds, pain.
Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.
2. Avoidance & Numbing
It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crossword or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it.
You may deal with the pain of your feelings by trying to feel nothing at all - by becoming emotionally numb. You communicate less with other people, who then find it hard to live or work with you.
3. Being "On Guard"
You find that you stay alert all the time, as if you are looking out for danger. You can't relax. This is called "hypervigilance". You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.
Other Symptoms
Emotional reactions to stress are often accompanied by:
muscle aches and pains
diarrhoea
irregular heartbeats
headaches
feelings of panic and fear
depression
drinking too much alcohol
using drugs (including painkillers).
Why are traumatic events so shocking?
They undermine our sense that life is fair, reasonably safe, and that we are secure. A traumatic experience makes it very clear that we can die at any time. The symptoms of PTSD are part of a normal reaction to narrowly avoided death.
Does everyone get PTSD after a traumatic experience?
No. But nearly everyone will have the symptoms of post traumatic stress for the first month or so. This is because they help to keep you going, and help you to understand the experience you have been through. This is an "acute stress reaction". Over a few weeks, most people slowly come to terms with what has happened, and their stress symptoms start to disappear.
Not everyone is so lucky. About 1 in 3 people will find that their symptoms just carry on and that they can't come to terms with what has happened. It is as though the process has got stuck. The symptoms of post traumatic stress, although normal in themselves, become a problem - or Post Traumatic Stress Disorder - when they go on for too long.
What makes PTSD worse?
The more disturbing the experience, the more likely you are to develop PTSD. The most traumatic events:
are sudden and unexpected
go on for a long time
you are trapped and can't get away
are man-made
cause many deaths
cause mutilation and loss of arms or legs
involve children.
What about ordinary "stress"?
Everybody feels stressed from time to time. Unfortunately, the word "stress" is used to mean two rather different things:
our inner sense of worry, feeling tense or feeling burdened.
or
the problems in our life that are giving us these feelings. This could be work, relationships, maybe just trying to get by without much money.
Unlike PTSD, these things are with us, day in and day out. They are part of normal, everyday life, but can produce anxiety, depression, tiredness, and headaches. They can also make some physical problems worse, such as stomach ulcers and skin problems. These are certainly troublesome, but they are not the same as PTSD.
Why does PTSD happen?
We don't know for certain. There are a several possible explanations for why PTSD occurs.
Psychological
When we are frightened, we remember things very clearly. Although it can be distressing to remember these things, it can help us to understand what happened and, in the long run, help us to survive.
The flashbacks, or replays, force us to think about what has happened. We can decide what to do if it happens again. After a while, we learn to think about it without becoming upset.
It is tiring and distressing to remember a trauma. Avoidance and numbing keep the number of replays down to a manageable level.
Being "on guard" means that we can react quickly if another crisis happens. We sometimes see this happening with survivors of an earthquake, when there may be second or third shocks. It can also give us the energy for the work that's needed after an accident or crisis.
But we don't want to spend the rest of our life going over it. We only want to think about it when we have to - if we find ourselves in a similar situation.
Physical
Adrenaline is a hormone our bodies produce when we are under stress. It "pumps up" the body to prepare it for action. When the stress disappears, the level of adrenaline should go back to normal. In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well.
The hippocampus is a part of the brain that processes memories. High levels of stress hormones, like adrenaline, can stop it from working properly - like "blowing a fuse". This means that flashbacks and nightmares continue because the memories of the trauma can't be processed. If the stress goes away and the adrenaline levels get back to normal, the brain is able to repair the damage itself, like other natural healing processes in the body. The disturbing memories can then be processed and the flashbacks and nightmares will slowly disappear.
How do I know when I've got over a traumatic experience?
When you can:
think about it without becoming distressed
not feel constantly under threat
not think about it at inappropriate times.
Why is PTSD often not recognised? None of us like to talk about upsetting events and feelings.
We may not want to admit to having symptoms, because we don't want to be thought of as weak or mentally unstable.
Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events.
People with PTSD often find it easier to talk about the other problems that go along with it - headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.
How can I tell if I have PTSD?
Have you have experienced a traumatic event of the sort described at the start of this article?
If you have, do you:
have vivid memories, flashbacks or nightmares?
avoid things that remind you of the event?
feel emotionally numb at times?
feel irritable and constantly on edge but can't see why?
eat more than usual, or use more drink or drugs than usual?
feel out of control of your mood?
find it more difficult to get on with other people?
have to keep very busy to cope?
feel depressed or exhausted?
If it is less that 6 weeks since the traumatic event, and these experiences are slowly improving, they may be part of the normal process of adjustment.
If it is more than 6 weeks since the event, and these experiences don't seem to be getting better, it is worth talking it over with your doctor.
Children and PTSD
PTSD can develop at any age.
Younger children may have upsetting dreams of the actual trauma, which then change into nightmares of monsters. They often re-live the trauma in their play. For example, a child involved in a serious road traffic accident might re-enact the crash with toy cars, over and over again.
They may lose interest in things they used to enjoy. They may find it hard to believe that they will live long enough to grow up.
They often complain of stomach aches and headaches.
How can PTSD be helped?
Helping yourself
Do ......... keep life as normal as possible
get back to your usual routine
talk about what happened to someone you trust
try relaxation exercises
go back to work
eat and exercise regularly
go back to where the traumatic event happened
take time to be with family and friends
drive with care - your concentration may be poor
be more careful generally - accidents are more likely at this time
speak to a doctor
expect to get better.
Don't ........
beat yourself up about it - PTSD symptoms are not a sign of weakness. They are a normal reaction, of normal people, to terrifying experiences
bottle up your feelings. If you have developed PTSD symptoms, don't keep it to yourself because treatment is usually very successful.
avoid talking about it.
expect the memories to go away immediately, they may be with you for quite some time.
expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
stay away from other people.
drink lots of alcohol or coffee or smoke more.
get overtired.
miss meals.
take holidays on your own.
What can interfere with getting better?
You may find that other people will:
not let you talk about it
avoid you
be angry with you
think of you as weak
blame you
These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won't help you because it doesn't give you the chance to talk over what has happened to you.
You may not be able to talk easily about it. A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can't remember what happened, can't put it into words, or can't make sense of it.
Treatment
Just as there are both physical and psychological aspects to PTSD, so there are both physical and psychological treatments for it.
Psychotherapy
All the effective psychotherapies for PTSD focus on the traumatic experiences that have produced your symptoms rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life.
You need to be able to remember what happened, as fully as possible, without being overwhelmed by fear and distress. These therapies help you to put words to the traumatic experiences that you have had. By remembering the event, going over it and making sense of it, your mind can do its normal job, of storing the memories away and moving on to other things.
If you can start to feel safe again and in control of your feelings, you won't need to avoid the memories as much. Indeed, you can gain more control over your memories so that you only think about them when you want to, rather than having them erupt into your mind spontaneously.
All these treatments should all be given by specialists in the treatment of PTSD. The sessions should be at least weekly, every week, with the same therapist, and should usually continue for 8-12 weeks. Although sessions will usually last around an hour, they may sometimes last up to 90 minutes.
Cognitive Behavioural Therapy (CBT) is a way of helping you to think differently about your memories, so that they become less distressing and more manageable. It will usually also involve some relaxation work to help you tolerate the discomfort of thinking about the traumatic events. For further information, see our factsheet on CBT.
EMDR (Eye Movement Desensitisation & Reprocessing) is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience. It may sound odd, but it has been shown to work.
Group therapy involves meeting with a group of other people who have been through the same, or a similar traumatic event. The fact that other people in the group do have some idea of what you have been through can make it much easier to talk about what has happened.
Medication
SSRI antidepressant tablets will both reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.
This type of medication should not make you sleepy, although they all have some side-effects in some people. They may also produce unpleasant symptoms if stopped quickly, so the dose should usually be reduced gradually. If they are helpful, you should carry on taking them for around 12 months. Soon after starting an antidepressany, some people may find that they feel more:
anxious
restless
suicidal
These feelings usually pass in a few days, but you should see your doctor regularly.
If these don't work for you, tricyclic or MAOI antidepressant tablets may still be helpful. For more information, see our factsheet on antidepressants.
Occasionally, if someone is so distressed that they cannot sleep or think clearly, anxiety-reducing medication may be necessary. These tablets should usually not be prescribed for more than 10 days or so.
Body-focussed Therapies
These can help to control the distress of PTSD. They can also reduce hyperarousal, or the feeling of being "on guard" all the time. These therapies include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They all help you to develop ways of relaxing and managing stress.
Effectiveness of Treatments
At present, there is evidence that EMDR, psychotherapy, cognitive behavioural therapy and antidepressants are all effective. There is not enough information for us to say that one of these treatments is better than another. There is no evidence that other forms of psychotherapy or counselling are helpful to PTSD.
Which treatments first?
The National Institute for Clinical Excellence (NICE) guidelines suggest that trauma-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.
For friends, relatives & colleagues
Do .......
watch out for any changes in behaviour - poor performance at work, lateness, taking sick leave, minor accidents
watch for anger, irritability, depression, lack of interest, lack of concentration
take time to allow a trauma survivor to tell their story
ask general questions
let them talk, don't interrupt the flow or come back with your own experiences.
Don't ....... tell a survivor you know how they feel - you don't
tell a survivor they're lucky to be alive - they'll get angry
minimise their experience - "it's not that bad, surely ..."
suggest that they just need to 'pull themselves together'.
14 January 2012
DE ADDICTION
De addiction
Addiction is a term defined a chronic relapsing disorder for people abusing substances like Smoking, alcohol, rave drugs, medical drugs. It is a tendency to make one feel euphoric ( well being) , there are several drugs which are available in the market which are used for abuse.
Several routes of drug transmission - Drinking, smoking, injecting, pills.
However the nature of the drug and its toxicity will be responsible for the morbidity or lethality of the person.
What happens to a drug abuser ?
The main complication of drug abusers is overdose and intoxication producing lethality, and behavioral problems both domestic and social leading to legal issues and family disruption.
How does he become a Drug abuser ?
There are several factors which are responsible for a person to become an drug addict, and psychiatrists now believe that it is mainly due to the congenital behavioral problem which leads to negative peer group and initializing the intake of drugs.
In India, Alcohol addiction is common, and de addiction has been very successful than abuse of other substances.
It becomes a therapy when...
A Professional team comprising of Psychiatrist, Medical Officer, Counsellor, Social Workers and Yoga Therapist involve in the treatment of addiction.
The person undergoes different stages of treatment and counselling, This process not only involves the individual but also the family members whose participation is very important in the prevention of relapse.
The Process…Admission
Treatment - Detoxification by the use of Antabuse Therapy and Aversion Therapy.
Therapeutic Interventions
Individual Counselling
Group Counselling
Family Counselling
Psycho Education
Follow-up
Outreach Programmes
Research
Admissions-The procedure…
The patient is first admitted as an in-patient.
Various investigations are done assess the physical and psychological condition of the patient.
A detailed case history is taken on the alcohol consumption or the form of drug addiction in order to know about the factors for the onset of the illness and the problems there after.
Treatment
The treatment is focused on enabling the patient from abstaining from drugs of any form and under any conditions for the rest of their life.
This is done by way of initially detoxifying the patient.
Detoxification
It is the medical management process used for the removal of toxic substances from the body by infusion and pharmocotherapy where the process takes about 3 days.
Antabuse Therapy
This treatment method is used predominately for those who are dependent on alcohol.
Alcohol is given to the patient for consumption along with the medication known as antabuse.
On consumption, the patient experiences very unpleasant side effects.
The negative side effects experienced by patient lead them to loose the liking towards alcohol that earlier used to bring him pleasure.
Aversion Therapy
Yet another method used as a Pre-final phase of treatment where the patient is allowed to consume his favorite brand of alcohol while on antabuse medications.
Here he experiences noxious reactions and severe adverse effects as a result of alcohol consumption.
This is used to bring awareness to the patient, that if he consumes alcohol again it would lead to the undesirable reactions. This process is done under close medical supervision.
Therapeutic Interventions
Individual Counselling
Counselling is a scientific process of assistance extended by an expert, to the individual. The process aims at enabling the individual to learn and pursue more realistic and satisfying solutions to his problems and difficulties.
The process resolves primarily around the relationship between the counselor and the client. The individual is more to understand all the information that has been accumulated about himself in the context of his work. The counsellor helps him to develop the ability to take wise, independent and responsible decisions. The counseling activities are systematically planned.
It is carried on over a period of time. The length of which is dependent upon the needs of the client. Each client is given minimum of 3-4 sessions, which lasts for about 30-60 minutes.
Issues relating to personal or problems such as extra marital affairs, legal issues, marital separation are dealt.
Group Counselling
A homogeneous group of individuals are brought in for a group discussion. The Group of Participants can consist of persons who are dependent or addicted to chemical substances, alcohol, cannabis, tobacco, etc. The number of participants in a group is 5 - 10 Members with a counselor. Each client is taken to participate in two sessions where the session runs in to time of about 30- 60 minutes per session. These sessions facilitate face-to-face
interaction. Issues Related to problems that arise due to addition, symptoms of addiction, breakdown of values and relapse and other relevant issues are discussed. As their problems are similar in nature, it helps them to share their experiences with one another and through this process it helps them to learn skills like coping, "Decision Making" and "Problem Solving".
Family Counselling
The family members of the chemically dependent person are a set of people who are hurt and confused. They are victims synergizing desperately to solve their problems. This family counseling session help the family members to get an information and insight regarding the problem and coping mechanisms. Basic issues such as the treatment programme, medications to
be given, relapse and recovery are discussed in the session. A minimum of 3-4 sessions are held for each member with a time duration of 30 - 60 minutes a session
Psycho Education
A programme that target the family members as well as the client to re-educate them on the basic issues such as disease concept, addiction related damages, relapse, overcoming personality defects, methods to stay sober, and the role of family members in handling the recovered addicts etc.
Three educative sessions for each individual and four educative sessions for the family members are given with the time duration of 30-60 minutes.
Follow up
The patients are reviewed periodically. Their medication aspects are seen to and counseling sessions are also held during the follow-ups
The outcome of the various therapeutic interventions given depends largely on the effectiveness of follow-up.
Efforts to make the patient re-integrate into the community and to attain the status of being a holistic and recovered person are the ultimate aim of the programme.
Aim of This Therapy…To enable persons dependent on alcohol and drugs, to recover and lead a sober life, involving a team of professionals in the treatment and rehabilitation.
To create an awareness regarding the negative outcome of addiction, the positive outcome of treatment and rehabilitation and about the access to professional help...
The Advantages of this Therapy
* Helps to abstain from drugs
* Treatment of the underlying psychiatric disorder or behavioral problem
* Counseling helps in building high moral and understand the responsibilities
* Family income increases due to null expenditure on alcohol
* Personality cognitive skills develop
* Regain the lost dignity and respect
* Acquire the family and social responsibilities.
* Engage in healthy living.
Addiction is a term defined a chronic relapsing disorder for people abusing substances like Smoking, alcohol, rave drugs, medical drugs. It is a tendency to make one feel euphoric ( well being) , there are several drugs which are available in the market which are used for abuse.
Several routes of drug transmission - Drinking, smoking, injecting, pills.
However the nature of the drug and its toxicity will be responsible for the morbidity or lethality of the person.
What happens to a drug abuser ?
The main complication of drug abusers is overdose and intoxication producing lethality, and behavioral problems both domestic and social leading to legal issues and family disruption.
How does he become a Drug abuser ?
There are several factors which are responsible for a person to become an drug addict, and psychiatrists now believe that it is mainly due to the congenital behavioral problem which leads to negative peer group and initializing the intake of drugs.
In India, Alcohol addiction is common, and de addiction has been very successful than abuse of other substances.
It becomes a therapy when...
A Professional team comprising of Psychiatrist, Medical Officer, Counsellor, Social Workers and Yoga Therapist involve in the treatment of addiction.
The person undergoes different stages of treatment and counselling, This process not only involves the individual but also the family members whose participation is very important in the prevention of relapse.
The Process…Admission
Treatment - Detoxification by the use of Antabuse Therapy and Aversion Therapy.
Therapeutic Interventions
Individual Counselling
Group Counselling
Family Counselling
Psycho Education
Follow-up
Outreach Programmes
Research
Admissions-The procedure…
The patient is first admitted as an in-patient.
Various investigations are done assess the physical and psychological condition of the patient.
A detailed case history is taken on the alcohol consumption or the form of drug addiction in order to know about the factors for the onset of the illness and the problems there after.
Treatment
The treatment is focused on enabling the patient from abstaining from drugs of any form and under any conditions for the rest of their life.
This is done by way of initially detoxifying the patient.
Detoxification
It is the medical management process used for the removal of toxic substances from the body by infusion and pharmocotherapy where the process takes about 3 days.
Antabuse Therapy
This treatment method is used predominately for those who are dependent on alcohol.
Alcohol is given to the patient for consumption along with the medication known as antabuse.
On consumption, the patient experiences very unpleasant side effects.
The negative side effects experienced by patient lead them to loose the liking towards alcohol that earlier used to bring him pleasure.
Aversion Therapy
Yet another method used as a Pre-final phase of treatment where the patient is allowed to consume his favorite brand of alcohol while on antabuse medications.
Here he experiences noxious reactions and severe adverse effects as a result of alcohol consumption.
This is used to bring awareness to the patient, that if he consumes alcohol again it would lead to the undesirable reactions. This process is done under close medical supervision.
Therapeutic Interventions
Individual Counselling
Counselling is a scientific process of assistance extended by an expert, to the individual. The process aims at enabling the individual to learn and pursue more realistic and satisfying solutions to his problems and difficulties.
The process resolves primarily around the relationship between the counselor and the client. The individual is more to understand all the information that has been accumulated about himself in the context of his work. The counsellor helps him to develop the ability to take wise, independent and responsible decisions. The counseling activities are systematically planned.
It is carried on over a period of time. The length of which is dependent upon the needs of the client. Each client is given minimum of 3-4 sessions, which lasts for about 30-60 minutes.
Issues relating to personal or problems such as extra marital affairs, legal issues, marital separation are dealt.
Group Counselling
A homogeneous group of individuals are brought in for a group discussion. The Group of Participants can consist of persons who are dependent or addicted to chemical substances, alcohol, cannabis, tobacco, etc. The number of participants in a group is 5 - 10 Members with a counselor. Each client is taken to participate in two sessions where the session runs in to time of about 30- 60 minutes per session. These sessions facilitate face-to-face
interaction. Issues Related to problems that arise due to addition, symptoms of addiction, breakdown of values and relapse and other relevant issues are discussed. As their problems are similar in nature, it helps them to share their experiences with one another and through this process it helps them to learn skills like coping, "Decision Making" and "Problem Solving".
Family Counselling
The family members of the chemically dependent person are a set of people who are hurt and confused. They are victims synergizing desperately to solve their problems. This family counseling session help the family members to get an information and insight regarding the problem and coping mechanisms. Basic issues such as the treatment programme, medications to
be given, relapse and recovery are discussed in the session. A minimum of 3-4 sessions are held for each member with a time duration of 30 - 60 minutes a session
Psycho Education
A programme that target the family members as well as the client to re-educate them on the basic issues such as disease concept, addiction related damages, relapse, overcoming personality defects, methods to stay sober, and the role of family members in handling the recovered addicts etc.
Three educative sessions for each individual and four educative sessions for the family members are given with the time duration of 30-60 minutes.
Follow up
The patients are reviewed periodically. Their medication aspects are seen to and counseling sessions are also held during the follow-ups
The outcome of the various therapeutic interventions given depends largely on the effectiveness of follow-up.
Efforts to make the patient re-integrate into the community and to attain the status of being a holistic and recovered person are the ultimate aim of the programme.
Aim of This Therapy…To enable persons dependent on alcohol and drugs, to recover and lead a sober life, involving a team of professionals in the treatment and rehabilitation.
To create an awareness regarding the negative outcome of addiction, the positive outcome of treatment and rehabilitation and about the access to professional help...
The Advantages of this Therapy
* Helps to abstain from drugs
* Treatment of the underlying psychiatric disorder or behavioral problem
* Counseling helps in building high moral and understand the responsibilities
* Family income increases due to null expenditure on alcohol
* Personality cognitive skills develop
* Regain the lost dignity and respect
* Acquire the family and social responsibilities.
* Engage in healthy living.
21 December 2011
TEST ANXIETY=EXAM FEAR
What is Test Anxiety?
Test anxiety is the feeling of nervousness and distress you experience before or during an exam. Students who suffer from test anxiety report difficulties with concentration, mental blocks, and distractibility.
There Are Two Types Of Anxiety=
Anticipatory: feeling of distress occurring while studying for or thinking about the exam.
Situational: feeling of distress occurring while taking the exam.
It is important to be aware of when anxiety attacks you so that you may use strategies in and out of the exam situation to manage the anxiety.
Test anxiety occurs in a wave so it will increase from when you first recognize it, come to a peak, and then subside.
What causes test anxiety?• Lack of preparation!
• Past experiences of blanking out or performing badly on exams.
• Focusing too much on the outcome.
• Focusing too much on how other classmates and friends are doing.
• Issues outside of school distracting you from studying for or concentrating on exam.
How does test anxiety affect you?
Test anxiety affects you in three ways:
(1)Physiologically (2) Behaviorally (3)Psychologically
Physiological reactions may include:
- increased heartbeat
- tensed muscles
- perspiration
- dry mouth
Behavioral reactions may include:
- Inability to make decisions, act, or express yourself.
- Difficulty reading and understanding questions on an exam.
- Difficulty organizing your thoughts.
- Difficulty recalling or retrieving terms and concepts.
Psychological reactions may include:
- Feeling apprehensive or uneasy.
- Feeling upset.
- Having self-doubt or negative self-talk.
What are some ways to deal with test anxiety before the exam?
*Prepare well and in advance
*Check your attitude
*Relax
How can you prepare well and in advance?
Gather information about the exam.
Set up a study schedule.
Review material often throughout the semester.
Test yourself.
Gather information about the exam
Know as much as you can about the exam so you can study in a way that will help enhance your performance. For example, you need to know how the exam is graded. Are points taken off for wrong answers? If so, you know that guessing is a bad option. Will the instructor allow partial points for answers that are not complete? If so, it is worth it to write down anything and everything you know about an answer to a question that is challenging.
To gather information about the exam ask:
- What kind of test am I going to take?
- How much time will I have?
- What material will be covered?
- How will the test be graded?
Set up a study schedule
Put specific study times into your schedule and determine study tasks for each review session.
Below is an example of a student’s review schedule one week before exam:
Weekend Monday Tuesday Thursday Friday
Gather materials – old exams, notes, and homework.
Study chaps. 1,2 Review chaps. 1,2;study 3 & notes Review chaps 1,2,3; study 4 & notes Put hard to remember material on a master study guide. Final review of study guide.
Review material effectively and often throughout the semester.
-Conduct review sessions 10 minutes a day for each class. Seeing, hearing, or interacting with the class material often will help you remember it.
-Study in short spurts (an hour or less) and take breaks, rather that studying straight through for several hours.
-Aim for understanding the material, not just memorizing.
Test Yourself
Just understanding the material when you are looking at it doesn’t mean you will remember it on the exam. In the test situation you will not have the answers; you will be given a time limit in which to perform, and naturally you will be anxious. All of these added aspects can lead to “blanking out” on the exam, especially if you have not studied well. It is therefore important to test yourself on the material. You can do this by:
-Making flash cards.
-Using chapter tests in your textbook.
-Turning each section heading into a question and then trying to answer it.
-Looking away from each section you are studying and reiterating (to yourself or a study partner), verbally or in writing, what that section is about.
How can you check your attitude before the exam?
Change negative self-talk into positive self-talk. For example, if the voice in your head says:
“I’ve never been good at Math. I’m going to fail this exam!”
Change it to:
“Math is not my best subject but if I practice and ask questions, I’ll be okay.”
-Keep in mind that one exam is unlikely to make or break your whole future.
-If issues outside of school distract you, jot them down on a piece of paper so you can come back to deal with them later.
For chronic anxiety or depression, talk to a professional.
Relax
Learn stress releasing strategies that you can use in and out of the exam situation. Practice the techniques so they become easy to use.
Exercise ,Listen Music that soothes or motivates you,stretch,practice stress releasing exercises
Following are Quick Relaxation Techniques you can use in or out of the classroom:
TENSE AND RELAX
If sitting in a chair in class, you can use your chair to help you with this exercise.
• Place your feet flat on the floor in front of you.
• With both hands, grab the underside of your chair.
• Push your feet into the ground and pull on your chair upward. Tense your muscles, holding for 5 seconds.
• Release your pull and relax your feet, letting your body go limp.
• Repeat as necessary.
BREATHE
3 Deep Breaths
• Inhale through your nose, taking in air as if filling your abdomen.
• Hold for 1 second.
• Exhale through your mouth or nose, slowly (make sure you exhale completely – push out every last bit of air).
• Repeat two more times.
Body Scan
• Start at one end of your body and focus on a specific muscle or muscle group.
• Concentrate on how that muscle feels. Is it tense?
• Consciously release the tension in the muscle.
• Continue throughout your entire body.
Guided Imagery
• Imagine that you are going away from where you are right now and traveling to a place where you want to be. This place may be a warm beach, a tropical forest, a cozy room, a pool of water…you decide.
• What does this place feel like?
- Is it warm or cool? Are there soothing breezes or comforting sun rays?
- Is there a refreshing mist or shower of rain?
- Is it bright or dim? What kind of light is there? – Daylight? Candlelight? Moonlight?
• What aromas does this place have? – Spring flowers? Pine trees? Citrus fruits? Salty seaside air? Fresh cut grass? Coffee? Mint?
• How does this place make you feel? – Peaceful? Tranquil? Refreshed? Beautiful? Strong? Confident? Whatever the feeling, embrace it; hold on to it.
• Now as you journey back to here, hold on to that feeling and bring it back with you.
What strategies can you use to relieve anxiety during the exam?
Here are some student suggestions:
Take a break. Stop for a minute, role your shoulders or close your eyes.
Get a drink of water. See if you can leave the room for a drink of water so you can briefly leave the exam environment.
Ask a question. Break the uncomfortable silence by asking the instructor a question.
Move on to an easier question. If being stuck on a question is frustrating you, move on and come back to the challenging one later.
Use positive self-talk. Talk to yourself and guide yourself
out of the anxiety.
Use your quick relaxation exercises. Allow yourself a time
out – take a few breaths, tense and relax, or do a quick stretch
Three Stages Of Test Taking
Before the exam
During the exam
After the exam
Before the exam:
Remember to gather information about the exam.
Prepare well through setting a study schedule, reviewing often, and testing yourself.
Get rest and eat well.
Know strategies for different test types – multiple choice, short answer, matching, and essay.
Strtegies for Different Type of Exam=
Multiple Choice Exams
• Read directions carefully. Most items ask for single answers but some may give you the option of marking several choices.
• Read each question thoroughly, then look at the choices.
• Underline key words and phrases. If the question is complicated, break it down into small or simple sections that are easier to understand.
• Pay attention to qualifiers. Words such as “only” or “except” or negative words such as “not” can confuse your understanding of what is being asked.
• Eliminate answers you know are incorrect. Check relevancy and accuracy of each answer.
• Look for patterns that may lead you to the answer. Sometimes choices that are more general or are of a middle value in a range may indicate a right answer.
• Read every word of each choice. Instructors may include answers that are right except for a single word.
• When a test includes a long reading passage, read questions first. This might help you focus on the information you need to answer the questions
Matching Exams
• Read directions carefully. Sometimes an instructor may want you to consider an answer only once; other times an instructor may want you to consider an applicable answer more than once.
• Start with the column that has the longest statements and match those with shorter statements or terms.
• Do easy matches first to eliminate possible answers and make it easy to spot the more difficult matches.
Short Answers Exams
• Look for clues. The sentence structure or number of blanks may give you clues to the answer.
• Don’t look hard for hidden meaning. Short answer questions are meant to test your ability to recall information..
• Over-answer. If you are stuck with two answers, write down both – you might get partial credit.
True/False Exam
• Check for qualifiers.
• Words such as all, always, only and never tend to indicate an absolute. This may indicate a false answer.
• Words such as generally, usually, often, and sometimes may indicate true answers.
• Look for two-part statements. If one part of the statement is incorrect, the whole statement is false.
• Don’t look hard for hidden meaning.
Essay Questions
• Survey exam. Read all questions and decide how much time you will spend on each.
• Analyze each question carefully. Understand what the question is asking. For example, is the question asking you to compare ideas or describe a situation? Underline key terms and phrases. Look for phrases that limit the topic such as “Between 1815-1830…” or “In the western part of …”
• Plan before you begin writing. Write down main ideas and examples and create an outline.
• Write your answer using your outline and fill in details.
• Review. Do a final check. Did you answers all parts of the question? Check for spelling and punctuation errors.
During the exam:
Do an information dump! Before you begin answering, jot down hard to remember formulas and terms on the margins or back of exam.
Survey exam. Before you begin answering, take a quick look at the whole exam. This may help you decide where to begin and how much time to spend on each question.
Read directions carefully and underline key terms and phrases.
Do easy questions first. They may give you clues for the more challenging questions.
Relax! Use your strategies to calm yourself.
After the exam:
Reward yourself! Keep practicing positive self-talk.
Analyze your exam.
• What went well and what didn’t?
• What type of questions did you find most challenge? Why?
Make and implement a plan to do better next time.
Set Goals For Change:
List test taking or study strategy ideas you think might help you perform better on exams. Then decide how and when you will implement them
In order to improve my test taking skills I will work on:
____________________________________________________________________________________________________
List two test taking or study skills you will incorporate this week:
1)______________________ How?__________________
2_______________________How?__________________
List two test taking or study skills you will incorporate this semester:
1)______________________How?___________________
2)______________________How?___________________
ALL THE BEST
Dr.NISHANT SAINI
M.D.PSYCHIATRY
Test anxiety is the feeling of nervousness and distress you experience before or during an exam. Students who suffer from test anxiety report difficulties with concentration, mental blocks, and distractibility.
There Are Two Types Of Anxiety=
Anticipatory: feeling of distress occurring while studying for or thinking about the exam.
Situational: feeling of distress occurring while taking the exam.
It is important to be aware of when anxiety attacks you so that you may use strategies in and out of the exam situation to manage the anxiety.
Test anxiety occurs in a wave so it will increase from when you first recognize it, come to a peak, and then subside.
What causes test anxiety?• Lack of preparation!
• Past experiences of blanking out or performing badly on exams.
• Focusing too much on the outcome.
• Focusing too much on how other classmates and friends are doing.
• Issues outside of school distracting you from studying for or concentrating on exam.
How does test anxiety affect you?
Test anxiety affects you in three ways:
(1)Physiologically (2) Behaviorally (3)Psychologically
Physiological reactions may include:
- increased heartbeat
- tensed muscles
- perspiration
- dry mouth
Behavioral reactions may include:
- Inability to make decisions, act, or express yourself.
- Difficulty reading and understanding questions on an exam.
- Difficulty organizing your thoughts.
- Difficulty recalling or retrieving terms and concepts.
Psychological reactions may include:
- Feeling apprehensive or uneasy.
- Feeling upset.
- Having self-doubt or negative self-talk.
What are some ways to deal with test anxiety before the exam?
*Prepare well and in advance
*Check your attitude
*Relax
How can you prepare well and in advance?
Gather information about the exam.
Set up a study schedule.
Review material often throughout the semester.
Test yourself.
Gather information about the exam
Know as much as you can about the exam so you can study in a way that will help enhance your performance. For example, you need to know how the exam is graded. Are points taken off for wrong answers? If so, you know that guessing is a bad option. Will the instructor allow partial points for answers that are not complete? If so, it is worth it to write down anything and everything you know about an answer to a question that is challenging.
To gather information about the exam ask:
- What kind of test am I going to take?
- How much time will I have?
- What material will be covered?
- How will the test be graded?
Set up a study schedule
Put specific study times into your schedule and determine study tasks for each review session.
Below is an example of a student’s review schedule one week before exam:
Weekend Monday Tuesday Thursday Friday
Gather materials – old exams, notes, and homework.
Study chaps. 1,2 Review chaps. 1,2;study 3 & notes Review chaps 1,2,3; study 4 & notes Put hard to remember material on a master study guide. Final review of study guide.
Review material effectively and often throughout the semester.
-Conduct review sessions 10 minutes a day for each class. Seeing, hearing, or interacting with the class material often will help you remember it.
-Study in short spurts (an hour or less) and take breaks, rather that studying straight through for several hours.
-Aim for understanding the material, not just memorizing.
Test Yourself
Just understanding the material when you are looking at it doesn’t mean you will remember it on the exam. In the test situation you will not have the answers; you will be given a time limit in which to perform, and naturally you will be anxious. All of these added aspects can lead to “blanking out” on the exam, especially if you have not studied well. It is therefore important to test yourself on the material. You can do this by:
-Making flash cards.
-Using chapter tests in your textbook.
-Turning each section heading into a question and then trying to answer it.
-Looking away from each section you are studying and reiterating (to yourself or a study partner), verbally or in writing, what that section is about.
How can you check your attitude before the exam?
Change negative self-talk into positive self-talk. For example, if the voice in your head says:
“I’ve never been good at Math. I’m going to fail this exam!”
Change it to:
“Math is not my best subject but if I practice and ask questions, I’ll be okay.”
-Keep in mind that one exam is unlikely to make or break your whole future.
-If issues outside of school distract you, jot them down on a piece of paper so you can come back to deal with them later.
For chronic anxiety or depression, talk to a professional.
Relax
Learn stress releasing strategies that you can use in and out of the exam situation. Practice the techniques so they become easy to use.
Exercise ,Listen Music that soothes or motivates you,stretch,practice stress releasing exercises
Following are Quick Relaxation Techniques you can use in or out of the classroom:
TENSE AND RELAX
If sitting in a chair in class, you can use your chair to help you with this exercise.
• Place your feet flat on the floor in front of you.
• With both hands, grab the underside of your chair.
• Push your feet into the ground and pull on your chair upward. Tense your muscles, holding for 5 seconds.
• Release your pull and relax your feet, letting your body go limp.
• Repeat as necessary.
BREATHE
3 Deep Breaths
• Inhale through your nose, taking in air as if filling your abdomen.
• Hold for 1 second.
• Exhale through your mouth or nose, slowly (make sure you exhale completely – push out every last bit of air).
• Repeat two more times.
Body Scan
• Start at one end of your body and focus on a specific muscle or muscle group.
• Concentrate on how that muscle feels. Is it tense?
• Consciously release the tension in the muscle.
• Continue throughout your entire body.
Guided Imagery
• Imagine that you are going away from where you are right now and traveling to a place where you want to be. This place may be a warm beach, a tropical forest, a cozy room, a pool of water…you decide.
• What does this place feel like?
- Is it warm or cool? Are there soothing breezes or comforting sun rays?
- Is there a refreshing mist or shower of rain?
- Is it bright or dim? What kind of light is there? – Daylight? Candlelight? Moonlight?
• What aromas does this place have? – Spring flowers? Pine trees? Citrus fruits? Salty seaside air? Fresh cut grass? Coffee? Mint?
• How does this place make you feel? – Peaceful? Tranquil? Refreshed? Beautiful? Strong? Confident? Whatever the feeling, embrace it; hold on to it.
• Now as you journey back to here, hold on to that feeling and bring it back with you.
What strategies can you use to relieve anxiety during the exam?
Here are some student suggestions:
Take a break. Stop for a minute, role your shoulders or close your eyes.
Get a drink of water. See if you can leave the room for a drink of water so you can briefly leave the exam environment.
Ask a question. Break the uncomfortable silence by asking the instructor a question.
Move on to an easier question. If being stuck on a question is frustrating you, move on and come back to the challenging one later.
Use positive self-talk. Talk to yourself and guide yourself
out of the anxiety.
Use your quick relaxation exercises. Allow yourself a time
out – take a few breaths, tense and relax, or do a quick stretch
Three Stages Of Test Taking
Before the exam
During the exam
After the exam
Before the exam:
Remember to gather information about the exam.
Prepare well through setting a study schedule, reviewing often, and testing yourself.
Get rest and eat well.
Know strategies for different test types – multiple choice, short answer, matching, and essay.
Strtegies for Different Type of Exam=
Multiple Choice Exams
• Read directions carefully. Most items ask for single answers but some may give you the option of marking several choices.
• Read each question thoroughly, then look at the choices.
• Underline key words and phrases. If the question is complicated, break it down into small or simple sections that are easier to understand.
• Pay attention to qualifiers. Words such as “only” or “except” or negative words such as “not” can confuse your understanding of what is being asked.
• Eliminate answers you know are incorrect. Check relevancy and accuracy of each answer.
• Look for patterns that may lead you to the answer. Sometimes choices that are more general or are of a middle value in a range may indicate a right answer.
• Read every word of each choice. Instructors may include answers that are right except for a single word.
• When a test includes a long reading passage, read questions first. This might help you focus on the information you need to answer the questions
Matching Exams
• Read directions carefully. Sometimes an instructor may want you to consider an answer only once; other times an instructor may want you to consider an applicable answer more than once.
• Start with the column that has the longest statements and match those with shorter statements or terms.
• Do easy matches first to eliminate possible answers and make it easy to spot the more difficult matches.
Short Answers Exams
• Look for clues. The sentence structure or number of blanks may give you clues to the answer.
• Don’t look hard for hidden meaning. Short answer questions are meant to test your ability to recall information..
• Over-answer. If you are stuck with two answers, write down both – you might get partial credit.
True/False Exam
• Check for qualifiers.
• Words such as all, always, only and never tend to indicate an absolute. This may indicate a false answer.
• Words such as generally, usually, often, and sometimes may indicate true answers.
• Look for two-part statements. If one part of the statement is incorrect, the whole statement is false.
• Don’t look hard for hidden meaning.
Essay Questions
• Survey exam. Read all questions and decide how much time you will spend on each.
• Analyze each question carefully. Understand what the question is asking. For example, is the question asking you to compare ideas or describe a situation? Underline key terms and phrases. Look for phrases that limit the topic such as “Between 1815-1830…” or “In the western part of …”
• Plan before you begin writing. Write down main ideas and examples and create an outline.
• Write your answer using your outline and fill in details.
• Review. Do a final check. Did you answers all parts of the question? Check for spelling and punctuation errors.
During the exam:
Do an information dump! Before you begin answering, jot down hard to remember formulas and terms on the margins or back of exam.
Survey exam. Before you begin answering, take a quick look at the whole exam. This may help you decide where to begin and how much time to spend on each question.
Read directions carefully and underline key terms and phrases.
Do easy questions first. They may give you clues for the more challenging questions.
Relax! Use your strategies to calm yourself.
After the exam:
Reward yourself! Keep practicing positive self-talk.
Analyze your exam.
• What went well and what didn’t?
• What type of questions did you find most challenge? Why?
Make and implement a plan to do better next time.
Set Goals For Change:
List test taking or study strategy ideas you think might help you perform better on exams. Then decide how and when you will implement them
In order to improve my test taking skills I will work on:
____________________________________________________________________________________________________
List two test taking or study skills you will incorporate this week:
1)______________________ How?__________________
2_______________________How?__________________
List two test taking or study skills you will incorporate this semester:
1)______________________How?___________________
2)______________________How?___________________
ALL THE BEST
Dr.NISHANT SAINI
M.D.PSYCHIATRY
SLEEP PROBLEMS IN CHILDHOOD
Sleep Problems in Childhood:
Introduction:
One of the most common problems in toddlers and young children is sleeplessness. The child may have difficulty settling to sleep, or wakes in the night and wants a parent. Very young children often fear being left alone at night. This ‘separation anxiety’ is normal at a young age. Difficulties in sleeping are due to a number of reasons such as napping too much in the daytime, bedtime fears and bedwetting. You might find that when your child gets very tired, they get irritable, aggressive or even overactive not sleepy.
Older children and teenagers can also have problems with sleeplessness. They might find it hard to sleep if they are worried, drinking too much tea or coffee, cola or energy drinks, or are using illegal drugs. Some will just get into the habit of going to sleep very late. After a while, they find that they can’t get to sleep at an earlier time.
It is important that your child has a regular sleep routine:
• Decide on regular times for going to bed and getting up.
• Stick to these times.
Sometimes, difficulty in sleeping is part of a severe Depression.
Daytime sleepiness:
This can simply be caused by your child not getting enough sleep at night. Reasons for this might include:
• Going out too late with friends, working or studying
•Stress or worry.
•Less commonly, loud snoring can wake a child this is called obstructive sleep apnoea. It
can be caused by large tonsils and adenoids at the side and back of the throat. Taking them out can sometimes help.
• Some young people sleep too much if they are depressed.
• Drug or alcohol misuse may be a factor.
• Narcolepsy is an unusual condition that causes unpredictable attacks of sleep during the day. People with narcolepsy may also have sudden attacks of weakness – this is called cataplexy.
Nightmares:
Most children have nightmares occasionally. These are vivid and frightening dreams. Children will usually remember the dream, and will need to be comforted so that they can get back to sleep. Nightmares can also be caused by worry, by nasty accidents, by bullying and by abuse of any kind. You can help by encouraging your child to talk about the dream or draw a picture of it. This will help you to find out the cause of the upset
and work out what help or support your child needs.
Night terrors:
Night terrors most commonly affect children between the ages of 4 and 12 years. They are completely different from nightmares or anxiety related dreams. Unlike nightmares, they happen to young children an hour or two after falling asleep. The first sign is that your child is screaming uncontrollably and seems to be awake. In spite of appearances, your child is still asleep. They will not be able to recognize you, will be confused and unable to communicate, and it is usually hard to reassure them. It is best not to try and wake them, but sit with them until the night terror passes, usually after about 5 minutes. Try not to feel upset yourself. It can be very distressing to see your child so disturbed, but they will not remember it in the morning. Children usually grow out of this.
Sleepwalking
Sleepwalking is similar to night terrors, but instead of being terrified, the child gets up out of bed and moves around. The main thing you can do to help is to make sure that they don’t hurt themselves. You may need to take practical precautions, like using a stair-gate, making sure that windows and doors are securely locked, and that fires are screened or put out. This is also something that children tend to grow out of.
Why sleep problems matter:
Sleep problems are very common. Most children’s sleep problems happen only occasionally. They are not serious and get better on their own with time. If they don’t, you need to take them seriously. As well as being upsetting, they may interfere with your child’s learning and behaviour. There may be an underlying health problem, physical or mental.
Where can I get help?
There are some simple things you can do to help your child sleep better:
• Develop a consistent, relaxing bedtime routine with your child. This should start with quiet time to help your child to wind down – for example, a bath followed by a short bedtime story before you say goodnight. This helps children to settle, and should end with your child falling asleep without the need for you to be with them.
•It is important to be loving, but firm, about when it is time for your child to settle down
for the night. When your child cries out, it is important to be sure that they are not wet, ill
or in pain. It is best to do this quickly, while still comforting and reassuring them. Don’t
spend too much time with them or take them into your bed, because this will reward them
for being awake.
• A dummy can help to comfort young infants who wake needing to suck. Once you have
weaned your child on to solid foods, it is best not to give them a bottle or dummy at night if they wake and can’t find it, they will probably start crying. A cuddly toy or favourite blanket can often help young children to cope with their separation anxiety.
Your general practitioner (GP) or health visitor can offer advice and help. If things don’t get better, it is worth thinking about asking for a specialist opinion from a Paediatrician or Psychiatrist. This will help to find out exactly what the problem is and how it can be best resolved.
Introduction:
One of the most common problems in toddlers and young children is sleeplessness. The child may have difficulty settling to sleep, or wakes in the night and wants a parent. Very young children often fear being left alone at night. This ‘separation anxiety’ is normal at a young age. Difficulties in sleeping are due to a number of reasons such as napping too much in the daytime, bedtime fears and bedwetting. You might find that when your child gets very tired, they get irritable, aggressive or even overactive not sleepy.
Older children and teenagers can also have problems with sleeplessness. They might find it hard to sleep if they are worried, drinking too much tea or coffee, cola or energy drinks, or are using illegal drugs. Some will just get into the habit of going to sleep very late. After a while, they find that they can’t get to sleep at an earlier time.
It is important that your child has a regular sleep routine:
• Decide on regular times for going to bed and getting up.
• Stick to these times.
Sometimes, difficulty in sleeping is part of a severe Depression.
Daytime sleepiness:
This can simply be caused by your child not getting enough sleep at night. Reasons for this might include:
• Going out too late with friends, working or studying
•Stress or worry.
•Less commonly, loud snoring can wake a child this is called obstructive sleep apnoea. It
can be caused by large tonsils and adenoids at the side and back of the throat. Taking them out can sometimes help.
• Some young people sleep too much if they are depressed.
• Drug or alcohol misuse may be a factor.
• Narcolepsy is an unusual condition that causes unpredictable attacks of sleep during the day. People with narcolepsy may also have sudden attacks of weakness – this is called cataplexy.
Nightmares:
Most children have nightmares occasionally. These are vivid and frightening dreams. Children will usually remember the dream, and will need to be comforted so that they can get back to sleep. Nightmares can also be caused by worry, by nasty accidents, by bullying and by abuse of any kind. You can help by encouraging your child to talk about the dream or draw a picture of it. This will help you to find out the cause of the upset
and work out what help or support your child needs.
Night terrors:
Night terrors most commonly affect children between the ages of 4 and 12 years. They are completely different from nightmares or anxiety related dreams. Unlike nightmares, they happen to young children an hour or two after falling asleep. The first sign is that your child is screaming uncontrollably and seems to be awake. In spite of appearances, your child is still asleep. They will not be able to recognize you, will be confused and unable to communicate, and it is usually hard to reassure them. It is best not to try and wake them, but sit with them until the night terror passes, usually after about 5 minutes. Try not to feel upset yourself. It can be very distressing to see your child so disturbed, but they will not remember it in the morning. Children usually grow out of this.
Sleepwalking
Sleepwalking is similar to night terrors, but instead of being terrified, the child gets up out of bed and moves around. The main thing you can do to help is to make sure that they don’t hurt themselves. You may need to take practical precautions, like using a stair-gate, making sure that windows and doors are securely locked, and that fires are screened or put out. This is also something that children tend to grow out of.
Why sleep problems matter:
Sleep problems are very common. Most children’s sleep problems happen only occasionally. They are not serious and get better on their own with time. If they don’t, you need to take them seriously. As well as being upsetting, they may interfere with your child’s learning and behaviour. There may be an underlying health problem, physical or mental.
Where can I get help?
There are some simple things you can do to help your child sleep better:
• Develop a consistent, relaxing bedtime routine with your child. This should start with quiet time to help your child to wind down – for example, a bath followed by a short bedtime story before you say goodnight. This helps children to settle, and should end with your child falling asleep without the need for you to be with them.
•It is important to be loving, but firm, about when it is time for your child to settle down
for the night. When your child cries out, it is important to be sure that they are not wet, ill
or in pain. It is best to do this quickly, while still comforting and reassuring them. Don’t
spend too much time with them or take them into your bed, because this will reward them
for being awake.
• A dummy can help to comfort young infants who wake needing to suck. Once you have
weaned your child on to solid foods, it is best not to give them a bottle or dummy at night if they wake and can’t find it, they will probably start crying. A cuddly toy or favourite blanket can often help young children to cope with their separation anxiety.
Your general practitioner (GP) or health visitor can offer advice and help. If things don’t get better, it is worth thinking about asking for a specialist opinion from a Paediatrician or Psychiatrist. This will help to find out exactly what the problem is and how it can be best resolved.
12 December 2011
EXAM PHOBIA
EXAM PHOBIA
It is a common experience that more than 50 per cent of students suffer from an examinations phobia.
It doesn't matter whether the student is intelligent or not. They all worry about forgetting or overlooking something or the other while appearing in an exam, not being able to recall important facts at the appropriate time and, most importantly, ending up with a low score or failing. And these fears become barriers in their performance, especially during exam time.
I want to share through this piece some of the major reasons leading to exam phobia along with some ways that can come in handy in helping students beat the fear and enjoy the learning process.
Most teachers as a general practice in schools target their teaching either directly or indirectly towards the exams. Being focused on that, they highlight the same for the students as well like emphasiszing the need to complete much of the syllabus before the exams, working on important topics that may come in the exams, revise the lessons before the exams, etc.
The students too, as a result of this, feel that exams are the most important thing. With that settled, they too start focusing on exams while living with a feeling of dread instead of enjoying their classes.
But before discussing ways to help students beat this fear, it would also be helpful to examine the facet of fear.
Sometimes fear is related to a specific subject as a result of which your confidence may rise or fall only when tested in that subject.
Students might also fear the punishment that would be awarded to them by their parents or teachers on getting low marks. Because if God forbid, they measure less on their expectations, they are not just punished for it by the teachers in the form of having to write the correct answer 10 times or sometimes even 100 but the parents too show their disappointment by ignoring them for several days.
Another aspect is being retained in the same class on failing the finals. In addition to all this, the students know that the teachers always appreciate those who get the highest marks in class so simply getting good or average grades is not good enough.
At this stage, when the students find themselves disinterested in their studies due to exam phobia, the role of the teachers in encouraging them to just do their best becomes even more important.
So how can a teacher help the agonising young minds to lose their fear of exams? The following tips may come in handy:
• Make your students aware of the fact that their getting less marks in the exams will not result in any kind of punishment. Help them realise that examinations are merely a segment of the learning process used to explore one's skills. Give the same message to the parents as well.
• Do make the students understand that the process of learning is far more important than giving exams. If a student takes an active interest in his or her studies while not thinking about being tested on it later on, he or she would automatically gain good marks.
• Appreciate even the slightest improvement in performances. It will enhance self esteem, making the child want to learn more and work hard to acquire more good grades. Also share the improvement in students with the parents which will also do away with the notion that teachers only call the parents when the child is failing in class.
• Help them believe in their strengths. All children have their own sets of hidden potential. Help them realise their good points. For example, some students may have good handwriting, some might have good presentation skills and so on. Ask them to use the best of their already existing skills and abilities during the exam to get better results instead of thinking and worrying about self-created fears.
• Help the students search out their own areas of weakness. Self assessment helps in finding out the area within oneself that needs improvement. For instance, I secured less marks in the exam because: (a) I made careless mistakes, (b) My presentation was not attractive, (c) My time management needs improvement, (d) I need to go through the concept with the teacher again and so on. After making them go through a process of self assessment, facilitate them to practically work on the weak areas either through tasks given in the classroom or through homework.
So how can a Parents help the agonising young minds to lose their fear of exams? The following tips may come in handy:
■never underestimate your children
■never force your child to choose their course
■take care of your child's dream
■always help your child to overcome stress
■parents role is to give adequate nutrition,environment for reading
■never compare your child with other student
■never give a goal or career line to student give yr child to select his career
■always keep a watch over child but don't spy on him
■always remember that everyone's brain has their own capcity so beyond this capacity nobody can't do anything
■give emotional support to your child
■always try to be in touch with teacher
AT THE END NEVER WAIT IF ANY MENTAL DISTURBANCE OR STRESS IS SEEN IN YOUR CHILDREN
CONSULT PSYCHIATRIST AND GET ACADEMIC GUIDANCE FOR YOUR CHILDREN AT THE BEGINING OF 10TH AND 12TH STD
It is a common experience that more than 50 per cent of students suffer from an examinations phobia.
It doesn't matter whether the student is intelligent or not. They all worry about forgetting or overlooking something or the other while appearing in an exam, not being able to recall important facts at the appropriate time and, most importantly, ending up with a low score or failing. And these fears become barriers in their performance, especially during exam time.
I want to share through this piece some of the major reasons leading to exam phobia along with some ways that can come in handy in helping students beat the fear and enjoy the learning process.
Most teachers as a general practice in schools target their teaching either directly or indirectly towards the exams. Being focused on that, they highlight the same for the students as well like emphasiszing the need to complete much of the syllabus before the exams, working on important topics that may come in the exams, revise the lessons before the exams, etc.
The students too, as a result of this, feel that exams are the most important thing. With that settled, they too start focusing on exams while living with a feeling of dread instead of enjoying their classes.
But before discussing ways to help students beat this fear, it would also be helpful to examine the facet of fear.
Sometimes fear is related to a specific subject as a result of which your confidence may rise or fall only when tested in that subject.
Students might also fear the punishment that would be awarded to them by their parents or teachers on getting low marks. Because if God forbid, they measure less on their expectations, they are not just punished for it by the teachers in the form of having to write the correct answer 10 times or sometimes even 100 but the parents too show their disappointment by ignoring them for several days.
Another aspect is being retained in the same class on failing the finals. In addition to all this, the students know that the teachers always appreciate those who get the highest marks in class so simply getting good or average grades is not good enough.
At this stage, when the students find themselves disinterested in their studies due to exam phobia, the role of the teachers in encouraging them to just do their best becomes even more important.
So how can a teacher help the agonising young minds to lose their fear of exams? The following tips may come in handy:
• Make your students aware of the fact that their getting less marks in the exams will not result in any kind of punishment. Help them realise that examinations are merely a segment of the learning process used to explore one's skills. Give the same message to the parents as well.
• Do make the students understand that the process of learning is far more important than giving exams. If a student takes an active interest in his or her studies while not thinking about being tested on it later on, he or she would automatically gain good marks.
• Appreciate even the slightest improvement in performances. It will enhance self esteem, making the child want to learn more and work hard to acquire more good grades. Also share the improvement in students with the parents which will also do away with the notion that teachers only call the parents when the child is failing in class.
• Help them believe in their strengths. All children have their own sets of hidden potential. Help them realise their good points. For example, some students may have good handwriting, some might have good presentation skills and so on. Ask them to use the best of their already existing skills and abilities during the exam to get better results instead of thinking and worrying about self-created fears.
• Help the students search out their own areas of weakness. Self assessment helps in finding out the area within oneself that needs improvement. For instance, I secured less marks in the exam because: (a) I made careless mistakes, (b) My presentation was not attractive, (c) My time management needs improvement, (d) I need to go through the concept with the teacher again and so on. After making them go through a process of self assessment, facilitate them to practically work on the weak areas either through tasks given in the classroom or through homework.
So how can a Parents help the agonising young minds to lose their fear of exams? The following tips may come in handy:
■never underestimate your children
■never force your child to choose their course
■take care of your child's dream
■always help your child to overcome stress
■parents role is to give adequate nutrition,environment for reading
■never compare your child with other student
■never give a goal or career line to student give yr child to select his career
■always keep a watch over child but don't spy on him
■always remember that everyone's brain has their own capcity so beyond this capacity nobody can't do anything
■give emotional support to your child
■always try to be in touch with teacher
AT THE END NEVER WAIT IF ANY MENTAL DISTURBANCE OR STRESS IS SEEN IN YOUR CHILDREN
CONSULT PSYCHIATRIST AND GET ACADEMIC GUIDANCE FOR YOUR CHILDREN AT THE BEGINING OF 10TH AND 12TH STD
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