November 2013

            


Current Sections

 

 

 


Editor : Dr. M.S. Bhatia
E-mail: manbhatia1@rediffmail.com

 

Editorial

Over diagnosis, overshadowing and overtreatment in Psychiatry

The recent articles “The Epidemic of Mental Illness' Why? and “The illusions of Psychiatry” have charged the practice of psychiatry. Psychiatrists have been blamed to often overdiagnse disorders of questionable scientific validity, overly fixed on medication solutions to life's problems and many have accepted a steady flow of drug industry money, creating many conflicts of interest. The recommendation to treat self remitting bipolar disorders life long has put fire in it. DSM has been criticized as illegal Bible of medical reimbursement. The charge becomes grave when the facts come to light that few people who are involved in devising classifications, are on the board of directors of drug industry, are involved in conducting drug trials, are linked to agencies for approving indications of drugs, are guest speakers or hosts of conferences sponsored by pharmaceuticals and also editors guest editors, reviewers, referees or authors for scientific journals sponsored by drug industry. To disapprove these charges, the conflicts of interests should be clearly mentioned.

The revision of classification should be need - and evidence-based. The mere mixing of clusters of symptoms to devise a new diagnosis must be discouraged and also, the inclusion of normal reactions e.g. grief reaction, stress reaction, adjustment disorder, performance anxiety (disorder), scholastic backwardness (disorder)

The issues of conflicts of interest have brought clinical medicine including psychiatry to an unprecedented crisis of credibility. The inclusion of cognitive symptoms (e.g. impaired concentration, amnesia etc.) in psychiatric disorders to promote the use (and sale) of nootropic drugs is an example. The fear that forthcoming DSM-5 will promote over diagnosis must be dispelled. Over diagnosis is the diagnosis of a condition or disease more often than it is actually present whereas misdiagnosis is an incorrect diagnosis. There is no doubt that among the medical professions, psychiatry is the most scientifically premature. Most of the psychiatric disorders are rather syndromes. The etiology of many psychiatric disorders is becoming blurred i.e. failure of genetic and neurotransmitter theories to stand by time. There is need to demarcate normally symptoms, disorder and syndrome e.g. Depression is best example. Diagnostic overshadowing also leads to denial of normal personality traits, situational normal reactions, problems, transient symptoms and organic factors. The classical example is epidemic rise in prevalence of ADHD in children and so, use of stimulants. There is also increase in inappropriate use of drugs in autistic disorder, specific learning disabilities emotional immaturity, behavioral problems in mentally retarded, post partum blues, grief and stress reactions, so called medicalisation . The sale of stimulants, sedate- hypnotics and antidepressants are clear reflections. There is also rise in use of drugs in the treatment of personality traits, normal reactions adjustment disorder symptoms (not disorders) and unapproved disorders. There is need to differentiate between unhappiness, sadness and depression. One has to differentiate whether anxiety reaction to painful condition is abnormal or not.

This is due to the increasing tendency to find out pharmacological solution of every psychological or environmental problem. The dramatic example is the lesser use of physical, psychological and behavioral therapies. Additional factors e.g. greater acceptance among physicians and the public of psychotropic drugs, tendency of family members to quick fix their contribution to mental disorder by drug treatable diagnosis (drug bullet for psychological culprit). One can infer from the observations that how many patients coming out of a psychiatrist's clinic do not receive drugs. The success of psychiatric practice is determined not only by how many patients you successfully treat by drugs but also by in how many, you are able to stop them. There is rapid rise in cases of iatrogenic drug dependence. True relapses need to be differentiated from withdrawal symptoms. Many drug trials are also under cloud as the efficacy of drugs has been erroneously put above placebos. Can one imagine use of selective group (selection bias), using ineffective drug or dose for comparison (i.e. drug – bias), using placebo (e.g. not revealing nature of placebos and in many trials placebo producing extra pyramidal symptoms (i.e. placebo-bias). Many trials are not single, double or triple blind but are there to make you blind. The classical example is safe – hype of atypical antipsychotics (but they are as unsafe metabolically and cardiologically as typical ones) and SSRI's (e.g. recent FDA warning not to use citalopram over 40 mg.)

Psychiatry has also been blamed for not putting efforts in promoting primary and tertiary prevention, accepting limitations and handing over rights of treatment to other professionals. Educating public, caregiver and other professionals is not much promoted. Due to limited availability of mental health professionals, one must accept multiple roles i.e. of a trainer, a researcher, a teacher and a clinician.

 

Message from Editor

Delhi Psychiatric Society started publishing its newsletter in early 1990's, which was modified to Delhi Psychiatric Bulletin. Later on, it took the shape of Delhi Psychiatry Journal in 2007. It is published twice a year and is indexed and subscribed by many agencies. Recently, its all issues have been indexed and made available free of cost at website www.medIND.nic.in ( a site of Indian Medlars, sponsored and run by National Informatics Center, Government of India). All contributions and suggestions are welcome to the editorial office by e-mail: manbhatia1@rediffmail.com or dps_journal@yahoo.co.in . They can also interact at our newly activated website. Members are requested to kindly check their addresses in the directory and send corrections in the form available at website.

 Dr.M.S.Bhatia

 

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THE WAR AGAINST TOBACCO: ROLE OF HEALTH PROFESSIONALS

 Tobacco consumption is necessary neither for the maintenance of life nor for the satisfaction of social, cultural or spiritual needs yet world's one-third adult population performs this bizarre act despite generally agreed health risks and acceptance by its users that it is harmful to health.

We have witnessed 100 million tobacco-related deaths in the last century and the toll is likely to be one billion in the 21 st century. According to World Health Organization there are about 1.3 billion tobacco users in the world currently and tobacco smoking is the most common form of tobacco consumption both in terms of prevalence and health consequences. 50% (650 million) of the current tobacco users will eventually die prematurely due to tobacco-related diseases in the next few of decades. It is estimated that by the year 2025, there will be about 10 million tobacco-related deaths world-wide and 70% of these deaths will be from the developing countries alone. These are preventable deaths.

India , the world's second largest consumer and producer of tobacco, has, currently 240 million tobacco users aged 15 years and above (195 million males and 45 million females). In all, 57% of the men and 11% of the women use tobacco in one form or the other.

More than 800 billion beedis and 100 billion cigarettes are consumed every year by 120 million Indians. India 's tobacco problem has serious implications for the country's fragile health-care system. The total cost of just three tobacco-related diseases – coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and tobacco related cancer – is estimated to be over Rs 308 billion (US$7.2 billion) per year. This is ironic and shocking for a country which is struggling to provide basic health care infrastructure and services to its billion-strong population.

While Indian Government has implemented several measures to control tobacco use over the past decade, these have been mostly piecemeal and ineffective. Despite of ample legal provisions and regulations, it is only since 2007 that more effective anti-tobacco measures such as smoke-free rules have been instituted and implemented.

Need of the hour is to sensitize the physicians to treat those who are already the victims of tobacco use. Every patient coming in contact with a doctor needs to be asked about the history of tobacco use and should be treated after enhancing his motivation to quit. It is more relevant to the psychiatrist as the prevalence of tobacco use is more than double in psychiatric patients.

R.C. Jiloha Director Professor & Head, Department of Psychiatry, GB Pant Hospital, Maulana Azad Medical College & University of Delhi

 

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Post Your Message, change in address & Tele. No.:


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Letter to the Editor
 

Dear Dr.Neelam Bohra,

Thank you very much for acknowedging my contribution to website.You are doing excellent job in updating website.I am happy that I have left my job in safe hands. Kindly also update datas regarding Govt. Hospitals providing free treatment. With best wishes for you and our website.

Dr. T.P.Jindal

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Dear Sir,                                                                                                                               
21/10/08

I am Abhilash from Mehrauli. I have completed the Masters in Social work from Baqngalore University, specialized in Family and Child Welfar as well as I had an experience in the Psychiatric settings too.I done my third semester field work in St. Johns Medical,College Bangalore (Psychiatric settings) . I am very sincere dedicated and believable person. I am trying my level best and  have been searching job for last 20 days  I could not find it till yet.  I took bank loan for my studies and this is the time to start repaying that money. So to get a job as soon as possible is the great necessity for me. If you can please help me I will be greatful to you. I am waiting for a positive replay.

Regards.
Abhi.

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Dr. Neelam Bohra
Delhi Psychiatric Society

Dear Dr. Bohra,

We thank you for conveying your good wishes on the occasion of inauguration of our Halfway Home & Day Care Centre in Greater Noida which took take place on 26 th July, 2008.

Although you could not make it to the inauguration function, it will be our pleasure to have you with us at a future date convenient to you.

You were kind enough to suggest that we submit details about our organization and link to our website to you which would be put on the website of Delhi Psychiatric Society.

Accordingly, we are attaching our write-up titled “Vishwas” which may kindly be put on the website. We are also attaching our Newsletter published in July 2008 which may also be included as a link, if possible.

Our website address is www.rfsindia.org . It is, currently, under revision. We shall inform you as soon as it is reconstructed. It should, possibly, take 4-6 weeks.

We have noted that the name of our organization is appearing with old address under Halfway Homes on the website of Delhi Psychiatric Society. We are giving revised information which may be included on the website

THE RICHMOND FELLOWSHIP SOCIETY ( INDIA ) DELHI BRANCH,

‘Vishwas'
30/3 Knowledge Park III,
Greater Noida - 201308, U.P. , INDIA
Phone: (0120) 3223331
E-mail: rfsdelhi@gmail.com

The above information may also be included in the list of NGOs.

Kindly note, that besides Halfway Home, we are running Day Care Centre and are also having Outreach programmes. We are, however, unable to locate any sections on DPS website where such information can be included.

Regards,
Yours sincerely,

V.S. Mathur
Secretary,
The Richmond Fellowship Society ( India ) Delhi Branch
Mobile : 99990 26730

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Respected sir,

With your kind guidance & blessings, we would like to organise several activities under the banner of DPS.
As per your telephonic instructions, i am submitting tentative plans for the year 2008 ,which will be finalized after the approval of executive council.


        --- Conducting regular clinical meetings/cme.there will be clinical meetings at sir Gangaram hospital             
on every third tuesday of every month from 3pm to 4pm..Dr.J.M.Wadhawan will be incharge of the above clinical meetings. the clinical  meeting will be followed by executive council meeting .

       ---  Conducting MidTermCME in july/august

       ---  Celebration of Mental Health Week, in which emphasis will be on mental health awareness in child  psychiatry, De-Addiction, psycho-sexual health education etc by camps, workshops, cme, symposium,seminars, press conference, tv& radio talks, etc.

Annual conference will be for two/three days, out of which, first day will be at delhi.
This is for your kind consideration.
Thank you again for your constant guidance & support.

with regards.

Tushar Jagawat
President
Delhi Psychiatric Society

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Dear Doctor Bohra,  

The website is indeed impressive. Lovely job, sir!
Thank you for hosting my name on the DPS website.
There are some changes I would like to incorporate on the home page & advt.
Kindly do the needful & oblige.

With best wishes,
Rajesh Nagpal

 
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To,
       DR.  N.K Bohra, DR. Bhatia and Dr.Kansal

                                          Subject:- Life membership and Delhi journal of Psychiatry.

     Sir,
                 I have received the April month DPJ and my name features as life member  on DPS website .Thank you very much. The editorial by DR. MS  Bhatia is really very provoking  and we should introspect ourselves that somewhere we are not doing our job sincerely.If we don't practice our profesion  and its all the subspecialities completely somebody else will do it.One of the reasons may be  number of psychiatrists, being less and most of them  are only concerned with treating major Illnesses like Schiz, bipoar, depression and anxiety disorder only.

Dr.Rama shanker
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Hello,

I'm writing to offer feedback for your web page, http://www.delhipsychiatricsociety.com/for%20patients%20and%20family%20members.htm. Your site is interesting and was useful for a project I'm working on. I found the link on your page, http://www.ocfoundation.org/, very helpful as well.

If you're interested in an additional resource for your page, I'd like to suggest an informative page about anxiety disorders that I found:

http://www.datehookup.com/content-a-guide-to-anxiety-disorders.htm

Best,
Erin Roberts

 
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DPS WEBSITE COMMITTEE

  CHAIRPERSON : Dr. T.P.Jindal
  EDITOR : Dr. M.S.Bhatia
  MEMBERS : Dr. Ashwani Kumar
Dr. Deepak Gupta
Dr.Pankaj Kumar
Dr.Anuj Mittal

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E-Group

In this age of electronic and instant communication and practical difficulties of meeting for meetings, a new e-group has been started. You can communicate your views and have instant reach to all members and prospective members of IAPP-Delhi.

 The address is:

 iaprivatepsychiatrydelhi@yahoogroups.com

 or  you can open the group by clicking:

 http://groups.yahoo.com/group/iaprivatepsychiatrydelhi

 or you may contact me to let me know that you would like to join at:

 samvednapsychiatry@hotmail.com

 Looking forward to an inter-active communication.

 Veena Kapoor

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Calender of Events

 

 

 

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