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All You Need to Know About Obsessive-Compulsive Disorder (OCD)

obsessive compulsive disorder

Obsessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts, which may or may not be accompanied by compensatory acts to reduce the stress caused by these thoughts; these are referred to as obsessions and compulsions, respectively. Adolescents are more likely to have OCD, which is under-reported and under-treated. Early intervention is critical since it can cause serious debilitation. This exercise covers the assessment and treatment of obsessive-compulsive disorder, as well as the role of the interprofessional team in assessing and treating patients with this problem.

Objectives:

  • Describe the indications and symptoms that can be used to identify the obsessive-compulsive disorder in a patient.
  • Summarize the obsessive-compulsive disorder treatment plan.
  • Explain how OCD affects neural networks.
  • Examine the value of strengthening interprofessional care coordination to improve the delivery of care for individuals with obsessive-compulsive disorder.

Introduction

Obsessive-compulsive disorder (OCD) is a disabling condition characterized by persistent intrusive thoughts that cause distress. Compulsions or routines may be used by the patient to alleviate the worry and suffering connected with these ideas. These rituals can be personal and private, or they can involve others; the rituals are used to compensate for the ego-dystonic sentiments associated with obsessional ideas, and they can result in a severe loss of function.

Among the most prevalent obsessions are:

  • Anxieties of contamination,
  • Aggression/harm,
  • Sexual worries
  • Religious fears
  • The drive to get things “exactly so”.

Some of the compensating compulsions for these obsessions are:

  • Washing and cleaning
  • Checking
  • Reassurance-seeking
  • Repeating
  • Sorting and Arranging.
  1. Obsessions, compulsions, or both are present:

The following two points are used to define obsessions:

  • Recurrent thoughts, desires, or visions that are perceived as undesired at some point during the disturbance and generate significant distress in most people.
  • The individual tries to repress such ideas, urges or visions with another thought or action (i.e., by replacing them with a compulsion).

The following two factors define compulsions:

  • Repetitive actions or thoughts that a person feels compelled to perform as a result of an obsession.
  • The behavioral or mental acts that are intended to reduce worry or suffering, or to prevent some dreaded situation; nevertheless, they do not correlate in a realistic way with the problem they are intended to prevent, or they are manifestly excessive.
  1. Obsessions take up a lot of time or create clinically substantial distress or impairment in social, occupational, or other vital aspects of life.
  2. The physiological consequences of a substance (e.g., a drug of abuse, a medicine) or another medical condition are not the factors causing obsessive-compulsive symptoms.
  3. The symptoms of another mental disorder do not better explain the disturbance
  • Excessive worries, as in a generalized anxiety disorder;
  • preoccupation with appearance, as in a body dysmorphic disorder;
  • difficulty discarding or parting with possessions, as in a hoarding disorder;
  • hair pulling, as in trichotillomania a hair-pulling disorder;
  • skin picking, as in excoriation [skin-picking] disorder;
  • stereotypies, as in a stereotyping disorder;
  • Eating disorders are characterized by ritualized eating habits.
  • drug or gambling obsession, as observed in substance-related and addiction disorders;
  • sickness anxiety disorder is characterized by an obsession with having an ailment;
  • Impulses, as seen in disruptive, impulse-control, and conduct disorders;
  • sexual drives or fantasies, as shown in paraphilic disorders;
  • thought insertion or delusional preoccupations, as seen in schizophrenia spectrum and other psychotic illnesses; or
  • repetitive behavior patterns, as seen in autism spectrum disorders.

OCD is listed as one of the ten most debilitating conditions by financial loss and a deterioration in the quality of life by the WHO because it has the potential to impede one’s social growth and development.

Causes

Obsessive-compulsive disorder (OCD) has no recognized cause, however, it is most likely multifactorial. There is a genetic tendency since genetic factors account for 45 to 65 percent of the variance in OCD.

An inability to cope with uncertainty, a sense of greater responsibility, and magical thinking appears to predispose people to obsessive-compulsive behaviors.

OCD appears to be inherited, as evidenced by twin and family studies. According to studies, children’s heritability ranges from 45 percent to 65 percent, whereas adults’ heredity ranges from 27 percent to 45 percent. Having an OCD family member raises your chances of having OCD. OCD has been linked to a variety of neurological disorders, including Parkinson’s disease, Sydenham chorea, traumatic brain injury (TBI), Tourette syndrome, Huntington’s disease, and epilepsy, to name a few.

Evaluation

Screening for the correct symptoms of obsessive-compulsive disorder is critical. The brief OCD screener is a standard tool.

It asks the patient to rank the following items in order of severity:

  • Obsessive thoughts and compulsions take up a lot of time.
  • Obsessive thoughts are interfering with your life.
  • Obsessive thoughts cause a lot of pain.
  • Obsessions must be overcome.
  • Controllability of obsessive ideas
  • The amount of time devoted to compulsive behavior
  • Compulsive behavior’s interference
  • The anguish that comes with compulsive conduct
  • Anti-compulsive behavior resistance
  • Controllability of obsessive behaviors

Treatment / Management

SSRIs and cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) are the mainstays of obsessive-compulsive disorder (OCD) treatment.

ERP entails exposing the patient to their anxieties while also encouraging them to resist the impulse to conduct a compulsion. The goal is to rebuild the mind and change the habitual patterns that have developed as a result of participation in the compulsion.

CBT seeks to change negative and harmful ideas. The patient can use mindfulness approaches like meditation and relaxation in addition to CBT and ERP. In a 2012 study focusing on Mindfulness-Based Cognitive Therapy, they discovered that over the course of eight weeks, two-thirds of their patients had a decrease in OCD symptoms. Unlike ERP, MBCT does not require deliberately exposing patients to their fears. Nonetheless, when a stressful incident occurs, the patient is urged to take time to reflect on their thoughts and feelings. MBCT focuses on the attitude toward preoccupation rather than the ideas.

A Word from Tulasi Healthcare

Tulasi Healthcare is a psychiatric rehab center in Gurgaon providing treatment for people suffering from mental disorders. Obsessive-compulsive disorder (OCD) is a crippling condition that is frequently under-reported. Screening people for symptoms of the disease is critical. It is critical to educate medical professionals, as well as those who work in educational systems with teenagers, to be more alert.

We’re getting closer to identifying what OCD is by pinpointing specific locations in the brain and focusing on the chemicals involved. Because OCD affects such a large percentage of the population, having therapists who are trained to deal with it is critical. As health care providers, it is our obligation to promote awareness and inform patients about treatment alternatives.

Primary care professionals, psychiatrists, psychologists, psychiatric nurses, social workers, and pharmacists work together to enhance outcomes. Prescriptions are reviewed by pharmacists, who also educate patients and their families and aid the team by screening for drug interactions. Clinicians can also seek advice from board-certified psychiatric pharmacists in order to administer the most effective medications.

Psychiatric nurses keep track of patients, educate them, and keep the rest of the team up to date on their progress. Patients with OCD may benefit from this multidisciplinary approach to treatment.

 

What is Drug-Induced Psychosis?

drug psychosis

What is Drug-Induced Psychosis?

Toxic psychosis, alcohol-induced psychosis, and drug-induced psychosis are all diagnostic terms for a mental health illness in which a person suffers hallucinations, delusions, or both within a month of using or withdrawing from prescription medicines, illegal drugs, and/or alcohol.

According to the Diagnostic and Statistical Manual (DSM-5), drug-induced psychosis affects 7% to 25% of individuals treated for their first psychotic episode.

If you or a loved one is suffering from the symptoms of a substance/medication-induced psychotic condition, there are various treatment options and services available to help.

SYMPTOMS

Delusions, hallucinations, or both are common symptoms of drug-induced psychotic illness. Individuals who are experiencing these symptoms may or may not be aware of whether their hallucinations and/or delusions are real.

Delusions

Delusions are false beliefs or thoughts that are not founded on reality.

The following are examples of delusions:

  • Persecutory: Feelings that others are trying to get you or are spying on you, even organizations.
  • Grandiose: Belief in yourself as being outstanding, unique, gifted, and superior to others.
  • Referential: Belief that people and their surroundings have hidden meanings that are meant to communicate with you.
  • Erotomanic: Belief in the existence of someone or numerous persons who are in love with you despite evidence to the contrary.
  • Nihilism: Beliefs that a tragedy will occur.
  • Somatic: Belief that there is a problem with your body.

“My old firm is monitoring my every move and is trying to get me,” for example, is a persecutory delusion. An erotomanic illusion could be, for example, “Aishwariya Rai is in love with me”.

Hallucinations

A hallucination is when you have an out-of-body experience with one or more senses that isn’t founded on reality.

The following are examples of hallucinations:

  • Auditory: Hearing voices or sounds that aren’t actually there.
  • Visual: Perceiving things that aren’t actually present
  • Olfactory: The ability to detect scents that no one else can.
  • Tactile: Having the sensation of being touched even when no one or nothing is touching you.
  • Gustatory: Tasting something even when you don’t have anything in your mouth.

In an auditory hallucination, for example, a person may hear a voice instructing them to flee or telling them that they are being followed. A visual hallucination occurs when a person sees someone, who isn’t actually there, following them.

CAUSES

A large percentage of people with a substance use disorder also have a co-occurring mental health disorder. While chemicals may not cause drug-induced psychosis directly, certain substances can trigger psychosis in people who are predisposed to it.

Risk factors for drug-induced psychotic disorder owing to cannabis, opiates, stimulants, or numerous substances were identified in a longitudinal study of persons who presented with drug-induced psychosis, these were:

  • Being a man
  • Being under the age of 30
  • Having a mental health problem that isn’t being addressed

Not only were these people at risk for substance-induced psychosis, but they were also more likely to acquire schizophrenia in the coming years.

Psychoactive Substances:

Drug-induced psychosis can be caused by a wide range of psychoactive drugs, including:

  • Alcohol
  • Cannabis
  • Phencyclidine (PCP)
  • Hallucinogens
  • Inhalants
  • Sedatives
  • Hypnotics
  • Amphetamines
  • Stimulants

DIAGNOSIS

Symptoms must have a considerable influence on your quality of life in order to be diagnosed with drug-induced psychosis.

While distinguishing drug-induced psychosis from the schizophrenia spectrum and other psychotic disorders might be challenging, there are a few crucial variables to consider.

With psychosis brought on by drugs or alcohol:

  • Symptoms appear within a month of using or detoxing from drugs, alcohol, or both.
  • Prior to the substance use or withdrawal, there are no signs or symptoms of psychosis.
  • Symptoms usually last less than a month.
  • Withdrawal symptoms normally fade after a while.
  • Individuals don’t experience disorganized speech or behavior, as well as decreased emotional expressiveness, which are common symptoms among people with schizophrenia spectrum and other psychotic diseases.

Onset during intoxication:

Symptoms of drug-induced psychosis might appear as soon as a substance is consumed.

When diagnosing someone, the treating physician or mental health professional will look to see if the symptoms started while the substance was still in their system. An onset during intoxication is a term used to describe such a situation.

Onset during withdrawal:

During withdrawal, one may have symptoms of drug-induced psychosis.

The treating doctor will keep track of how long the symptoms last to make sure no other mental health issues are present.

If the symptoms persist for more than a month after the substance has been removed from the system, they may ask for more information to determine if another mental health disease, such as drug-induced mood disorder, is a better fit for the symptoms.

TREATMENT

Treatment for drug-induced psychosis varies based on the patient and their specific needs. Stopping the triggering substance and closely monitoring the patient in a safe setting may be sufficient in many circumstances. Different substances, like in alcohol, may necessitate more severe treatment.

While it’s necessary to get the substance out of the person’s system (acute), it’s also critical to address any underlying mental health issues (long-term). Combining acute and long-term care might sometimes prevent a person from developing drug-induced psychosis in the future.

Medication

Medications can be used to alleviate the symptoms of drug-induced psychosis and to assist the person’s mood to normalize.

Psychotherapy

To lessen the odds of having drug-induced psychosis again in the long run, it’s critical to treat any underlying mental health disorders.

Among the treatment options available are:

  • Cognitive Behavioral Therapy (CBT)
  • Inpatient treatment for drug and/or alcohol abuse is available.
  • Outpatient treatment for drug and/or alcohol abuse is available.
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Dialectical Behavior Therapy (DBT)
  • Group Therapy

Alcohol-Induced Psychosis Considerations

When compared to other substances and treatments, alcohol withdrawal may necessitate greater monitoring. The individual may have delirium tremens (DTs), symptoms of alcohol-induced psychosis, and bodily function failure in severe cases, which can be deadly.

Treatment and care options may include:

  • Tests and monitoring.
  • Vitals stabilization, electrolyte and vitamin replenishment, and liver disease testing
  • If necessary, sedation with medication
  • Suicide assessment and monitoring

Beginning inpatient or outpatient treatment once withdrawal is complete and the patient has stabilized can be extremely beneficial. In addition to counseling, support groups may be effective.

COPING

It’s critical to emphasize self-care if you or a loved one is experiencing symptoms of substance/medication-induced psychosis.

Aside from getting professional help, you can also:

  • Begin to practise mindfulness to help you cope with stress.
  • Ground yourself by using breathing exercises.
  • Look for indicators of caregiver exhaustion and take some time to relax.
  • Talk to someone you trust about what you’re going through.
  • Read up on the latest research on drug-induced psychosis.

A Word from Tulasi Healthcare

Although experiencing symptoms of psychosis can be terrifying, keep in mind that they may be directly related to a substance or medication that can be addressed. If you or a loved one is suffering symptoms of psychosis, contact a medical expert right away so you can get the help you need.

Importance of Mental Health

mental health

Mental health consists of our emotional, psychological, and socio-economic well-being. Our thoughts, feelings, and actions are affected by it. It determines how we handle stress, relate to others, and make choices.

The importance of Mental health is visible at every stage of life, starting from childhood to adolescence and right through adulthood.

There are indicators that measure living conditions like housing and employment but they fail to measure what people think and feel about their lives and the quality of their relationships.

How people view their emotions and rate their resilience, whether they are being able to realize their potential, or what is their overall satisfaction with life – i.e., their “well-being.”

Well-being, in general, includes judgments of life satisfaction and feelings ranging from depression to joy. Mental health problems can alter the thinking, mood, behavior and the overall well-being of people over the span of their lives.

Factors contributing to mental health problems include:

– Genetic / Hereditary factors, such as brain chemistry and genes.

– Experiences in life, such as trauma or abuse.

– Family history of mental health problems.

– Alcohol / Drug dependency.

Positive mental health allows people to:

– Realize their full potential.

– Cope with the stresses of life.

– Work productively.

– Make meaningful contributions to their communities.

Ways to maintain positive mental health include:

– Getting professional help if needed.

– Connecting with others.

– Staying positive.

– Getting physically active.

– Helping others.

– Getting enough sleep.

– Developing coping skills.

Points to be noted: 

  • Mental Health does not mean the absence of disease alone; it is in essence a valuable resource which allows people to realize aspirations, satisfy needs and at the same time be able to cope with the environment in order to live a long, happy, productive, and fruitful life.
  • Mental health enables socio-economic and personal development which is fundamental to mental well-being.
  • Mental Health promotion consists of the process of enabling people to exercise increased control over their lives and improve their overall health.
  • Environmental and social resources of mental health often include: peaceful environment, safe housing, economic security and a stable ecosystem.
  • Individual resources for mental health can include: physical activity, healthful diet, social ties, resiliency, positive emotions, and autonomy.
  • Mental Health promotion activities are aimed at strengthening such individual, environmental and social resources that may ultimately improve overall well-being.
  • There can be devastating consequences of long-term Mental Illness on the human body and spirit. An inability to deal with daily life pressures can lead to issues with our job, relationships, and our overall health. Whether we realize it or not, our mental capacity to deal with life can negatively impact others as well.

Seven Components of Mental Health

1. In-person therapy

  • Few of us are completely equipped with the tools needed for good mental health in daily living; we often need support to better understand our life experiences in order to see patterns and emotions that need further evaluation.
  • There is a higher need for in person therapy in 2021, now more than ever before. In general, we humans feel a need to decompress from the pressures and stresses of life as we learn new techniques for self-care and regulation that can improve our quality of life.

2. Community

  • Treating mental illness in 2021 may look different from years past, but that is no excuse to isolate ourselves and wallow in our own unique set of issues. Building a solid community of support, love, and friendships around us will be an essential part of our wellness journey.
  • We must surround ourselves with like-minded people; those who wish to become healthier and happier, and be uplifted by good conversations, in-person meetings, virtual care services and similar exchanges with their support circle. In doing so, one will realize that this journey is not a solo trip, and that they have people around them to improve the quality of their life.

 3. Physical health

  • The body and the brain are intimately interconnected, hence the saying ‘In a healthy body is a healthy mind’. Our body is an intricate network of systems, all working together to help us navigate life successfully, and we have a responsibility to take care of it.
  • Eating well, getting adequate exercise, sleep, and hydration are valuable actions we can take to preserve our physical well-being, which in turn will help us feel more positive about life in general.

 4. Intellectual health

Committing to being a lifelong learner and exercising one’s mind regularly is a valuable part of one’s mental health process. Like all aspects of mental health, intellectual health requires balance, learning of new skills and acquiring new knowledge that will open doors of opportunities, improving one’s life significantly.

5. Environmental health

  • The environment can significantly impact a person’s mental state of mind; being subjected to daily stressors and less than ideal living conditions can negatively impact our mental health and cause mental illness.
  • We must do what we can to remove those aspects from our lives that are stressing us out – relationships, living conditions, social situations, physical health issues – will help reduce the stress response in our brain that causes poor cognitive function.

6. Boundaries

  • It is next to impossible to fulfill all of life’s obligations and to take care of oneself as well; learning to set boundaries and saying “no” to things that are not essential will allow us to take out time for prioritizing our mental health.
  • Initially, one might feel guilty if they haven’t said no to friends and family before, but the more we stand up for ourselves and take back our time, the easier it becomes to practice daily habits that preserve our mental health.

7. Self-Care

  • The gifts of the last few years include more time for many, people are learning the fine art of self-care from the comfort of their homes, this leaves one with no choice but to take an introspective look at what they need most.
  • Doing those things that nurture body, soul, and spirit will improve not only our lives, but the lives of those around us as well.
Conclusion

Our Mental Health and Wellbeing is in our own hands, we must take the necessary steps to ensure that it is in a good condition so as to help us achieve our basic aim of living a happy, productive and satisfying life.

Ajitinder Sandhu

Best Psychiatric Hospital in Delhi and Gurgaon

tulasi healthcare

Tulasi Healthcare is one of the top private psychiatric hospitals in North India located in Delhi and Gurgaon. We have an excellent track record of providing quality healthcare services for the past 20 plus years.

Our new facility, inaugurated in November 2020, has been spaciously built with state-of-the-art technology, keeping in mind the welfare of the patients. It has a capacity of 100 beds, recreational facilities like gym, sports hall for badminton and cricket, pool, billiards and table tennis tables along with a sports and yoga instructor.

We provide individualized treatment to each and every patient. They are supported by a team of psychologists who are available round-the-clock along with a team of general physicians, nurses and other paramedical staff.

A mini workforce of cleaners ensures that the whole atmosphere is hygienic and the kitchen staff of expert chefs provide nutritious as well as delicious food at regular intervals.

Being a topnotch psychiatric hospital, patients are actively engaged in various activities, both recreational and educational. They are encouraged to follow a healthy daily routine with a set time table. Daily one-on-one counseling sessions with experienced psychologists are conducted for all patients along with periodic family outings and family counseling sessions.

Our psychiatric hospital strives to provide a holistic approach by aiming to resolve mental health issues of the patients as well as interpersonal relationship issues between families and the patients.

For more information please contact us +91-7707070001

OCD among children

ocd in children

A child may have been struggling with an obsessive-compulsive disorder (OCD) when unsolicited thoughts, and the actions which result from such thoughts, happen often, take up a lot of time (usually more than an hour everyday), obstruct her/his routine of activities, or make her/him feel distressed. Such unwelcome thoughts are called obsessions & the resultant behaviours are called compulsions.

Such a child (suffering from OCD) sporadically has thoughts that bother her/him, and she/he may also contemplate doing something about such thoughts in order to tackle them, even if it calls for acting illogically. For a few children, the beliefs and the impulses to execute a set of illogical activities continue to exist, even if they disregard such thoughts or try to completely eradicate such thoughts from their memory.

The first step towards effective treatment of a child suffering from OCD is to properly address and comprehensively evaluate the diagnosed ailment with the help of a child psychiatrist or at a Child Psychiatry Hospital. Such an all-inclusive evaluation conducted at a Child Psychiatry Hospital will help determine whether or not the unease or anguish relate to reminiscences of a hurtful event which has traumatised the child in the past.

Susceptibility (risk) factors for in-patient violence at psychiatric hospitals

psychiatric hospital in delhi

The assessment and management of risk and susceptibility of violence in the patients with mental disorders residing in psychiatric hospitals have been extensively debated over the past many years. Some mental disorders and a few specific genetic factors have proven to modify the risk associated with violence. Skills for precise evaluation and management of risks are essential for psychiatrists and other clinicians involved in the treatment of mental disorders, to prevent undesirable results. Historically, risk assessment has been conducted basis the evaluators’ clinical impressions.

Despite the recent development and breakthroughs in the field of risk assessment, there has been a foreseeable risk of erroneous estimation of future violence. 4 techniques are principally used in risk management: monitoring, supervision, treatment, and victim protection. A recent trend in this field is bearing in mind protective factors, and some useful tools focused on this have been introduced in clinical setting. In future, biological factors may be integrated into risk assessment and estimation of treatment response.

The assessment and management of risk for violence presents significant disputes for forensic mental health practitioners. Mentally Disordered Offenders (MDOs) are subjects of psychiatry, and psychiatric nurses are therefore exposed to a high risk of persecution. In addition, accurate inference of risk and effective intrusion for the risk of violence, are necessary to proceed towards the deinstitutionalization of patients with mental disorders. Despite some opinions opposing the involvement of psychiatrists in violence risk management, mental health practitioners are expected to evaluate the risk of violence and estimate the necessity of confinement for patients with mental disorders. Ultimately, mental health practitioners need to develop skills to evaluate and manage the risk of untimely death of the patients and of others in the patients’ environment through risk assessment.

Risk management refers to the process of ameliorating a patient’s predisposition for violence to reduce the risk of unwanted outcomes.

There are several biological factors pertinent to the materialization of violence. The amygdala plays a crucial role in impetuosity, alongside the hypothalamus and prefrontal cortex. Prompting of the anterior, lateral, ventromedial, and dorsomedial nuclei in the hypothalamus causes hostility. The amygdala deregulates dread and disquiet, also resulting in violent behavior. Prefrontal cortex dysfunction can also lead to irresponsible & aggressive behavior.

Some neuro chemical transmitters also control aggression. Low serotonin and gamma-aminobutyric acid are linked with impulsivity. In addition, high doses of nor-adrenaline, acetylcholine, and dopamine are likely to cause aggression. Congenital / hereditary factors have also been under focus in relation to aggressive behavior. Also, currently, psychotic symptoms are widely considered to be associated with an increased likelihood of violence.

Structured Professional Judgment (SPJ), a process of risk assessment that is currently prevailing as the chief method of risk assessment, emphasizes on the importance of both static and dynamic factors of the subjects, and has overcome the shortcomings of both unstructured clinical judgment and actuarial risk assessment.

Risk assessment and management are essential tasks for forensic psychiatrists and other mental health professionals who operate in psychiatric hospitals or in other such IPD settings. General psychiatric practitioners can often be involved in this challenging work, as unavoidably. Thus, precise and well-balanced risk assessment methods are needed to efficiently tackle & avert the risk of violence at psychiatric hospitals.

Patient assaults among staff members of Mental Health Hospitals

drug rehabilitation in delhi

Patients physically assaulting the staff at mental hospitals where they are admit, which results in minor/ severe injuries or even deaths is alarmingly prevalent in the current scenario, especially in IPD settings (such as in mental hospitals).

Paramedical staffs, psychiatrists, psychologists and counselors face manifold types of antagonism, violence, and beating at work, collectively referred to as workplace violence, which usually is sparked off by patients. Whether workplace violence negatively affects staff well-being may be related not only to its presence, but also to a person’s pressure reactivity. The creation of a healing environment is a vital goal for psychiatric inpatient settings. Interpersonal hostility in the form of discord, antagonism, violence, and assault are common occurrences in mental hospital wards, and impair the development of a treatment-conducive environment. These also create hardships for staff well-being, detracting them from patient care.

Several studies have documented that psychiatric staff are at high risk of workplace violence, including physical assault and verbal aggression by patients, visitors, supervisors, and coworkers

Staff members are likely to appraise conflict with patients in a different way when compared to appraisal of conflicts with coworkers and supervisors, bearing in mind that it is a part of a patient’s pathology.

An international review of violence toward nurses establishes that 55% of nurses in psychiatric and mental hospital settings experienced physical assault and that psychiatric settings had a higher rate of violence than any other health care setting. It is generally accepted that these assault records’ data are underestimates, because many staff may under-report harassment or assault due to fear of being perceived as less competent or being blamed, peer pressure not to report assault based on the gender of the person assaulted, or a lack of desire to deal with excessive paperwork or even of the threat of being fired from the job. According to recent studies, staff who are assaulted tend to be young (less than 30 years old), less experienced, less educated, spend more time with patients and are less qualified.

Direct care staff can feel beleaguered, vulnerable, disturbed, and shamed by assault and spoken hostility in their respective mental hospital units. The most commonly reported poignant consequences of assault and verbal aggression are fright, annoyance, rage, dread, disquiet, stress, and irritability. Similar to persons who have experienced traumatic events in the past, psychiatric unit staff who have been assaulted by patients are at increased risk of developing PTSD (post traumatic stress disorder) and major depression.

Job performance can also be adversely affected by feelings of insecurity; staff members who feel unsafe at work may engage in behaviors that impair curative bonding with patients: such as avoidance, passivity, and inconsistent or harsh enforcement of ward rules.

Mental hospitals suffer as organizations when staff safety is jeopardized. The incidence of episodes of violence in mental hospitals has direct costs for medical care, litigation, worker’s compensation benefits, paid leave, and substitute staffing. Additionally, there are indirect costs related to low self-esteem, employment and retention difficulties, service disruption, compromised public relations, impaired job performance, and the development of a negative therapeutic environment.

Prevalence of self-stigma and its association with self-esteem among patients in mental hospitals

psychiatric hospital delhi ncr

Stigma against mental disorders cuts across all age, religion, ethnic origin or socio-economic strata. In the same way, self-stigma among psychiatric patients admit in mental hospitals or in other IPD settings is also prevalent worldwide. The consequences of self-stigma are low self-confidence, increased severity of symptoms, low adherence to prescribed medication & treatment, increased suicide rate and an overall decreased quality of life.

Mental disorders are accompanied by reactions from the societies and communities of the suffering persons, that adds a dimension of suffering to the existent condition of the sufferer, which is called “second illness” or “stigma”.

Most studies highlight the existence of two dimensions of stigma namely, public stigma and self-stigma or internalized stigma. Public stigma is comprised of the negative attitudes held by members of the public about devalued people. On the other hand, self-stigma occurs when people internalize those public attitudes and suffer numerous negative consequences as a result.

Negative attitudes of people in general (hospital staffs, other people in society) towards them, during the process of admission into a mental hospital, may be an underlying cause for them to internalize such negative attitudes leading to self-stigma.

According to a study, prevalence of self- stigma among psychiatric patients is high: ranging from 22.5 to 97.4% in different countries: it is 36% in USA, 97.4% in Ethiopia, 22.5% in Nigeria, 49.5% in China and 50–66% in India.

In addition to this, self-stigma among psychiatric patients is associated with poor quality of life, low treatment adherence, decreased esteem, increased severity of symptoms, low self-efficacy and poor recovery. In extreme circumstances, self-stigma is associated with a higher rate of suicidality.

Self-stigma is strongly linked with low self-esteem that is directly related to the prognosis and impediment of the disease condition. On the other hand, positive self-esteem is basic characteristic of mental health that protects the people’s mental health from the impact of negative influences of mental illness. Furthermore, it promotes and facilitates effective coping with stressful situations, thus acting as a protective factor in mental health. This imperative element of mental health is vulnerable to self-stigma among psychiatric patients.

Implementation of awareness programs could help in reduction of self-stigma.

Furthermore, self-stigma and self-esteem have a strong negative relationship, which implies that as self-stigma increases, self-esteem decreases.

So in order to protect the self-esteem of psychiatric patients residing in mental hospitals or other such IPD settings, self-stigma must be reduced.

Different interventions and therapies being practiced at mental hospitals, which are focused on reduction and elimination of self-stigma like healthy self-concept, self-stigma reduction program, ending self-stigma, and cognitive therapy might help in reducing self-stigma. Self-esteem enhancement programs can also decrease self-stigma. A reduction in public stigma is also suggested here.

Multiple Barriers against Successful Care for Depressed Patients at Mental Hospitals

mental hospital in delhi

A study of 21 countries with the World Health Organization (WHO) Mental Health Surveys has concluded that only 52.6% of persons with depressive disorders in low-income countries have received treatment. Studies have recognized more than a few difficult consequences of mental disorders going untreated such as: pre-mature mortality, unemployment, poverty, homelessness, co-morbid substance abuse, addiction, poor physical health and suicide. Some initiatives have been taken up recently to reduce the gap in mental health treatment which mentally ill persons avail of at mental hospitals and in other such IPD settings.

However, the gap is still large and there is a huge dearth of mental health practitioners, especially in low and middle-income countries (LMICs). Understanding the reasons why people with mental disorders drop out of or fail to seek treatment could help in developing policies and plans to overcome these barriers to effective mental health treatment at mental hospitals. A plethora of factors are supposedly responsible for impeding mental health treatment, some of which are: a lack of apparent need, stigma, not knowing where to go for treatment (which mental hospital to go to), belief that the problem will be resolved on its own, desire to deal with the problem oneself, inability to afford treatment expenses, doubting the effectiveness of the treatment, and lack of availability of services.

Although safe and effective treatment of depression is available, many individuals with a diagnosis of depression do not get their condition treated. Many adults diagnosed with depression do not receive treatment, despite the availability of safe and effective psychological and pharmacological treatments.

Recent data from the World Health Organization (WHO) suggests that only 16.5% of individuals with major depressive disorder each year receive minimally adequate treatment.

The financial cost of non-engagement is high, and antidepressant use among patients with mental illness is associated with reduced mortality and rate of completed suicide.

Pragmatic, real life physical barriers include perceived or real inability to pay (or lack of insurance coverage), lack of child care or transport, and not knowing where to go for treatment of depression.

Psychological barriers include stigmatization associated with depression (both public stigma & self-stigma), doubting the treatment (assuming treatment is ineffective), or concerns that others may find out which will lead to public stigma, Culture-specific nuances, can also complicate the detection of depression and the uptake of treatment.

It has been established now that treatment uptake is a substantial barrier that prevents universal screening efforts from reaching their full potential for improving mental health of a large population. The utility of the depressive disorder treatments depends on the first step of treatment initiation, and is usually undertaken by mental health practitioners at mental hospitals.

Psychiatric disorders which affect suicidal patients admitted into psychiatric hospitals

suicide prevention

Suicidal patients admitted into psychiatric hospitals

Patients with suicidal behavior (SB) who are admitted into psychiatric hospitals are considered to be at a higher risk of suicide. However, the number of studies that have addressed this population of patients is insufficient when compared to the number of studies conducted on suicidal patients in psychiatric hospitals, both in emergency and regular IPD settings.

Suicidal behavior (SB) is a chief concern for mental health practitioners and often an underlying cause of emergency treatment and admission into psychiatric hospitals. It also requires the individual attention of the mental health practitioner as it is usually seen as a salient sign of a high risk of suicide. Psychiatric disorders have been established to be a major contributory factor for suicidal behavior among patients in psychiatric hospitals. Treatment of these disorders is likely to play an important role in plummeting SB recurrence and averting suicide.

Most of the contemporary studies suggest that suicide is one of the leading causes of untimely death among patients with chronic psychotic disorders.

Suicidal behavior is closely associated with mental disorders. Practically all mental disorders bear an augmented risk of suicidal ideation, suicide attempt, and suicide. Psychiatric disorder may be a nearly necessary, yet inadequate, risk factor for suicide. Approximately 90 % of persons who attempt or commit suicide meet diagnostic criteria for psychiatric disarray, the psychiatric disorder most often being mood disorder, substance use disorder, psychosis, and personality disorders. The peril of suicidal behavior in nervousness disorders and eating disorders, both having strong co-morbidity with depression, is often misjudged. Ineffective treatments, co-morbidity, non-compliance with treatment / administration of prescribed medication are some of the most common issues and challenges faced during treatment of suicidal persons.

On the other hand, there is also increasing evidence of lower risk of suicidal behavior in cases of closely monitored long-term treatment of suicidal patients, indicating that treatment adherence is an important factor in cases of medical suicide prevention.

Suicidal behaviors usually result from a combination of several factors.

The primary risk factor in suicide which can be treated is depression:

The strongest predictor of suicide is the amount of time spent during an episode of depression. Suicide is more common when major depression or bipolar depression is accompanied by severe anxiety. Risk of suicidal thoughts and attempts may increase in younger age groups in case antidepressant drugs are administered:

Following are a few more risk factors for suicide:

  • Most severe mental disorders
  • Use/Abuse of alcohol, drugs of abuse, and prescription analgesics
  • Previous suicide attempts
  • Serious physical disorders, particularly in the elderly
  • Personality disorders
  • Impulsivity
  • Unemployment and economic slumps
  • Disturbing childhood experiences
  • History of suicide and/or mental disorders in family