General Adult Psychiatry

Mental illness affects the way we think, feel and behave. When people get affected by the mental illness, it can affect their functional level and overall life in general. The symptoms of mental illness depend on the type of mental illness.Mental health problems are not a sign of weakness. They are upsetting and frightening experience. The impact due to the mental illness not only affects the patients but also the whole family. Talking to the professionals can relieve the distress and pain due to mental illness.

Anyone can suffer from a mental health problem. Globally it can affect one in four people and range from common mental health problems, such as depression and anxiety, to more rare problems such as schizophrenia and bipolar disorder.

Adult ADHD (Attention Deficit Hyperactivity Disorder) is a mental or developmental neurobehavioral disorder characterised by significant difficulties of inattention, hyperactivity, impulsiveness or a combination. It is significantly under-diagnosed.

ADHD sufferers are often very intelligent, creative and intuitive people who regularly exhibit symptoms including:

  • Sense of underachievement, organisational difficulties, procrastination, and many projects underway simultaneously which are seldom completed
  • Interpersonal problems, a tendency to blurt things out without thinking, and problems in relationships
  • Search for high stimulation and a low threshold tolerance
  • A tendency to worry, a sense of insecurity, and mood swings
  • Anxiety, depression and substance misuse

If you have any concerns about adult ADHD, please contact us as soon as possible about ADHD assessment and treatment.

Our treatment approach for ADHD

At ARAM hospital, our approach to the assessment and treatment of adult ADHD combines an individualised programme with treatments based on current clinical evidence.

ADHD assessment

An ADHD assessment is via a well researched protocol the Connors semi-structured interview with you, and, where possible, a family member. The initial ADHD assessment takes approximately two hours. The assessment will be followed by a consultation with the Psychiatrist to clarify the diagnosis of ADHD and offer ADHD treatment options.

ADHD treatments

The treatment of adult ADHD consists of medication, cognitive behaviour therapy, psycho-education, family and couple therapy.

Anger is a natural emotion which, sometimes, we all experience depending on the situation. Anger, when not channelised properly, can be destructive. It will have negative impact on physical health, mental health and relationships. Therefore, the problems due to mental illness should be understood and treated. In ARAM psychiatry hospital, we adopt different treatment strategies to treat anger management issues. The treatment includes individualised treatment programmes based on current clinical evidence. You may attend as an outpatient, day patient or inpatient.

Talking therapies

Talking therapies are available to help explore, understand and manage your anger positively. Cognitive Behavioural Therapy, known as CBT, can aid learn more constructive emotional and behavioural responses.

Individual treatment

we also offer alternative therapies, like meditation, relaxation, sleep therapy and physical therapies.

People with bipolar affective disorder will have severe mood swings. Bipolar affective disorder is also called Manic depression. The moods swings can be either low or depressed state or high or manic state or mixture of both depression and manic state. These states usually last several weeks or months and are far beyond what most of us experience.

Our approach to treating bipolar here at ARAM Hospital Trichy combines individualised treatment programmes with treatments based on current clinical evidence. We treat Bipolar affective disorder through two different types of treatment : talking therapies and medication.

Cognitive Behavioural Therapy (CBT) can help with bipolar depression and identify coping skills. Psycho education can educate about bipolar, and mood monitoring and mood strategies can help when mood is swinging and stop your mood swinging into a full-blown manic or depressive bipolar episode.

Depression

If you become depressed, you will notice some of these changes:

Emotional

  • feeling sad most of the day that last for at least two weeks.
  • losing interest in things
  • being unable to enjoy things
  • feeling restless and agitated
  • losing self-confidence
  • feeling useless, inadequate and hopeless
  • feeling more irritable than usual
  • thinking of suicide

Thinking

  • can’t think positively or hopefully
  • finding it hard to make even simple decisions
  • difficulty in concentrating

Physical

  • losing appetite and weight
  • difficulty in getting to sleep
  • waking earlier than usual
  • feeling tired
  • constipation

Behaviour

  • difficulty in doing everyday chores
  • crying a lot – or feeling like you want to cry
  • avoiding contact with other people

Mania

Mania is an extreme sense of well-being, energy and optimism. It can be so intense that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and – occasionally – dangerous ways. It can affect the function of life. You or your loved ones may notice the following symptoms.

Emotional

  • very happy and excited
  • irritated with other people who don’t share your optimistic outlook
  • feeling more important than usual

Thinking

  • full of new and exciting ideas
  • moving quickly from one idea to another
  • hearing voices that other people can’t hear

Physical

  • full of energy
  • unable or unwilling to sleep

Behaviour

  • making plans that are unrealistic
  • very active, moving around very quickly
  • behaving unusually
  • talking very quickly – other people may find it hard to understand what you are talking about
  • making odd decisions on the spur of the moment, sometimes with disastrous consequences
  • recklessly spending your money
  • over-familiar or recklessly critical with other people
  • less inhibited in general

Psychotic symptoms

If an episode of mania or depression becomes very severe, you may develop psychotic symptoms.

  • In a manic episode – these will tend to be grandiose beliefs about yourself – that you are on an important mission or that you have special powers and abilities.
  • In a depressive episode – that you are uniquely guilty, that you are worse than anybody else, or even that you don’t exist.

As well as these unusual beliefs, you might experience hallucinations – when you hear, smell, feel or see something, but there isn’t anything (or anybody) there to account for it.

Between episodes

It used to be thought that if you had bipolar disorder, you would return to normal in between mood swings. We now know that this is not so for many people with bipolar disorder. You may continue to experience mild depressive symptoms and problems in thinking even when you seem to be better.

Anxiety disorder can be a disabling for many people. There different forms of anxiety disorder and they are Generalised anxiety disorder, Agarophobia, Panic disorder, Specific phobia, Social Phobia, and Obsessive compulsive disorder. It is important to distinguish the nature and types of the anxiety disorder through thorough assessment of the patients in order to devise the treatment plan, although the chemical involved in the causation of these disorders and the medical treatment for these treatments are the same as each disorder requires specific type of psychological therapy.

In ARAM psychiatry services, we offer various therapies for different anxiety disorder and they are as follows.

  • Relaxation techniques
  • Breathing techniques
  • Exposure and response prevention therapy
  • Cognitive behaviour therapy
  • Systematic desensitisation

Depression is the most common psychiatric illness which affects 10 % of population. When people gets depression, they feel sad persistently; loose interest on things that they used to enjoy; loose appetite and weight; have sleeping difficulty; feel hopeless, worthless and suicidal. Failing to treat depression can affect the individuals health, job and relationship and can escalate risk to themselves. Depression is a treatable condition and can be treated with medication and psychological therapies like Cognitive Behaviour Therapy. In ARAM psychiatry services, we have trained CBT therapist who are well verse in administering Cognitive Behaviour therapy at an advanced level considering the cultural and language sensitivity. Individuals with depression get negative thoughts and call negative thoughts as thinking errors. Example, self criticism, think that others do not like him or her, think that life is doomed when it is not the case. Our psychologists/ therapists help individuals to identify these negative thoughts and challenge these negative thoughts.

Obsessive Compulsive Disorder , known as OCD, is a mental health disorder, in which individual have repeated unwanted thoughts, feelings or behaviour. It can be repeating the same action like washing over and over. OCD can be understood and treated using a variety of approaches.

Our approach to treating OCD at ARAM hospital Trichy includes individualised treatment programmes based on current clinical evidence. You may attend as an outpatient, day patient or inpatient.

Talking therapy

There are two types of Cognitive Behavioural Therapy, known as CBT, that treat OCD. The first one is Exposure Response Prevention (ERP) is a way to stop compulsive behaviours and anxieties strengthening each other by gradually facing your fears and learning to prevent the usual compulsive behaviours. The second one is Cognitive Therapy (CT) and it is goal directed, systematic and problem solving therapeutic approach that focuses on the way we think and act in order to help overcome and manage emotional difficulties.

Medication

Medication can also be effective in improving OCD symptoms. It can be used in combination with CBT to reduce obsessions and compulsions.

Symptoms of OCD

Obsessions

Obsessions are unwanted, unpleasant and repeated thoughts, images, doubts or ruminations in your mind. You try not to think about them, but they won’t go away. Individuals with obsessions experience shocking or blasphemous single words or short phrases. They may wonder for hours whether you might have caused an accident or misfortune to someone, endlessly argue with themselves or bothered, in a way that other people are not, if things are not in the exactly the right order, not balanced or not in the right place

Compulsions

Compulsions are mental acts or repetitive behaviour. Individuals with OCD experience obsessional thoughts like counting or saying a special word over and over again or avoidance by avoiding to touch particular objects, go to certain places or take risks or accepting responsibility. They may have rituals such as wash hands frequently or repeatedly ask others to tell you that everything is alright.

OCD may cause feelings of anxiety. Individuals can feel tense, anxious, fearful, guilty, disgusted or depressed. They feel better if they carry out your compulsive behaviour, or ritual.

Helping those with OCD

Talking about the problem

Contact a professional who will be able to help you, on your own or in a group. Regular contact face to face or over the phone, Up to ten hours of contact is recommended to start with, but you may need more.

This usually happens every week or two weeks to start with, and can last for between 45 and 60 minutes at a time.

Inpatient admission

Admission will only be suggested if:

  • Your symptoms are very severe, you cannot look after yourself properly or you have thoughts about suicide
  • You have other serious mental health problems, such as an eating disorder, schizophrenia, psychosis or a severe depression
  • Your OCD prevents you getting to a clinic for treatment

The word ‘personality’ refers to the pattern of thoughts, feelings and behaviour that makes each of us the individuals that we are. Generally our personality develops as we go through different life experiences and as our circumstances change. We are usually flexible enough to learn from past experiences and change our behaviour to cope with life more effectively.

If your patterns of thinking, feeling and behaving are more difficult to change, you will have a more limited range of emotions, attitudes and behaviours with which to cope with everyday life. However, the diagnosis of a personality disorder applies if you have personality difficulties which affect all aspects of your life, all the time, and make life difficult for you and for those around you.

CBT can help you examine your usual pattern of thoughts and attitudes and allow you to challenge ideas and beliefs that cause you problems and psychodynamic therapy can help you manage your relationships with other people and improve the way you feel about yourself. Dialectical behaviour therapy teaches skills to help manage emotions, improve the way you interact with others and change the behaviour that causes you the most problems. Arts therapies help to express how you are feeling if you are having difficulty putting things into words and group therapy is beneficial for anyone who avoids social situations or depends too much on another person.

Anxiety and Panic are normal human feelings when in a threatening or difficult situation. However, if this panic anxiety remains at a high level it can become so severe it is difficult to deal with everyday life, you may feel out of control or experience a panic attack.

A panic attack is an exaggeration of the normal response to fear, stress or excitement. It is the rapid build-up of overwhelming sensations, such as a pounding heartbeat, feeling faint, sweating, nausea, chest pains, breathing discomfort, feelings of losing control, shaky limbs and legs turning to jelly.

You may fear that you are going to pass out black, have a heart attack or convinced you are going to die – making this a terrifying experience.

There are two types of treatment for panic attacks:

Talking therapies

Psychotherapy or counselling can help you understand, come to terms with and find strategies to overcome your panic attacks, CBT can help you learn more positive emotional and behavioural responses to situations and feelings and Mindfulness Based Cognitive Therapy can make you more aware and mindful of what you’re experiencing.

Medication

Medication can also be effective for panic attacks.

Advise to reduce panic attacks:

    • Try and reduce your exposure to stressful situations.

Express your needs. Find someone to talk to so that you do not bottle up emotions.

  • Try and make lifestyle changes such as regular exercise, avoiding stimulants such as cigarettes and alcohol, eating regular meals and avoiding processed foods and drinks to keep blood sugar levels stable.
  • Support groups can allow you to share feelings and discuss strategies.
  • Try not to depend on others for reassurance. It’s better to rely on yourself and your own coping strategies. Tell yourself you are fine, not dying or going mad.
  • Breathe from diaphragm. With hands on stomach, slowly breathe in through nose while counting to four. Your stomach should rise. Breathe out, to a count of four, and your stomach should collapse.
  • relaxation techniques.
  • Focus on the positive. If you feel an attack coming on try to distract yourself with positive thoughts and tasks.
  • Accept and face your feelings during an attack.

Relationship is a complex dynamics which is determined by various factors. Relationship can be affected by various reasons as follows:

  • Sexual problem
  • Anger management
  • Financial issues
  • Parenting problems
  • Infidelity
  • Poor communication between the partners
  • Domestic violence
  • Grief or loss
  • Significant life events changes

In ARAM psychiatry services, the relationship and interpersonal therapy will be offered by the psychiatrist, the trained family counsellors or therapists. The therapist will help the couple to understand the underlying emotions, behaviour, and communication issues that affect the relationship. Through the marriage counselling we would help the couple to understand each other better and understand the underlying issues that affect the relationship better. We will give weekly home wok and exercises to follow. We help couples to use tools to deal with conflicts, solve the problems, and improve bonding and trust.

Schizophrenia is a major psychiatric disorder which affects about 1 % of the general population. Patients with schizophrenia experience symptoms like hallucinations( i.e seeing or hearing things that are not there), delusions (having false belief) and thought disorders. They loose interests in their activities and friendship and they tend to get isolated in their life. Research evidence suggests that early identification and treatment of schizophrenia will result in good positive outcome. But unfortunately, due to lack of awareness, some people present to the psychiatry services very late which result in poor prognosis and dysfunctional in the life. Our ARAM psychiatry service help to create mental health awareness among the general public through conducting awareness campaigns and public education work. We work with general practitioners for the early identification of psychotic illnesses and referral to the psychiatry service. We optimise treatment for the psychotic illness in such a way that the patients can benefit from the medication with minimal side effects. Failure to take effective treatment for the psychotic illnesses can increase the violence and suicide risks. Our clinical staffs perform regular risk assessments and make risk management plans. Our team members help the patients to develop socialising skills, daily living skills, and other required skills which will enable the patients to integrate back in to the society and function successfully. We provide rehabilitation work for those patients who have lost their skills and enable them to function independently. We work with parents and family and give them psycho-education. Our holistic approach in the treatment of schizophrenia help the patients to lead the dignified independent life.

Emergencies In Psychiatry

There are number of occasions in which psychiatric emergencies occur. The emergencies situations might require urgent hospital admissions for monitoring and treatment. In some cases agitation, aggression and violence towards others are common and in some, risk to self such as self harm, suicidal attempt, and self neglecting can happen. There are also risk of vulnerability, non compliance with medication. While the patients live in the community, we periodically assess risks in order to identify early warning signs of risks and manage if any effectively.

In ARAM psychiatry services, we offer home care treatment for those who refuse to come to the hospital. Through home based emergency treatment we can treat patients effectively without needing to admit patients in the inpatient ward.