Depression or Bereavement?

Have you ever lost your loved ones? 

Are you still stuck in those memories? 

Are you confused about your condition that whether you're in Grief or in Depression?

This blog will help you out to know your mental status, let's dive in to the topic.. 

 

Bereavement is a state of grief related to Death of a loved ones.

 In DSM-5 Bereavement is not a mental disorder, however Uncomplicated bereavement is a condition that may be a focus of Clinical Attention. 

Clinical Presentations

Mild

1) Feeling of Sadness. 

2) Insomnia 

3) Diminished Appetite 

4) Weight loss

5) Aloofness 

6) Not indulged in even their favorite activities. 

 Moderate & Severe 

1) Intense Guilt related to issues beyond those surrounding the death of a loved ones. 

2) Thought about being dead inorder to be with the deceased person. 

3) Feeling Worthlessness. 

4) Marked Psychomotor Retardation 

5) Prolonged Severe functional Impairments 

6) Hallucinations other than the transient perceptions of the voice of the deceased Person. 

Course & Prognosis 

The course and prognosis depend on the Severity of Illness, Rapidity of Interventions and the degree of Response to the Interventions.

The Age of onset, Episode Severity and The presence of Co-morbidity also influence course and prognosis.

"The Younger the age of Onset, the higher the recurrence of multiple episodes."

 In general 90% recover from a first episode of Moderate to Major bereavement within 1 to 2 years.

The mean length of an Untreated episode of major Bereavement is 8 to 12 months.

The cumulative probability of recurrence is 20 to 60% within 2 years and 70% by 5 years. 

The Most significant risk for relapse is in the 6 months to 1 year after Discontinuing treatment.

Children in Grief who live in families with high levels of chronic conflicts are more likely to have Relapses. 

How to Diagnose??

Children's Depression Rating Scale-Revised (CDRS-R)  is a 17-item instruments administred by Clinicians separately to the Parents and Child or Adolscent. 

The Clinicians scores a rating for each item using the information from both the Parent and the Child. The scale assesses Affective, Somatic, Cognitive, and Psychomotor symptoms. A cumulative score of 40 is a marker for Moderate Depression and a score of 45 or higher for Significant depression. 

Evidence- based Treatment Studies

The adolescent who were drifted to depression from prolonged bereavement were chosen for the study.  The Treatment for Adolescents with Depression Study (TADS)  divided 439 Adolescents between 12 and 17 years of age into Three treatment group of 12 weeks. 

The first group composed of either Fluoxetine alone (10 to 40 mg/day).

The second group composed of Fluoxetine with same dose range in combination with CBT (Cognitive behavioral therapy).

The third group was on CBT alone.

Based on rating of the Children's Depression Rating Scale-Revised (CDRS-R), combination treatment had significantly superior response rates compared with either treatment alone. Based on CGI scores at 12 weeks, rates of much or very much improved were 71% for the combined treatment, 60.6% for the Fluoxetine group, 43.2% for the CBT alone group,  and 34.4% for the Placebo group. By the end of 9 months of treatment, however, response rates for each group had converged, so that response for the combination group was 86%, Fluoxetine group response was about 81%  and CBT alone group response was about 81%. 

Psychosocial Interventions 

1) Cognitive Behavioral Therapy- It is an efficacious intervention for the treatment of moderately severe depression in children and adolescents. CBT aim to challenge Maladaptive beliefs and enhance problem-solving abilities and social competence. 

2) Relaxation techniques- 

• Deep breathing. Deep, slow breathing can help you release anxiety and relax from head to toe. Try it at set times throughout the day or whenever you feel stress building. Combine deep breathing with meditation for even greater relaxation, stress relief, and focus.
• Exercise. This is a great relaxation technique, says Payne, and it offers great physical health benefits, too. Yoga is a particularly beneficial therapy because it focuses on meditation, balance, deep breathing, and relaxation all at the same time.
• Surround yourself with scents. Some people find certain pleasant aromas very relaxing. Known as aromatherapy, this technique can be as simple as lighting a candle scented with a favorite fragrance.
• Take a vacation in your mind. Called visual or guided imagery, this relaxation technique uses your imagination to carry yourself away from daily stress. Picture yourself in a serene, peaceful place that makes you happy. Take time to experience all the sensations in your mind.
• Warm up. Treat yourself to a long, luxurious soak in a bubble bath or lose yourself in the steam of a hot shower. Even sipping on a mug of hot coffee, tea, or cocoa can be soothing.
• Scribble out your stress. If something's bothering you and you just need to get it off your chest, a diary or journal can be your best friend. Take a few moments each day — or any time you feel down or stressed — to write about your fears, concerns, or frustrations.

3) Interpersonal Psychotherapy (IPT)-

IPT focuses on improving depression through focus on ways in which depression interferes with interpersonal relationships and overcoming these challenges. The four main area of focus with interpersonal psychotherapy include Loss, Interpersonal disputes,Role transition, and Interpersonal Deficits.

4) Interpersonal Psychotherapy for Adolscent (IPT- A)- 

A modification of Interpersonal therapy to more specifically address depression for adolescents (IPT-A) include a focus on separation from Parents, Authority figures, Peer Pressure and Dyadic relationship. A 12 week study of 48 adolescents with major depression randomly assigned to IPT-A or clinical monitoring found the group receiving IPT-A showed Decreased depressive symptoms, Increased Social functioning, and Improved problem solving compared to the other group. 

5) Developmental Education and Parenting Interventions -

The team developed a Psychoeducation control condition, Developmental Education and Parenting Interventions for parents using small group sessions. The DEPI condition was designed to educate parents about child development and emphasized Emotional and Social development without individual coaching or practice with behavioral techniques.

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Sleep Paralysis: A Mythical Monster or A Psychiatric Illness

In cold night in December I was in deep sleep when suddenly my sleep got interrupted and I was awakened. I tried to get up to check the time when I noticed that I wasn't able to move. I tried but I was not even able to move my fingers. I don't remember whether I've opened my eyes or not but Yes I was fully alert and suddenly I felt a weight on my chest, as like someone was sitting on my chest and was trying to choke me. I became breathless, gasping for air, trying to pull out the weight on my chest, got anxious and tried every ways to help myself but it was like someone has restricted my arms and legs. After a couple of minutes in struggle I was finally freed I suddenly sat on the bed, was breathing with my open mouth in order to inhale as much oxygen as I can, My forhead was soaked in cold sweat and there was a heaviness on my chest as if someone has just stood up from my chest. I calmed myself, sipped some water, recited some prayers, and again went to bed. While thinking about the recent event I was drifted to sleep. 

Folklores regarding Sleep Paralysis -

1) Descendants of Lillith: Lillith or 

     She-demon is referred in the Summerian King list of 2400 BC, where Lillith was considered a Vampire and a Harlot, the "Beautiful Maiden" where once she chose a man, he is Her's Forever. 

                           Lillith

In The Bible, Isaiah 34:14, she is referred to as "Screech Owl", i.e a creature of the night where she haunted Good Women who were childbearing. 

Lillith bore 4 children, one of four succubi or Vampire-like Demon named Lilliu preyed on Men while they were asleep while other three Subbus named Lillitu or She-demon had nocturnal union with Men.

                      

                      Succubus

2) "The Nightmare":

Swiss artist Henry Fuseli, protrayed the phenomena through painting, "The Nightmare" in which a young lady lies limply sprawled across her bed, and an Incubus is squatting gortesquely on her stomach as in to draw her into the darkest nightmare. The painting is the best potrayel of clinical presentation of Sleep Paralysis. 

3) The Old Hag: 

Old Hag or Night Hag is the name given to Nightmare in Cannadian and North Eastern America. Hag was actually seen as mystical creatures, as a Spirit, Goddess and in some folklores as Witches who takes the form of Gorsteque or Hideous Old Woman, and often had a power over the  Elements or Magic. They have gained both Fear and Respect in equal lengths by the Superstitions.

There are many superstition or beliefs spread worldwide regarding Sleep paralysis. 

Let's now dive in towards Scientific Reasons:

Sleep Paralysis-

Sleep Paralysis is one of the example of Sleep-wake Disorders. During sleep, brain cycles through 4 stages of sleep:

Stage 1-3 known as Non-rapid Eye Movement (NREM) 

Stage 4 known as Rapid Eye Movement (REM) or Paradoxical Sleep.

Brain releases some waves which is detected by Electroencephalography (EEG) in which it signals the muscles to relax. "When there is a dysfunctional synchronization between the signals of Brain and relaxation of muscles, it leads to Sleep Paralysis." 

Muscles are "Turned off" during REM sleep phase. If any person's brain get activated and alert during the REM phase then that person will experience Sleep Paralysis. 

Types of Sleep Paralysis:

Sleep Paralysis is divided into 2 parts-

1) Hypnagogic or Pre-dormital.               sleep paralysis- It is a phase before body shifts into deep sleep. 

Body relaxes slowly, usually less aware around the surroundings. However, if someone remains or become aware while falling asleep, it may notice that one cannot move or speak. 

2) Hypnopompic or Post-dormital sleep paralysis- During sleep, body alters between REM and NREM sleep. One cycle of REM and NREM sleep last about 90 minutes.

NREM sleep occur first and take upto 75% of overall sleep time. During NREM sleep, body relaxes and restores itself. At the end of NREM sleep body shifts to REM. 

During REM sleep eyes moves quickly and dreams occur, but the rest of the body remain relaxed. During this phase for any reason if the brain cells get activated making someone alert it will be noticed that one will be fully aware of the surroundings but still cannot move it's body parts which lead to experience "Sleep Paralysis".

As every muscles is relaxed the diaphragmatic muscles and respiratory centres are also relaxed, so when someone is awake during REM phase it'll be noticed that one will have Trouble Breathing, Gasping for air and may also experience that something is weighted on their chest adding more trouble in breathing. 

As the brain is not fully alert or in active phase, it leads to imagine distorted images which lead to a person experiencing Visual Haullicination. That's why some claim that they saw a Demon or felt like someone is squatting on their chest trying to choke them. 

Reasons for experiencing sleep paralysis-

1) Lack of sleep. 

2) Disturbed sleep schedule.

3) Mental condition such stress or            Bipolar disorder. 

4) Sleeping on the back. 

5) Night time leg cramps. 

6) Narcolepsy ( a kind of sleep disorder in which a person is drowsy in day time even when he sleeps for 8-10 hrs during night).

7) Substance Abuse ( Alocoholic, Tobacco Consumer, drug addict etc.) 

Treatment-

1) Improve sleep Habits.

2) Treat mental health issues. 

3) If dealing with depression use anti-       depressants drugs. 

4) If dealing with Narcolepsy consult to nearest Psychologist and Psychiatrist. 

A Bully: The Hidden Demon

 Have you ever got bullied? 

We all know the story of a victim, but what about the Hunter? 

Have you ever thought what goes inside the bully's mind? 

Adolescent Temper Tantrums

Temper Tantrum 

Parenting is one of the Most difficult task in the existing task in this world. Now your Sweet Calm child has drastically changed into a Subborn, Aggressive person. Every individual go through this stage of adolescence. Adolscent is a Blossoming phase where an individual's body is preparing itself to turn into an Adult. Adolescents not only go through Physical changes but also Mental changes. 

Not everyone is easily adaptable to change, to some people "Changes are Scary" and it's Normal. We all get sometimes scared by changes,while dealing with changes which occur within themselves,individual also get to tackle day-to-day obstacles like:

- School and Assignments 

- Educational Achievements

- Thriving for parent's expectations 

- Adjusting themselves to Peer groups. 

Woaah! While dealing with soooo much they also go through physical, and mental changes. While being busy in their own stuffs when they turn towards someone who can understand them. They Find No one!  So they turn themselves to their peers. If they are in good company they'll get help but if not then What? 

They can turn them to activities that can drastically affect their health, social life and can even be drawn to perform criminal activities which can drag them to complete darkness. 

I know that There's generation difference between a Parent and Child but if you really Love your child and don't want them to be drag into darkness then follow these 6 Steps:

1) Be a Friend: 

If you want your child to be honest and open to you then you've to be your child's Friend. I understand that there's a Generation difference between You and and Your Child but you also need to understand, that time has evolved. The phase which you were facing in your adulthood might be your adolscent child be facing right now. Try to get involve in your child's life that doesn't mean you've to interfere in all his matters. 

Believe your child. Develop the bond where your child can trust you and is able to ventilate out all his problems, insecurities with you. 

Where it's necessary Hold their Hands where not let them take their own path. Even if they fail encourage them and tell them "Even if the Whole world is against them you'll always be by their side." 

When you develop such bond the tendancy of your child to fall in prey of others decreases and even if there's a bit chance he'll let you know and you can save your child from becoming a prey or a victim. 

2) Importance of Trust: 

Trust is the most Vital Element to build any relation. Teach the importance of Trust to your teen. And when they obligate that trust then let them face their consequences. 

My intention is not to "Spoon-feed" your child this way you'll ruin his future. It's very important for your child to face life experiences and also face it's consequences. For example: If you got to know that your child was taking alcohol. After your encounter he promised to never repeat this mistake. After few days you again caught him taking alcohol secretly then it's important that you let him know that he broke your trust. Let him understand his fault and ask him How will he develop the trust again??  Questioning him will help him understand his fault and will help him introspect his fault. 

3) Be your child's Influencer: 

Set Yourself an example for your child. 

- If you're stoping him to stop wasting time on screen then first stop yourself from spending a lot of your time on social sites and other stuffs.

- Being alcoholic or drug abuser parent what guidance you'll provide to your child if he ever step on being a drug user? 

- Not only your behavior but your child also follows your Mentality. The way you see world and people around affect your reaction towards your outer world in form of your behavior and this trait is mimicked by your child. 

- Be open-minded, be Gentle to the people who are inferior, Be a learner. 

- One important point I'll add is Show your struggle to your child. Let them know that you sacrificed your new dress in order to buy them their toys. I know parents refrain such act but you need to understand that if you want your child to respect each penny which you earned or which he'll be earning no matter what his socioeconomic status be then Show him your struggle, Your Sacrifices and Hard work which you dedicate each second of your life in order to provide him one time meal.  

Why you think Rich people have Rich Brats?? Because they have no idea how their parents hold such Assets. They have just seen luxuries and Comfort which is Dangerous for their later Life. 

4) Appreciate and provide positive reinforcement to your Child:

Study your child and accept him with all his beauty and flaws. There are many parents who don't know their child. Yes! You Heard Right!! Reason? Well because they don't have time for their child. Here's I'm not potraying Workaholic Parents as Vamp! But you need to spend ample amount of time with your child. Earning money to secure your child's future is every parent's task, but Will that money be helpful to save your child from becoming a Victim to this cruel world? 

The more you spend your time with your child the more you'll know his quality, interest and hobbies. 

In this 21st Century, there's nothing from which you can't earn. So let your child discover his passion and motivate him to pursue it as his career. 

5) Understand that Teens are Self-centered:

Growing up was never easy. Adolescent goes through many ups and down. Physical, Hormonal and Mental alterations that changes their life. This is a new phase in their life and there are many adjustments that require a preparation. While the adolescents are preparaing themselves for the new changes they take a lot of time and hence tend to become self-centered. This is the phase where every teenage thinks that no-one understands them so Be little Patient and hold your child whenever they need you. 

6) Signs of Stress:

Being Bullied is one of the most common stressor in adolscent's life. Parents should keep a keen observation in your child's sudden behavior. 

If your child has suddenly become aloof, spending alone time, has crying spells, caught red handed while stealing money or other valuable product then instead of screaming find the reason behind it. It might be due to being bullied. 

Other stressors can be:

* School work load. 

* Assignments 

* Educational Achievement 

* Heartbreaks. 

Take seriously your child's stress as bing in denial or deviating your child's stress can lead to Depression. 

Relatable Content: Does parents affect.                                           their child's.                                                           personality? 

https://encyclopsychiatry.blogspot.com/2021/11/does-parents-affect-their-childs.html

How Toilet Training can affect your Child's behavior and Personality????

 

"Parents are our First Teacher and Home is our First School" it's a very common belief. Have you ever thought that the training which you give to your child in early days of their Life can affect their Latter Stages of their life?

 It can alter their ways of Thinking, Behavoir and can even modify their Personality?

Toilet Training is the teaching where  parents demonstrate ways to help their child learn ways to defecate. Toilet training usually starts at the early age range from 18 months to 3 Years. 

Now You might be thinking that you all have undergone this stage and somewhere someone might be training their child to defecate, then 

• How could your or your child's  behavior dependent on it??
•     Whether its affecting in Good or Bad ways??                         
• And most importantly,  how come you have not noticed any behavioral change in your child?? 

  Well here's the answer to your queries. It has affected your child's behavior not only your Child but after reading the latter context You can also match some of your behavior traits that can be related to your Toilet Training.

According to Psychosexual Developmental Theory given by Sigmund Freud states that "The major task in the Anal Stage(18 months-3 Years) is gaining Independance and control with particular focus on the "Excretory Function" which implies that the ways and techniques which Parents use on their child while toilet training affects their behavior as the child learns Independance and Control during this stage and if the child learns anything incorrectly then his or her behavior will be adversely affected.  

           Sigmund Freud divided the training in 2 phases:

1. Anal-Retentive Personality:  If the parents have Early started the Toilet training i.e before 18 months or If the parents have given Harsh Training then the child is more likely to develop Anal-Retentive Personality.                                                                                  Characteristics of Anal-Retentive Personality:                                          Obsessively tidy and clean.               Intolerant to those who aren't.         Punctual.                                              Very Careful.                                         Stingy.                                                     Obstinate.                                             Witholding.                                         Meticulous.                                        Passive aggressive                                                                              
2. Anal-Expulsive Personality: If the parents were too liberal during the toilet training the child likely to develop Anal-Expulsive Personality.       

Characteristics of Anal-Expulsive        Personality:                                                   Excessively Sloppy.                                     Disorganized.                                              Reckless.                                                      Careless.                                                        Defiant.                                                          

Conclusion:

    In this above context we got the information regarding How Toilet Training affects Your child's Personality. If not given attention or care towards it how behavoral and Personality alterations can affect your child.

Anything Over or Under its limit leads to Maladaptive Behavior. 

If this content helped you in any ways Do leave a comment. And you can also Share your opinion and experiences in the comment section. Any suggestions is highly Appreciated and Welcomed. 

                                                

Does Parents affect their Child's Personality??

                    

Brief description of Mental Health

 

History about Mental Health

Primitive beliefs regarding mental disturbances took several views. Some thought that an individual with mental illness had been disposessed of his or her soul and the only way to wellness could be achieved if the original soul return to his own body.  Because of this Superstition people went through ritualistic exorcism which were often Inhumane and includes Brutal beatings, Starvation, and other torturous means. 

A change in Society regarding Mental Health

The position of ancient believes on Mental Health changed over time with expanding Knowledge about Mental illness.

Hippocrates (about 400 B.C) began the movement away from belief in supernatural power. Hippocrates associated Insanity and mental illness with an irregularity in the interaction of the four body fluids (also called Humor) :

> Blood also called Sanguine

> Black bile also called Melancholic 

> Yellow Bile also called Choleric

> Phlegm also called Phlegmatic

Disequilibrium among these four Humors was thought to cause Mental Illness, and it was often treated by inducing Vomiting and Diarrhea with potent Cathartic Drugs. 

The First Hospital in America to admit clients with Mental Illness was established in Philadelphia in the middle of 18th century. Benjamin Rush often called Father of American Psychiatry, was a phsician at the hospital. Although he included Kindness, Exercise and Socialization,  he also employed harsher methods soch as Bloodletting, Purging, various types of Physical Restraints,and Extremes of temperature, reflecting the medical therapies of that era.

The emergence of Psychiatric Nursing began in 1873 with the graduation of Linda Richards from the nursing program of the New England Hospital for Women and Children in Boston. She has come to be known as the First American Psychiatric Nurse. Significant change didnot occur until 1955, when incorporation of psychiatric nursing into their curricula became a requirement for all undergraduate school of nursing. Nursing Curricula emphasized the importance of  Nurse- Patient relationship and Therapeutic Communication Techniques. Nursing interventions in the somatic therapies (e.g Insulin and electroconvulsive Therapy)  provided impetus for the incorporation of these concepts into nursing's body knowledge.

      

  Relation between Maslow         Hierarchy and Mental Health 

According to Maslow Hierarchy: "Every individual strive to attain it's highest level  of  Self-Actualization through it's inner and outer motives. He identified a "Hierarchy of Needs" the lower ones requiring fulfillment before those at higher levels can be achieved,with Self-Actualization being fulfillment of one's highest potential." 

Maslow described self-actualization as being "Psychological healthy fully human, highly evolved and fully mature. " He believed that "Healthy" or "Self-actualized" individuals possessed the following characteristics:

• An appropriate perception of reality.
• The ability to accept oneself, others,and human nature. 
• The ability to manifest spontaneity. 
• The problem solving capacity. 
• A need for detachement and desire for privacy. 
• Identification of Humankind. 
• Ability to achieve satisfactory interpersonal relationships. 
• A democratic character structure and strong desire for eithics. 
• Creativeness.
• A degree of nonconformance. 

                     Mental Illness 

A universal concept of Mental illness is difficult, because of the cultural factors that influence it. Horwitz (2002) identifies elements that can define mental illness to some extent:

1. Incomprehensibility: When observers are unable to find meaning or motive behind the action or behavior it is termed as Mental Illness. Horwitz states, "Observer attributes labels of mental illness when the Rules, Conventions, and Understanding they use to interpret behavior fail to find any intelligible motivation behind an action. "
2. Cultural relativity: The element of cultural relativity considers that these rules, conventions,and understanding are conceived within an individual's own particular culture.

 " A Behavior that is recognized as mentally ill in one society may be viewed as "normal" in another society, and Vice-Versa."

Horwitz Cultural Aspects of Mental Illness:

• Usually members of the lay community, rather than a psychiatric professional,intially recognize that an individual's behavior deviates from the societal norms. 
• People who are related to individual or who are of same cultural or social groups are less likely to label an individual's behavior as mentally ill than someone who is rationally or culturally distant. 
• Psychiatrist see a person with mental illness most often when the family members can no longer deny the illness and often when the members are at its worst. 
• Individual is the lowest social class usually display the highest amount of mental illness symotoms. However, they tend to tolerate a wider range of behaviors that deviate from societal norms and are less likely to consider these behaviors as indicative of mental illness. 
• Members of the higher social classes are likely to be self-labled by family members or friends. 
• The more highly educated the person, the greater recognition of mental illness behaviors.
• Women are more likely than Men to recognize the symptoms of mental illness and seek assistance.
• The Greater the Cultural distance from the mainstream of society,the Greater the likelihood of negative response by society to mental illness.

           

                   Conclusion 

1. Psychiatric care has its roots in ancient times, when etiology was based in superstition and ideas related to the supernatural.
2. Treatments were often inhumane and included brutal beatings, starvation and other torturous means. 
3. Hippocrates associated insanity and mental illness with an irregularity in the interaction of the four body fluids (Humors) - Blood, black bile, yellow bile and phlegm. 
4. Conditions for care of the mentally ill have improved largely because of leaders such as Benjamin Rush, linda Richards.
5. Relationship between Maslow and Mental Health. 
6. In determining mental illness according to Horwitz individuals are influenced by Incomprehensibility and Cultural relativity.