11
SRINAGAR, THURSDAY
Greater Kashmir
DR ARSHAD HUSSAIN
arshadtina@gmail.com.
“The day 10th October is the 21st
anniversary of mental health day.
Twenty years back Richard Hunter
thought of telling the world that
there is no health without mental
health and he proclaimed 10th Octo-
ber as mental health day to focus the
world attention on improved care for
mental health issues. The world woke
up to the reality of mental health and
10th October has become the regu-
lar affair world over to recognize
and register the epidemic of mental
health problems. The theme of World
Mental Health Day in 2013 is “Mental
health and older adults”.
To age is to grow, and decline at
the same time; aging is a biological
reality with its own processes most
of them still not in our control. With
improving global health aged popula-
tion is increasing steadily. The world
will soon have a unique demographic
spectacle; those aged 65 and more will
outnumber those aged less than 5. The
world population of 60yrs and above
is estimated to reach 2 billion by 2050
and has already doubled since 1980.
This is undoubtedly a cause to rejoice
for GLobal health initiatives but these
celebrations may be premature if we
do not brace up to these new shifts in
the demographics. Older people make
important contributions to society
When the mind gives up....
…..Humans can even kill themselves!!!
DR. MOHAMMAD MAQBOOL DAR
P
revalence. Transient suicidal ideation
is seen in most of the normal people.
According to survey by World Health
Organization (W H O) in 1983, around
2,400 persons commit suicide every day.
Most recent figures from 21 countries
show annual average suicide rate vary-
ing from 7.1 to 33.9 per lac population
above 15 years of age. Hungary, Sweden,
Denmark, Austria and Germany are the
leading countries as so far of suicide is
concerned the lowest number of suicide
being in Chile and Ireland.
In India, 150 to 200 people commit
suicide every day. The average preva-
lence of suicide is about 10 per lac of
population. The ratio of attempted sui-
cide to suicide is 8-10: 1 .
Suicide rates increase with age,
and on average are 50 times greater
in males than in females but the rate
of attempted suicide are maximum in
adult females. Suicide is the second
most common cause of death among
adolescents and youth.
THE MAIN CAUSES OF SUICIDE
CAN BE CLASSIFIED AS:
a. Genetic: There is an increased
incidence of suicide in relatives
of those who have committed it
and the concordance for suicide
in monozygotic twins may be as
high as 18 %.The role of genetic
factors is also proved by the asso-
ciation of suicide with increased
familial incidence of psychiatric
illness (Depression, Schizophre-
nia, Alcoholism, etc.).
b. Mental Illness: Depression, Alco-
holism, Schizophrenia, Person-
ality Disorder, Drug abuse, etc.,
are the leading causes of suicide.
c. Physical Illness: There is an
increased prevalence of suicidal
ideation in patients suffering
from viral fevour, hepatitis,
kidney failure, multilating inju-
ries, cancer, etc.In epileptics; the
risk is 4 times more. The intake
KASHMIR: IN THE BACKDROP OF 10TH OCTOBER
Our elderly are lonely; do we realise!!!
as family members, volunteers and
as active participants in the work-
force. The wisdom they have gained
through life experience makes them
a vital social resource.But with this
demographic shift come the challeng-
es and most of this challenges are to
health care. It is important to prepare
health providers and societies to meet
the specific needs of older popula-
tions.With age we lose ability to live
independently because of restricted
mobility,loss of vigour and declining
cognitive functioning.
Along with these global demo-
graphic trends are enormous social
upheavals with globalisation,
urbanisation , declining of family as
unit.which will mean fewer people
to care for aging population within
the families.
The definition of ‘health’ with
regard to old age is a subject of debate.
There is a consensus that health in old
age cannot meaningfully be defined
as the absence of disease because the
prevalence of diagnosable disorders
in elderly populations is high. Instead,
health is considered to be multifac-
eted: The diagnosis of disease should
be complemented by assessment of
discomfort associated with symptoms
(e.g., pain), life threat, treatment con-
sequences (e.g., side effects of medica-
tion), functional capacity and subjec-
tive health evaluations (Borchelt et
al., 1999). Furthermore, Rowe & Khan
(1987) suggested that the health of sub-
groups of older adults be defined in
terms of their status relative to age
and cohort .Non communicable dis-
eases are the commonest afflictions of
elderly population,among them neu-
The policy makers need to wake up to the new realities and priorities and act now.
of drugs like phenothiazines
(anti-schizophrenic), barbitu-
rates and oral contraceptives
make one more prone to suicide.
d. Psychological Mechanisms:
Freud believed that suicide
was aggression turned inward
against a loved person with
whom the individual had iden-
tified.
e. Situational: The escape from
unbearable situation is a domi-
nant theme in children’s suicide
and suicidal attempts.
Durkheim described 3 different
social categories of suicide:
i. Egoistic: Due to loss of integra-
tion leads to a sense of isolation
and morbid individualism,
ii. Altruistic: As seen in war, Army
men dying for the country,
iii. Anomic: When there is dis-
turbance in the balance of the
individual’s aspiration on the
hand and the values of society
on the other.
2) COMMON RISK FACTORS IN
SUICIDE:
History:
History of previous suicide attempts.
Family history of affective illness,
suicide and alcohol dependence.
Personal factors such as bereave-
ments or other losses.
Advanced age, particularly in males.
Marital status: widowed, divorced
or separated.
Living alone, poor social ties.
Unemployment, retired.
Associated Illnesses and Conditions
Chronic, painfull, physical illnesses.
Psychiatric illnesses, particularly
depression.
Personality Disorders-antisocial,
Drug dependence
Insomnia, Anorexia and sexual
impairment.
Sudden Unaccountable well being in
a depressed patient.
Social Stresses.
Mental Status
Suicidal ruminations
Guilt feelings
Feelings of worthlessness and hope-
lessness
10 102013

ropsychiatric disorders are the com- feeling related to the person’s own purpose and hope that the distinction years, to nearly 70 million in 2030 .The
monest.20 percent of elderly do have experience of deficient social rela- between two gets blurred. I also see total number of new cases of demen-
some neuropsychiatric illness severe tions. That subjective experience role of our spiritual being, which is tia each year worldwide is nearly 7.7
enough to cause disability.Depres- usually come from deficient external innate to our culture and hence our million, implying one new case every
sion and dementia are the commonest factors like social networking, social very being helping us mourn and four seconds. Ask the families who
but good proportion of elderly have support etc or psychological and per- grieve without getting depressed. have patient with dementia ,it is over-
anxiety disorders .Multiple social, sonality factors leading to aloofness. Elderly maltreatment is increas- whelming for patients but it is no less
psychological, and biological factors Loneliness besides being important ingly being recognised as an impor- burden on families. Dementia effects
determine the level of mental health of cause for depression substantially tant mental health issue of aging. families physically socially ,economi-
a person at any point of time. As well increases risk of suicide and suicide There is very scarce data about this cally and psychologically as well.
as the typical life stressors common attempts in elderly. Loneliness also problem from under developed and The problems are plenty but do
to all people, many older adults lose contributes significantly to deaths developing world ,but is increasingly we have solutions. The focus of our
their ability to live independently because of other physical causes. being recognised in developed world health care system is still communi-
because of limited mobility, Loneliness of elderly is also in more than 7percent of aged popu- cable diseases, below 5, maternal and
chronic pain, frailty or of concern to our culture. lation. WHO defines Elder maltreat- child health, the focus has to remain
other mental or physi- The conflict created ment as a single or repeated act, or as we still have lot to do in these prior-
cal problems, and empty nests wherein lack of appropriate action, occurring ity areas , but we cannot be oblivious
require some form parents pushed their within any relationship where there is to the changing realities of health .
of long-term care. kids out of Kash- an expectation of trust which causes Aging society and its mental health
In addition, older mir for safety con- harm or distress to an older person. consequences are a reality and we need
people are more cerns. These kids when we look at our changed urban- to refocus our health agendas to fit in
likely to experi- were brought up in ised breaking culture and this defini- needs of changing society. From less-
ence events such as alien cultures, there tion maltreatment seems to be plenty ening loneliness to preventing elderly
bereavement, a drop chances of coming without mechanisms of redressal. abuse to early detection and diagnosis
in socioeconomic back decreased with Elie Wiesel said that without of depression and dementia the tasks
status with retirement, every passing day memory there is no culture. Without are many. All stake holders need to be
or a disability. All of these because of employabil- memory there is no civilisation, no involved and a public health approach
factors can result in isolation, ity and adjustability in own society, no future. And one of the con- is the only way forward to improve
loss of independence, loneliness and culture,the net is majestic mansions sequences of changing demograph- care and quality of elderly population.
psychological distress in older people. with lonely elderly.....Empty Nest. ics is lot of elderly population with The complete dissociation between
Mental health then impacts the physi- Loss and grief are integral part of fading memories -dementia as it is need and planning is reflected in the
cal health and vice versa and this aging, from loss of mobility to inde- called is not part of normal aging it fact that we still do not have geriatric
vicious circle usually has devastating pendence and to loss of loved ones, is a clinical syndrome that effects health facility even at tertiary care
effects on elderly. elderly do experience these losses at memory, behaviour and thinking centres of state. The policy makers
Depression is a common affliction higher frequency than young popula- and hence the routines. Dementia is need to wake up to the new realities
of of old age and in contrast to the fac- tion. Thus do contribute to depres- a global epidemic projections indi- and priorities and act now. By all what
tors responsible in younger age like sive morbidity, in-spite of what DSM cate that the number of people with we have done in health till now has
genetic and psychological predisposi- tells us I strongly feel that grief and dementia will continue to grow, devel- achieved the goal of adding years to life
tion, negative life events depression mourning are part of our normal oping countries will experience the expectancy,but what we need to do now
of old age is usually linked to physi- being and not diseases and only when greatest growth. The total number of is to add life to these years.
cal ailments disability and frailty. they result in complete loss of joy and people with dementia worldwide is
The other important factors is loneli- pleasure and result into sense of per- estimated at more than 35million and
ness which is a subjective, negative vasive despair rather than sense of is projected to nearly double every 20 Dr Arshad Hussain is assistant professor department of psychiatry,
Govt Medical College Srinagar
Palatial Houses or Empty Nests
Lonely parents living in grand houses mourning the absence of children
Loss of Self-esteem toms like apathy, fatigue may
Agitation and restlessness dominate the clinical picture. In
west highest suicide rate is among
Planning and preparations elderly males, with alcoholism. As
Verbal expression of suicidal intent stress and deaths of friends are so
Suicide notes and warnings common among the elderly, adjust-
Precautions against discovery and DR. ARIF MAGHRIBI ment disorder, depression and
failure of suicidal attempt arifmaghribi@yahoo.com. adjustment disorder are common.
Methods adopted- violent methods Adjustment Disorders: These
indicate greater risk are common in old age and are due
Preparation for the final exit: exe- Mental health of our elders is a to the numerous stresses – loss,
cution of will, settlement of pending matter of grave concern now. Few physical illness, retirement or
affairs. decades back it wasn’t so. But living outside. Symptoms include
Procurement and possession of with rapid urbanization, high anxiety, depression, agitation.
lethal agents. rate of unemployment, growing Grief is common and may mimic a
trend of nuclear family, things major depression but often has an
3) Management: Once suicide is have changed radically. Many obvious precipitant, is short lived
committed, it is obviously no longer from our state - doctors, engi- with therapy. Alcohol, nicotine is
treatable. The management of sui- neers, MBAs, and others - have also a common response to stress
cide, therefore, lies in preventing left for other countries as they in the elderly and is frequently
the act at suicide prevention cen- could not find a job; after initial unrecognized.
ters, crisis intervention centers (both reluctance they left for abroad How can we HELP: Be sup-
of them are not available as yet on leaving their old parents alone. I portive, respectful, sympathetic
a large scale in India), Psychiatric see huge houses, but wearing dis- and a good listener. Let them
emergency services, medical emer- tressed silence and gloom. Most express, listen to them with
gency services, social welfare centers
or even at home of the patient.
Let them of them suffer from what was
found in the West; empty nest
patience and attention. While
talking hold their hand, kiss it
express, listen syndrome. Although our society and become a human placebo.
SOME IMPORTANT STEPS FOR
PREVENTING SUICIDE INCLUDE:
to them with is in a denial mode but it’s very
much common now. Following
Encourage patients to express
themselves - about guilt, loneli-
i. Take all the suicidal threats, patience and are the common ailments that ness - and unburden themselves.
Gestures and /or attempts seri-
ously and notify a psychiatrist
attention. flourish in such a state of affairs.
Dementia: It often presents
Encourage self-esteem. Helping
patients review their life can be
or a mental health professional. While talking first with agitation, anxiety, highly beneficial. Reminiscence
ii. Psychiatrist (or a mental health depression. Dementia also is adaptive coping behavior and
professional) should quantify
hold their presents with symptoms like helps promote self esteem. Encour-
the seriousness of the situation hand, kiss it forgetfulness ,impaired cogni- age continued interests, friend-
- a proper risk assessment - and tive activities and aggression. ships, socialization, activities and
take remedial precautionary and become There is no magical cure or self support. Be a presence. Be
measures. Inspect physical sur- a human complete cure for dementia, as available----frequent, regular and
roundings and remove all means it’s progressive and nonrevers- always reachable by phone.
of committing suicide, such as placebo. ible. Never the less consulting Biggest Donts: Never ask for a
sharp objects,ropes,drugs,fire a psychiatrist or a qualified sleep inducing medicine to keep old
arms,etc. Also, search the counselor can make life of a people sedated and hence shrug off
patient thoroughly; surveil- person with dementia lot more your responsibility, it has always
lance, depending on the sever- comfortable. Always check that proven to be harmful not only to
ity of risk. the patient of dementia does his your parents, but in most of cases
iii. Acute psychiatric emergency hearing and eye test on regular your children steal that medicine
interview. basis. Those lucky children who and get addicted to it.
iv. Counseling and guidance. To remain with patient of dementia Lastly we all must remember
deal with the desire to attempt must make sure he meets his old how our old parents and relatives
suicide, and to deal with on- friends, visits places familiar to cared for us when we were kids,
going life stressors, and teach- him often. Reiki therapy has a did they ever complain? How won-
ing coping skills and interper- soothing effect on patients with derful if someone living in a nucle-
sonal skills. dementia. ar family visits his parents today,
v. Treatment of the psychiatric Depression. Major depression spends time with them, gifts them
disorder(s) with medication, can develop in old age for the first something…….
Psychotherapy and /or ECT. time or be a recurrence of a major
affective disorder. Along with
Author is Associate Prof. Psychiatry.Govt.Medical College,Sgr. depressed mood, physical symp- Author is trained in mental health ailments.