Observation of mental health week at Jagjivan Ram Hospital Western Rly Mumbai Central

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Observation of mental health week at Jagjivan Ram
Hospital Western Rly Mumbai Central

• Following activities were carried out
• 1 Public awareness lecture by Dr Charles Pinto,
  Dr Malay Dave and Dr J P Rawat on the importance
  of psychological issues in chronic medical
  illnesses 7 and 8th October 2010
• 2 poster exhibition on the theme of mental
  health week 2010 8th to 10th October 2010
• 3- stress management programmed for the medical
  personnel on 9th October 2010

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Mental Health Day Theme (WFMH)

• MENTAL HEALTH AND CHRONIC PHYSICAL ILLNESSES
• THE NEED FOR CONTINUED AND INTEGRATED CARE

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10 Strategies to manage the Psychological Impact
of Chronic Illness

• Nutrition
• Exercise
• Spiritual
• Health care
• Communication
• Education
• Pace yourself
• Humour
• Relationships
• STRESS Management

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STRESS MANAGEMENT

• BY
• DR.J.P. RAWAT
• PSYCHIATRIST
• Sr DMO JRH BCT

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INTRODUCTION

• What is stress?
• Who is affected living , age ?
• Why they are affected? Role of Good parenting,
  
• Temperament gt Personality and develops
  good Coping mechanism
• Is it preventable?
• Whether it is manageable?

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WHAT IS STRESS ?
I HATE YOU

• Stress is the wear and tear our minds and
  bodies experience as we attempt to cope with our
  continually changing environment

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WHAT IS STRESS ?
HELP ME!

• Stress is the reaction people have to
  excessive pressures or other types of demand
  placed upon them. It arises when they worry that
  they cant cope.

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Stress is not in our environment

• it is what we perceive in our mind and body.

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DEFINITION

• S P gt R
• Stress occurs when the pressure is greater than
  the resource

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DEFINITION

• Internal state which can be caused by
• Physical demand on the body
• Exercise
• Disease
• Environmental factors
• Extremes of temperatures
• Natural calamities
• Social situations
• When these are evaluated as potentially harmful,
  uncontrollable
• or exceeding our resources for coping.

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STRESSORS ? STRESS ? DISTRESS

• Varies from person to person.
• Some stressors are common to all
• Infection.
• Injuries.
• Dangerous events.
• Actual threat to self-esteem.

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Stages Duration Optimum out come Unfavorable ratio
1. Basic Trust Vs Basic mistrust Up to 1 yr. ADMO 25years Hope Depression, 295
2. Autonomy Vs shame doubt 1-3 yrs. ADMO Self control OCD, delinquent behavior
3. Initiative Vs Guilt 3-5 yrs. ADMO DMO Sense of purpose GAD, phobia
4. Industry Vs Inferiority 6-11 yrs. DMO, SrDMO , Sense of competence pleasure in work Inferiority
5. Identity Vs role confusion 11-20 yrs. JAG Sense of consistency 295, conduct disorder
6. Intimacy Vs isolation 21-40 yrs. SAG Loving relationship Schizoid
7. Generativity Vs stagnation 40-65 yrs. CMD Productivity creativity, CARE Depression
8. Ego Identity Vs despair 65 yrs. DGRHS Uses Wisdom Psychosomatic illness, hypo chondriasis
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FOR ATTENDING THE TOP POSTS - NEEDS IN
THE HIERARACHY ARE   
1.    Physiological needs 2.    Safety
needs 3.    Belonging love needs 4.    Esteem
needs 5.    Self actualization
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  1. Authoritative and caring parents   a)
Firm about rules expected high level of
maturity achievements. b) Nurtuant
and responsive to their children Result
Energetic, friendly, curious self reliant  2.
Permissive parents   Little self reliance,
poor self control Result Impulsive and
aggressive  3. Highly controlling authoritarian
HITLER Result Apprehensive, withdrawn,
unhappy, distrustful
PARENTING
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AROUSAL PERFORMANCE

• Arousal energizes performance.
• Optimal level

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STRESS RATING SCALE
Life event Death of life partner Major injury/illness Marriage Being fired at work Argument with spouse Major change in work responsbility-prm/dem/trf Trouble with boss Major change in living conditions Debt for small purposes Major change in sleeping habits Adolescent 69 50 50 50 41 38 26 35 28 18 Adult 100 52 50 47 35 29 23 25 17 16 Elderly 73 65 50 62 45 40 39 48 52 36
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STRESS RATING SCALE
Life event Major change in health of fly. memb Pregnancy Gaining a new family member Death of close friend Son/daughter leaving home Major change in eating habit Vacations Minor violation of law Outstanding personal achievement Adolescent 44 45 43 46 34 18 19 12 31 Adult 44 40 39 37 29 15 13 11 28 Elderly 59 47 36 52 43 45 30 47 34
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GRADES OF STRESS

• By adding the life change units, a life
  crisis score can be obtained for that year
• MILD 150-199 life change units
• MODERATE 200-299
• MAJOR gt300

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The Stress Response
Dr. Hans Selye
Dr. Walter Cannon
1930s
Flight or Fight Response
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How body reacts with stress psycho physiologically

• Alarm response
• Adaptation
• Exhaustion

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ALARM RESPONSE

• This is the Fight or Flight response that
  prepares the body for immediate action.

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ADAPTATION PHASE

• If the source persists, the body prepares for
  long-term protection, secreting hormones to
  increase blood sugar levels.
• This phase is common and not necessarily
  harmful, but must include periods of relaxation
  and rest to counterbalance the stress response.
• Fatigue, concentration lapses, irritability
  and lethargy result as the stress turns negative.

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EXHAUSTION

• In chronic stress situations, sufferers enter
  the exhaustion phase - emotional, physical and
  mental resources suffer heavily,
• the body experiences adrenal exhaustion
  leading to decreased stress tolerance,
  progressive mental and physical exhaustion,
  illness and collapse.

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TYPES OF STRESSORS

• External
• Internal

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EXTERNAL STRESSORS

• Physical Environment
• Social Interaction
• Organisational
• Major Life Events
• Daily Hassles

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PHYSICAL ENVIRONMENT

• Noise
• Bright Lights
• Heat
• Confined Spaces

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SOCIAL INTERACTION

• Rudeness
• Bossiness
• Aggressiveness by others
• Bullying

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ORGANISATIONAL

• Rules
• Regulations
• Red - Tape
• Deadlines

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MAJOR LIFE EVENTS

• Birth
• Death
• Lost job
• Promotion
• Marital status change

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DAILY HASSLES

• Commuting
• Misplaced keys
• Mechanical breakdowns

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INTERNAL STRESSORS

• Lifestyle choices
• Negative self - talk
• Mind traps
• Personality traits

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LIFESTYLE CHOICES

• Caffeine
• Lack of sleep
• Overloaded schedule

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NEGATIVE SELF - TALK

• Pessimistic thinking
• Self criticism
• Over analysing

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MIND TRAPS

• Unrealistic expectations
• Taking things personally
• All or nothing thinking
• Exaggeration
• Rigid thinking

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PERSONALITY TRAITS

• Perfectionists
• Workaholics

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TYPES OF STRESS

• Negative stress
• Positive stress

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NEGATIVE STRESS

• It is a contributory factor in minor
  conditions, such as headaches, digestive
  problems, skin complaints, insomnia and ulcers.
• Excessive, prolonged and unrelieved stress can
  have a harmful effect on mental, physical and
  spiritual health.

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POSITIVE STRESS

• Stress can also have a positive effect,
  spurring motivation and awareness, providing the
  stimulation to cope with challenging situations.
• Stress also provides the sense of urgency and
  alertness needed for survival when confronting
  threatening situations.

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THE INDIVIDUAL

• Everyone is different, with unique perceptions
  of, and reactions to events.
• There is no single level of stress that is
  optimal for all people.
• Some are more sensitive owing to experiences
  in childhood, the influence of teachers, parents
  and religion etc.

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Self Perception

• Most of the stress we experience is
  self-generated.
• How we perceive life - whether an event makes
  us feel threatened or stimulated, encouraged or
  discouraged, happy or sad - depends to a large
  extent on how we perceive ourselves.

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Introspection

• Self-generated stress is something of a
  paradox, because so many people think of external
  causes when they are upset.
• Recognising that we create most of our own
  upsets is an important first step towards coping
  with them.

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SYMPTOMS OF STRESS

• Physical symptoms
• Mental symptoms
• Behavioural symptoms
• Emotional symptoms

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PHYSICAL SYMPTOMS

• Sleep pattern changes
• Fatigue
• Digestion changes
• Loss of sexual drive
• Headaches
• Aches and pains
• Infections
• Indigestion

• Dizziness
• Fainting
• Sweating trembling
• Tingling hands feet
• Breathlessness
• Palpitations
• Missed heartbeats

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MENTAL SYMPTOMS

• Lack of concentration
• Memory lapses
• Difficulty in making decisions
• Confusion
• Disorientation
• Panic attacks

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BEHAVIOURAL SYMPTOMS

• Appetite changes - too much or too little
• Eating disorders - anorexia, bulimia
• Increased intake of alcohol other drugs
• Increased smoking
• Restlessness
• Fidgeting
• Nail biting
• Hypochondria

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EMOTIONAL SYMPTOMS

• Bouts of depression
• Impatience
• Fits of rage
• Tearfulness
• Deterioration of personal hygiene and appearance

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STRESS RELATED ILLNESSES

• Stress is not the same as ill-health, but has
  been related to such illnesses as
• Cardiovascular disease
• Immune system disease
• Asthma
• Diabetes

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STRESS RELATED ILLNESSES

• Digestive disorders
• Ulcers
• Skin complaints - psoriasis
• Headaches and migraines
• Pre-menstrual syndrome
• Depression

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• DISTRESS CYCLE
• Stressors
• Immediate
• effect
• Long term effect
• Overall cost

Chemical Emotional Social
Community Family Work
Decision Plan Phobic
Stress overloading
Behavioral Physiological Emotional Cognitive
Overeating alcohol intake Smoking muscle tension, HR, BP Anger, anxiety, Depression Concern traction
Obesity, alcoholism HT, IHD, DM, migraine anxiety dep phobia, personality Sleep, memory, obsessive.
Decreased productivity Enjoyment intimacy
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STRESS CONTROL

• A B C STRATEGY

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ABC STRATEGY

• A AWARENESS
• What causes you stress?
• How do you react?

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ABC STRATEGY

• B BALANCE
• There is a fine line between positive / negative
  stress
• How much can you cope with before it becomes
  negative ?

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ABC STRATEGY

• C CONTROL
• What can you do to help yourself combat the
  negative effects of stress ?

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Stress Management Techniques

• Change your thinking
• Change your behaviour
• Change your lifestyle

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Change your Thinking

• Re-framing
• Positive thinking

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Re-framing

• Re-framing is a technique to change the way
  you look at things in order to feel better about
  them.
• There are many ways to interpret the same
  situation so pick the one you like.
• Re-framing does not change the external
  reality, but helps you view things in a different
  light and less stressfully.

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Positive Thinking

• Forget powerlessness, dejection, despair,
  failure
• Stress leaves us vulnerable to negative
  suggestion so focus on positives
• Focus on your strengths
• Learn from the stress you are under
• Look for opportunities
• Seek out the positive - make a change.

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Change your Behaviour

• Be assertive
• Get organised
• Ventilation
• Humour
• Diversion

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Being Assertive

• Being assertive involves standing up for your
  personal rights and
• expressing your thoughts, feelings and beliefs
  
• directly, honestly and spontaneously in ways
  that dont infringe the rights of others.

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Get Organised

• Poor organisation is one of the most common
  causes of stress.
• Structured approaches offer security against
  out of the blue problems.
• Prioritising objectives, duties and activities
  makes them manageable and achievable.
• Dont overload your mind.
• Organisation will help avoid personal and
  professional chaos.

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Time Management

• Make a list
• What MUST be done
• What SHOULD be done
• What would you LIKE to do
• Cut out time wasting
• Learn to drop unimportant activities
• Say no or delegate

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Time Management

• Plan your day
• Set achievable goals
• Dont waste time making excuses for not doing
  something

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Ventilation

• A problem shared is a problem halved
• Develop a support network through friends or
  colleagues to talk with. Its not always events
  that are stressful but how we perceive them.
• Writing a diary or notes may help release
  feelings but do not re-read what has been
  written.

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Humour

• Good stress - reducer
• Applies at home and work
• Relieves muscular tension
• Improves breathing
• Pumps endorphins into the bloodstream - the
  bodys natural painkillers

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Diversion

• Take time out
• Get away from things that bother you
• Calm down
• Think logically

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Change Your Lifestyle

• Diet
• Smoking Alcohol
• Exercise
• Sleep
• Leisure
• Relaxation

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Diet

• Healthy eating habits
• Avoid Caffeine (Stimulant)
• Avoid Sugar and Salt
• Avoid Fast Foods
• Regular Meals

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Smoking and Alcohol

• Avoid or Moderate your consumption
• No to DRUGS

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Benefits of Exercise

• Uses up excess energy released by the Fight or
  Flight reaction.
• Improves blood circulation
• Lowers blood pressure
• Clears the mind of worrying thoughts
• Improves self image
• Makes you feel better about yourself
• Increases social contact

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Sleep

• Good stress reducer
• Difficult to cope when tired
• Wake refreshed after nights sleep
• Plenty of daytime energy

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Leisure

• Interest
• Gives you a break from stresses
• Provides outlet for relief
• Provides social contact

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Benefits of Relaxation

• Lowers blood pressure
• Combats fatigue
• Promotes sleep
• Reduces pain
• Eases muscle tension

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Relaxation

• Decreases mental worries
• Increases concentration
• Increases productivity
• Increases clear thinking

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Spirituality

• Yoga beneficial
• Meditation Useful
• Prayers and Reading Holy Books helps in changing
  mindset and attitude
• Inner Healing and self Awareness decreases stress
• Faith , beliefs not Rituals are vital

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• WELLNESS CYCLE
• Stress
• Health promoting lifestyle responses
• Techniques skills Adaptive
  Adaptive Adaptive
• 
  Behavioral Physical Cognitive
  emotional
• Responses
  Responses Responses
• 
  assertiveness, nutrition stress
  inoculation,
• time
  mgmt. Exercise cognitive
  restructure
• 
  relaxation
• Long term effects self esteem
  improved improved mental health self
  respect self respect
  physical Resistance to future
• self
  confidence health stresses
• 
  resistance to
• 
  disease
• Overall benefits productivity, enjoyment
  intimacy

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CONCLUSION

• Prevention is better than cure.
• For preventing the mental illness there is no
  vaccine like polio,DPT Etc.
• Identify the stressors develop good coping
  mechanism so that stress can be managed before it
  kills you.
• Perception Analysis Action

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THOUGHT FOR THE DAY

• Never blame anyone in your life because -
• good people give happiness
• bad people give experience
• worst people give you a lesson
• and best people give you memories.

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SPECIAL THANKS TO -

• Dr Charles Pinto
• Dr Malay Dave
• Dr Ravi Kamath
• Staff of JRH
• FOR MAKING THIS MENTAL HEALTH WEEK SUCESSFUL