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McXtra Care Newsletter | May 2019

A) MAIN FEATURE – IDENTIFYING & UNDERSTANDING MENTAL HEALTH ILLNESSES

May month has been declared the International Mental Health Awareness Month

Awareness of physical illnesses like Diabetes, Blood pressure, Arthritis, Asthma etc, is high, however mental health problems or illnesses are not only an ignored health aspect in our country, but also associated with myths and stigmas. This increases reluctance in acceptance, diagnosis and treatment.

Some alarming statistics….
In India, 10-14% suffer from mental health problems, with an estimated 56 million people suffering from depression and 38 million from anxiety disorders, according to a WHO report.

The myths and stigmas….
Health surveys have revealed that 50-60% of people have fixed, adverse opinions of people diagnosed with mental illnesses. People have reservations about mixing with them in society and working with them.

Most people don’t accept the mental illnesses are real problems like physical illnesses and dismiss them off as mere attitudinal or behavioral problems of ‘difficult’ people.

Often, mental illnesses are just clubbed as a single entity, but actually there are many different kinds of mental illnesses treated differently and specifically.

Sensitivity and understanding of mental illnesses can help in prevention as well as early diagnosis and treatment, which can greatly enhance corporate productivity and individual performance.

Table shows an overview of various mental illnesses and their presentation which can be a quick anytime reference for knowledge and understanding.

	Type of Mental Health Disorder	% affected in India	*Signs and Symptoms*
1.	Schizophrenia (Psychosis or Psychotic disorders)	0.4-1.4%	1. Touch with reality lost, affecting how one thinks, feels, behaves 2. Can have hallucinations (perceptions of having seen, heard, touched, tasted or smelled something that wasn’t actually there), delusions (irrational beliefs), and agitated body movements 3. Flat affect- loss of emotion, expression, focus, pleasure, desire and motivation with reduced speaking 4. Difficulty in making decisions, execution of tasks and applying/analyzing information
2.	Mood disorders
a.	Bipolar (Manic- Depressive disorder)	0.3-0.5%	1. Experience ‘mood periods’ of unusually intense emotion, behaviors, activity levels and changes in sleep patterns. 2. Manic episode or phase- increased energy and activity than normal, trouble in sleeping, fast talking, agitation or excitement, and recklessness 3. Depressive episode or phase- feels sad, down, empty, or hopeless, decreased activity and energy levels, sleeps or eats too little or too much, is unable to enjoy anything and thinks of death/ suicide 4. Phases may alternate, or present together or one phase maybe more dominant/longer than the other
b.	Depression	2.7-5.3%	1. Persistently feeling sad, hopeless, lack of pleasure, crying spells, difficulty in initiating activity or getting out of bed, effect on work and family life, and social withdrawal 2. Thoughts of death, suicide may occur
3.	Stress related disorders (Neurosis)
a.	Anxiety (Generalized Anxiety Disorder -GAD, and Panic disorders)	1.9%	1. Generalized Anxiety – Persistent worrying, fear, overthinking, restlessness, inability to focus and sleep properly 2. Panic disorder – Intense anxiety attacks which are sudden feelings of uncontrollable fear without real danger. One feels as if mentally losing control with physical symptoms like fast heartbeat, chest or stomach pain, breathing difficulty, weakness, dizziness, sweating or cold chills, and sometimes fainting
b.	Phobias (Specific Phobic anxiety)	1.2%	1. Intense fear of something (like claustrophobia-fear of closed spaces, acrophobia- fear of heights, etc)
c.	Obsessive Compulsive Disorder (OCD)	0.8%	1. When doing something becomes an obsession and compulsion to a point when one knows it is irrational but can’t quit and it starts disrupting daily life and work (like Washing hands constantly due to fear of germs/ getting dirty or repeated orderly placing of things etc)
d.	Post- Traumatic Stress Disorder (PTSD)	0.2%	1. Triggered by a terrifying event by either experiencing or witnessing it 2. Symptoms include flashbacks, nightmares, uncontrollable thoughts, about the event, severe anxiety and inability to move on in life
4.	Mental/behavioral problems due to Psycho-active substance abuse
	Alcohol	20.9%	1. Can manifest in multiple ways like aggression, violence, recklessness, inappropriate behavior, change in sleep and eating patterns, anxiety, depression or moodiness, decreased focus and work productivity, social withdrawal, and relationship problems 2. This may lead to, coexist with or be a result of other mental illnesses
	Tobacco	4.7%
	Other narcotic drugs/ substances	0.6%

Vulnerability…
The 40-60 years age group shows high vulnerability to mental health disorders. Schizophrenia affects both genders equally, however Bipolar disorders and Substance abuse problems affect men more while Depressive and Stress related disorders affect females more.

Just as someone can have many physical disorders together like diabetes, high BP or high cholesterol, the same can happen with mental disorders. So sometimes anxiety-depression can co-exist or patient may present manic and depressive states together in Bipolar disorder, or someone may become a Substance abuser because of Depression or become Obsessive-compulsive due to Anxiety disorder.

What causes mental disorders…
The cause of mental disorders is the imbalance of chemicals in the brain and nerves.

Some chemicals have a calming effect, while some have an exciting effect, so an imbalance towards the excitatory chemical can lead to anxiety. Therefore, anti-anxiety medicines act by increasing levels of calming chemical mediators.

There are chemicals which control mood and prevent depression, and a fall in these can lead to depressed state, while a rise can lead to mania or schizophrenia. Therefore, there are medicines which can increase and medicines which can decrease these chemicals.

Usually medicines are given along with or after a trial of counselling therapy which involves listening, discussing and advising suitable lifestyle and behavioral modifications to the patient.

Many physical illnesses may be associated with underlying mental illness also and sometimes not addressing that part does not give patient complete relief from his physical symptoms. This is seen in conditions like Chronic Pains, and Digestive or Bowel problems.

Most patients with mental health illness have normal intelligence and are as capable, competent and talented as any other person. There should be no undue fear, reservation or hesitation in mixing, interacting and working with anyone undergoing or in need of treatment for any mental illness.

In-fact, if one is aware of the types and presentations of mental illnesses, one can help oneself or a known one to seek help for diagnosis and treatment which can greatly help in regaining health, productivity and normalcy in life, just as would happen after treating a physical illness.

References: NMHS report: Mental Health 2015; WHO Common mental disorders: Global Health Estimates 2017; TLLLF 2018 NATIONAL SURVEY REPORT: Mental Health Perception; NIMH Clinical symptomatology and management.

TRENDING FEATURE – RELATION OF DIET WITH MENTAL HEALTH

A recent study in 2019 showed that poor mental health is linked with poor diet quality regardless of gender, age, education, marital status and income level.

Increased consumption of sugar and high amount of processed grains and fats in diet, have been linked with depression, bipolar disorders and poor mental health.

The vitamins in diet which have been linked to optimal mental health are Vitamin D, Vitamin C, Folic acid and Vitamin B10. While among the minerals, Iron, Zinc, and Magnesium have shown benefits to mental health. In addition, including Omega 3 fatty acid foods like fish, or flaxseed and walnuts in your diet can also add benefit.

Below are some of the dietary items which should be included or avoided to improve and maintain Mental Health. In addition, good water intake of at least 8 glasses of water (2 liters)/day, timely meals and avoiding skipping meals is important for mental health. It is also important to test for levels of Iron, Vitamin D and B10 if suffering from low moods, fatigue, and stress.

INCLUDE		AVOID
1. Whole grains, Yogurt 2. Green Vegetable, Fruits and nuts 3. Fish, fish oils, olive oil		1. Sugary drinks and food 2. Caffeine (coffee) 3. High fat dairy products

Reference:International Journal of Food Sciences and Nutrition 16 Feb 2019

C) Easy Mental Health tips at Work

Here are 3 easy techniques which can help you to de-stress & boost mental health when at work

1. Square breathing:Sit in a comfortable, upright position on the chair. Inhale through your nose for four counts (1, 2, 3, 4). Hold that breath in for four counts, exhale through your nose for four counts and then hold that breath out for four counts. That’s one cycle. Repeat 10 times, going at your own pace

	2. Shoulder stretch: Interlace your fingers, and raise your arms above your head, with your palms facing upwards in line with your ears, while you look straight ahead and relax your shoulder blades (don’t shrug). Hold for five full breaths in and out through your nose and release. Repeat 3-5 times.

	3. Heart opener: Standing with your feet hip-distance apart (that is hip, all the way through the knee, ankle, and foot are in a line), reach your hands behind you, clasping them together in a fist at the base of your back. Looking straight ahead, lift your clasped hands as high as you can behind you, pulling your shoulder blades together. Hold for five full breaths. Repeat 3-5 times

Clearing and neatening your work-station/desk also helps boost mental health!
De-clutter to de-stress…

		CLUES
		Across
		4 – Intense fear of a specific thing or situation 6 – Perception of sensations which actually don’t exist 7 – Stress busting green colored fruit 8 – Alternating mania and depression 9 – Depression is a ______ disorder

		Down
		1 – Substance of abuse 2 – Another name for stress related disorders 3 – A dietary mineral good for mental health 5 – Intense anxiety attack 10 – Compulsive uncontrollable and irrational habit