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

Mental Health Day Theme (WFMH) MENTAL HEALTH AND CHRONIC PHYSICAL ILLNESSES THE NEED FOR CONTINUED AND INTEGRATED CARE

10 Strategies to manage the Psychological Impact of Chronic Illness Nutrition Exercise Spiritual Health care Communication Education Pace yourself Humour Relationships STRESS Management

STRESS MANAGEMENT BY: DR.J.P. RAWAT PSYCHIATRIST Sr DMO JRH BCT

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

I HATE YOU WHAT IS STRESS ? Stress is the “wear and tear” our minds and bodies experience as we attempt to cope with our continually changing environment

HELP ME! WHAT IS STRESS ? Stress is the reaction people have to excessive pressures or other types of demand placed upon them. It arises when they worry that they can’t cope.

Stress is not in our environment… …it is what we perceive in our mind and body.

Stress occurs when the pressure is greater than the resource DEFINITION S = P > R Stress occurs when the pressure is greater than the resource

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.

STRESSORS  STRESS  DISTRESS Varies from person to person. Some stressors are common to all: Infection. Injuries. Dangerous events. Actual threat to self-esteem.

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

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

PARENTING: 1. Authoritative and caring parents   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:

AROUSAL & PERFORMANCE Arousal energizes performance. Optimal level

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 41 38 26 35 28 18 Adult 100 52 47 29 23 25 17 16 Elderly 73 65 62 45 40 39 48 36

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 40 39 37 29 15 13 11 28 Elderly 59 47 36 52 30

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: >300 “

The Stress Response Dr. Hans Selye Dr. Walter Cannon 1930’s ‘ Flight or Fight Response’

How body reacts with stress psycho physiologically Alarm response Adaptation Exhaustion

ALARM RESPONSE This is the “ Fight or Flight” response that prepares the body for immediate action.

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.

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.

TYPES OF STRESSORS External Internal

EXTERNAL STRESSORS Physical Environment Social Interaction Organisational Major Life Events Daily Hassles

PHYSICAL ENVIRONMENT Noise Bright Lights Heat Confined Spaces

SOCIAL INTERACTION Rudeness Bossiness Aggressiveness by others Bullying

ORGANISATIONAL Rules Regulations “Red - Tape” Deadlines

MAJOR LIFE EVENTS Birth Death Lost job Promotion Marital status change

DAILY HASSLES Commuting Misplaced keys Mechanical breakdowns

INTERNAL STRESSORS Lifestyle choices Negative self - talk Mind traps Personality traits

LIFESTYLE CHOICES Caffeine Lack of sleep Overloaded schedule

NEGATIVE SELF - TALK Pessimistic thinking Self criticism Over analysing

MIND TRAPS Unrealistic expectations Taking things personally All or nothing thinking Exaggeration Rigid thinking

PERSONALITY TRAITS Perfectionists Workaholics

TYPES OF STRESS Negative stress Positive stress

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.

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.

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.

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.

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.

SYMPTOMS OF STRESS Physical symptoms Mental symptoms Behavioural symptoms Emotional symptoms

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

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

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

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

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

STRESS RELATED ILLNESSES Digestive disorders Ulcers Skin complaints - psoriasis Headaches and migraines Pre-menstrual syndrome Depression

Stressors: DISTRESS CYCLE 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

STRESS CONTROL A B C STRATEGY

ABC STRATEGY A = AWARENESS What causes you stress? How do you react?

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

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

Stress Management Techniques Change your thinking Change your behaviour Change your lifestyle

Change your Thinking Re-framing Positive thinking

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.

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.

Change your Behaviour Be assertive Get organised Ventilation Humour Diversion

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 don’t infringe the rights of others.

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. Don’t overload your mind. Organisation will help avoid personal and professional chaos.

What would you LIKE to do Learn to drop unimportant activities 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

Don’t waste time making excuses for not doing something Time Management Plan your day Set achievable goals Don’t waste time making excuses for not doing something

‘A problem shared is a problem halved’ Ventilation ‘A problem shared is a problem halved’ Develop a support network through friends or colleagues to talk with. It’s 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.

Humour Good stress - reducer Applies at home and work Relieves muscular tension Improves breathing Pumps endorphins into the bloodstream - the body’s natural painkillers

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

Change Your Lifestyle Diet Smoking & Alcohol Exercise Sleep Leisure Relaxation

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

Avoid or Moderate your consumption Smoking and Alcohol Avoid or Moderate your consumption No to DRUGS

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

Sleep Good stress reducer Difficult to cope when tired Wake refreshed after night’s sleep Plenty of daytime energy

Leisure Interest Gives you a ‘break’ from stresses Provides outlet for relief Provides social contact

Benefits of Relaxation Lowers blood pressure Combats fatigue Promotes sleep Reduces pain Eases muscle tension

Relaxation Decreases mental worries Increases concentration Increases productivity Increases clear thinking

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

Health promoting lifestyle responses 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

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

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.

FOR MAKING THIS MENTAL HEALTH WEEK SUCESSFUL SPECIAL THANKS TO - Dr Charles Pinto Dr Malay Dave Dr Ravi Kamath Staff of JRH FOR MAKING THIS MENTAL HEALTH WEEK SUCESSFUL