Embracing AI and LLM in Psychiatry: A Positive Leap Forward

As a Consultant Psychiatrist with a deep interest in cloud computing, machine learning (ML), and artificial intelligence (AI), I am intrigued with how these cutting-edge technologies are transforming the field of psychiatry. It's an exciting time for our profession, as we harness the power of AI and Large Language Models (LLM) to enhance patient care in truly remarkable ways.

1. Early Detection and Diagnosis: AI algorithms can analyse vast datasets, including patient interviews and medical records, to identify subtle patterns that might escape the human eye. This enables early detection and more accurate diagnoses, paving the way for timely interventions specially for disorders like First onset psychosis, Bipolar Affective disorder, Dementia of different types and many more.

2. Personalised Treatment Plans: Each individual's mental health journey is unique. AI can help create personalised treatment plans by considering a patient's genetic makeup, lifestyle, and responses to previous treatments. This tailored approach can improve treatment outcomes significantly. AI can also incorporate patients’ wishes in the care planning process.

3. Therapeutic Support: LLMs, like the one you're engaging with right now, have the potential to offer round-the-clock therapeutic support. They can provide information, resources, and even offer a non-judgmental space for individuals to express their thoughts and feelings.

4. Data-Driven Insights: Cloud computing allows us to securely store and analyse vast amounts of mental health data. By aggregating and anonymising this information, we gain valuable insights into population-level trends, which can inform public health policies and resource allocation.

5. Reducing Stigma: AI-powered mental health tools can help break down the stigma associated with seeking help. People may find it easier to confide in an AI interface initially, which can then facilitate referrals to human clinicians when necessary.

6. Continuous Monitoring: AI can provide continuous monitoring of patients' mental health, helping us detect early signs of relapse or crisis. This proactive approach can prevent hospitalisations and improve overall well-being.

7. Enhancing Clinician Capabilities: AI is not here to replace psychiatrists but to empower them. It can assist clinicians in making more informed decisions, reducing administrative burdens, and allowing us to spend more quality time with our patients.

As we embrace AI and LLM in psychiatry, let's remember that the core of our profession is the compassionate, humanistic care we provide. These technologies are tools to amplify our abilities, not replace our empathy and understanding. It's an exciting journey we're on, and I'm enthusiastic about the positive impact it will have on mental health care for years to come. #AIinPsychiatry #MentalHealthTech #HumanisticPsychiatry 🧠🤖🌟 By Dr Arghya Sarkhel, Consultant Psychiatrist, Living Mind, UK

Nurturing Mental Well-being: Understanding and Managing Anxiety

Introduction:

Welcome to Living Mind's blog post for Mental Health Awareness Week! This year, we are focusing on a prevalent and often misunderstood topic: anxiety. While anxiety is a normal emotion, it can sometimes spiral into a mental health problem. We aim to increase awareness and understanding of anxiety, equipping you with valuable information on preventing it from becoming overwhelming. Additionally, we will emphasise the importance of demanding change to prioritise mental health in society. So, let's dive in and explore how we can better manage anxiety and nurture our mental well-being.

Understanding Anxiety:

Anxiety can manifest in various ways and is often triggered by life events such as exams, relationships, work-related changes, or financial concerns. It's crucial to recognise that everyone experiences anxiety differently, and its effects can range from mild uneasiness to severe distress. By acknowledging anxiety as a normal response to stress, we can reduce the stigma surrounding it and promote understanding and empathy.

At the same time, if anxiety or related symptoms start affecting our functioning significantly, please consider getting help from mental health professionals. You might need talking therapy, medication or combination of both.

Preventing Anxiety from Becoming a Problem:

1. Self-Care and Stress Management: Prioritise self-care activities that help you relax and recharge. Engage in hobbies, exercise regularly, practice mindfulness or meditation, and ensure you get enough sleep. These practices can help build resilience and reduce anxiety triggers.

2. Social Support: Strong relationships and a support network can provide comfort and reassurance during challenging times. Reach out to loved ones, friends, or support groups to share your feelings and seek guidance when needed.

3. Healthy Lifestyle Choices: Maintain a balanced diet, limit caffeine and alcohol intake, and avoid smoking. Proper nutrition and a healthy lifestyle contribute to overall well-being, positively impacting your mental health.

4. Time Management: Proactively plan and organise your time to reduce overwhelming situations. Break tasks into manageable chunks, prioritise effectively, and remember to schedule time for relaxation and self-care.

5. Positive Thinking and Mindset: Challenge negative thoughts and replace them with positive affirmations. Practicing gratitude and focusing on the present moment can help reframe your perspective and reduce anxiety.

Demanding Change:

While personal coping strategies are vital, it's equally important to advocate for systemic change. Here's how you can make a difference:

1. Education and Awareness: Share accurate information about anxiety and mental health with friends, family, and colleagues. Encourage open conversations to reduce stigma and promote understanding.

2. Support Mental Health Initiatives: Engage with organisations, like Living Mind, that actively work to improve mental health services, accessibility, and support systems. Sign petitions, participate in events, and spread awareness through social media.

3. Promote Workplace Well-being: Advocate for mental health resources and support in your workplace. Encourage employers to provide employee assistance programs, mental health days, and a supportive work environment.

4. Influence Policy and Funding: Write to your local representatives, urging them to prioritise mental health in government policies and budgets. By vocalising our collective concerns, we can drive change at a systemic level.

Conclusion:

During this Mental Health Awareness Week, let's come together to understand anxiety better and promote its effective management. By focusing on preventive measures and demanding change, we can ensure that mental health remains a key priority in society. Remember, each of us has a role to play in nurturing our own well-being and supporting those around us. Together, we can create a more compassionate and empathetic world for all.

If you or someone you know is struggling with anxiety or any mental health issues, please reach out to a mental health professional or helpline for support.

Stay informed, stay compassionate, and let's make mental health a priority!

Disclaimer: This blog post is for informational purposes only and should not replace professional advice.

Moving Forward with Strength: The Power of Solution-Focused Therapy in Trauma Treatment"

Solution-focused therapy (SFT) is a goal-oriented and future-focused approach that has been found to be effective in the treatment of trauma in mental health. SFT emphasizes identifying and building on the strengths and resources of individuals to promote positive change, rather than focusing on the problems or symptoms they may be experiencing.

Research has shown that SFT can help individuals who have experienced trauma to develop coping skills, improve their emotional regulation, and enhance their overall functioning. SFT can also be particularly useful for individuals who may be resistant to traditional talking therapy approaches or who are seeking more brief and practical solutions.

One of the key benefits of SFT is that it can help individuals to feel empowered and in control of their own recovery. By focusing on their strengths and resources, individuals can develop a sense of agency and become more actively engaged in their own healing process. SFT can also help individuals to reframe their experiences of trauma and see themselves as capable of overcoming challenges, which can be an important step towards healing.

Overall, SFT can be an effective approach for addressing trauma in mental health. It can help individuals to identify and build on their strengths and resources, feel empowered and in control of their recovery, and develop practical skills for coping with trauma-related symptoms. However, it is important to note that not all individuals may respond equally well to SFT, and it is important to work with a qualified mental health professional who can help to determine the most appropriate treatment approach for each individual.

Blooming through Trauma: How Gardening Can Nurture Resilience and Healing

Gardening can be a therapeutic activity for individuals who have experienced trauma, as it allows for a sense of control, relaxation, and connection with nature. Here are some specific areas that gardening can address for individuals with a history of trauma, along with assigned flowers and nourishing activities:

1. Resilience: The sunflower is a symbol of resilience and can be assigned to this area. To nourish resilience, one can engage in activities that help build strength and perseverance, such as setting small goals and working towards them, practising self-care, and seeking out supportive relationships.

2. Withstanding abandonment: The forget-me-not is a symbol of love and remembrance, and can be assigned to this area. To nourish a sense of connection and stability, one can engage in activities that promote self-love and connection to others, such as journaling, practising gratitude, and reaching out to supportive friends or family members.

3. Tackling judgment and criticism: The rose is a symbol of love and beauty, and can be assigned to this area. To nourish self-esteem and reduce negative self-talk, one can engage in activities that promote self-compassion, such as practising positive affirmations, mindfulness, and self-reflection.

4. Social activities: The daisy is a symbol of friendship and can be assigned to this area. To nourish social connection, one can engage in activities that promote socialisation, such as joining a gardening club, attending community events, and reaching out to friends or family members to spend time together.

To help bloom these flowers, one can engage in a variety of nourishing activities. These may include:

• Planting and caring for the assigned flowers in a garden or container, providing regular water and sunlight.

• Keeping a journal to track progress and growth in each of the assigned areas.

• Practising mindfulness exercises, such as deep breathing or meditation, to stay present and grounded while working in the garden. Please visit our album on Mindfulness exercise - this is available on www.livingmind.co.uk

• Seeking support from a mental health professional or support group to work through trauma-related issues.

• Engaging in self-care activities, such as taking breaks when feeling overwhelmed, getting enough sleep and exercise, and eating a balanced diet.

Overall, this gardening exercise can be a valuable tool for individuals who have experienced trauma, and can help address a range of areas related to resilience, abandonment, judgement, and social connection. Whether planting and caring for flowers in a garden or drawing a garden and flowers in a notebook, this exercise can provide a therapeutic outlet and an opportunity for growth and healing.

Bipolar disorder: 5 things a psychiatrist wants you to know

Bipolar disorder hit the headlines this week, after singer Mariah Carey revealed that she has been secretly suffering from the mental health condition for nearly two decades. In a candid interview with People, the US star explained that she decided to speak up about living with the condition in order to help break the 'stigma' surrounding mental illness.

'I'm hopeful we can get to a place where the stigma is lifted from people going through anything alone,' she said. It can be incredibly isolating. It does not have to define you and I refuse to allow it to define me or control me.' Bipolar disorder, formerly known as manic depression, is a condition affecting your moods, which can result in swings from one extreme to the other, according to the NHS. Sufferers experience periods or episodes of depression and mania, which can leave them feeling 'high and overactive'.

And, while most of us have heard of bipolar, its complexity and the variety of forms it can take, means there are some misconceptions surrounding it, as the mental health charity Mind notes on its website. Here, we speak to Harley Street Consultant Psychiatrist Dr Arghya Sarkhel of Living Mind, to debunk some of the biggest myths about Bipolar Disorder...

Myth 1: Bipolar is rare

'Surprisingly, bipolar disorder is not uncommon,' Dr Sarkhel tells us. 'In fact, one in every 100 people have a chance of developing it.'

On top of this, the NHS notes that bipolar disorder may initially be confused with clinical depression.

'Almost 20 percent of people with bipolar are diagnosed with depression first,' Dr Sarkhel says. 'It's only over time when they have distinct mania or hypomania that their diagnosis is then revised.'

Myth 2: Bipolar Disorder can only develop when you're young

While the NHS notes that sufferers often develop symptoms between the ages of 15 and 19, Dr Sarkhel tells us that the onset usually occurs between your early to late twenties.

That said, the condition can actually develop at any age. 'It's rare after 40, although not impossible,' Dr Sarkhel explains, adding that physical conditions including a brain tumour or head injury in later life can cause bipolar.

Myth 3: Sufferers are just 'moody'

If you always assumed that bipolar disorder is just another way of saying 'mood swings', then you've been mistaken. 'One of the biggest misconceptions about bipolar disorder is that the mood swings experienced are the type that we can all suffer with from time to time,' says Dr Sarkhel. 'They are, in fact, quite different.

'The mood swings are much more severe,' he continues. 'Each episode lasts much longer than our common "mood swings".' In fact, Dr Sarkhel tells us that the majority of sufferers are more likely to experience periods of depression rather than mania, while depressive episodes also tend to last for much longer.

'Mania tends to last for weeks, whereas depressive episodes usually last for months,' he explains.

As well as this, bipolar disorder is about much more than mood swings, Dr Sarkhel explains. 'Other symptoms include racing thoughts, pressure of speech, increased or reduced energy, reduced need for sleep, suicidal thoughts and psychotic features, such as delusion, hallucination or thought disorder.

'Most importantly, the reason this is classified as a disorder is that it leads to severe impairment in both social and occupational functioning, unlike simple mood swings that subside spontaneously and quickly without any active intervention.'

Myth 4: Manic episodes are positive

As the NHS explains, anyone going though a period of mania may feel happy, with lots of energy and creativity. However Dr Sarkhel argues that this is actually a myth on one level.

'Because of your elated mood, your perception of experiences gets distorted,' he says. 'But, overall, these symptoms are distressing – even if they may appear positive on the surface.'

He continues: 'Another big misconception is that manic states improve a person's productivity or performance. But, in reality, mania can be equally, if not more distressing than depression because of its severe disruption of functioning as a result of unstable mood, erratic behaviour or poor attention.'

Myth 5: There's only one type of bipolar disorder

As mentioned above, bipolar is a complex condition and the pattern of mood swings varies widely between people. In fact, as Dr Sarkhel tell us, there are several types of bipolar disorder...

'With Type 1, you will go through manic and depressive episodes; in Type 2, you will experience hypomania (a less severe form of mania) and depression but without having a manic episode. In Type 3, you can experience a manic switch induced by antidepressants. And there is also Rapid Cycling, where sufferers experience four or more episodes in a year.'

If you are worried that you may be suffering from bipolar disorder or another mental health issue, speak to your GP or visit Mind's website for further assistance.

Originally posted on : https://www.prima.co.uk/diet-and-health/healthy-living/advice/a43386/bipolar-disorder-myths-debunked/

Can RTMS treat depression without the side effects of medication?

Whatever headlines you might read about how antidepressants don’t work, for millions of people, they do.

In 2016, there were 64.7 million prescriptions for them in England alone. So, as a country, we’re taking a lot of these little pills – and mostly finding them very beneficial. However, they don’t come without drawbacks. Like all medications, they can have side effects – such as loss of libido, nausea, weight gain, shakiness or tiredness.

Another treatment option which isn’t talked very much about is RTMS (Repetitive Transcranial Magnetic Stimulation). The treatment bills itself as a drug-free therapy powerful enough for patients to stop taking antidepressants.

It sounds a bit terrifying, and might make you think of scenes of people getting strapped down for Electroconvulsive Therapy (ECT). That’s not really how it happens. It passes a magnetic pulse into your brain, producing a small amount of electric current in a specific area, and people can sit up and chat throughout the treatment. Although it’s fairly rare for people to have it on the NHS due to the cost, it is approved by NICE in cases where people have ‘treatment resistant’ depression (if antidepressants have not been effective) or for people who can’t or won’t tolerate the side effects.

What to expect if you have RTMS

• The treatment involves placing a coil next to your head and passing a magnetic pulse into your brain creating a small electric current, consultant psychiatrist Dr Arghya Sarkhel explains.

• It doesn’t hurt, but you will hear and feel a tapping sensation, as if there is a small woodpecker pecking at your skull.

• The aim is to stimulate your neurones to become more active, helping people regain interest in life and start to function better.

• Each session will last around 20 minutes, during which time you’re totally conscious and can chat, lie back or read a magazine if you’re so inclined.

• Afterwards, you should be fine to go back to work and carry on as normal. However, you may feel slightly ‘out of it’ for a few hours afterwards, so it might be a good idea to travel by public transport rather than driving to your appointment to be on the safe side.

• People usually have a course lasting four to six weeks, having RTMS five days a week. By this point, the hope is that you will be in remission and free of symptoms, to the extent you do not need further treatment (although you may arrange top-up treatments every month or so.)

• Before each session, it’s important to be well hydrated so your brain is working at its proper capacity. Drink plenty of water beforehand, and bring a bottle with you to drink afterwards.

• You should avoid any strenuous activity before and immediately after the session.

• The treatment isn’t suitable for anyone with a metal implant in their head. You should also keep any metallic objects and bank cards away from you during the treatment, as they could affect the magnetic pulse.

• There is a minor risk that it could trigger a seizure, however the likelihood of this is extremely low. Other more common side effects include a headache or scalp tingling.

• Some people describe feeling a fog of depression lifting from them soon after starting the treatment.

However, just like any treatment it is unlikely to work miracles – so you need to make sure you continue working hard to keep up a healthy lifestyle in general (exercise, healthy eating, socialising) to get the full benefits.

Consultant psychiatrist Dr Arghya Sarkhel, who offers the treatment at his clinic Living Mind, says it can be really useful for people who want to stop taking antidepressants.

‘It is almost a side-effect free intervention,’ he said. ‘But not many NHS trusts deliver it, because it is expensive.’

We asked him why patients might want to avoid medication for depression. He said they can cause various side effects, ranging from sexual dysfunction to weight gain. Note the word ‘can’: Many people won’t experience any of these – and in any case, if you’re having an acute episode of depression, you can probably put up with feeling a little shaky or turned off if it helps you get back on an even keel.

Dr Sarkhel told metro.co.uk: ‘Antidepressants do have their place, and they are an effective way of treating biological and cognitive symptoms of depression: thoughts of hopelessness, suicide, as well as loss of appetite and loss of interest in day-to-day activities.

‘They are often the first drugs prescribed by GPs, but they are not without problems.  The most popular are SSRIs, such as fluoxetine, citalopram, sertraline and escitalopram.

‘One of the things we don’t talk about much is sexual dysfunction, which can be equally frustrating for men and women. Men mainly talk about erection difficulties, sometimes dysfunction in ejaculation.

‘Women can have orgasm dysfunction, but the most common side effect is a diminished libido – a loss of interest in sexual contact. ‘Obviously that has a significant impact on their mood and quality of life and relationships. ‘Unfortunately, that is one of the recognised side effects of SSRIs.’

This is one of the most potentially awkward side effects, and something which may put people off taking the medication. You’re probably more willing to put up with having a stomach ache than losing interest in your partner or not being able to orgasm for the duration of the time you take it.

However, Dr Sarkhel stressed that not everyone will experience this. It also doesn’t last after you stop taking the medication, so it’s not like you’re confining your sex life to the dustbin for the rest of your life.

Other side effects from SSRIs can include stomach upsets, nausea, vomiting and sometimes diarrhoea, he said. Occasionally they cause weight gain, and they can cause tiredness.

Another potential issue is that they can be difficult to stop taking. Some people talk about having a sensation of ‘brain zapping’ as the medication leaves their system, particularly if the drug has a short half life so there is less hanging around in the body to taper gradually.

‘Sometimes people have excessive sweating, yawning or nightmares,’ Dr Sarkhel said. ‘Particularly increased anxiety is one of the common ones. A lot of people can potentially go back on them and retire them more slowly.

A couple of our patients had difficulty coming off Venlafaxine. One patient wanted to come off because she wanted to start a family. As soon as we started reducing it, she started experiencing heightened anxiety and sleep problems.’

People who don’t do well on SSRIs might try Mirtazapine.

It generally has a sedative side effect, and can cause people to put on weight due to increased appetite. These side effects aren’t usually helpful, but in some cases they might be positive.

‘We prescribe it when patents are having sleep problems or their eating is poor, because we want to take advantage of the side effects,’ Dr Sarkhel said.

He said that for patients who choose RTMS to go ‘drug free’ and avoid these kinds of side effects, it’s important to not rely on it entirely to fix everything.

‘During the sessions of RTMS, I tend to spend time with the patient talking about lifestyle, diet or nutrition,’ he said.

‘I’m very interested in mindfulness. If we can get our brains engaged in meaningful activities, the success of RTMS is much more superior.

‘So we combine mindfulness with RTMS during these sessions.’

With the cost of RTMS running into thousands of pounds if you are treated privately, it’s likely to be an option for people who have exhausted more obvious methods of treatment, rather than the first thing you turn to.

It’s definitely worth trying medication first, to see if you are able to tolerate the side effects (you may be one of the lucky ones who has none at all).

Psychiatric Needs of Elderly Prisoners

The number of elderly prisoners is increasing and evidence suggests that there is significant unidentified psychiatric morbidity in this group. Currently, elderly prisoners who have psychiatric needs are managed either by the generic forensic psychiatric services or generic old age psychiatry services. Drs Arghya Sarkhel, Carlo Thomas and Ajit Shah discuss the extent of the problem and how these patients can be better identified.

The number of elderly prisoners in England and Wales is increasing. In 1990, the number of elderly male prisoners (those who have been tried and found guilty) was 472. This rose to 808 in 2000 and then to 1,496 in 20021,2. Several studies have demonstrated that there is significant unidentified psychiatric morbidity within this group of sentenced prisoners as well as those on remand. Taylor and Parrot3 found that 50 per cent of male remand prisoners over the age of 55 years had hidden active symptoms of mental illness on entering the prison. This rate was twice that of remand prisoners under the age of 55 years. Alcohol-related disorders, including withdrawal features and functional psychosis, were the most prevalent psychiatric diagnoses. In the vast majority of cases, psychiatric morbidity had not been previously identified. In the same sample about half the subjects had significant physical morbidity, and this rate was again twice that of those under the age of 55 years. An Israeli study reported similar findings4 . In addition, a study of sentenced male prisoners over the age of 60 years across 15 prisons revealed that 32 per cent had a psychiatric illness2 . The most common problems were personality disorders and depressive illness. However, only 12 per cent of the depressed group received antidepressants and only 40 per cent had a documented history of depression. Out of all the study’s sample group, 75 per cent were receiving medication. Those with cardiovascular, respiratory and endocrine health problems were prescribed medication that was appropriately targeted5 . However, only 18 per cent of subjects with recorded psychiatric morbidity were treated with psychotropic drugs. Also, it was found that substance misuse or dependence was rarely recorded in the patients’ notes5 . But it is not only elderly prisoners who have unidentified mental illnesses. A community study from Essex reported that 28 per cent of elderly people apprehended by the police had a mental illness, which was higher than those apprehended from the general population6 . The most common psychiatric diagnoses were ‘organic’ and depressive illness; this was particularly the case among shoplifters.

Identifying psychiatric morbidity

This psychiatric morbidity in this group is likely to increase as the number of elderly prisoners is growing. Therefore, there is a need to identify and treat these individuals and this is important from the primary care perspective as the responsibility for prison medical services has been with Primary Care Trusts (PCTs) since 1st April 20057 . There is some evidence that elderly prisoners are receiving appropriate treatment for their physical health problems and are in contact with prison doctors1,5. This contact provides an opportunity to identify and treat mental illnesses. Another way these illnesses could be identified is to make the PCT that provides services to a prison aware of the significant psychiatric morbidity among elderly prisoners. In addition, as such prisoners have high levels of physical morbidity, they are likely to come in contact with a geriatrician. This provides another opportunity for psychiatric morbidity to be identified. These approaches would also be consistent with Standard 7 of the National Service Framework for Older People8 . However, both the primary care and secondary care general medical systems may need support (including advice on treatment and management) from more specialist psychiatric services within secondary care settings or even at a tertiary care level.

Improvements for the future

Efforts should be made to identify cases of psychiatric morbidity much earlier in the Criminal Justice System (CJS) than imprisonment (i.e. identification of psychiatric morbidity at the time of arrest and/or trial). It has been suggested that efforts to service the hidden psychiatric morbidity amongst the elderly (at whatever stage) within the CJS requires multi-agency collaboration involving the public, the CJS department, mental health services and the prison service9 . Improving the awareness of the importance of recognising mental illness in elderly people within the CJS, among the police and lawyers, has also been advocated9 . As well as these measures, it has been proposed that a court diversion scheme would be a useful interface between the judicial system and mental health services9 . In a court diversion scheme, individuals with suspected mental illnesses are assessed before the trial (often on court premises) to see if they can be diverted to receive treatment in the mental health system. As elderly prisoners with psychiatric illnesses fall between prison, forensic psychiatry and old age psychiatry services, it has been suggested that there should be an integrated approach between these groups10. This is because alone, these three groups may be ill equipped to manage this group of patients. This integrated approach should include joint training initiatives and development of specialist old age psychiatry liaison services to prisons and forensic psychiatric units10. Regional forensic psychiatric services may also be helpful in offering advice, but they may be reluctant to admit elderly patients into their units because their wards may not be suitable for frail, physically ill and vulnerable elderly11,12. This may result in elderly mentally ill prisoners remaining in the prison system11. As a solution, the development of a small number of tertiary specialist forensic old age psychiatry services at a regional or supra-regional level has been proposed9,11,13,14. Such a service could include secure beds on a dedicated ward, the ability to deliver services to prisons and the probation service, the ability to deliver sex offender programmes as well as a liaison service to prisons, and both generic old age and forensic psychiatry services. Unfortunately there is no consensus about the most appropriate model and there are some organisations already offering some components of the services described above.

Conclusion

There is significant hidden psychiatric morbidity among elderly prisoners so it is important to develop services to recognise and treat this morbidity

REFRENCES

1. Howse K. Growing old in prison. A scoping study in older prisoners. Prison Reform Trust. 2003

2. Fazel S, Hope T, O’Donnel I, et al. Hidden psychiatric morbidity in elderly prisoners. British Journal of Psychiatry 2001; 179: 535–39

3. Taylor P, Parrot JM. Elderly offenders. A study of age-related factors among custodially remanded prisoners. British Journal of Psychiatry British Journal of Psychiatry 1988; 152: 1722–731

4. Barak Y, Perry T, Elizon A. Elderly criminals: a study of fi rst criminal offence in old age. International Journal of Geriatric Psychiatry Journal of Geriatric Psychiatry 1995; 10: 511–16

5. Fazel S, Hope T, O’Donell I. Jacoby R. Unmet treatment needs of older prisoners: a primary care survey. Age & Ageing 2004; 33: 396–98

6. Needahm-Bennett H, Parrot J, MacDonald AJD. Psychiatric disorder and policing the elderly offender. Criminal Behaviour Mental Health. 1996; 6: 241–52

7. De Viggiani N, Orme J, Powell J, et al. New arrangements for prison health care. Provide an opportunity and challenge for primary care trusts. British Medical Journal British Medical Journal 2005; 330: 918

8. National Health Service. National Service Framework for Older People. HMSO, 2001

9. Nnatu I, Mohamed F, Shah A. Is there a need for elderly forensic psychiatry service? Medicine, Science and the Law 2005; 45: 154–60

10. Curtice M, Parker J, Wismayer F, et al. The elderly offender: an 11 year survey of referrals to a forensic psychiatry service. Journal of Forensic Psychiatry and Psychology and Psychology 2003;14: 253–6

11. Yorston G. Special services. Old Age Psychiatrist. 2002; Autumn: 7

12. Coid J, Fazel S, Khatan N. Elderly patients admitted to secure forensic psychiatry services. Journal of Forensic Psychiatry Forensic Psychiatry 2003;13: 416–27

13. Yorston G. Aged and dangerous: old age forensic psychiatry. British Journal of Psychiatry of Psychiatry 1999;174: 193–95

14. Tomar R, Treaseden I, Shah AK. Is there a case for a specialist forensic psychiatry service for the elderly?. International Journal of Geriatric Psychiatry. 2005; 20: 51-56

Originally Published at : https://www.gmjournal.co.uk/media/20143/feb06p23.pdf

Mental Health in the Time Of Corona

In the current situations of this pandemic, the word that is looming in the minds of every individual is “UNCERTAINTY”.  Understandably many of us are anxious about the global situation, the challenge remains: how we could navigate through our lives without significant compromise in social and occupational functioning.

How to protect your Mental Health during a Quarantine ?

Mental Health issues can arrive at any phase of our lives and the current environment poses a greater risk at triggering it. This instability is one of the main sources for the perceived stress, anxiety and other forms of psychological disturbances in today’s world. It might be a relapse of an existing mental illness or might be the first time when you are not feeling well psychologically. It depends primarily on our anticipation of the post-pandemic society, of what exactly it might have in store for us. It could also lead to the comparison of the current times with the beautiful days of the past. In a nutshell, we can experience a wide range of emotions thus leading to a feeling of helplessness and unanswerable “uncertainty”.

How this pandemic is triggering OCD or Obsessive Compulsive Disorder?

In recent studies by the World Health Organisation (WHO), experts have issued a warning that this current situation can lead to anxiety and especially, OCD. This disorder affects our social functioning and contains two parts primarily. One, the obsession – it includes those repetitive intrusive irrational thoughts which we want to get rid off but are not able to. The contamination of germs is one of the most common obsessive thoughts. Two, the behaviour -- these obsessive thoughts can lead to some form of ritualistic behaviour. Here, for example, washing hands repeatedly, touching objects symmetrically.

Now in the coronavirus pandemic, it is crucial to understand the boundary between rational, understandable preoccupation for prevention and irrational intense preoccupation, which is beyond the range of an understandable reaction. This habit of repeatedly washing hands can become 50-60 times a day and here it becomes pathological. It brings us to a halt, slows our performances in both personal and professional fields. So the anxiety arising from the coronavirus situation can precipitate a relapse of OCD or just aid to the vulnerability of a person to develop it for the first time.

 How do we manage our anxiety level?

The first step is to identify if something feels ‘wrong’. Sleep deprivation, being in a constant state of anxiety, disturbances in your daily performance levels are some of the common features.  There are several approaches but the first approach recommended by Dr Arghya Sarkhel, Consultant Psychiatrist from Living Mind is the simplest one – sharing your thoughts with friends and family even before we think about taking professional help. To talk to someone whom you trust is a life-changing step. Confiding in someone would inevitably release some stress from our shoulders. If someone is already having a pre-existing history, then they could opt for some top-up sessions with their therapists, counsellors, psychologists or psychotherapists.

In cognitive-behavioural theory, one is taught to identify our catastrophic thinking and how to challenge those thoughts by keeping a “THOUGHT DIARY”, or using another method called the “flashcard technique”, where one writes down some of the facts that will challenge the catastrophic thoughts. Flashing those written cards repeatedly to ourselves would help reduce the intensity and frequency of our ‘thinking errors’ and of course thus leading to improve our functioning and quality of life.

One area of the front of the brain known as the orbitofrontal cortex is affected significantly in OCD and medications play a vital role along with talking therapy in restoring the function of this part of the cortex. One shouldn’t hesitate to talk to the GPs (if one is in the UK) or psychiatrists in NHS or private psychiatrist. It is important to find out if there is a necessity to simply tweak the medications. Many of us are quite anxious to go out of our homes to seek professional help, so fortunately some GPs and family physicians are providing remote consultations i.e. online consultations. Dr Sarkhel requests each and everyone to not ignore any symptoms of mental illness. Just like the occurrence of sudden cough and cold could be symptoms of COVID-19, similarly, the occurrence of unusual and different behaviours and thoughts should be taken seriously too. Help is available for all.

How should one deal with this intense and constant FEAR?

Fear is a natural response when our mind perceives that we are threatened, it might be internal or external. The constant flashing numbers of COVID deaths on our televisions screens, mobile phones, etc, creates this fear of losing our loved ones, especially, our elder relatives. It is important to recognise if our fear is crossing the level that is normally expected. If we are not performing well at work, if we have slowed down in our lives and if we start avoiding things are the major tell-tale signs.

In this context, Dr Sarkhel at Living Mind advises on an integrated approach to help everyone struggling in the current situations—MINDFULNESS  is one of the key aspects Dr Sarkhel explains.

It is an extremely powerful and yet under-used method, whose concept initially came from Zen of Buddhism. The idea that encompasses mindfulness is that it gives us the skill to embrace both good and bad emotions. The fear we feel is an emotional response, whereas doing some regular mindfulness exercise, will teach us the skill to accept our feelings just the way it is, and not have the impulse to react to it. Mindfulness often uses simple breathing exercise, that facilitates the recognition of physical and emotional experiences in detail. It is well researched now by neuroimaging studies that mindfulness improves the functioning of our frontal lobe of the brain which deals with many higher cognitive functions.

There are various books and online exercise sessions where one could find it. Also one could try the mindfulness audio sessions created by Living Mind’s own Dr Arghya Sarkhel, available in Spotify, Google Play, Youtube and many other digital platforms. The album “MINDFUL LIVING” contains 10 separate tracks for different conditions, one of them being ‘managing anxiety’. These easy-to-do guided meditations are amazing ways to relax and take care of ourselves.

How to approach mental illness without taking medications?

Living Mind believes in the integrated approach to helping mental issues. Dr Arghya Sarkhel is one of the few psychiatrists who are advocating the method of rTMS. It is known now by extensive research that brain circuits have a huge role to play as it is their functions, the increase or decrease of which, results in depression, anxiety, OCD, etc.  ‘Medication’ is involved in modulating the chemical imbalance of the brain and ‘Talking Therapy’ is involved in modifying our thoughts and behaviours. Now rTMS is involved in the electrical modulation of our brain circuits.

 In our brain, the nerves are connected through electric energy, which is seen to be slightly loosely connected in the frontal lobe in patients of depression. In the TRANSCRANIAL MAGNETIC STIMULATION, a magnetic coil sits on the frontal part of the head and emits magnetic pulses and this is what distinguishes it from ECT (ELECTROCONVULSIVE THERAPY), where electricity is directly given and produces side-effects such as headaches and memory loss. But in rTMS, all these side-effects are absent as it is a much-focused treatment using a fundamental law of physics that talks about the conversion of magnetic energy into electrical energy. Repeated sessions of rTMS help to re-enforce and strengthen that loose circuit. Patients can relax during the treatment by reading a book, watching a video, talk, etc. People who do not want to take the drug route to fight depression, rTMS is the true saviour. Apart from Depression, Anxiety and OCD are also treated by this method. It is also seen that when a patient is under medication or talking therapy, rTMS can improve the outcome of pharmacological and psychological interventions. Patients get more involved in therapy, their information processing skill gets better with rTMS.

Finally, last but not the least, as Dr Sarkhel explains, we as a global society need to realise that even in this difficult situation of COVID-19, we have a CHOICE. It is extremely empowering to think that we are in control, we have the choice to decide that if we want o feel miserable and keep worrying always or we can adapt our lives around it by embracing these difficult emotions. As soon as we realise this power of choice, the world with its million opportunities opens up. We become aware and get ready to adapt to this new world to this “NEW NORMAL” and make the best use of it. 

Living Mind

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Making Lives Meaningful - campaign by Living Mind

Living Mind is pleased to celebrate World Mental Health Day - our aim is to promote awareness of mental health, beating the stigma and making lives meaningful.

What is Eye Movement Desensitization and Reprocessing (EMDR) Therapy?

We offer EMDR or Eye Movement Desensitisation and Reprocessing at Living Mind, a highly effective therapy carried out by our resident Psychotherapist Gary Marshall. Eye Movement Desensitisation and Reprocessing (EMDR) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences.  Repeated studies show that by using EMDR therapy, people can experience the benefits of psychotherapy that once took years to make a difference.

How can Eye Movement Desensitisation and Reprocessing (EMDR) therapy help with mental health problems and emotional issues?

It is widely assumed that severe emotional pain requires a long time to heal.  EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma.  When you cut your hand, your body works to close the wound.  If a foreign object or repeated injury irritates the wound, it festers and causes pain.  Once the block is removed, healing resumes.  EMDR therapy demonstrates that a similar sequence of events occurs with mental processes.  The brain’s information processing system naturally moves toward mental health.  If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering.  Once the block is removed, healing resumes.  Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.

What successful stories have there been for Eye Movement Desensitisation and Reprocessing (EMDR) therapy?

More than 30 positive controlled outcome studies have been done on EMDR therapy.  Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions.  Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions.

There has been so much research on EMDR therapy that it is now recognised as an effective form of treatment for trauma and other disturbing experiences by organisations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy.  Millions of people have been treated successfully over the past 25 years.

How does Eye Movement Desensitisation and Reprocessing (EMDR) therapy work?

EMDR therapy is an eight-phase treatment.  Eye movements (or other bilateral stimulation) are used during one part of the session.  After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings.

In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.  For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.”  Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes.  The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them.  Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the client’s’ thoughts, feelings and behaviour are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.

EMDR therapy is available with Living Mind in London

For more information or to book a free 15-minute consultation please contact us at info@livingmind.co.uk or call 07753 430829.

Drug Free Treatment for Depression now Available

Dr. Sarkhel administering treatment

After the success of our renowned non-invasive drug-free treatment TMS at Harley Street and in Brentwood, we now offer Integrated TMS at The Carters Green Clinic, West Bromwich, Birmingham. Integrated TMS treats depression, chronic pain, addiction, migraines and many other conditions.

Carters Green Clinic is situated in North West Birmingham in the suburb of West Bromwich. Living Mind offer additional services including: blood testing, psychiatric assessment, and medical acupuncture. Our expansion of this service means we can treat those in an area where the number of people suffering from depression is growing.

Between 2015-2016, it is reported by the NHS that 165,194 people in the Birmingham and Black Country area were struggling with depression, whereas this number the year before was significantly lower at 146,568. The town of Dudley alone which is next to our clinic in West Bromwich has over 24,277 people suffering with depression - that’s one in ten adults. (Source)

We offer a unique approach to TMS through integration with complementary therapies such as mindfulness, talking therapy and to provide superior results. This allows the patient to practice mindfulness techniques at the same time as receiving treatment. Take a look at this article from The Metro where Dr. Arghya talks to Jen Mills about the treatment and how it can benefit those with depression.

TMS for the treatment of Major Depressive Disorder was approved by The National Institute For Health and Care Excellence (NICE) in 2015. On being approved as an effective treatment for depression, NICE noted that: 'the commentary from patients was positive and described significant benefits to their quality of life, including the advantages, for some patients, of being able to stop the use of oral antidepressant medications'. TMS is non-invasive as it does not involve any anesthesia, surgery or oral medication.

TMS isn't just effective for the treatment of depression, it can treat a number of ailments including:

• Anxiety Disorder

• Cocaine Addiction

• Anorexia Nervosa

• Chronic Pain

• Migraines

• Post-Traumatic Stress Disorder

• Obsessive Compulsive Disorder

• Depersonalisation Disorder

• Tinnitus

Integrated TMS is now available at The Carters Green Clinic, 371, High Street, West Bromwich alongside Living Mind's Harley Street Clinic, London and The Crushes Manor Clinic in Brentwood, Essex. It is situated on major bus routes to and from town including numbers 74, 79, 41, 44, and 47.

For more information or to book a free 15-minute consultation please contact us at info@livingmind.co.uk or call 07753 430829.

Integrated TMS Launches in Essex

After its success on Harley Street, we have decided to add Integrated TMS, to our services at Crushes Manor Clinic, Brentwood to answer the growing need for a drug-free treatment option for depression, chronic pain, migraines and other pain and mental health disorders. This treatment synergizes TMS (Transcranial Magnetic Stimulation) with complementary therapies such as mindfulness, talking therapy and reflexology to provide superior results.

TMS for the treatment of Major Depressive Disorder has been approved by The National Institute For Health and Care Excellence (NICE). On being approved as an effective treatment for depression, NICE noted that: 'the commentary from patients was positive and described significant benefits to their quality of life, including the advantages, for some patients, of being able to stop the use of oral antidepressant medications.'

TMS (Transcranial Magnetic Stimulation) is an effective non-invasive treatment which is a popular choice for a large number of people that do not respond to antidepressant medication or cannot tolerate their side effects. The treatment can be used alongside antidepressants and is generally pain-free. 

How does TMS work?
TMS works by delivering repetitive pulses of electromagnetic energy through a headpiece targeting specific parts of the brain which control mood. It is known that people suffering from depression have reduced blood flow, glucose metabolism and generalised activity in this part of the brain. Repeated stimulation of this area of the brain produces an anti-depressant effect on people who are suffering from major depression. rTMS does not require anesthesia and is not to be confused with Electroconvulsive Therapy which requires a general anesthetic and has unpleasant side effects. 

What does a treatment plan look like? 
A typical treatment plan for depression will involve 5 treatments per week for 2-6 weeks. The treatments are approx 30 minutes and results are often seen in the first couple of weeks. The price for depression treatment is £200 per session. A typical migraine treatment involves 3 sessions per week for 3 weeks and for chronic pain - 1-2 sessions per week for 2-6 weeks. Cost for chronic pain and migraine is £150 per session.  A bespoke plan is created for each client so it is hard to say how much the treatment will cost before consultation.

Integrated TMS will be available at Crushes Manor Clinic, Brentwood from September 2018 alongside Living Mind's Harley Street Clinic, London.

World Suicide Prevention Day - How Can We OVERCOME Suicide?

#WorldSuicidePreventionDay     #SuicidePrevention   #WSPD

Suicide is a phenomenon that we, as global citizens, ought to take responsibility to prevent. At present, globally approximately one million precious lives are lost every year by suicide. It is important to recognise that suicide is not a disease or illness itself, it is an unfortunate and irreversible manifestation arising out of several factors such as stressful life events or social circumstances. Triggers for this can come in a variety of different forms including finances, relationships, occupations etc. and can also come from a variety of mental illnesses such as Depression, Bipolar Affective Disorder, Addiction disorders, Eating Disorders, etc. 

Looking into the prevention of suicide, we need to look at the following things, both on their own and in combination with each other:

• Enabling and empowering people to recognise early signs of uncomfortable emotions

• Giving access to people to talk / ventilate their difficult feelings in particular hopelessness in a confidential yet supportive environment

• Installation of hope without being patronising

• Giving information of potential solutions or alternative approaches in life - whether it is finance, occupation, interpersonal relationships etc.

• Early access to effective treatment of mental illnesses in the most appropriate setting i.e community vs inpatient setting

• Access to crisis service - again it could be in relation to mental illness, social crisis, financial crisis etc.

• Increasing awareness that suicide is preventable

Some statistics about suicide in the UK from the Office of National Statistics:

• In 2017 there were 5,821 suicides registered in the UK, an age-standardised rate of 10.1 deaths per 100,000 population.

• The UK male suicide rate of 15.5 deaths per 100,000 was the lowest since our time-series began in 1981; for females, the UK rate was 4.9 deaths per 100,000, this remains consistent with the rates seen in the last 10 years.

• Males accounted for three-quarters of suicides registered in 2017 (4,382 deaths), which has been the case since the mid-1990s.

• The highest age-specific suicide rate was 24.8 deaths per 100,000 among males aged 45 to 49 years; for females, the age group with the highest rate was 50 to 54 years, at 6.8 deaths per 100,000.

• Scotland had the highest suicide rate in Great Britain with 13.9 deaths per 100,000 persons, and England the lowest with 9.2 deaths per 100,000.

Overall there has been a decrease in suicide rates in the UK which possibly suggests an increased awareness, more access to help and creating safer environments when it comes to specific interventions to prevent suicide. We are still a long way off as our aim should be 0 percent. 

As a society, both professionals and non-professionals can contribute to lowering these statistics in our own ways - at the end of the day we are all human.  Contributing toward this can be in many forms, whether it means being there for crisis periods, giving others the right information to access help, increasing resources to provide effective and safe treatments, and other social interventions.

Suicide is not a crime, it is often the tip of the iceberg  - lets start addressing the issues hidden in the iceberg  - aiming towards society with 0 percent suicide!

How does living by the sea affect your mental health?

The environment plays a significant role in an individual's emotional well being. A recent study1 from New Zealand and Michigan University concluded that 'residential exposure to blue space is associated with lower psychological distress'. There are a number of underlying factors that could explain the association between living by seaside and improvement of mental health conditions. Another piece of research from the University of Exeter showed similar results in the UK population, where a positive correlation is found between the proximity of residence to coast and ‘good health’. 

The seaside provides the perfect combination of water and open space. In general, watching or being in water facilitates relaxation. Let us now think of few of our special senses:

Often the sound and vision of water from sea or ocean is observed to lift our mood. On a biological level, this audio-visual stimulus incites our parasympathetic nervous system which helps us becoming calm and relaxed. The touch of sand in our hands or feet provides an improved sense of well-being. This is also likely to be a conditioned effect in our thought process as we tend to associate beach with harmony, peace, relaxation etc. The smell of the breeze in seaside leads to a state of relaxation. 

Living in wider open space often encourages us to engage in regular exercise whether it is gentle strolling along the seaside or running, jogging etc. along the beach. Exercise is already proven to increase the relevant neurotransmitters like serotonin and noradrenaline which are deficient in people who are suffering with Depression. Therefore it may not be a big surprise that people living closer to sea or ocean, tend to have a more healthy lifestyle.  

Staring at the blue water and horizon can induce a semi-meditative state in our mind. A number of mindfulness exercises are based on the sea or a beach environment. Having seen the effectiveness of mindfulness in stress, anxiety and depression at my clinical practice, I believe that the residents by the side of sea, ocean or river will have ideal opportunities to practise mindfulness-based meditation exercise either by sitting on the beach, or even watching the waterfront from their homes. Mindfulness not only is an effective treatment modality for anxiety, depression and stress-related disorders, but it also promotes our overall emotional wellbeing. 

Having a home by the sea side brings us closer to nature, unlike the city environment where bricks and mortars remain a constant repertoire.

As far as the evidence base is concerned, all we can conclude at this stage is that there remains a positive association between positive mental health and living closer to sea or ocean. Larger randomised controlled studies are needed to establish the cause and effect relationship between these two factors. 

1. Nutsford et al, Health & Place, May 2016, Vol 39, p: 70-78

Written by Dr Arghya Sarkhel - Consultant Psychiatrist, Living Mind
FRCPsych, DPM (Dublin), MSc in Neuroscience (London)

Dry January - Living Mind's Approach

As the new year passes, many will have given thought to going without alcohol in alignment with Dry January. From an emotional or psychological perspective, Dry January is about giving a closer look at our wellbeing and health. Staying dry from alcohol, smoking and unhealthy eating are the obvious choices although there are endless reasons to take part in Dry January.

According to research carried out at the Royal Free Hospital in London, 79% of participants who took part saved money, 62% had better sleep and more energy, and 49% lost weight. It seems like a no-brainer! Why wouldn’t you want to take part? Giving up these unhealthy habits for a month will help to instill a new sense of life into you and will undoubtedly leave you feeling refreshed.

During Dry January, you can also take the time to relieve yourself from thoughts and ideas which can compromise our functioning. How about instilling some self-compassion - regular practice fills our mind with kindness, pleasure, a sense of wellness and thereby hardly leaves any room for unhelpful thoughts to enter. Practising mindfulness helps to increase inner resilience along with physical activity and regular exercise helps to restore balance of neurotransmitters and helps maintain our 'dryness'.

At Living Mind, we can help you in a variety of ways to achieve and maintain this dryness, nourishing emotional health not just for January but for months and years to come.

Understanding Depression: What is it? How can you beat it?

Depression is a symptom that each of us can experience in our lifetime. But it is only considered as illness or disorder when low mood becomes pervasive and persistent irrespective of the possible triggers and when it compromises our social and or occupational functioning. It can affect our appetite, sleep and energy. Losing interest in day to day activities is one of the characteristic symptoms. Attention and concentration are also affected. 

We tend to form rather pessimistic views about almost anything about ourselves and the world around us. Blaming ourselves, excessive feelings of guilt, hopelessness and helplessness shape an individual’s thought patterns. Sometimes, depression is so intense and severe, we may have thoughts of deliberate self harm or even suicide. 

On a positive note, Depressive disorder is potentially a treatable condition. As it's aetiology is multifactorial i.e biological, psychological and social; the treatment plan should also address these domains.  At Living Mind, we look into these factors in a systematic manner. 

To diagnose, Consultant Psychiatrist, Dr Sarkhel goes through an extensive initial assessment, and makes sure that the diagnosis is accurate. This rules out any other possible physical illnesses that could mimic the  symptoms of depression. The patient is always involved while formulating a comprehensive care plan. 

At Living Mind, we have taken a step further.  Our emphasis is on bringing non pharmacological and pharmacological treatments together including complementary therapies. We offer Reflexology, Mindfulness and Acupuncture, advice on Lifestyle and Nutrition.  We have observed significant improvement with inclusion of these complementary approaches. 

Very soon, we will be able to deliver state of the art, drug free intervention for Depression in the form of repetitive Transcranial Magnetic Stimulation (rTMS). This is a groundbreaking, new biological approach which targets the part of the brain responsible for the symptoms of depression. It is safe, effective and does not need sedation or anaesthesia. This is widely practised in USA and Europe.  At Living Mind, rTMS can be combined with other modalities of treatment depending on needs and patient’s choices.

Our focus is making accurate assessment, exploring the different aetiological factors and delivering the most appropriate treatment suitable for the individual person. Our humble goal is Making Lives Meaningful!

For more information, please visit our website livingmind.co.uk/rtms/

What is Bipolar Disorder and how it affects the daily life of an individual.

Bipolar Mood Swings

One in every 100 adults will be diagnosed with Bipolar Disorder at some point in their life. 

Bipolar disorder can occur at any age, although it more common in younger age-groups. 3.4% of 16–24 year olds.

Bipolar Disorder, also known as Manic Depressive Illness, is a condition that affects a person’s mood, energy and activity level, which can swing from one extreme to another and varies widely among people. Some people may only have a couple of bipolar episodes in their lifetime and are stable in between depressive, manic or hypomanic episodes, while others suffer from a number of these episodes during their life.

People with bipolar disorder experience periods of depression and mania: Depressive period associated with very low and lethargic feelings while during mania period very high and overactive. 

Symptoms of bipolar disorder depend on the period/episode the person experiences.

Depression
 A person can be diagnosed with clinical depression before having a future manic episode (sometimes years later), after which you may be diagnosed with bipolar disorder.
During an episode of depression, the person may have overwhelming feelings of worthlessness, which can potentially lead to suicidal thoughts.

Mania
Sometimes it is hard to acknowledge for the patient that he or she is experiencing mania. It can feel very positive, as the person feels very creative and energetic, full of energy, ambitious plans and ideas. Losing interest in food and sleep, talking quickly and becoming annoyed easily are also common characteristics of this phase. People with this disorder may also experience symptoms of psychosis, where they see or hear things that aren't there or become convinced of the things that aren't true.

 There are 4 types of Bipolar disorder. 

Bipolar I Disorder is characterised by unrated manic period which generally lasts for about 3 to 6 months and can be accompanied by depression which can last for about 6-12 months. 

Bipolar II Disorder or hypomania is diagnosed when depressive episodes are more severe than manic ones. 

When mood swings become more regular, i.e. 4 in 12 months period, it can indicate that a person suffers from the third type of BD called Rapid Cycling. 

Cyclothymia is diagnosed when there are numerous periods of hypomanic and depressive symptoms which last for more than a year. 

Other Unspecified Bipolar or Related Disorder is diagnosed when mood swings are not as severe as those in the above mentioned types, but there is a possibility that it can develop into full bipolar disorder.

What causes bipolar disorder?

Although the exact cause of bipolar disorder is unknown, it's believed that a number of things can trigger an episode. For example, extreme stress, life-changing events, as well as genetic and chemical factors.

Stressful life events.  Some experts believe that a person may develop bipolar disorder if he or she experienced severe emotional distress or childhood trauma.

This could be because experiencing trauma and distress as a child can have a big effect on your ability to regulate your emotions.

Life changing period both positive and negative, such as: a relationship breakdown, money worries and poverty, traumatic loss are also believed to affect the quality of a person’s life.

Genetic inheritance. Researchers believe that environmental factors can also triggers symptoms of bipolar disorder. For most people, family members are an influential part of their environment as they grow up.

Brain chemistry research evidence suggests that bipolar symptoms can be treated with certain psychiatric medications, which are known to act on the neurotransmitters (messenger chemicals) in the brain. This suggests that bipolar disorder may be related to problems with the function of these neurotransmitters. 

Treating Bipolar Disorder
When it comes to the treatment of Bipolar disorder at Living Mind we not only look into pharmacological intervention, but with equal importance we explore and advise on lifestyle choices, stress management and social activities.

We aim to personalise the treatment for every individual to control the effects of an episode and help someone with bipolar disorder live life as normally as possible. Our approach is based on combining orthodox and complementary treatments such as Mindfulness, Reflexology and Acupuncture. 

There are several options for treating bipolar disorder that can make a difference. The following treatment options are available:

    •    medication, to treat the main symptoms of depression and mania when they occur;

    •    learning to recognise the triggers and signs of an episode of depression or mania;

    •    psychological treatment – such as talking therapy, which can help you deal with depression, and provides advice about how to improve your relationships;

    •    lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, as well as advice on improving your diet and getting more sleep.

It is believed that the best way to control bipolar disorder is to use a combination of different treatment methods.

We offer help and advice for people with a long-term bipolar condition. This includes self-help and self-management advice, and learning to deal with the practical aspects of a long-term condition.