Psychosocial Impact of Multiple Sclerosis: Challenges and Solutions

Psychosocial Impact of Multiple Sclerosis: Challenges and Solutions

Adil Ali   16 May

Multiple sclerosis (MS) is a disease of the central nervous system characterized by an immune-mediated attack on the myelin and oligodendrocytes, resulting in inflammatory lesions, astrocytic scarring, and axonal loss. It is estimated that more than 300,000 people in the United States have MS, and there is some epidemiologic evidence that the incidence is increasing in women. Symptoms of MS are wide ranging in nature and severity and may or may not include disturbances in gait, balance, vision, bladder and/or bowel function, sensation, sexual function, psychiatric status, and cognition. The course of MS is highly variable, although the expected life span is decreased only by a few years.

Psychosocial Challenges

MS is an unpredictable, potentially disabling disease. Although outcomes can be estimated in large epidemiologic studies and follow-up studies from large clinical trials, it is very difficult to predict long-term outcomes for a given individual. This uncertainty represents a challenge to the coping capacity of persons with MS. There are a number of specific psychosocial challenges, including clinical depression, anxiety, sexual dysfunction, cognitive changes, and demoralization and grief associated with MS-related losses.

Clinical Depression and Grief

Depression is the most common psychiatric disorder in MS. Major depression is a serious psychiatric disorder that is distinguished from minor depression, discouragement, and grief by the persistence, severity, and number of symptoms.

According to the Diagnostic and Statistical Manual for Mental Disorders, 4th edition, text revision, a diagnosis of major depression requires an individual to have a sad or irritable mood most of the day and nearly every day for at least 2 weeks. In addition, there must be 4 other symptoms present during this time, which may include:

• anhedonia (loss of interest in the things one is usually interested in and capable of doing);
• feelings of worthlessness or excessive/inappropriate guilt;
• significant increase or decrease in appetite with weight gain or loss;
• change in sleep patterns (waking up 2-3 hours earlier than usual, or increase in number of hours of sleeps each day, by several hours or more);
• recurrent thoughts of death or suicidal feelings and thoughts;
• fatigue;
• attentional impairment; and
• sexual dysfunction.

Some of the symptoms associated with major depression are also associated with MS. Consequently, it's important to differentiate between social withdrawal associated with depression (due to loss of interest in usual social activities) and the inability to socialize in one's usual manner due to MS symptoms or impairments. If the persistent and severe mood changes that characterize major depression are not present, such symptoms are most likely due to MS.

Major depression among those with MS is consistently related to a loss in the perceived quality of life and is associated with decreases in self-care, including adhering to disease-modifying medications in MS, the failure of which may lead to long-term disease morbidity. In contrast to clinical depression, normal grief tends to occur after a loss (eg, recent exacerbation that produced permanent neurologic impairments). Grief is not associated with significant sustained impairments in function and is not typically associated with anhedonia.

In MS there is increased suicidal risk. One study that evaluated death records in MS found that suicide rates in MS patients were up to 7.5 times greater than in the general population. These findings are supported by other studies that show that suicidal ideation and lifetime suicidal intent among individuals with MS were approximately 18% and 28% respectively.

Evidence from several studies suggests that many MS patients who experience major depression are not treated or are significantly undertreated for their depressive symptoms. The latter studies highlight the need for increased systematic screening in MS for depression. Decreases in depression in MS patients receiving treatment for depression have also been associated with decreases in in-vitro antigen-specific and non-antigen-specific TH1-mediated interferon-gamma production, which may reflect an underlying inflammatory component associated with major depression in MS.

Because numerous studies estimate that between 36% and 60% of MS patients will experience an episode of major depression at some point during their lifetime, it is imperative to screen for depression during visits. Recommendations for screening have included the use of self-report scales, such as the Beck Depression Inventory II, Patient Health Questionnaire, and Chicago Multiscale Depression Inventory. One study found that simply asking the following questions was able to detect the presence of a major depressive episode with high sensitivity and specificity:

During the past 2 weeks, have you often been bothered by feeling down, depressed, or hopeless?
During the past 2 weeks, have you often been bothered by little interest or pleasure in doing things?
Several randomized trials in MS have indicated that depression can be treated successfully with a variety of antidepressant medications, cognitive-behavioral therapy, or both. The relative effect sizes of antidepressant therapy and cognitive-behavioral therapy on depression in MS have been found to be similar, so individuals can be offered a choice. However, in patients with severe depression, mental health professionals consider antidepressant therapy the first line of treatment, with psychotherapy serving as an important adjunctive therapy. There is some evidence that offering both antidepressant treatment and psychotherapy will confer improved long-term outcomes over either treatment alone.

Anxiety

The prevalence rates of clinically significant symptoms of anxiety in MS vary from 12% to 90% with most studies indicating 30% to 50%. Risk factors for anxiety disorders in MS patients have included female sex, time since diagnosis, comorbid diagnosis of depression, limited social support, and disability status. MS patients report significantly more anxiety than do healthy controls, with anxiety symptoms associated with fatigue, sleep disturbance, problem-solving deficits, pain, and disability status. It is possible that screening assessments or targeted interventions can be put into place based on the findings about prevalence rates or predictors of anxiety.

The point-prevalence of clinically significant anxiety was found to be 25% in one study, which was 3 times the rate of clinically significant depression in the sample. Females were significantly more anxious than males, and anxiety comorbid with depression was associated with increased thoughts of self-harm, more somatic complaints, and greater social dysfunction.

Social anxiety has also been found to be common. In one study, 30.6% of serial clinic patients met criteria for social phobia (fear and avoidance of social situations) on the Social Phobia Inventory, which was not associated with severity of disability. The presence of social phobia was associated with reduced health-related quality of life. To date, no treatments for social phobia in MS have been reported in the literature.

Injection phobia is also fairly common in MS. This is a problematic symptom, as most disease-modifying therapies are delivered by injection and require a schedule of either subcutaneous or intramuscular injections ranging in frequency from daily to weekly. Patients with injection phobia often select a family member/friend/other to conduct the injection, which is strongly linked to poor long-term adherence.

Cognitive-behavioral therapy for the treatment of injection phobia in MS patients was successful in one small sample pilot study published to date. In this study, 8 patients who could not self-inject due to phobia were able to do so within 7 treatment sessions, and 7 of 8 patients continued to self-inject at 3-month follow up. Given poor long-term adherence associated with non-self-injection, it is advisable to treat injection phobia early.

The MS literature cites the treatment of generalized anxiety with psychopharmacologic agents, including benzodiazepines and SSRI's. To date, one randomized clinical trial of short-term (6 weeks) cognitive-behavioral therapy reported clinically significant reductions in anxiety (and comorbid depression) with treatment (cognitive-behavioral therapy combined with progressive deep-muscle relaxation training adapted for patients with MS) relative to non-treatment (MS clinic services only). This study also reported that treated patients showed increases in coping behaviors that were associated with better emotional management and problem-solving behaviors. More recently, a 1-year, open-label trial of escitalopram in women with relapsing-remitting MS reported reduced risk for relapses associated with stressful life events; results will need to be replicated in larger samples with better controlled studies.

Cognitive Dysfunction in MS

Prevalence studies report that 43% to 65% of persons diagnosed with MS have objective cognitive impairments on neuropsychological tests. The prevalence rates range widely, in part due to sampling and other study design issues. Studies that focused on community samples of MS patients and excluded clinic patients report lower rates, while studies that sampled clinic patients report higher rates.

The types of cognitive impairments identified in MS are wide ranging and have included slowed processing speed, impairments in verbal and visual memory, various aspects of attention, visual-spatial judgment, verbal fluency, and executive function. Cognitive impairments can occur very early in MS, and several studies have identified impairments in patients with clinically isolated syndrome before meeting the criteria for clinically definite MS. The severity of cognitive impairment in MS also ranges widely, mirroring the variability of other clinical symptoms. Most patients have multifocal impairments with relatively good preservation of premorbid language abilities and some aspects of reasoning skills. Occasionally the severity is extreme, with the obvious presence of a dementia. Natural history studies are few but have indicated that patients identified with a focal cognitive impairment are likely to have progression of that impairment longitudinally and to develop additional impairments.

Cognitive impairments have been found to be highly associated with employment problems, social problems, difficulties in activities of daily living, and quality of life. The presence of a cognitive impairment cannot be predicted from the overall severity of disability, as numerous studies report the relationship between them to be quite modest. Cognitive impairments correlate better with a variety of MRI metrics, including T2 lesion load, T1 "black hole" lesions, cerebral atrophy, diffusion tensor imaging, and diffusion-weighted imaging studies. Third-ventricle width has been highly associated with the presence of cognitive impairments, probably due to the relationship between proximal thalamic and other structures that are highly related to cognitive function. Overall, studies have indicated that measures of atrophy account for more variance in cognition than does lesion burden.

The literature on the treatment of cognitive impairments is relatively sparse. Symptomatic treatment studies are inconclusive or largely negative. There are few large-scale, well-controlled, or well-designed studies on cognitive rehabilitation to date, although preliminary studies have found that verbal learning and memory can be improved objectively. Evidence from substudies of clinical trials of disease-modifying therapies indicates that cognitive impairments can be prevented or delayed. Studies of beta-interferon 1a and 1b found fewer cognitive deficits at the end of trials in patients randomly assigned to active treatment arms, although substudy data from a clinical trial of glatiramer acetate did not find differences between groups. Differences in results between disease-modifying therapies must not be overinterpreted, however, because these trials were not designed or powered to evaluate cognitive outcomes as either primary or secondary endpoints. Future studies that are designed and powered for that purpose will shed better light on the impact of disease-modifying therapy on cognition.

This article was originally published in Medscape by authors: Frederick W. Foley, PhD, faculty and disclosures

The motherlode of 'mother love' chemicals

The motherlode of 'mother love' chemicals

Adil Ali   14 May

The feel-good brain chemical dopamine appears to play a role in the development of a healthy bond between a mother and baby, a new study suggests.

Dopamine may motivate moms to do more for their children because it makes mothers feel better, researchers said.

And this may not end when babies get older. "It is very likely that the processes we observed between mothers and their infants continues through the life span as their children grow," said study co-author Lisa Feldman Barrett. She's a psychology professor at Northeastern University in Boston.

"It may also be the case that this process supports people as they provide care and nurture to one another in close relationships," she added.

Previously, research has linked mother-baby bonding to the hormone oxytocin.

In this study, the researchers wanted to learn more about what goes on in the brain that helps motivate mothers to take care of their babies.

"Newborns are completely helpless and rely on their parents for survival. A mother must figure out if her infant is hungry, tired, uncomfortable, or lonely to provide appropriate care. So mothers must be highly motivated to care for their infants," Barrett pointed out.

Previous research in rodents has suggested that the brain chemical dopamine is key to bonding between mothers and infants, said study lead author Shir Atzil. She's a post-doctoral fellow at Massachusetts General Hospital in Boston.

"Rat mothers who are highly motivated to care for their pups secrete more dopamine in response to their pups. But the chemical basis of mother-infant bonding in humans was still a mystery," Atzil said.

For the new study, the researchers enlisted 19 mothers (aged 21 to 42) and their babies (aged 4 months to 2 years). The investigators video-recorded the mothers interacting with their babies to see how they got along. Then the researchers had the moms undergo brain scans as they watched videos of their babies or other babies.

The brains of the mothers secreted more dopamine when they watched their own babies, Atzil said. Judging by the videos of the mothers and babies interacting, she said, "mothers who secrete more dopamine were more likely to provide optimal care for their infants, were more sensitive to their infants' needs, and adjusted their own behavior to meet those needs."

Atzil said the research shows how important dopamine is in optimal maternal caregiving. Conversely, the study also gives clues to what might be going wrong in mothers who don't or can't properly care for their babies.

"Mothers who were less responsive to their infants also secreted less dopamine when watching films of their infants. This provides us with hints as to what goes wrong in a mother's brain when she is struggling to provide for her infant," Atzil said.

What does this mean in the long term?

Barrett said the researchers suspect that the brains of the infants themselves develop at a higher level when their mother does a better job of caring for them.

"An infant is not born with a fully developed brain," she said. "Its wiring develops over a number of years, and normal brain development requires responsive caregivers. Infants who do not receive the normal care they require are more likely to do poorly at school, have lower achievement levels, and are at risk for mental and physical disease as adults."

What about fathers and others who take care of babies who aren't their biological mothers? They may also feel a dopamine boost from taking care of an infant, but future research is needed to know for sure, Barrett said.

Paul Zak, founding director of the Center for Neuroeconomics Studies at Claremont Graduate University, said the study results may seem obvious. Of course women who bond more with their babies "have stronger responses in the brain to their infants in areas that make it feel good to care for them and in areas associated with emotional connection," he said.

Still, he said, the study authors connected all this to how the mothers bonded with their babies in a way that's "important and convincing."

Zak pointed out, however, that the study is small so it may not apply to all mothers.

And he added that it's not clear if "great moms are born that way or become that way," since the study can't show whether some mothers are primed for better bonding before their child is born.

The study was published online Feb. 13 in the Proceedings of the National Academy of Sciences.

More information: Lisa Feldman Barrett, Ph.D., professor, psychology, Northeastern University, Boston; Shir Atzil, Ph.D., post-doctoral fellow, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston; Paul Zak, Ph.D., chairman and professor, economics, and founding director, Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, Calif.; Feb. 13, 2017, Proceedings of the National Academy of Sciences, online. www.pnas.org/cgi/doi/10.1073/pnas.1612233114

Journal reference: Proceedings of the National Academy of Sciences via Medical Xpress

Child molestation is not a joke: Hadiqa Kiani on Yasir Hussain's slip of tongue

Child molestation is not a joke: Hadiqa Kiani on Yasir Hussain's slip of tongue

Adil Ali   02 May

The tasteless joke made by the show’s host Yasir Hussain on the 5th Hum Awards when Ahsan Khan won the award for his role in critically acclaimed serial Udaari, left many furious.

While Jibran Nasir slammed the Lahore Se Aagay actor’s crass humour on Twitter, Hadiqa Kiani also gave her two cents on the matter.

The Dupatta singer, who was present at the award ceremony, took to Twitter to expressed her feeling about the very delicate issue Udaari showcased and how Yasir’s joke ruined it all.

She wrote, “I guess I was lucky enough to have left the award show before this disgusting joke was cracked. This is exactly what’s wrong with out society, people think it’s okay to stoop so low and speak in such a foul manner. I’m not putting the blame exclusively on Mr Yasir Hussain, but on everyone in the room who sat in that room and laughed along… you all deserved to be questioned.”

“Staying silent in the face of rape culture is bad enough…but to laugh along and encourage it? Despicable. God, when especially honouring Ahsan and the whole Udaari team for shedding light on such an issue…all of it was just tainted by that joke. So, in case you need to be reminded, child molestation is not a joke, it is a serious crime that violates BASIC human rights. Disgusted,” she further added.

Here’s the original post:

#HumAwards2017 #YasirHussain #RapeCulture #Pakistan pic.twitter.com/f26IxbABrk

— Hadiqa Kiani (@Hadiqa_Kiani) May 1, 2017

Muniba Mazari, too condemned the crude joke and posted:

Speechless!!! pic.twitter.com/azDGTYC91m

— MunibaMazariOfficial (@muniba_mazari) April 30, 2017

Child Labour and its Dismal Psychological Implications

Child Labour and its Dismal Psychological Implications

Adil Ali   30 April

The psychological effects of child labour in third-world countries are considerably intense as compared to the rest of the world due to poverty, low literacy rates and improper conduct with children.

Psychological effects of child labour are as severe as its physical ones but unfortunately, they received attention only at the end of the twentieth century.

Depression, hopelessness, shame, guilt, loss of confidence and anxiety are some of the horrible emotional effects of child labour, leading to a high risk of mental illness and antisocial behavior. To mitigate the psychological effects of child labour, proper awareness and education in societies are the utmost requirement.

Child labour is a very commonplace problem which has moved from a matter of regional and national anxiety to international discussion and possibly needs global influence and policy imposition. In order to overcome this enormous problem of our times, one must fully understand the factors which result in child labor, its consequences, and how to prevent it without harming affected children.

The problem of child labour significantly depends on culture and geographical location e.g. the younger generations of third-world countries are the main victims. According to UNICEF statistics, about one-third of the child population in developing countries do not even complete four years of education, culminating in circumstances of child labor (UNICEF, 2008).

An international labour organization (ILO) approximation shows that approximately 180 million children in developing countries are completely embroiled in child labour, and in Pakistan specifically, 12.5 million children were laboring.

One basic reason that pushes children to work is the low socio-economic condition of their family. Many times, their work ends up unpaid and compensated for only by their boarding and lodging. Child labour creates many physical hazards to child health but the most devastating effect is in fact psychological.

Children who become involved in different labor-related works have no opportunity to develop their natural psycho-social health; about 40% of child labourers are affected by abnormal psychological growth (Jordan, 2012).

Both the parents and children are often not aware of the scale of hazards to which these children are exposed. In some cases, the parents do know but can nnot find another alternative to create a source of income. To mitigate child labour, efforts must be made to create an environment which makes it easier for every child to go to school and prevents their parents from pulling out them before they can finish their basic education.

During the 19th century, the term “child labour” was introduced in Britain with the implication that the children should not be dragged to work (International Labour Organization). The International Labour Organization (ILO) defines child labour as an activity other than study or play carried out by a person, paid or unpaid, under the age of fifteen.

In 1989, the United Nation (UN) set the full range of children’s rights at the Convention on the Rights of the Child as well as the two ILO conventions, the Minimum Age Convention (No. 138, 1973) and the Worst Forms of Child Labour Convention (No.182, 1999). These rights were to protect children from exploitation and from any sort of work which would be harmful to their health (physical, mental, moral, spiritual or social).

The criteria set by ILO as ‘hazardous work’ was, ‘work that exposes children to physical harm, sexual exploitation, and psychological effects.’

As previously stated, the main reason that pushes children to work is the poor economic condition of their families. In most cases, a child’s family cannot even afford basic food and housing, let alone basic education for children. There are numerous reasons behind those families’ poverty, including national, traditional, historical and cultural.

Other reasons which may lead children to work include family breakdown (e.g. divorce) or a stigmatized attitude towards girls e.g. girls are discouraged from studying at school and propelled into adulthood at a much younger age than boys, either by work or an early wedding.

The employers are interested in hiring children because they are cheap and obedient. Inadequate laws and lack of education provide further opportunities to society to drag children into work.

In general, studies show that children working in factories and mines operate machinery, use chemicals, and are exposed to high or very cold temperatures, which ultimately endangers their lives. Also, children are used to direct life-threatening situational works such as sex work, as soldiers in wars, drugs and smuggling.

One particular example from the United State of America is that the victims of occupational accidents are aged 15-17 twice as often as they are adults (UNICEF, 2011). The lack of personal experience and emotional and physical maturity puts their lives in dangers.

Until 1998, most national and international studies focused their attention on the physical effects of child labour. However, children are more prone to psychological and social risks as compared to physical (reported by Leng and Mayers in 1998). Due to a lack of physical and mental maturity children are always appointed to the lowest grades and levels of their work.

Another study comparing psychological and behavioral problems between the working and non-working children shows that children’s development in the working case is almost seized. The study, conducted by Matalqa in 2004 in the streets of Jordan, showed that working children have lower levels of adaptive skill, lesser physical health and demonstrate unwanted social behaviors.

Child labourers using obscene words, exhibiting high emotions with low creativity and relying on excess use of cigarettes and alcohol was also one of the conclusions reported by Dmour in 2006. Child trafficking, which comes under the worst forms of child labour, has lasting psychological effects on the victims.

Children separated from their families, homes and communities continuously encounter sexual abuse and emotional trauma. Depression, hopelessness, shame, guilt, nightmares, loss of confidence, low self-esteem and anxiety are the appalling consequences faced by these trafficking children.

These pessimistic indications influence their senses and put them in a cycle of self-blame. Psychological abuse tremendously affects self-concept, personal goals, and relationships with others and seriously damages emotional well-being. Sexually-abused children are more likely to experience offensive emotional outcomes such as symptoms of post-traumatic stress disorder (PTSD) and suicide.

Children exposed to these numerous experiences of victimization are at high risk of mental illness. Adults who experience such forms of child labour are likely to resort to violence and display antisocial behavior (Gordon Betcherman, Jean Fares,Amy Luinstra, and Robert Prouty, July, 2004).

To mitigate child labour, a coordinated set of multiple actions with well-meaning intentions is of the utmost importance. For example, to address the root causes of child labour, we must prevent children from dropping out of school and discourage parents from putting their children in the labor market.

It is necessary to construct appropriate and concise laws and policies which not only ensure child protection but are also understood by the parents in such a way so as to compel them to obey those laws.

In conclusion, child labour is a social and moral problem which damages society constantly. To understand and mitigate this problem, one should first fully understand the reasons which push children into the labor market, then the outcome of child labour and its impact on societies, and the need to explore appropriate approaches to bringing back children from labour work to schools.

Around the world, different reasons for child labour have been pointed out but the main reason stands as poverty. Child labour has numerous consequences but the psychological impact is the most long-term problem and needs attention on an emergency basis, especially in third-world countries where people lack awareness of it.

Existing studies about the psychological effect of child labour report that victims of child labour face depression, lack of trust, hopelessness, low levels of confidence, shame and guilt, low self-esteem and anxiety, and may grow up to be adults who also pose certain risks to society. For a better future and protective society, several coordinated actions must be taken to mitigate child labour.

Governments as well as responsible organizations around the world must provide an environment which makes it easier for poor people to keep their children in school (at least until primary education) and create awareness in societies about child labour and its outcomes.

Courtesy: JPMS Medical Blog / Dawn News

References:
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Betcherman, G., Fares, J., Luinstra, A., ( July 2004), Child Labor, Education, and Children’s            Rights: Gordon Betcherman.
Dykman, R., McPherson, B., Ackerman, P., Newton, J., Mooney, D., Wherry, J., et al. (1997).     Internalizing and externalizing characteristics of sexually and/or physically abused             children. Integrative Physiological & Behavioral Science, 32, 62–74.
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‘Depression rising alarmingly in Pakistan's urban areas’

‘Depression rising alarmingly in Pakistan's urban areas’

Adil Ali   07 April

KARACHI: The Pakistan Medical Association on Thursday said depression in the country was much higher than the world average while its incidence was alarmingly greater in urban centres than rural districts.

Declaring ‘Depression’ the theme of World Health Day this year, the PMA said mental problems in the country were growing, particularly in big cities.

“Around 35.7 per cent citizens of Karachi are affected with mental illness, while 43pc people in Quetta and 53.4pc in Lahore are also affected,” said Dr Qaisar Sajjad, secretary general of the PMA in a statement.

Globally, said the PMA, depression affected 20pc of people while in Pakistan it was more serious with an estimated 34pc of the population suffering from it.

“Both genetic and environmental factors play chiefly in its pathogenesis.”

World Health Day will be observed today (Friday) across the world.

The PMA said it took it as an opportunity to highlight the issue and create awareness of the disease among the people of Pakistan.

Depression is a common and serious medical illness that negatively affects how one feels and the way one thinks and how one acts. “Fortunately, it is also treatable,” said the PMA official.

“Depression causes feelings of sadness and/or a loss of interest in activities one enjoyed once. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.”

Dr Sajjad said a number of factors could augment the chance of depression. Past physical, sexual, or emotional abuse could cause depression later in life; and certain medications could increase risk of depression.

“Depression may result from personal conflicts or disputes with family members or friends. A family history of depression may increase the risk. Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can lead to depression.”

He said depression affected the cities here more, which was in conformity with what was happening in the rest of the world’s cities, as the urban life alienated a person more than rural settings.

“Apart from these causes, power shortages, non-availability of potable water, unemployment, traffic jams, intolerance, insecurity, and law and order situation are also factors which increase depression day by day in our society.

“Even the way our channels broadcast breaking news increases depression.”

Experts said depression symptoms could vary from mild to severe and included feeling sad or having a depressed mood, loss of interest or pleasure in activities once enjoyed, changes in appetite (weight loss or gain unrelated to dieting), trouble sleeping or sleeping too much, loss of energy or increased fatigue, increase in aimless physical activity [hand-wringing or pacing] or slowed movements and speech [actions observable by others], feeling worthless or guilty, difficulty in thinking, concentrating or making decisions, and thinking about death or committing suicide.

Prof S. Haroon Ahmed said the prevalence of depressive disorder in Pakistan was more than 40pc with women accounting for 57.5pc while more than a quarter of men in the country were depressed.

The PMA said as depression was the root cause of many mental disorders and sickness, there was a need to develop a policy to tackle anxiety and depressive disorders on a national scale.

“Steps need to be taken to overcome the dearth of qualified psychiatrists in the country.”

Published in Dawn, April 7th, 2017

“TAME” – Tremor Acquisition Minimization Device by NUST Students

“TAME” – Tremor Acquisition Minimization Device by NUST Students

Adil Ali   04 April

The anti-tremor device namely “TAME” by the students from NUST – National University of Sciences and Technology, won the 2016-2017 Design Challenge held by the Stanford Center on Longevity in USA.

What are Tremors?

Mostly affecting the hands, a tremor is a type of neurological disorder where a person experiences unintentional, shaking movement. Besides hands, it can affect other body parts like the head and voice too.

There are many types of tremors depending upon the nature of the involuntary movements and their sources. They are categorized as follows:

Resting tremors – These tremors occur when your muscles are resting, and when you move those muscles the tremors may disappear or become less noticeable. Example, Parkinson’s disease.

Action tremors – These tremors occur when you are intentionally or purposefully moving the muscle of the body part, such as, when you are writing, pushing a button, or you are reaching for an object. Example, multiple sclerosis. Action tremors are again of two types – postural tremor, and kinetic or intention tremor.

Idiopathic tremors – This is a type of tremor that has developed spontaneously or due to an unknown cause. Example, Idiopathic Dystonic Tremor.

Common treatment for tremors:
Conventional forms of treatment include medication and physiotherapy to help the patient strengthen their muscles and reduce the intensity of the tremors. But now there might just be a ray of hope for these patients who might be able to go back to normal life with the help of this device called TAME.

What is TAME?

Short for tremor acquisition and minimization, it is the World’s First wearable device for pathological tremor categorization and real time suppression. Pathological tremors are the most common neurological movement disorder which cause involuntary rhythmic shaking of various parts of the human body, most commonly the hands.

Around 280 Million people worldwide have lost their independence due to these tremors. They have to depend on others to perform the simplest tasks in life like eating, drinking and even dressing themselves. But unfortunately even after such medical advancements the scientists are far from even understanding the root cause of the disorder let alone find a cure for it.

A team from SEECS, NUST comprising of Awais Shafique, Hooriya Anam and Muhammad Arsalan Javed under the supervision of Dr. Syed Muhammad Raza Kazmi, are working on a breakthrough technology called TAME which is a noninvasive Tremor Suppression device that can give back the control and ease to the tremor patients to perform their routine tasks without hindering their voluntary movements.

TAME uses a technique called Functional Electrical Stimulation in which low voltage electric current is used for muscle actuation and to generate movement.  Motion censors are used to detect how the tremor is moving in the arm and the device in turn, generate a counter movement for suppression of the tremor and to stabilize the hand.

It is a complete solution for the treatment and diagnosis of Pathological Tremor patients in the form of an intuitive, user friendly and easily manageable wearable device connected to cloud storage for easy management and sharing of diagnosis files. The team competed in BITA 2015 with the most brilliant innovations from Industry and Academia in Pakistan and received the Best I.T innovation Award 2015 along with PKR. 1 Million.

A team from SEECS, NUST comprising of Awais Shafique, Hooriya Anam and Muhammad Arsalan Javed under the supervision of Dr. Syed Muhammad Raza Kazmi, are working on this breakthrough technology called TAME.

Watch the following short video to learn about the project:

Are you raising nice kids? A Harvard psychologist gives 5 ways to raise them to be kind

Are you raising nice kids? A Harvard psychologist gives 5 ways to raise them to be kind

Adil Ali   25 March

Earlier this year, I wrote about teaching empathy, and whether you are a parent who does so. The idea behind it is from Richard Weissbourd, a Harvard psychologist with the graduate school of education, who runs the Making Caring Common project, aimed to help teach kids to be kind.

I know, you’d think they are or that parents are teaching that themselves, right? Not so, according to a new study released by the group.

About 80 percent of the youth in the study said their parents were more concerned with their achievement or happiness than whether they cared for others. The interviewees were also three times more likely to agree that “My parents are prouder if I get good grades in my classes than if I’m a caring community member in class and school.”

Weissbourd and his cohorts have come up with recommendations about how to raise children to become caring, respectful and responsible adults. Why is this important? Because if we want our children to be moral people, we have to, well, raise them that way.

“Children are not born simply good or bad and we should never give up on them. They need adults who will help them become caring, respectful, and responsible for their communities at every stage of their childhood,” the researchers write.

The five strategies to raise moral, caring children, according to Making Caring Common:

1. Make caring for others a priority

Why? Parents tend to prioritize their children’s happiness and achievements over their children’s concern for others. But children need to learn to balance their needs with the needs of others, whether it’s passing the ball to a teammate or deciding to stand up for friend who is being bullied.

How? Children need to hear from parents that caring for others is a top priority. A big part of that is holding children to high ethical expectations, such as honoring their commitments, even if it makes them unhappy. For example, before kids quit a sports team, band, or a friendship, we should ask them to consider their obligations to the group or the friend and encourage them to work out problems before quitting.

Try this
• Instead of saying to your kids: “The most important thing is that you’re happy,” say “The most important thing is that you’re kind.”
• Make sure that your older children always address others respectfully, even when they’re tired, distracted, or angry.
• Emphasize caring when you interact with other key adults in your children’s lives. For example, ask teachers whether your children are good community members at school.

2. Provide opportunities for children to practice caring and gratitude

Why? It’s never too late to become a good person, but it won’t happen on its own. Children need to practice caring for others and expressing gratitude for those who care for them and contribute to others’ lives. Studies show that people who are in the habit of expressing gratitude are more likely to be helpful, generous, compassionate, and forgiving—and they’re also more likely to be happy and healthy.

How? Learning to be caring is like learning to play a sport or an instrument. Daily repetition—whether it’s a helping a friend with homework, pitching in around the house, or having a classroom job—make caring second nature and develop and hone youth’s caregiving capacities. Learning gratitude similarly involves regularly practicing it.

Try this
• Don’t reward your child for every act of helpfulness, such as clearing the dinner table. We should expect our kids to help around the house, with siblings, and with neighbors and only reward uncommon acts of kindness.
• Talk to your child about caring and uncaring acts they see on television and about acts of justice and injustice they might witness or hear about in the news.
• Make gratitude a daily ritual at dinnertime, bedtime, in the car, or on the subway. Express thanks for those who contribute to us and others in large and small ways.

3. Expand your child’s circle of concern.

Why? Almost all children care about a small circle of their families and friends. Our challenge is help our children learn to care about someone outside that circle, such as the new kid in class, someone who doesn’t speak their language, the school custodian, or someone who lives in a distant country.

How? Children need to learn to zoom in, by listening closely and attending to those in their immediate circle, and to zoom out, by taking in the big picture and considering the many perspectives of the people they interact with daily, including those who are vulnerable. They also need to consider how their decisions, such as quitting a sports team or a band, can ripple out and harm various members of their communities. Especially in our more global world, children need to develop concern for people who live in very different cultures and communities than their own.

Try this
• Make sure your children are friendly and grateful with all the people in their daily lives, such as a bus driver or a waitress.
• Encourage children to care for those who are vulnerable. Give children some simple ideas for stepping into the “caring and courage zone,” like comforting a classmate who was teased.
• Use a newspaper or TV story to encourage your child to think about hardships faced by children in another country.

4. Be a strong moral role model and mentor.

Why? Children learn ethical values by watching the actions of adults they respect. They also learn values by thinking through ethical dilemmas with adults, e.g. “Should I invite a new neighbor to my birthday party when my best friend doesn’t like her?”

How? Being a moral role model and mentor means that we need to practice honesty, fairness, and caring ourselves. But it doesn’t mean being perfect all the time. For our children to respect and trust us, we need to acknowledge our mistakes and flaws. We also need to respect children’s thinking and listen to their perspectives, demonstrating to them how we want them to engage others.

Try this:
• Model caring for others by doing community service at least once a month. Even better, do this service with your child.
• Give your child an ethical dilemma at dinner or ask your child about dilemmas they’ve faced.

5. Guide children in managing destructive feelings

Why? Often the ability to care for others is overwhelmed by anger, shame, envy, or other negative feelings.

How? We need to teach children that all feelings are okay, but some ways of dealing with them are not helpful. Children need our help learning to cope with these feelings in productive ways.

Try this
Here’s a simple way to teach your kids to calm down: ask your child to stop, take a deep breath through the nose and exhale through the mouth, and count to five. Practice when your child is calm. Then, when you see her getting upset, remind her about the steps and do them with her. After a while she’ll start to do it on her own so that she can express her feelings in a helpful and appropriate way.

Courtesy: Washington Post / Image Design by FreePik

People Who Seek Mental Health Help Choose Therapy Over Medication

People Who Seek Mental Health Help Choose Therapy Over Medication

Adil Ali   24 March

It may be because patients don’t understand how these drugs work.

People who seek professional help for mental health conditions like depression or panic disorder are more likely to accept and follow through when talk therapy is prescribed, rather than medication, according to a new meta-analysis of previous research.

The report, published by the American Psychological Association, found that patients were as much as three times more likely to refuse or not complete their recommended mental health treatment if it took the form of psychotropic medicine, such as antidepressants, instead of psychotherapy.

The effect was most dramatic for people with depression and social anxiety, who were twice as likely to refuse medication, and people with panic disorder, who were almost three times as likely to do so.

The analysis consisted of 186 studies on more than 17,000 patients, 8 percent of whom refused the recommended treatment plan. In addition to treatment refusal, the studies measured whether or not the patients completed their plans.

The study authors say that the analysis did not take into account the reasons why patients refused or dropped out of their treatment plan but they have some theories. Patients may feel that therapy takes a more in-depth approach as a way to tackle the complexities of mental health disorders, according to the researchers.

Some patients may also struggle to understand how medication works or what it does in the brain, causing them to avoid it.

“Psychotropic medications may help a lot of people, and I think some do see them as a relatively easy and potentially quick fix, but I think others view their problems as more complex and worry that medications will only provide a temporary or surface level solution for the difficulties they are facing in their lives,” co-author Roger Greenberg, a professor at SUNY Upstate Medical University, said in a statement.

It’s worth noting the analysis didn’t find a significant difference or rate of dropout for patients who took medication in combination with therapy. Experts say that a combination of therapy and medication is often the most successful way to treat mental health issues. Psychotherapy has been found to help people manage the environmental factors that could exacerbate a condition while medication can help with the physiological, chemical effects in the brain.

Again, the authors didn’t research the motivations of the patients who refused medicine, so it’s difficult to conclude why they made their choice, but there’s no denying the stigma facing those who take mental health medication is prevalent. It’s a stereotype mental health advocates are working to dismantle in the public eye.

In the end, keeping patients involved and engaged in treating their condition is preferable to their abandoning the effort entirely. And ultimately, seeking any treatment is better than not seeking it at all.

Courtesy: Huffington Post