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| HEALTH TRIBUNE | Wednesday,
November 27, 2002,
Chandigarh, India |
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Diagnosing & curing mental ailments Kidney transplantation-IV INFO
CAPSULE
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Diagnosing & curing mental ailments THE World Health Organisation considers mental illness as one of the most important problems of the day. Unfortunately, even today most mental disorders remain undiagnosed and untreated. Lack of awareness and ignorance contribute to the chronicity of mental illnesses. In my long practice of 25 years — dealing with these patients and their families — I have made the following important observations regarding major psychiatric disorders which may prove beneficial to patients and their families: (a) A number of patients are brought to a doctor months and years after the onset of the illness. It is often observed that as the time passes, an untreated case may become more and more chronic and complicated, and it takes a longer time to respond. (b) In a majority of the cases, patients are taken to faith healers and various non-professional agencies, and significant time is lost in the process. (c) Many patients and their families do not adhere to the treatment. They discontinue the psychiatric treatment for various reasons. It has also been observed that as the initial improvement appears, the family discontinues the treatment against medical advice. (d) Today, modern or allopathic medicine provides the best hope for the vast array of serious psychiatric disorders. Alternative systems of medicine and methods like yoga, meditation and naturopathy also provide good relief to patients having mild-to-moderate problems. I have commonly observed that families are unable to take a decision about which medical system they should approach. Many patients keep on shifting from one system to another, leading to chronicity and complications. For the awareness of the general readers I am giving a list of important symptoms of major mental disorders which can help them to identify the illnesses: (i) Behaviour changes: These are important changes to appear in case of psychiatric disorders. Patients of depression and schizophrenia become slow and withdrawn. They tend to isolate themselves from their friends, colleagues and relatives. They start losing their interest in day-today activities. Many patients shut themselves in their homes for months and years together. Schizophrenia patients show changes like self-laughing, self-talking, self-muttering, undue suspiciousness, and odd behaviour. Their talk may become irrelevant and incoherent. They may become hostile and paranoid against others. Without any reason they become highly critical of others. (ii) Emotional abnormalities: Emotions become dry in schizophrenia patients. Their concern for the problems of their families and friends evaporates. They appear quite detached from the social life and start living in their own world of thoughts and imageries. Inappropriate emotions are commonly observed in schizophrenics. Paranoid patients show intense suspiciousness and hostility against others. They accuse others for their failures and problems. (iii) Perceptual abnormalities: Psychotic patients commonly suffer from perceptual abnormalities like hallucinations and illusions. Schizophrenics commonly experience auditory hallucinations. They feel they are hearing voices of other people. Others pass commentary about them. (iv) Cognitive disturbances: Memory, intelligence, orientation, concentration and judgement get affected in patients suffering from organic brain disease. Pre-senile dementia and senile dementia are the common examples where cognitive functions get disturbed. Patients of chronic depression also show changes in cognitive functions. Many depressed persons report of falling memory but in these cases, following recovery, they regain their memory functions. Cognitive disturbances are also reported by chronic schizophrenic cases. (v) Thinking abnormalities: Many patients with psychiatric illnesses feel that their thoughts are going haywire. They appear losing control on their thinking process. They may become pathologically preoccupied with their bodily functions. Paranoid patients may feel that everyone has turned against them and is plotting to kill them. They may feel that others may poison them. Depressed patients become negative and pessimistic. Conclusion: The above mentioned disturbances are some of the most important symptoms of psychiatric ailments and can help us to identify a vast majority of such cases. Early diagnosis and treatment are essential for successful handling of most such cases. The writer is a Ludhiana-based psychiatrist.
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Kidney transplantation-IV THE question also arises as to what price society should fix for the donation of a kidney. So far, it has been completely arbitrary, subject to bargaining between the donor and the middleman, dependent on the level of awareness of the donor about the value of a kidney, and the ability of the middleman to bully the donor. Should it be based on the financial status of the recipient, the donor, the urgency of the recipient’s need or the degree of “matching” between the donor and the recipient? Should the price be decided at an auction where the kidney would go to the highest bidder? Once an “easy” way of making money becomes evident to a poor person, it will be a temptation for him to get more through donations from other members of the family. Several husband-wife donor pairs have been found reported in medical journals as well as lay Press. There are reports of “communities” or “kidney-villages” where several households have members who have donated their kidney for money. In these communities, a person not willing to sell his kidney would come under increasing social pressure to follow this course of action, whatever his personal beliefs. We believe that the very idea of a potential recipient scouting the market for the cheapest kidney and a potential donor looking for the recipient who would pay the most, fundamentally degrades human values. The freedom of an individual must be circumscribed by the needs of society and by the greater good of social order and morality. The Human Organ Transplant Act proposes both fine and a jail term for the people involved in the act of buying or selling organs for transplant. The authorities have, however, failed miserably in enforcing this law. Till date there is not even one instance where anyone has been convicted under this Act. It needs to be emphasised that though India has gained notoriety as the cradle of paid transplants, commercialisation in transplantation is not solely an Indian phenomenon. Reports indicate that at various times it has been practised in South America, the Philippines, Egypt, Iran, Iraq, and Turkey with an active involvement of professionals from affluent European, Middle-Eastern and other Asian countries. The debate on the place of payment in transplantation will certainly go on until poverty, the cause that gives rise to such a situation, is eradicated. The balance of access and distribution puts the rich always as beneficiaries and the poor at the giving end. This can be considered analogous to the rich, being able to buy their way out of a national duty, or to get a job for a consideration, to the detriment of an equally deserving person from a socially disadvantaged group. Relaxation of moral standards in any country opens the door to the slippery slope of corruption, exploitation and degradation. The time has come for amending the Human Organ Transplant Act, 1994, and modifying the “clause of unrelated donors offering organs on emotional grounds”. False affidavits stating that the donation was being made only on humanitarian grounds due to love and affection are freely submitted with the help of middlemen and touts. It is indeed surprising that these donors suddenly develop affection for recipients whom they met just before the transplantation. The Authorisation Committees clear the donations on the submission of affidavits without any verification of the background. In order to enlarge the pool of living related donors, second-degree relatives such as cousins, nephews, nieces, aunts and uncles should be included in the near relative category. In several instances, marriages of convenience have taken place and spouses have been forced to donate their kidneys under pressure. The government must rise from its slumber. After enacting the Transplant Act in 1994, the Government of India and the state governments have been mute spectators to this trading activity. Society must debate thoroughly the whole issue of transplantation so that a reasonable solution can be found. Dr Chugh is the Emeritus Professor of Nephrology and Dr Jha is an Associate Professor at the PGI, Chandigarh. (Concluded)
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INFO CAPSULE NEW YORK: A vaccine in its first clinical trials has proved 100 per cent successful in preventing cervical cancer, raising hopes of removing the lethal disease from the face of the earth. If further tests ear out the results, the vaccine could be available in five years for the sexually transmitted disease which kills 2,2500 and attacks 4,70,000 women annually. According to researchers, the vaccine kills the virus which causes the disease. It uses the safer part of the virus to make the body produce antibodies against the cancer. PTI Impatience causes high blood pressure
NEW YORK: A sense of urgency and impatience might impress your boss but it is bad for your blood pressure. Researchers have found a correlation between having a sense of time, urgency and impatience (TUI) and increased risk of developing high blood pressure or hypertension. “The higher the tendency of time urgency and impatience, the higher the risk of developing hypertension,” researcher Dr LeJingh Yan told a television network. “This applies to young adults who are impatient and do not have enough time to finish what they need to do”, he said.
PTI
Satellite-linked device for the blind
LONDON: A new hand-held device called “Victor Trekker” will soon help blind and partially-sighted people to find their way around cities and know more about the places they visit and things happening around them. The device, linked to a satellite in space, tells the users which road they are walking down, which shops and buildings are near them and when they are coming up to a junction, reports BBC. Yvan Legace, Vice-President of VisuAid, a Canada-based company that developed the device in association with the Royal National Institute for the Blind (RNIB), said it would make the visually handicapped more independent.
ANI
Arthritis of spine
WASHINGTON: A new US survey has revealed that many people suffering from arthritis of the spine are diagnosed very late, which often puts them at increased risk for permanent spinal damage. According to experts, ankylosing spondylitis (AS) typically strikes people in their twenties. The disease can progress to the point where the spine fuses, making it difficult or impossible for a person with the disease to move the spine or neck. The survey included more than 2,000 people with AS and was commissioned by the Spondylitis Association of America. It found that 61 per cent of the people with AS had symptoms by the time they were 29, and that many had to see a number of doctors before they received a correct diagnosis.
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