Tag Archive | Patients

Watch Your Cognition…. What’s That Mean?

There are many stories of my patients to share here with you. But I feel it’s Important to know scientifically, what are we seeing here or what’s exactly being wrong with these patients.     Image

In simple words all these people having psychiatric disorders/psychological illnesses are having impaired or distorted cognition, hence the behavioral abnormalities or deviations.

How do we come to behave in a certain way? The answer is simple. It requires 3 steps = COGNITION, AFFECT & CONATION. This Triad is the Key of our Healthy ‘beingness’ within the societal or cultural Norms. Cognition is the way we perceive our world or a situation, it leads to formation of a belief to which an emotional valence is added that is; ‘Affect’; that in turn leads to a behavior or pattern of behaviors that is, ‘Conation’. When any of these components is impaired, then that may result in a disorder or illness.

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Now let’s see other definitions of ‘COGNITION’=

In science, cognition is a group of mental processes that includes attentionmemory, producing and understanding languagelearningreasoningproblem solving, and decision making. Various disciplines, such as psychology, philosophy, linguistics, and computer science all study cognition. However, the term’s usage varies across disciplines; for example, in psychology and cognitive science, “cognition” usually refers to an information processing view of an individual’s psychological functions. It is also used in a branch of social psychology called social cognition to explain attitudesattribution, and groups dynamics. In cognitive psychology, cognition is typically assumed to be information processing in a participant’s or operator’s mind or brain.

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Cognition is a faculty for the processing of information, applying knowledge, and changing preferences. Cognition, or cognitive processes, can be natural or artificial, conscious or unconscious. The sort of mental processes described as cognitive are largely influenced by research which has successfully used this paradigm in the past, likely starting with Thomas Aquinas, who divided the study of behavior into two broad categories: cognitive (how we know the world), and affective (how we understand the world via feelings and emotions). Consequently, this description tends to apply to processes such as memoryassociationconcept formation,, languageattentionperceptionactionproblem solving and mental imagery.

Cognitive deficits are highly prevalent in many psychiatric/psychological illnesses, including psychotic & mood disorders like schizophrenia, depression, bipolar disorder, and schizoaffective disorder, anxiety disorders, personality disorders, alcohol & drug addiction etc. Numerous studies suggest that patients with severe psychiatric disorders have impaired sustained attention, impaired thought process and memory . A wide spectrum of  ‘EXECUTIVE DEFICITS’  ie. Deficits or deficiencies of the executive functions of brain like Planning, Problem solving, Recognizing the patterns, Scanning, Differentiating, Vigilance, Decision making & Performing goal-oriented tasks have been described along with diminished verbal fluency and information processing speed. There has been an Increasing recognition that psychosocial prognosis,( that is outcome with betterment from the illness) is directly related to the severity of the cognitive impairments.

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When evaluating cognitive function in routine practice, clinicians usually compare the patient score against the norms in the general healthy population to ascertain whether the patient cognitive function is preserved or impaired. In such case, comparison allows to determine the distance to what a particular patient separate from the mean score. Nevertheless, in many cases the practitioner refers the patient to a specialist for formal recognition when his/her performance is unusually low compared with patients with same condition. Particularly when additional etiologies (in addition or replacement of schizophrenia) responsible for the high cognitive impairment observed is suspected. Concerning this point, patient score should be compared with the norms belonging to subjects with the same health condition to assess how the different is the patient scoring related to his/her population of reference. This information can improve the clinician´s understanding of patient´s cognitive strength and weakness, put a patient’s cognitive abilities into perspective for their diagnosis, and facilitate multidisciplinary treatment decisions.

THE NEXT STORY WILL BE CONTINUED SOON….

A Girl With Swirling Mood…!

Welcome to the new post about my patients, their behaviors, the science behind it, their striving to lead life functionally prudent, sustaining through their stressful obstacles, sometimes failing, sometimes bouncing back or sometime just living in silence struggling secretively. There is always a pattern of their psychological problems or disorders. Each pattern is unique & hence it becomes interesting & challenging to come forth with tailor-made treatment plan.

Ok.. so here is a story of Simran, a 23 yrs old female working in MNC. I remember it was her fourth meeting with me & she was on medications for her depressive episodes, lack of energy & inability to sustain the decisions she would make. On the other hand she was giving excellent results at her company. It seemed her work was the only domain where she was actually dissociating herself from her mundane life. She really loved her job. Was paid handsomely as well. Still her family was very much worried about her. The question is WHY?

Then I interviewed her father. As per his narration, Simran was a very sweet girl since childhood. Everybody would adore her for her intelligence & playfulness. She was never alone & would be always surrounded by friends or relatives. School was her  comfort zone. She would always excel in exams & apparently there  was never a complaint from her school. As she grew, reached her adolescence & things started changing. She started showing tremendous emotional upheavals. She started getting more & more thoughtful, at least she appeared so. She, when went to college, which she managed somehow studying at the same time struggling with her emotional turmoil, the things worsened and one day she broke down. She was found sitting on a bench in college campus bunking all the lectures. One of her friends was searching for her when it seemed she was sitting preoccupied there for hours together in despair. Her friend tried to probe her as to what had exactly happened. And she looked at her friend with blank look as if she was physically not present in that moment. Her friend shook her and she startled, tears started flowing down her cheeks then she screamed & started crying uncontrollably.  Her friend took her back home & explained to her parents what had happened. The parents were aware about her psychological changes but this was a shock for them as now it was evident that now her emotions are not only restraining to her own self but behaviorally showing up. Here it was the scenario where her life was getting out of control of herself & parents were helpless. They tried their best to sympathize with her & make her speak her mind out. But here her intelligence became an obstacle.. She said her mind was running on four different tracks and she couldn’t decide how to handle it causing a lot more anxiety & low mood.

And the day came when she appeared in my cabin. I remember I was just relaxing in my chair with my hands resting on side bars with my pen lying over my desk. “ Hello doctor “she whispered which I could catch & curiously looked at her. What I saw was a young good looking girl in her twenties approx, looking at me with a blank face with her hands loosely held aside. “ Hello” I said and offered her a seat. “ Yes, How can I help you? Start from your name.”

“I am Simran. I’m pursuing my  bachelor’s degree in science. I love my college and studies & wanna take up a job in corporate sector. I have a friend of mine who is HR in one of the companies & I know I can get a job there.” “What’s a problem then?” I continued. “ You know I don’t feel that confident & I doubt I could achieve that.” “ How are you doing otherwise, I mean in your daily life” She paused for couple of minutes.. “It’s difficult to stay focused and I just can’t enjoy my daily affairs. I feel at times time should seize so that I can gather myself to go ahead as I did couple of months ago. What’s happening to me doctor?” Here I paused for a moment to give her time to speak more. She looked completely drained out with her cloths & grooming barely managed to be little presentable. “ Simran, I think you have lost your confidence & self esteem seem is low. As your age is concerned you are having a lot of hormonal changes occurring in your body. You are low in mood & that’s because the physiology of your brain  is changing. Your energy levels have gone down as you are not able to cope up with these changes. You are a strong woman as your past history is concerned.” “ No I am not a strong woman. If I was then why I couldn’t cope up with my life?” She interrupted me. “ I can understand the agony you are in. But see many a times it’s just not in your hand what goes wrong with your inner world. You are intelligent too as you are able to understand that these things are happening to you. I’ve seen many young ones just not getting what’s happening with them. They either blame someone or their life and just go on with illness they are harboring and lead a very unhappy life. I can see you are preoccupied with anxiety & worry about your daily & future life, but I can also see some insight in you that can help you understanding your mood problem better. There is always a mood beneath your aspirations & anxieties. So your main problem now is you are probably developing a mood disorder which we can tackle for sure.”

Then I explained her what is ‘Mood Disorder’ and started her on antidepressants & mood stabilizers. She was not showing any suicidal ideation or any psychotic features. So she was by far manageable at this time. I completed a psychotherapy session and gave her some tasks to boost her self esteem. “ So all the best. We will meet after 15 days Take care & call me if required.” I concluded & she left with much hope & reassurance. The next two meetings were good. Her father accompanied everytime she came to me. Afterall he also required some counseling & psycho education as to what’s happening with his daughter. Her mother never came but called me to tell she is improving.

And the day came when our 4th meeting was nearing. I got a frantic call by her mother. “ Doctor she has been behaving weird from last week. I was about to call you but thought she is trying to cope up with her tensions but today in office she just poured her meal on a colleague, she is talking a lot about owning that office. Recently her appraisal was there & she got promoted but now they have escorted her to home & have told to take a leave for a while. What to do?” “ See me as soon as possible” I advised thinking she is having the mood swings & the trigger was her appraisal. Let’s see when she comes.

It was Friday, almost all my appointments were over. I was thinking of week end. Quite engrossed I was scribbling on paper in front of me. And door of my cabin was opened by Simran in a force as if she was wanting to see me urgently… “ HI DOC..!” “How are you?” and she started singing a song..” I have a dream, a song to sing, to help me cope with everything”  It was a number by ABBA I recollected. I let her do what she wanted to do or say. I wanted to see where she resolves. Somehow I could grab her attention and asked her to sit. She denied and said she was feeling exuberant and enjoyed standing, probably she would start little dancing as well, I thought.  What I was seeing was a perfect mania, the highest mood swing on mood & energy continuum. I tried to communicate with her in vain. What could I do now? I looked at her father who was totally depressed and full of worrying & concerned. Simran was totally unaware of the reality.

I looked at her & then pick my pen & wrote a prescription for her increasing a dose of mood stabilizer & decreasing antidepressant. At that point I just could do that. She might need an admission. But let’s try this as her family support system was good. I reassured her father again as he now knew the pattern of her illness. Then she had gone..

I got up from my chair. Now I had some other plans for week end. I climbed down my clinic. Open a door lock of my car. Started driving and guess what I was humming the song ‘ I’ve a dream, a song to sing, to help me cope with anything” I just smiled at myself.

Now the next meeting with Simran was awaited…!!