National Addictions Conference- Cardiff 2012

It was a matter of pride for hosting the Royal College of Psychiatrists Addictions Annual Conference in Cardiff this year. It is the first time that it was hosted in Cardiff. The feedback of the conference had been very good spanning from the topics covered to the minute details of the venue, the organisation and the hospitality. Dr Tony Jewell’s opening set the Welsh flavour and that carried on throughout. It was timely for the press release regarding the minimum pricing of alcohol to be released just before the conference as well. Listening to the news today, I picked up that the national alcohol consumption is being reported as going down with more health concerns, rising taxes and increased price to buy alcohol and based on that it was being argued that ‘minimum pricing’ should not be a strategic direction.

Most importantly, it is clear that pricing does have an impact on levels of consumption and given all the evidence on price- elasticity, the ‘marketing- mix’ used by the alcohol industry, the impact of availability and licensing, in my opinion, it becomes even more important to endorse ‘minimum pricing’.

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Psychological Trauma and Brain- Part 2

Carrying on from the previous post one can argue whether PTSD or traumatic symptoms following trauma are ‘disorders of memory’ or ‘disorders of forgetting’. The virtue of understanding these concepts lies in understanding what happens in the brain when memories are laid down. So let me spend sometime on that.

What we know from knowledge of memory systems in our brain is that during exposure to the traumatic incidents, the ‘action systems’ are set in motion and settle down to adaptation as one comes through to the other side of the traumatic event. The memories of the event initially are ’emotionally charged’ and get stored in a specific part of the brain. Now as the processing is complete- a narrative quality to the memory is established and it gets stored as yet another complete memory (almost like a photograph in an old picture album). Whenever one needs to access it, it becomes almost a case of going back to the album, picking the photo and describing it as a story in the broader timeline of an individual’s life. A personal example could be demonstrative here- when I learnt to ride my bike without stabilisers, I can recollect from my life’s picture album a memory where my brother, a cousin and dad supported me from behind and I rode round and round in circles in the back garden of my cousins house in Watford and suddenly realised that on my last round I was riding on my own with two of them standing and just watching me ride whilst my dad was in the middle of the garden stopped at the spot where he had left me on my own.

A negative event, similarly, gets processed and on complete processing gets a narrative quality. One could go and access that memory as well without getting unduly distressed or even if does experience a subjective distress, it is but just a memory in the story of life. However, people suffering with sequalae of trauma are not able to process that event completely and the emotional aspects of that event get stored as the main memory with the primitive systems being in a state of ‘chronic activation’ thus restricting the processing from happening, and hence they are ‘not able to forget’ the event and life becomes pre-occupied and organised around the traumatic event. This is seen in various clinical presentations in Psychiatric practice.

So how can psychiatric treatments work? Working in my capacity of a private psychiatrist in Wales, I use both to pharmacological treatments including anti- depressants, Prazosin and others along with Eye Movement Desensititation and Reprocessing (EMDR). The idea behind EMDR is the facilitation of complete processing of the traumatic memory thus helping the establishment of the narrative quality and being able to move on in life.

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