Bipolar, ADHD, Emotional Instability or something else- What is it that I have?

If the above title hits home, then you are not alone. In routine clinical practice, I often get referrals that are primarily for mood swings and unstable emotions. With this, the common psychiatric condition that springs to most people’s mind is one of Bipolar Disorder. However, upon detailed assessments of mood, emotional regulation and other cognitive functions, quite often people are reassured that all mood swings do not necessarily equate to Bipolar Disorder. Adult ADHD can be mistaken and hence missed along with a Personality Disorder.

Some links here might help clarify Bipolar Disorder. But a comprehensive assessment of developmental history, mood symptoms, emotional instability by a trained professional is very important to arrive at a proper diagnosis, leading on to appropriate management.

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Gambling Myths- 2

Problem Gambling is not a problem if the individual engaged in Gambling behaviour is able to afford it.

Affordability has got no association with Problem Gambling. When the relationship to gambling takes priority over other areas of life eg spending more time in Gambling and less time with significant others to fulfil the roles such as the role of a spouse, partner, parent, employee etc. that becomes Problem Gambling.

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Being Assertive- Part 2

First of all wishing everyone a very Happy New Year 2014!

And to keep it short and crisp there are some good resources to start using. This podcast gives an introduction of principles of increasing confidence and being more assertive.

Once you have seen this, then you can also use this workbook by Dr Chris Williams.

More on some techniques to practice in the next post.

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Naltrexone in Alcohol Dependence

Alcohol Dependence is still a major cause of concern throughout UK. The issue of ‘minimum pricing’ is up for debate (probably for my next blog) but this post is about the use of Naltrexone in Alcohol Use Disorders. One of the mechanisms that Alcohol gives a pleasurable effect is through our Brain’s Opioid System. Naltrexone is an Opiate Blocker which is used for maintaining abstinence from Opiate Dependence and is licensed in UK in its Oral form. Several studies across the world have been done to demonstrate efficiency of other forms- Depot Naltrexone and Implants as well (most suited for motivated individuals).

Naltrexone has also been used over many years for Alcohol Use disorders for people in recovery, as it blocks the Opioid System, thus causing less pleasurable effects with drinking. The British Association of Pharmacology- Substance Misuse Guidelines have endorsed its use as well. Since it is not licensed in UK for this indication, only specialists in Addiction Psychiatry would generally prescribe this. Naltrexone has beneficial effects- one mechanism of ‘pharmacological extinction’ with Naltrexone and drinking alcohol may be possible but in my experience as a Consultant Psychiatrist in Wales, it has not caused a total extinction of the effects but has certainly helped people with reducing the amounts of alcohol they consume, the number of heavy drinking days and have reported that Alcohol does not affect them the same way as without the Naltrexone. One other effect is that the cravings to drink (which is a significant factor for relapse to heavy drinking) have reduced with Naltrexone.

The Naltrexone depot is a useful formulation which has its effect up to a month and aids concordance along with sustaining its effects. Vivitrol (US Preparation) is already licensed as a treatment for Alcohol Use Disorder in the USA. A similar preparation is available in UK, albeit in the Private Sector only.

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Keeping positive amidst life’s illusions

triangle Pictures, Images and Photos

Sometimes, when things are not going the way they were planned and the reality seems distorted, think of the Kanizsa Triangle which can solve some of the dilemmas- have a closer look at the white triangle which seems as the most prominent and white with distinct edges. And in reality, there is no white triangle- it is an optical illusion. Perhaps life’s situations can present bit like the triangle with reality being distorted or overcast by illusions- illusions that we make ourselves!

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