IMPHAL MONDAY 13 OCTOBER 2014 IMPHAL MONDAY 13 OCTOBER 2014 Depression of later life (old age) Dr K Shatibala Devi Today's Thought That which does not kill us makes us stronger. Friedrich Nietzsche. Child labour and education for girl child Central points of Nobel prize Children and education. One a child labour activist and the other a champion for children’s education. Kailash Satyarthi and Malala Yousafzai. One an Indian and the other a Pakistani. In naming the two as the winners of this year’s Nobel Peace prize, the Nobel Committee has succeeded in making a powerful statement particularly at this point of time when tension between the two countries is running palpably high. Not that the award will help to ease tension between the two countries which have been at war at least three times, but in naming the two as the co-winners of the Peace prize, a significant statement has been delivered. Nothing much in common between the two but central to the two characters is the never say die spirit towards a cause they believe in. Protecting the rights of children and championing the cause of education for the girl child. Heroes in many sense of the term, but not something which have come easy to them. If Satyarthi had to resign from a comfortable job to dedicate his life towards children’s rights for well over three decades, Malala on the other hand had to fight not only the bullet which nearly snuffed out her life but also a repressive mindset which is still caught in a time warp that education is not meant for the girl child. Takes more than mortal courage and guts to speak out for something as universal as education for the girl child. Again not easy to give up a cushy job and embark on a mission so that the rights of children are not violated, especially in a country like India which has seen and experienced the scourge of child labour for decades. Understandably the spotlight is on Satyarthi and Malala but for the Nobel Peace prize to have any real meaning and substance, it would do a whole lot of good to mankind, if the lessons learnt from the decision of the Nobel Committee are not allowed to be lost. Central to the decision to bestow the award on the two characters is the underlying need to take up the cause of children, wherever they may be. Protecting the rights of children and championing the cause of girl education should not and cannot be viewed only through the prism of awards. Recognition and acknowledgement for the work they have done is no doubt important and the Nobel Committee has done its job but more important would be for the world as a whole to understand the significance of the award. And certainly working and contributing towards the causes which they have taken up will go a long way in underlining the point that the rights of all children and education of the girl child is fundamental to humanity. Children’s rights and education for the girl child should be accorded the primacy that they deserve. It would be in the fitness of things too if the world, especially India and Pakistan see the Peace prize as something more than the rights of children and education for the girl child but the need to maintain peace and harmony between two nuclear power neighbours. Etc.. etc... Alarm rings on how uptake if existing prevention options for anal STIs and HIV Bobby Ramakant, Citizen News Service (CNS) Dr Ishwar Gilada, President of AIDS Society of India, and a noted HIV physician who was among the first few medical professionals who responded to HIV care when first case was diagnosed in India, was moderating this panel discussion at AIDS 2014. "Unsafe sexual practices among transgender women were rare at that time when I did my study with Hijra community in 1983-1984. We could never have imagined then that Hijra community will come to International conferences. People used to laugh at them when transgender people used to come to JJ Hospital for care. I started a special clinic in OPD from 2pm-4pm in 1983 at JJ Hospital for transgender people. Back then we used to write male or female H (Hijra) as sex, but it took decades for government to finally recognize the third gender." Dr Badri N Saxena, Chair of Microbicides Expert Group of Indian Council of Medical Research (ICMR) said (via web link) that there is hardly any choice under national HIV or STI prevention programmes except barrier method such as male condoms (female condoms are limited to very few targeted interventions or other social marketing initiatives). Few more options are available in private healthcare sector such as vaginal creams. Dr Saxena pointed out that there are 30 million episodes of STIs annually. Dr Saxena also advocated for a need-based phased introduction of PreExposure Prophylaxis (PrEP) to provide another option to MSM people who might benefit from expanded range of HIV and non-HIV STI prevention options. 'Invisible' key population Dr RR Gangakhedkar, Deputy Director, National AIDS Research Institute, ICMR said (via web link) that according to the mapping estimates there are 0.412 million MSM in India. Overall HIV prevalence rate among MSM is 4.4% and TGs is 8.8% (2011). There are targetted interventions (TIs) for both key populations in India offering STI services, linkage with HIV testing and care services, condom promotion, peer education, outreach, among others. There are over 201 MSM TIs that include over 37 communitybased organizations-led TIs. Coverage as per the MSM population estimates is over 70%. Additionally, a program named "Pehchan" is also being implemented. 20 TIs are exclusively for transgender people. Dr Gangakhedkar added: Though the overall coverage is Depression is a very common mental illness and about 1 in 7 people experience a depressive episode during their lifetime. Depression usually have a recurrence or even a chronic course thereby leading to significance impairment in psychosocial functioning which account for the fourth leading course of disability. The economic cost can be staggering, spent on medical treatment and also loss of productivity and premature deaths worldwide. Depression affects suffered by women then in men and reasons implicated are hormones, more psychosocial stressors suffered by women and childbirth. Depression occurs before age 20yrs in 40%, 50% in age group 20yrs to 50yrs and 10% after 50yrs of age. Depression illness disorder in later life is linked to poor health which adds to the many medical illness common in the age. How do we know one has depression? From time to time one experience low mood, sadness depending on the situations and events. But in depression there is a qualitative change in mood which is intense and uncomfortable, associated with other physical symptoms of appetite and sleep, problem and in many areas of functioning. There is sense of emptiness and sadness and others will see them as off mood or tearful. Interest and pleasure in all activities will be diminished with lack of attention and concentration, feeling dull and lethargic. There may be poor appetite or increase in appetite leading to weight loss or weight leading to weight loss or weight gain and also difficulty sleeping either of increased sleeping and sleepiness. Restlessness or retardation both mentally and physically. Weakness, fatigue and loss of energy is another complaint. Inability to take decision and sense of worthlessness, hopelessness, inappropriate guilt feeling and recurrent thought of death, desire to suicide or making attempt to end life. The above mentioned symptoms if present most of the day, almost every day for a period of two weeks affecting previous level of functioning can be diagnosed as having depressive illness. Types of depression in later life may be mild depressive disorder, moderate depression and severe depression. In mild depression the symptoms are felt as distressing but can symptoms felt as distressing but can continue to function in life relatively normal. In moderate type symptoms are subjectively more distressed than in mild form and though they can maintain their daily life function, they struggle with considerable difficulty. However in severe depression there is marked distress and are often agitated or retarded and their ability to function in their usual role is severely limited and impaired. Presenting symptoms 1. Age-related factors: Late life depressive disorders in older people usually complain less of sadness than younger adults and more concerned on physical health. Hypochondrial complaints are the mainstay with several unexplained pain syndromes such as aches and pain of joints, back pain, chest pain, abdominal pain or musculoskeletal pain of any part of the body. Other symptoms present are insomnia, sense of loneliness, forgetfulness anxiousness, tenseness, changes in personality traits behavioural disorder, inappropriate concern of bowel movement, disturbance in appetite, late-onset abuse of alcohol etc. since the complaints are mostly physical rather than emotion, with minimal expression of sadness, and diagnosis of depression may be missed. 2. Psychosis: Psychotic symptoms are likely to occur more higher in late-life depression. They usually present with delusion (false, fixed belief) of having severe medical illness, delusion of guilt, poverty and worthlessness. When severely depressed, patients may have delusion that his organs are damaged and that they are no more alive. Auditory hallucinations or hearing of voice that is not present of saying bad and negative things about them. There is frequent self murmuring and self-talking, withdrawal, anger and being hostile as they feel others are out to harm him or poison him. 3. Apathy and amotivation: Apathy and lack of motivation is another symptom seen in late life depression where there is lack of emotional response and goal-directed activity. They feel fatigue, lethargic and absence of drive, indifference poverty of thought and action. These are seen more so after a stroke, head injury, neuronal degeneration (dementia) 4. Suicide: Older people with depression are at risk of committing suicide. Elderly rarer/ take overdoses of medicines as a means to commit suicide and the means differ from culture to culture. In the western and pain killers are common and U.S shooting by firearms among older depressed men are quite frequent. Suicide attempts among older population are not to draw attention or suicide threat or by accident. Their intent ar; serious. What are the suicide risks in later life depression? The general factors include those who had past suicide attempt or episode of self-harm, male gender living alone who have no social or family support who had experienced negative life events. Presence of longstanding stressors which may be environmental or financial and presence of chronic medical conditions including cancer. Elderly who misuse and abuse alcohol are also at higher risk of committing suicide. Illness factors such as mental illnesses (mood disorder, psychosis, substance use) and who have sleep problems, agitation restlessness, guilt feelings, hopelessness and low self-esteem and hypochondriacal pre-occupations are a major risk factor that can propel to ending their life. There are also specific behaviours such as suicide intent or plans expressed, altering wills and severe self-neglect The type of thought impairment and its significance in late-life depression What lead to late-life depression? In late life depression genetic cause is less but it can be precipitated by negative life events such as loss(near relatives, financial etc) depression is more common in women at all age particularly who are widows and divorces mostly due to long standing stress and difficulties faced by women. Elderly who have had past history of persistent depressions alcohol dependence and schizophrenia are move at risk. Physical, medical ill-health and handicap with poor social support, poverty, loneliness and who have personality problem can also lead to depression in late-life. Medical conditions and drugs that may cause organic depressive disorder. Medicals conditions illnesses include diabetes, thyroid disorder, hypercalcaemia, anaemia and sub nutrition. Others include heart disease, stroke, brain tumors, dementia, Alzheimer’s disease, Parkinson’s disease SLE, cancer of lung and pancreases, syphilis, AIDS and other chronic infections. Drug that arc implicated in causing depression are: 1. Antihypertensive (beta-blockers, reserpine, digoxia, mifedipine, calcium channel agents etc) 2. Steroids 3. Analgesics (opioids) 4. Antiparkinson 5. Neuroleptics, benzodiazepines 6. Alcohol, interferon Common life events and chronic stress that causes depression Life events: 1. Death of spouse, offspring 2. Separation 3. Acute physical illness, life threatening medical, surgical illnesses 4. Sudden displacement or homelessness 5. Major financial crisis 6. Conflict, quarrel with family or friend and even 7. Loss or death of a pet. Chronic stress: 1. Declining health and inability to move around leading to dependence 2. Impaired memory, hearing and vision 3. Any major family problem and marital difficulties 4. problems at work place, socio-economic decline and retirement 5. Being a career of chronically ill and dependent family members. Other associated illness with depression in late life Other illness associated with late life depression cognitive impairment - depression is highly prevalent in dementia and chronic depression is a risk factor for dementia. Stroke and mood disorder After a stroke in about 20% of patients develop depression within the first year (3-6 months) Post stroke emotionalism Emotional changes following a stroke are common and effect 20%- 25%. In emotionalism there may be sudden crying or laughing without any reason or warning. Depressed mood and emotionalism can occur together. Coronary heart disease In 15% to 20% of patients who had coronary event (myocardial infarct or heart failure etc) depressive symptoms occur further, presence of depression is a risk for cardiac diseases and early death With age diabetes type 2 h Diabetes With age the development of type 2 diabetes increase and diabetes is associated with development of depression. Research shows that presence of depression in diabetes patients increase the risk of complications and poorer blood sugar control. (To be contd) The writer is Asst. Prof Psych - Dept, JNIMS. Our society: A treacherous society Birkarnelzelzit Thiyam The chaste meaning of a house and a home has a chasm. A house is made up of bricks and stones i.e. with hands but a home are made up with hearts. A home consists of a colossal and a comely family. And we know a small family is a happy family. A small family is like a bird flying in the sky, the right wing stands for the father and the left wing stands for the mother. And the feathers, rather acting like their children i.e. gives them hope to fly. Sometimes when the right wing and the left wings lack co-ordination the bird deviates from the path. And when they cleaved, the bird no longer flies. In order not to let the bird fall, the two wings must be like our eyes which understand each other so well. They always streams down tears together when they cry. They laugh together when they are happy. They closed together and opened together. Due to some execrable trend which is really excruciating, the above heavenly lines have become theoretical. It is well known fact that movies are the mirror of our society. But some daft people have translated it so well that, movies have rather became a turncoat for this society. In “yaiskhul pakhang angao ba” the director tries to bring out the fact that studies and love cannot go together and we have to negotiate the love for becoming a deferential per- son. But on the other hand some cretin puts all the dialogs and acting of hero and heroine, and how the story goes by in reality. To divulge the truth, this act had misleaded them. And, when this spring hits their tender hearts, they are confused between ‘loves’ and ‘like’. As there is a saying “when you like a flower, you pluck it and when you love a flower you water it”. So this generation has started plucking own their lives. This thing mainly happens in co-education schools. I know the world will commit a faux pass on disclosing that the young pillars of our nation got paired in early age as they can’t imagine the future because they are in adolescence stage. I know the world will be dumbfounded to know the mindsets of these sections of people. Without any financial limbs people have started setting their foot in married life. A real love happens only when the platform of understanding between the two is very strong. Now, when they can’t fulfil their crying stomach, their love becomes poisonous. Numerous cases of divorce arises base on this factor. If this thing happens after having children, the future of the child is left with a big question mark. And when their stomach is empty education is beyond the orbit of their imagination. Now, let me discuss three fettle or conditions. First, a couple in which both male and female are employed. They are at peace i.e. they live at present and hardly financial crisis happens. And if their marriage wasn’t an engage, i.e. a love marriage, they live more happily. In most of the engage marriage lack of understanding arises between the two. Second, if male is employed and female isn’t. They are anxious as they live in the future because they have limited capital and they are afraid as their future dreams might not be fulfilled. As the lady is unemployed, she confines herself with the household activities from dusk to dawn. But all her efforts became useless in front of the eyes of the society as she didn’t give any financial support to the family. The above figure is one of the strongest figures to show that women are looked down. Third, if male and female are both unemployed. They are depressed i.e. they are living in the past because they kept repenting as their future becomes cloudy. In my opinion, for overcoming this crisis, the only option left with them is to just get satisfied with what they are. Society often says “ladies have pineapple eyes”, the only reason is they look for one who will look after them and care them. But this don’t happen to all and sundry, there are some ladies who took advantage of this. Now, at this climax what I would like to highlight is that, western people are already developed, especially their mental status. But for us, we aren’t developing mentally, instead in fashion. And I feel that it will be alive and kicking if girls know the condition of this society, which is lacking in every field. This noxious trend of turning youths into fashionista must be stopped. There must be a hindrance in the dress they wear as this will directly or indirectly become a leading factor to the loss of our culture. Taking the point that we are sound enough to understand my lines, I would not like to differentiate between celebrities and common people. So, better stop copping them except the good ones. Males too took a vital role in making our society a fiasco. Their hell system is covered by many thick curtains of lies. They turned many boons into curses and the best example for this is the misuse of mobile phones and social networks, hiding their identities. Their nerves are packed up with physical dominance over ladies. Now a days, many youths have converted the tuition centres into dating places, which makes our society search for her grave. The birth of a girl child is an occasion of despondency in the family, while that of a boy is one of great joy and merriment. The chariot of social life cannot run only with a single wheel and yet why is there so little recognition of the importance of the other wheel? In most homes women live a life not better than that of slaves. There are no better place than the hewers of wood and drawers of water. Can a society in which women are treated like this make any progress? When we get hurt of injured “MOTHER” is the first word that strikes our tongue. Once Nepolean bornapard said “Give me a good mother, I will rule the world”. We have the incidents of “Nupilal”. And we also do know who are Marry Kom and Sarita. Now, can we say that women are the weaker section of the society or the vulnerable member? A giant NO. And there are other many Himalayan proofs which needs no mentioned. Parents are the ones who must take a vital role for a strong future. Let’s assume that parents are the horse riders and the horse itself is the child. And they are on a track which cannot be deviated in all likelihood i.e. on the road to success. Many grasses are growing by the side of the road which denotes bad things. Now, it is the horse that has to move on, not the rider. When the horse slows down, the rider strikes to move on. And when the horse tries to eat the side grasses, the rider pulls it back to the track. But now a day, parents have become a turncoat for them. Buying of mobiles, motor cycles, etc by the parents for their children is my main concerned here. When the parents buy these things for their children, it’s same as the rider cutting the grass and feeding the horse. This is the problem for this kaliyuga. In the culmination, to stay away from these above obnoxious stories, a proper family planning should be done. Small family is a happy family as less opinion comes up. Dowry must be abolished and it can be done only through the light of education. To have less number of children so that parents can give them maximum care. And parents must be very open to their children. The above mentioned problems and solutions are not parables but the facts. Let’s maintain parity and parallelism between male and female. Let’s not forget the women contribute the second line of defence in the battle of life. The mentioned above problems and solutions are not parables but the facts. Let’s maintain parity and parallelism between male and female. Let’s not forget the women contribute the second line of defence in the battle of life. The writer is a student of Sainik School Imphal. The self-styled showman/humble brags of Facebook Porcia Soubam Facebook is supposed to be used to connect with friends and maybe scope out people who interest you. I do not think that Facebook should be used to gloat, brag, show-off or try to make other people feel like losers compared to you. That’s what I am seeing now when I check FB. It turns me off. I don’t see the point; in fact, I think showing off on FB smacks of desperation. Facebook, in my opinion, should be used for the truth, should be used to foster genuine, mutually positive social connections, and it should also be used to announce good personal news such as the birth of a baby or the publication of a book. What I’ve been seeing lately, though, is Facebook’s original purpose twisted as a tool for one-upping others, or wide-network keeping-up-with-the-Jacks and Joneses. That makes me sort of sick. Then I remind myself: they are showing off for a reason. Perhaps, they are insecure. Because they want to make other people nervous, maybe (which is frankly sociopathic, isn’t it?), and at any rate, they are just being sort of stupid or selfcongratulatory. It’s fine to be happy, of course, and to share good news. But, if we constantly talk about your great life and great dinner and great day on FB, does it mean sharing “good news?” No. I think it’s just you seeming as if you are trying to make other people feel bad that they don’t have it as great as you. I have especially good days, too. But I don’t post updates about what’s great in my life. Besides, if all you seem to do is brag on Facebook and then I finally see you in person, what am I supposed to ask you? Remember: I already seem to know much everything (except for the bad stuff, the likely truth). Most of them have a really bad past so to boost their image in front of people they just status update (check-ins, eating- out or drinking) or post pictures of themselves having fun. Nowadays, it’s like a competition between people, to make each one of them jealous of each other. Facebook is for selfloathing. The ubiquity of Facebook-status updates have made the “humblebrag” the de facto method of choice for those wanting to share their achievements with as many people as possible, often in lieu of having anything else to say. I am appalled by this form of “ego-advertising”. The new clan of publicity-hungry people who wants to show off what they are up to. Now, people are updating their check-ins at airports, eating or drinking at this so and so place or staying at this XYZ hotel. What does this speak off? In short, I would say empty vessels make more noise. You don’t do these things often that you think it must be highlighted or you think there are many people who can’t afford it, so you need to show them that I am above you people. The moment you step out of your hometown, you want to show to the world of FB that you are flying out to some place. How many people are flying in and out every day, leave India, from your own city. If every one of us does a check-in, imagine the net traffic. Remember! You are not the first person travelling by air. In the flight you have taken, there must be some who have gone on similar trips many times. Why are the fast food chains mushrooming in India? It’s the growth… so you are not the first or the last person to go to MacD, a KFC, Pizza Hut and so on and so forth. Wake up! Highlight if you have achieved or re-created history. Deflate that ego…I am at this and that airport, eatery or hotel. The achievers are the modest ones and those without intellect/knowledge are the ones with gas, ever ready to show off what they are up to. Now, which category do you fall in? The self-styled showman… In FB, I read somebody updating his status as so and so is flying to the bathroom. I was amused, thinking he must be someone like me who is sick and tired. I would appreciate if you do a check-in before flying to Mars, having breakfast atop Mt Everest…what you are doing at the moment, many people have done that again and again. Rivet over it, don’t you think you are making yourself cheap announcing something which by any standard is not an achievement or any mean feat, but some form of cheap publicity. And, why do you think it is necessary from your side to tell this news (I call it news because it is something new for your good self). Wake up! Do not entice others or give a chance to talk behind your back. Are you on a self-promotion spree to get many “likes”? Has FB announced any prizes for maximum “likes”? You may say/think: None of your business… well! It’s not my business…but, why I am saying this is because in totality, we have drifted away from the core purpose of networking to publicity through cheap thrills. Many of your known and unknown friends would love to see how you look now and read your progress in life. But the parameter of your progress is not the check-ins or what you are eating…it is more of what you achieved as a person. The ego trips, the “ego eatings” and ego stays in hotels are not the real fun which you have set out for. Enjoy your trips and stays without the announcements. Are you going on a trip or a holiday or eating out to show it off to others or for your own relaxation. Capture your moments worth sharing, but not what hundreds and hundreds of individuals are doing every minute, sans your style of selfpublicity. There’s a saying: Too much is not good! Don’t over expose your ego, for in the end you might end up being the publicity-hungry ego maniac… I say over expose because you already have some ego, which is why you have done checkin, eating outs and hotel updates. Control our ego, for egos are not socially palatable.