OSHO CLinic Psychiatry & Psychology

16/04/2024

Power and Justice ( Global paradox )

Power is an animalistic behavior, through which humanistic invention “justice” is served. ( biggest lie and root cause of human suffering )
There is no concept of “ justice “ and “ deeds” and their aftermath in animals or any other species. But evolutionary frontal lobe of human brain changed everything and invention of “ justice” emerged.
Animalistic nature of power was smartly used by human race to serve so called “Justice”. Justice is very lucrative and well appreciated term by all of us. Two opposite are made interlinked and whole human race is deluded with synchronicity of both.
Should humans believe in justice that is governed and guided on piles of power?
Why one should wait for justice if it is influenced by power?
Everyday injustice is happening with weak people, employer use power against employees. Politicians , administrators, judiciary, police, all rich, misuse power and favour their favourites with all kind of vested interests
Today I had encounter with one IAS officer and director of very sensitive department. I was saddened to witness that how justice has been crushed by power and shamelessly , Ironically, she has no acceptance or shame that she is tarnishing justice by her misuse of power and her vested interest.
An IAS or IPS or ministers are favourable jobs , not because of their talent for justice but because they pre assumed by people to rich and manipulative and powerful.
This veil has been so invisible that almost all powerful administrators are wilfully control our lives of common people for their own favour-and rewards and no one can dare to question powerful people.
Why justice has been introduced and valued and linked with power so much if it is impossible or not plausible in human race. We all talk about injustice and give strong opinions against it, but we witness it every day life and don’t recognise or deny it.
Why we all common people are deluded
about concept of justice? Why we need power for justice? Power and justice are two opposite ends.
Why we are not made aware about value of power during our bringing up? Why power is not the ultimate goal of life teachings?
Since the origin of human race, Power was the main agenda to survive. With passage of time and evolution , powerful tribes learned more easy and comforting way to maintain and then these tribes introduced the concept of justice. Irony was that, justice term was intended for masses and weak class of people. It was smartest move by powerful human race to cut down their enemies and now the fight was between two powerful people. Rest all were deluded with the concept of justice.
What if our blue print ( DNA) has no concept of justice or not meant for this man made term? Is there any concept or receptors is human brain for justice and its impact? Are we all made hypnotic?
Our whole human history has been deprived from the truth that only power exists and survives.
In end I will quote words from my favourite philosopher “ Fredrick Nietzsche “
“ Ultimate purpose or goal of human life is to seek power” “ Rest all is conspiracy”

“Justice is imposed burden on weak race invented by power and only exists in human race”

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16/02/2024

Not for weak hearted✍🏿

Mystic Pad 🤔of Sir Sigmund Freud; his vision to understand human mind through “ mystic Pad”
Mystic pad of Freud is three layer object, where lower base is of dark resin covered by wax paper and topmost celloloid layer. Base of mystic pad represents the unconscious mind, wax sheet represent conscious awareness of what Stylus( we will discuss in later part) is writing. celluloid layer( perception ) only function as protection to tearing chance of Wax sheet ( consciousness) by stylus. In romantic play of stylus, celluloid and wax sheet is what makes permanent ingrained expression of stylus on dark basin base layer( unconscious). Freud wrote that when stylus in not in use, wax sheet ( consciousness) start fading and impression by stylus disappear. And circle of rewriting and fading goes on.
Stylus is functional aspect of both perception ( first layer) and consciousness ( second layer)

Freud, gave immense importance to base layer where impression are permanent and visible under light or symbolization. He further explained that dark resin base is the infinite “void” or abyss and has intense gravitation to pull desires and to fill the “ cosmic void”.
Dark resin is chimeric in nature and alter its impression in chaotic way. Or just entropy plays in randomness. Ironically this randomness can be altered by consciousness and perception through stylus.
Can fetus feel emotions? or any fear? Or does fetus feel emotions? Is fetus is in absolute bliss(no desire)?
Freud believed and demonstrated absolute blissfullness and hence the infinite void. Freud beautifully explained that prenatal period pure dark resin without other two layers and stylus.
It means without perception and consciousness and hence “ no mind” state.

Modern behavioural science also agreeing to mystic pad concept of Freud but in more refined intellectual, and in more real way.

Our current genome, in amalgamation of billions of genes of our ancestors. This legacy is dark resin of first layer, and possess unique intelligence. Our consciousness is directly influenced by base of mystic pad and perception is epigenetics. Epigenetics is only part that can altered to alter consciousness and even uneven dark resin ( unconscious layer)

We will continue further shortly 🙏

OSHO CLinic Psychiatry & Psychology
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08/02/2024

Autism Spectrum and Cannabinoids

Autism spectrum disorder (ASD) is a group of heterogeneous neurodevelopmental disorders, commonly characterized by an early-onset impairment in social interactions and communications, accompanied by restricted or repetitive patterns of behavior, language deficits and cognitive impairments. Approximately 50% of ASD children and adolescents demonstrate behavioral difficulties, including aggression, self-injury, tantrums and attention deficit, hyperactivity.

The incidence of ASD is about 1–2.5%(quite alarming)

The endocannabinoid system in ASD

The endocannabinoid system, the endogenous target of cannabis active pharmaceutical ingredients plays an important role in central nervous system development, in synaptic plasticity, and in the response to endogenous and environmental challenges.
Particularly, the ECS has been shown to participate in the regulation of social reward behavior, plausibly by oxytocin-dependent activation of the ECS.

The ECS comprises cannabinoid receptors, endocannabinoids as potentially ligands, and enzymes responsible for the synthesis and degradation of these endocannabinoids.
Two most potent 2-Arachidonoyl glycerol (2-AG) and arachidonoyl ethanolamine (Anandamide, AEA) are the best-studied endocannabinoids. They have different synthesis and degradation conducted by different enzymatic pathways and impart distinct physiological and pathophysiological roles. The ECS involves multiple cannabinoid receptors, the most common being cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2), which are mostly expressed in the central nervous system and throughout the immune system, respectively.
Other receptors include the transient receptor potential (TRP) channels, and the peroxisome proliferator activated receptors (PPAR’s). In addition to their activation by endogenous cannabinoids.

Currently, no established pharmacological treatment for the core symptoms of ASD is available. Some medications were approved by the US (FDA) to treat associated symptoms, including irritability, aggression and behavioral disorders. Commonly used medications include psychotropic drugs (such as atypical antipsychotics), selective serotonin reuptake inhibitors (SSRI’s), stimulants or anxiolytics.

Low dose risperidone and aripiprazole have FDA approval for behavioural issues in ASD.

Cannabis is a multifaceted plant with hundreds of different chemical entities, including cannabinoids, terpenes and flavonoids. Among the cannabinoids, the most abundant in terms of content and studies, are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC, the psychoactive cannabinoid, binds with high affinity to the two ECS main receptors, CB1 and CB2. Common effects of THC include euphoria, altered sensory perception and relaxation. Given its psychoactive potential, THC is rarely used in young ASD patients. CBD has a much wider role, potency and receptor binding properties in a variety of conditions. CBD effects include anticonvulsant, anxiolytic, anti-inflammatory, anti-oxidant and neuroprotective and neuroregulatory functions. CBD interacts with many signaling systems, including TRPV1 (Transient Receptor Potential cation channel subfamily V member 1), TRPV2 (Transient Receptor Potential cation channel subfamily V member 2), adenosine, 5-HT1a (serotonin 1A and PPARγ (Peroxisome proliferator- activated receptor

Studies have pointed to a possible deficiency of the ECS in ASD, which is plausibly involved in ASD. Alterations of the ECS have been demonstrated in several animal models of ASD. In some of these models, activating the ECS reversed the social deficits. Recent studies have demonstrated lower serum levels of AEA, as well as of PEA (N-palmitoylethanolamine) and OEA (N-oleoylethanolamine); two endocannabinoid-like compounds in children with ASD as compared to controls. These may suggest that impaired signaling of AEA (and possibly of their associated compounds) is involved in the pathophysiology of ASD.

Specifically for the case of ASD, CBD may play a role in the regulation of social cognition and behavior via interaction with oxytocin and vasopression signaling at TRPV1 and TRPV2 CBD further acts as an antidepressant and an anxiolytic agent, via 5-HT1a modulation, and most importantly, elevates AEA levels, as a modulator of its degraded enzyme, FAAH (Fatty acid amide hydrolase).

Cannabidiol ( CBD ) already has US FDA approval for resistant seizures in Dravet syndrome, Lenox Gestaut syndrome and tuberous sclerosis complex with significant efficacy. India has recently got approval for CBD use for mentioned indications.
Dosages of CBD in autism are much lower ( 0.2-0.5mg/kg ) than in other indications( 5-15/mg/kg.

Though, we don’t have FDA approval for CBD use in autism but its positive effects are well published as case series and one recent double blind placebo control trial.
Moreover, THC as low dosages along with CBD and other cannabinoids may potentials its efficacy.
The entourage effect of cannabis is well known and might be Midas touch in ASD also.

I personally have seen modest to good results of L- Carnosine in ASD and other neurodevelopment disorders and I am in for use of CBD in ASD

More research and clinical trials might prove more and more use of Cannabis extract in various mental health disorders.

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DBTDialectical Behavioural Therapy The treatment of all aspects of mental health. Childhood Behavioral Disorders Child psychologist in Panchkula Psychiatric Disorders Drug De-addiction treatment in Panchkula – For Consultation Contact today. Su***de Prevention Helpline Helpline 24/7 Call Now: +91 ...

17/05/2023

30/01/2022

Prepare yourself to get amazed!

The most important hidden secret to live happily is, live to get amazed. You may at work place, at home, in market, or anywhere, there are always a chance to get amazed. Amazing is a wonderful experience and everybody likes to get amazed. But unfortunately we miss most of the opportunities and make amazing as special event. We restrict amazing to certain events or hobbies and feel good at intervals. We listen to music, go to party, we travel, we invite people and do lots of other activities just to get amazed. Our ability to feel amazed has been compromised to an extent that sorrow ness, loneliness, depression, low self esteem has curbed most of us.
Our involvement with internet, video gaming, virtual reality is one way of get amazed but it does not happen for long time and we keep repeating and adding something to feel amazed.
Have we lost the art to get amazed or we are unaware of the beauty of getting amazed. Child is the best example of feeling amazed most of the time. Child express his amaze ness through out the day. But as we grow older we lost this beautiful phenomenon and our whole life is cornered to our fix ideas, our belief system or our faulty process of growth.
We listen a joke and get amazed. It means that when something out of the box comes to our consciousness, amazing happens. Same joke can’t make to feel amazed again and again.
Something new or unorthodox is needed to feel amazing. Our life style is more like a ritual phenomenon of repeating life process again and again. We expect, we deliver, we desire and these things are more or less same everyday.
We go to office, meet same employees, we work, do gossip, do talk, and repeat everything next day. At home we spend time with family, eat together, or share life with each other and sleep. We put efforts to feel good and amazed but this really does not happen.
Where we lack that we are not able to get amazed and feel good?
In my opinion or my research with human behavior, we have lost art of listening, and communication to an extent that we lost all interest in people. Most of our life is communication between different people or same people again and again. Effective communication is the key to feel good but effective communication is a learning process. We have general tendency to see another person with a same view or fix idea. We make certain predictions and label another person in set category. Our predictions has made us to lost the feeling of get amazed. We talk, but don’t communicate, we see, but don’t visualise, we hear, but don’t listen. Communication, visualising, and listening requires conscious effort and we are not conscious most of the time. When we talk our whole effort is to give reply or ask question, moreover, our mind starts preparing to give answers or ask question before the topic actually finishes. We are uncomfortable with the idea of ‘not knowing’. We pretend that we already knew it and we feel condescending to admit that we don’t know. We have answers to everything happening around us. Our questions too are egoistic and we expect suited answers or we loose interest in communication.
Habits and hobbies are well admired in the whole world and we feel proud to announce our habits and hobbies. Taking daily shower is habit not a hobby. Playing football seems to be hobby. Whole world has forgotten the difference between two. Habits don’t amaze us but hobbies do. But habits are in hundreds and hobbies to are limited to three or four or even less. More wonder is that we have made our hobbies more like habits. Logic is simple, hobbies requires conscious effort hence, it is easy and comfortable to change hobbies to habits. This is a paradox, we should have an effort to change habits into hobbies but the reverse is happening.
We need to make efforts to change our way of living, we need awareness to make conscious effort. We need to mediate our mind, we need to breath deeply, we need to know our own personality, to know our emotions, to know our involuntary or voluntary reactions. Once we know our self more and more, we will not feel the same way, these changes in the feelings are very sensitive and raw. This rawness in feelings give us opportunities to feel amazed. We will start visualising newness and we will start listening in whole different way. Everything will appears changeable and transient. Fear to loose will disappears as fear comes from fix idea over certain period of time and in this process, effective management to get rid of fear, is lost and eventually leads to sustain feelings or worry, sorrow, and resentment.
Very often, as we hear any news which is out of our comfortable zone, our head start feeling tight, there is feeling of rush of blood in the body, and state of unawareness develop. This happens because we start predicting the consequences in the middle of news and there is fear of losing something that curbs us. Mental awareness is to be exactly present consciously when something like that happens. Focusing on present situation with mindfulness and finding out various options to deal with the stress is the key to stop vicious cycle of stress. When we practice this daily, feeling of being amazed will become your co partner.

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28/11/2021

Learn DBT skills, be a master of your own emotions!

Human beings are social animal. We can not operate life according to our instincts.
We all born with instincts of constant pleasure and gratification. As Pleasure and gratification is ultimate goal of life, we try to achieve it every moment and work hard to make it possible. Newborn child is full of inborn instincts of pleasure, newborn needs pleasure all the time without any sense of right or wrong, moral or immoral, plausible or not, mother fulfil child pleasure by feeding her, showering love, and giving nearly 24 hour attention. As we grow old we learn concept of social constraints, moral constraints and legal constraints. We are exposed to wild freedom with strong conditions. Our mind initially rejects and gradually accepts the restricted way of living. We often feel frustrated, dejected, helpless to such restrictions. Finding no options we get adapted to reality and start finding moments of pleasure and gratification. We work hard, put ourselves to unpleasant conditions to seek moments of pleasure. We keep fighting for finding pleasure, often in money, kids, power, and in narcissism. Fight continues through life and finally ends with our death. Contemporary theory of spiritualism, gives us chance to fulfil constant pleasure against all odds, but it appears illusion to most of the participant.
In this roller coaster ride of life, emotions play immense role to seek satisfaction( pleasure ). It’s our emotions that decide our contentment with given life. Emotions are almost involuntary phenomenon and our genetics play huge role in determination of our emotions. Environmental factors also play adjuvant role based on our genetic make of our behaviour.
Every human is unique in his or her genetic make up, in its phenotypic expression, so the emotions.
Emotional intelligence concept was launched to fit individuals into the bell curve of Statistical science. Those who can not fit into bell curve, psychology labelled them as emotionally less intelligent or emotionally unstable. Emotionally unstable people reacts according to their temperament without putting filter of rational mind. In this reaction rational mind comes into play little later than than emotional mind, and leads to shame, guilt, remorse and feeling of dejection. It keeps on happening repeatedly and vicious cycle of unstable temperament and dejection by rational mind starts and that lead further deterioration of overall mental health.
Borderline personality disorder(BPD) is one of the most disastrous disorder that effects emotional well being of person. Heightened sensitivity to emotions particularly negative emotions, unstable sense of own self, and identity adds fuel to already damaged emotional health. Impulsivity and rage becomes part of life, constant feeling of emptiness becomes part of life. There are episodes of dissociation from self and reality that leads to repetitive self harms. Relationships get ruined and there is constant chase to find stable self. Substance abuse becomes the temporary solution to avoid the emotional turmoil.
Dialectical behaviour therapy, particularly designed to improve emotional health of borderline patients. DBT focus on all aspects of BPD and is evidence base therapy to treat BPD.
DBT focus on particularly four parameters as
Mindfulness
Distress tolerance
Emotional regulation
Interpersonal effectiveness
Each section is mastered with the help of trained DBT therapist. DBT is usually done either by 24 weekly sessions or 48 weekly sessions after complete psychometric assessment. DBT requires team of trained DBT psychiatrist, real life coach, co therapist and 24hour crisis intervention therapist.
DBT can be done by both online or offline sessions. Each session is carefully monitored and home assignments are given to patients in every session. As DBT sessions progress, patients start wearing a mask of rational mind and that is almost ego ideal with the original temperament. Eventually patients get reflex changes in emotional mind and rational mind takes over the control in crisis.

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15/09/2021

He**in (IV drug abuse) induced Toxic leucoencephalopathy!

We had a patient in Neelam hospital emergency with o***m ( he**in ) overdose. Patient was unconscious with shallow breathing, pupils were pin pointed with fluctuating vitals. Patient was immediately given naloxone IV. With repeated doses of naloxone patient recovered intermittent consciousness with severe o***m withdrawals. Patient was managed conservatively and shifted to psychiatry ICU. With due course of time patient become better and on third day patient was fully conscious. We were planning for naltrexone implant for the patient in coming days but on 5th day of admission patient suddenly developed high grade fever ( 104 ) with loss of consciousness. Neurological examination shows poor GCS score. Next day patient had intermittent awakening with continuous fever. Patient was evaluated. CSF studies were insignificant. Patient was intubated and put of ventilator. Patient MRI brain was done. MRI showed demyelination changes in bilateral temporal lobe along with involvement of frontal lobe. MRI additionally showed involvement of carpus callosum also. Provisional diagnosis of toxic leukoencephalopathy was made and patient was shifted under neurology care team. Tracheostomy was done after one week. Over the course of time patient had developed bacterial infection in chest and further complications. Patient was managed conservatively and symptomatically. After one month of course patient, he was discharged in afebrile condition with quadriplegic condition. After three month of discharge patient had minimal improvement. Now after five month of home care patient still in same condition.
First Video of patient showing when he developed acute fever along with loss of consciousness
Second video showing current status of patient after six month.

Discussion
Toxic leucoencephalopathy is rare complication of IV drug abuse of opioids. There are other toxins also which lead to same condition.
Prognosis of toxic leucoencephalopathy is though good but it varies from patient of patient and involvement of brain areas.

09/09/2021

Role of IV infusion of propofol in Alcohol withdrawal delirium( AWD ) or Delirium Tremens ( DT )

We had patient in psychiatry Opd of Neelam Hospital, Rajpura with history of excessive intake of alcohol ( two and half bottles per day). Patient had tremors in hand, anxious behavior and history of recent increase in Alchol since six months. Patient was admitted in Psychiatry ICU. Patient was evaluated and started on IV benzodiazepine and thiamine along with Haloperidol IM. Patient has uneventful course for initial two days. On third night patient become confused, anxious, restless, agitated with aggressive and violent behavior. He was disoriented with symptoms of fluctuating vitals. Diagnosis of Delirium Tremens was made. Dosages of benzodiazepines was increased up to hourly injection of lorazepam along with haloperidol slow infusion. Patient symptoms were not improving inspite of increasing dose of lorazepam. On 2nd of DT patient had similar picture of symptoms. Agitation had increased with confused orientation. Benzodiazepines and SOS haloperidol was not showing any improvement. After heavy use of benzodiazepines approx 300 mg of lorazepam in three days patient was still agitated and delirious and aimlessly wandering in ICU. Patient was hallucinating and behaving in bizarre manner.
After discussion with critical care team and with back up of anaesthetist patient was started on slow IV infusion of propofol.
Decided dose was 2mg/kg/hour. Patient was on constant monitoring of blood pressure and SPO2. Patient stated getting drowsy and eventually slept with intermittent awakening. Dose of propofol was increased to 3mg/kg/hour and patient was sedated completely.
Propofol infusion was given for 24 hours and patient was maintaining his BP and SPO2. After 24 hours propofol infusion was stopped, patient remained sedated for next 8hours. On awakening patient was little drowsy but well oriented, there was no restlessness, no agitation. There Were no signs of Delirium Tremens. Patient was maintained on low dose benzodiazepines along with IV fluids and thiamine.

Discussion.
DT is though infrequent manifestation of alcohol withdrawal but it can pose medical emergency. There are about 5% to 15% chances of mortality in DT. Standard treatment of DT is liberal use of benzodiazepines till patient gets sedated. But there are patients who don’t respond to benzodiazepines treatment and it becomes benzodiazepines resistant DT.

Propofol,being positive modulator of GABA and negative modulator of Glutamate, acts as sedative and has GABAnergic role snd dampens excito / toxicity
Propofol infusion requires back up support of critical care team that can monitor vital parameters and should ready for intubation when required.

Other way of treating benzodiazepines resistant DT is intubate the patient and start IV profile infusion for 36-48hours.

Propofol IV infusion can be considered as alternative or adjutant therapy to treat difficult DT.
Video of patient after starting propofol and 36 hours after propofol

20/09/2020

During Covid pandemic, mental health is at stake. Social distancing, fear of getting Covid, financial constraints, low confidence, anxiety, boredome, disturbed sleep and disturbed mood are common symptoms among Population.
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