 Good evening, those who are present and those who are with us virtually, I want to thank God for this movement once again that we want to continue with our series on mental health. Thank you brother for the introduction and the welcome. I want to believe that if you started with us at least you are somewhere and at the end of the series at least you will be able to know at least you have something you can talk about mental health. If you can forget everything at least remember that there's a mind. Hello, yes, at least remember that there's a mind is not a hoax, it is not a myth, it is real. And secondly that mind as much as you may not see it, you may not touch it and you may not feel it, it is actually subject to illnesses. And yesterday we were able to see and demonstrate the very close connection between the mind and the body. That when one is sick the other one is likely to fail. I was discussing with my colleague afterwards and she showed actually she was able to affirm that one time there was a research done with children, those who were born before premature in a nursery and they really wanted to see what are the factors that will contribute to weight gain. And it was very simple, they demonstrated that those children would not have mothers, they are somewhere abandoned. They actually gained weight poorly and yet the nutrition, everything, all the other factors were constant. Meaning that that absence of the mother, they even affected the units. That is how the mind is, even the one and the children were very, very young. And therefore I'm very excited that I've gotten a forum where we need to share, emphasize the issues of the mind. So that as I said the three is that at least you are aware you accept that these things are real and that you can be able to take action for yourself or for your friend or your family member. Today we are continuing and I'm looking at what are the types of illnesses, the disorders of the mind. Yes I know our main focus is prevention but you can only prevent what you already know that it is there. And that's why I say that at least if you don't go home with anything, home knowing that there's a mind and the mind can be sick. So today we are looking at the types of mental disorders. Remember we have said, I've not said diseases, I've talked about disorders. Sometimes we refer them as illnesses but mostly disorders such that because even in the diagnosis we use what we call syndromic approach and therefore it's a combination of various signs and symptoms that we tell you that there is a problem and this problem is this. Looking at the slide we have several but allow me I will run very fast but I will take a little bit of time in the last one, the personality disorders. Therefore I'm starting with the mood disorders and we have talked about this. Those who are with me from the very beginning we say that the mind is the one which controls our mood and therefore those moods can actually be sick and when they are sick to the clinical level when they are clinically significant they become disorders. This is one of the groups of mental disorders that is very common and I'm glad that at least people are comfortable saying you know I was diagnosed with depression even if it is not depression even if it is schizophrenia somebody is comfortable talking about depression it's coming out. It is less stigmatized because it is very common. So among the mood disorders we have diseases like the depression which sometimes is far as unipolar because it's just one side. Then the second one which is apipolar where somebody swings between the high mood and low mood that is the manic and the depression and many of us are aware of this. Now they say so and so behaves like apipolar. I don't know whether people know what that one means but somehow it's a conversation many people are talking about and indeed it's very common. In the extreme state of these mood disorders the people with mood disorders especially in the manic phase these are the people who are pressured of speech. They talk a lot, they are grandiose and the other things that we don't talk about they are the people who invest generously and they are very generous. Somebody said when he was in that manic phase he was like you know God says we share and therefore she gave everything. All our children clothes were given out, all our clothes were given out. She took loans and bought so many things women groups were bought for land and everything. By the time she is coming out of that she had actually used over 8 million. So sometimes it can be very destructive and costly to the family and therefore it's important for us to note and know that there is help. I know many times when somebody is in that state they will always tell you they are not sick you are the one who is sick. Unfortunate for this one the lawyers are taken up when the lady was like I think my husband is not fit enough for me so I want to divorce and the lawyers jumped in not knowing the state of this person but the time the phase is over and you don't know now how to face your client even though it was really a client. Mood disorders we have others like hypomania those are the classes within the mood disorders. I don't think I want to continue that but then I say it is one of the commonest especially depression. Two types of depression the primary and secondary. I think I've mentioned that primary depression is also referred as indigenous and it runs in families. Unfortunately it is what contributes to some families being labeled as caste because you find that they commit suicide because of untreated primary depression that runs in that family. So when you see a family with some issues it's not because they are caste it's not because they are demon possessed it's because they have that depression that has not been diagnosed and treated. Allow me to move to the next group of disorders. When you talk about anxiety disorder it's not just one disorder but there are many as even in mood disorders and this is where we have quite a significant challenges because they actually mimic the physical illnesses. Reset has shown that 30 to 40% of people seeking help who are coming with health problems especially in the primary health setting they are actually suffering from anxiety disorders. Because majority of them will present with even headache fever you know shivering palpitations that is they had been very fast. Some features of high sympathetic outflow and what happens is that because this mimics actually the physical ailments like malaria, typhoid and all those you will find that most of them are misdiagnosed or missed out. I had mentioned about the investigations of these physical illnesses so somebody investigates especially in the western part where there is a lot of malaria and when you cannot pick those parasites you say maybe it is in the liver and you are given medicine. You go home you don't change you come back maybe it is typhoid so you are given the typhoid. Until there is others which call brucellosis and all those things people have been treated severely because of anxiety disorders. I said about 40% of those clients suffer from anxiety disorders. Among those ones we find that there is one which is very common and which can be very dramatic if I may use that one something called panic disorder. A panic attack is a state where somebody feels like he is actually dying and I always say they die for 10 minutes. What happens is they have decreased air, they are yearning for air, chest pain, they have palpitations, their heart is beating and they will tell you I am holding it so that it doesn't come out. The person is sweating and for sure the person feels like he is actually breathing his last breath. Many times they will be rushed to hospital and fortunately before you reach the hospital the attack is over. So you are actually in the hospital and you are really trying to convince the doctor that doctor I was dying. Now what was the problem and unfortunately many times when the vital signs are taken everything is fine. Then the doctor looks at you and say are you for real and imagine now the relative the person who has brought you to hospital will look at you and say why you pretending. Those things are real and they are usually very bad and we need to understand. But at least many people now are trying to appreciate that that is a panic attack and sometimes if you are aware of it you can manage it even at home by doing very simple exercises called relaxation as long as you have somebody reassuring anxiety disorders. The next one is schizophrenia and this is what we refer as psychosis. Not other psychotic disorder but it is supposed to be schizophrenia and other psychotic disorders. This is what mental health many people think it is. The madness that is what we call it we don't call it madness we call it schizophrenia or psychotic disorders and they are mainly characterized by people actually they are out of touch with reality. They don't know where they are and one of the commonest presentation is also hallucinations where you have hallucinations in any of the senses the five senses. One can feel and you see them picking actually insects on their skin and you look carefully there is nothing and you really pick them. Somebody will tell you this food actually is smelling soap. Why did you put food soap in the food and yet you are testing the same food and you can't taste anything. The smell, the taste, the feel, the sight and the hearing. What is most common is actually the hearing. We call them auditory hallucinations where people will be responding to non-existent voices or answering things that you have not asked them. But indeed they hear them and that is one of the needs. The schizophrenia has a specific way of diagnosis which you call shinidas. It's not important for us to know after all I'm only creating awareness. I'm not making psychiatrist. So be aware of that but that is what we know. These are conditions which can be managed. Unfortunately the extreme ones respond to medication poorly and these are the people you find being in the streets in the markets and we refer them as chronic schizophrenia. Those ones sometimes because they have not been treated, because there is resistance to treatment or people have just given up and said this cannot be treated. I can tell you that well treated and closely followed they can be actually able to do at least something or even be able to be productive but many times they are left out. The next one is what you call somatiform disorders. Somai means body and therefore these are diseases that present with physical symptoms but they don't originate from the body. They are not physical. They are from the mind but they are presenting physical. The main ones are what you call hypochondriosis and that is a disease where sometimes we refer them to the diseases of medical students because every time you are thought of a disease you feel like you are actually having it. So you go home and say I think that one I know I have it. There is another one we used to refer as hysteria but now this is called conversionary and need disorder because it is the psychic conflict that are converted to the physical form so that they can be addressed. And I think some of the things we have seen they can present with even paralysis where somebody cannot even respond even if you burn the person and yet there is no problem with the nerves. I think we all saw what was happening in the girls and when they went to Khemuri there was nothing that was found in blood. So it can be that dramatic and extreme. I have seen people with convulsions. You see the way you think it is epilepsy but they don't meet the classical and they don't respond to the medications for epilepsy. We call them pseudo seizures but you look at them you can think actually somebody is having epilepsy. Of course the other symptoms we include even headache, abdominal pain, anything, back aches and all those things but the problem is not at the back it the problem is in the mind yet the signs and symptoms are physical. We are eating disorders maybe some of you have known about this ones and this is mostly because of the way we are actually sometimes we relate to our children you know we hear people talking about you and all that those ones the mind does not take it kindly they go and actually affect these children or these people and in themselves whenever they look at the mirror they see themselves so big and therefore they will eat and go and induce vomiting. They are usually very unorexting very thin and actually they are fatal diseases because you might find an adult weighing as little as 30 kgs and whenever they eat they actually belt it's not their wish but it is something that is because of the mind that has really induced that kind of behavior. We are two main ones called anorexia nervosa and bulimia. We have other group called the lilium dementia and amnesty cognitive disorders. This is actually where mostly for the old but it can also be as a result of chronic medical conditions depending on which one. We have seen it in some diseases for example HIV where you have the psychiatric manifestations of the HIV AIDS disease but it is very common in old age I think you have had dementia. This is a special dementia called Alzheimer's this one can affect even young age because it is not necessarily an old disease. The main symptoms of this is mainly forgetting and also forgetting and of course motor aspect where people are slowed in terms of what they are doing. The second last the mental illness is due to chronic medical conditions this I think I say that sometimes when somebody has been sick for a very long time we always miss out the mental health aspect. Chronic diseases will include cancer hypertension, even diabetes some of the endocrine diseases almost always you find that they are actually associated with the mental aspect they can have depression they can be associated with anxiety they can also present with those somatopharm disorders but their origin is medical condition. Some conditions like thyroid hypothyroidism is associated with depression and also we know that in some conditions for example even the hormonal based conditions can also present with the mental disorders. There is one that I have left there substance abuse substance abuse can induce any of those that is how bad it is I was talking to a patient this morning and she is telling me she doesn't know what started first whether it was depression or alcoholism and she has really battled with all of them sometimes she stops the drugs so that she can now deal with alcohol and then of course because sometimes you tell them you cannot take the two so these things sometimes you may find that somebody is developing mental illnesses when they lay their hands on substances they use it for self-medication and in that way now you may always want to blame the substance yet the person may be had anxiety people who take drugs to be actually confident there are people who cannot stand before but when they have taken something then you find that they are really on top of things so that one you find that there is something that is underlying they are using a substance to treat and unfortunately as that continues you find that the person now gets a double diagnosis whereby there is addiction and the disease which he was in quotes treating but of course it was not treating allow me to look at personal disorders which is really the elephant in the house many at times we are not very serious about I don't even know but spreadically we hear people talk about I think my husband is a narcissist I think you have heard about that I think that personally is a disorder I don't even know which one allow me to take you through yes personal disorders these are perversive enduring patterns of behavior they start as trades trades is think that you actually you groom them they are not they are not really bothering you but with time when now they mature they become now disorders mainly the patterns of thinking perceiving, reacting and relating we can see these are things that make relationship or which actually hold relationship so if we have a pattern that is perversive and in terms of thinking perceiving, reacting and relating then things are not going to be as usual so they cause by the time we are talking about a personal disorder it means they have reached a state whereby they have caused significant distress and with functional impairment some personal disorders cannot even allow you to continue with the work because you cannot even relate with your colleagues live alone being a family man or a family person or as a child who is obedient so this the cause is a combination of genetic and environmental factors that interact so you can see if it is genetic then it is not somebody's fault and it is not something that you can switch on switch off and that is why it is so tough and somebody says why can't you change I just want you to change your behavior excuse me it is beyond the behavior because there is a genetic component in it is good to know that these particular personal disorders are severe during the young age they start around adoresant but as you grow old you might find it less so for those who have gone through that middle age and all that you can actually be excited that things may not be that bad after all but are we able to stand during that time when it is at the peak it shows us that 90% of the population that is not a small percentage have these personal disorders but when you come to the diagnosed mental illnesses that have shown they actually go up to 50% so sometimes even in the very very good experts you may not be able to differentiate between the now the disorders and the personal disorder because the management is different so it goes up to 50% of those ones there is no clear and this is interesting there is no clear distinction in terms of sex, socioeconomic status and even race so anybody can suffer from personal disorders including the professionals including the pastors sometimes I get when you are interacting there are even some pastors who have these personal disorders and therefore the shapa desas are in trouble because they are supposed to be straight they are supposed to be smart and you look at it as a pastor are you really a pastor? hello it is not about pastors because they don't they don't miss out they don't they are not clear they don't respect and race and profession I can see time is not there but we can continue with this one because this is very passionate because if I cannot tell you anything please let me tell you about personal disorders because many families are suffering most of the divorces are actually due to those differences and we are not aware and when I finish I will be able to tell you that if I was given a chance I would say like the way we said that before you are actually united you can go for a HIV test maybe going forward we might be going for personality tests before we can combine so that you know where you are entering hello may God bless us because tomorrow we will pick up from there and also look at the topic for tomorrow because indeed it is important to understand personal disorders because they direct it has been demonstrated that they direct cost in terms of family and everything in terms of treatment because the ones which are directly in terms of productivity at work and everything it is much more than the other conditions that I have talked about and that is why I am saying I really want to really dive deeper to the personal disorders and maybe at the end of it all you will be able to diagnose yourself whether you have one may God help us so that tomorrow we will be ready to see which one is yours I am going to say the types and you are the only one who will be taking and saying that is me may God bless you let's pray Gracious Father God of Gods and the King of Kings we give you glory and honor for who you are and what you want to tell us this moment we thank you for this session that you have taken us through Lord even as we continue to learn more so that my father we can be from the point of knowledge and understanding to be able to help ourselves and even those around us thank you because of this as we continue to be with us in Jesus name we pray Amen