Pyschiatry aids people at all stages in life


Psychiatry is a vexing discipline, because as much as patients like to have black-and-white answers and solutions to emotional and mental ailments, the reality is that most psychiatric conditions are elusive, fleeting and defined in shades of gray.

This seems to be more and more true as the psychiatric profession begins to understand more about how human brains (and people) work.

"More and more we are defining things in terms of spectrums," explained Dr. Sabooh Mubbashar, the new psychiatrist at Sharon Hospital.

Originally from Pakistan, the 33-year-old doctor has completed his residency training in adult psychiatry from the Yale University School of Medicine, an advanced fellowship in child/adolescent psychiatry from the respected Yale Child Study Center and a fellowship at Yale in psychopharmacology. In his new private practice and at the hospital, he sees patients as young as 2 and as old as, well, 95 so far, but he’s only been here for two months. With the longevity of Northwest Corner residents, he’ll probably be seeing some 100-plus-year olds before long.

For the elderly, Mubbashar said, many pyschiatric problems tend to run along what he refers to as the "dementia spectrum." It can range from having difficulty remembering what breakfast consisted of to what he called "severe dementia, where patients have a hard time keeping up with a train of thought.’"

There are many kinds of dementia, he noted, including the well-known Alzheimer’s disease. There is also vascular dementia, which, simply put, can be caused by poor blood supplies to the brain. People with blood-pressure problems, who are at greater risk of suffering from a stroke, are also at greater risk of developing this type of dementia.

Depression often accompanies dementia, he said, as do irritability and agitation.

"This is manifested frequently as low frustration tolerance and bouts of agitation," he said, adding that, "Oftentimes, depression in the elderly can mask and present as dementia. There are drugs that can slow the progress of dementia," but no cure has been found once the disease has settled in.


Getting help — and evaluations


Many adult children worry that a parent is showing signs of dementia, and many older adults have the same fears for themselves. As is so often the case in life, often a visit to the doctor can put an end to needless worrying — or open the door to early treatment that can change the course of someone’s life for the better. But it’s often difficult or even impossible to get a parent to the senior behavioral center at the hospital; and sometimes, those refusals become more adamant as the parent becomes less lucid. What recourse is there for a family member who genuinely wants to help?

"Sometimes," Mubbashar said delicately, "you have to call 911 and explain that you have an elderly person who is living alone and having memory problems, and the home is in a bad condition, or they are forgetting to take medications and not eating meals; and my mother or my father or my relative is very resistant to coming to the hospital for evaluation."

An ambulance can be sent. The patient can then undergo a full neuro-psychiatric evaluation (covered by Medicare) in the senior behavioral center.

"Such an evaluation would include a complete medical workup, carefully teasing apart the dementia from the depression and seeing if any underlying physical issues are masquerading as dementia," he said. "Sometimes simple things such as a liver failure or renal failure can present as dementia in the elderly.

"During the hospital stay, in addition to evaluation, the doctors and the hospital staff also assess for response to medication.

"And another significant piece of this includes finding an appropriate disposition plan for the patient."

If it’s determined that the person can not go home and live alone (even with a helper who comes in daily to check in, administer meds and perhaps cook a meal), then the hospital staff helps to make arrangements for the transition to a nursing home.

Although many children will blanche at the thought of taking such measures with a beloved relative, Mubbashar stresses that often it can be a matter of life or death.

"I saw a lady the other day who had been living alone," he recalled. "A neighbor was watching over her, and her children visited her every weekend. But she had apparently fainted and fallen, and was not found for two-and-a-half days. By then she had renal failure and extreme dehydration. So in that kind of situation, you might feel guilty for calling 911; but you might be saving a life.


 


To be continued next week with Dr. Mubbashar’s views on treating young people. To learn more about the psychiatric needs of children and adults, call him at 860-364-4288.

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