The Poor Me Syndrome-Social media networking sites like Facebook and their adverse neurological and psychiatric consequences

The Poor Me Syndrome-Social media networking sites like Facebook and their adverse neurological and psychiatric consequences

Nitin K Sethi, Prahlad K Sethi

The spread and reach of the Internet has heralded a social media revolution in its wake. Social media are a group of Internet-based applications (networking websites, blogs, microblogs, content communities, virtual game worlds) that allow creation and exchange of user-generated content. The use of social media networking websites like Facebook, Twitter and LinkedIn has increased exponentially. In 2014 the total number of monthly active Facebook users was reported to be 1,310,000,000 and total number of minutes spent on Facebook per month was 640,000,000. Forty eight percent of Facebook users log in every day and an equal percentage of users between the ages of 18-34 reportedly check Facebook on waking up. 1We are today more connected to each other than ever before. How we communicate with each other, exchange and share information has undergone a pervasive change. Gone are the days when one kept in touch with family and a few close friends either via postal mail (nowadays referred to as snail mail or smail-yes smail was slow but dependable) or via the invention of Alexander Graham Bell (collect call anyone?). Today’s generation has e-mail, cellphones and cellphone apps. We prefer to text rather than call someone in person, e-mail rather than put pen to paper.

A year ago a 28-year-old young lady consulted me for her seizure disorder. At the time of her presentation; she was on 4 anticonvulsant medications, seizures were well controlled but she was experiencing cognitive side-effects and fatigue. Over the ensuing months under close observation, I began to taper her off one anticonvulsant. Her seizure control remained stable and she felt better. All was going well till one day I received a frantic call from her mother. My patient had attempted suicide by overdosing on her anticonvulsants. She was rushed to a local hospital and later transferred to my hospital where she remained in the intensive care unit for 10 days. As her condition stabilized, she was transferred to the neurology floor and later discharged to a rehab facility. I had the opportunity to speak to her mother recently and asked her the reason why her daughter had attempted suicide. Her attempted suicide it turned out was neither related to her seizure disorder nor her anticonvulsants. Rather she fell a victim to the poor me syndrome. Two of her friends on Facebook had changed their status from single to married and one had uploaded pictures frolicking in the sun with her new beau. Seeing those updates had made my patient feel that life as it was for her was not worth living.

The poor me syndrome is likely an under recognized and under reported consequence of social media networking sites like Facebook. We are increasingly conscious about our online persona and how we reflect that to others. So happy memories and status changes are more likely to be uploaded and updated than times of sadness and struggle. In the days of yore before Facebook was born we knew little what our friends were up to in their lives- who were getting married, who had a new girlfriend or had purchased an awesome house by the beach. Ignorance as they say is indeed bliss for what we did not know did not affect us. Now though; a happy post by one of your friend risks creating sadness and feelings of hopelessness in you.

References

1. Facebook statistics. http://www.statisticbrain.com/facebook-statistics/2014.

Medical, legal and ethical issues surrounding brain death-the physician’s perspective

Medical, legal and ethical issues surrounding brain death-the physician’s perspective

 

Nitin K Sethi1, Prahlad K Sethi2

 

1New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (U.S.A.)

2Department of Neurology, Sir Ganga Ram Hospital, New Delhi India

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Consider this scenario. A-46-year-old lady suffers an out of hospital cardiac arrest. Cardiopulmonary resuscitation is initiated on the scene by a passerby and later by emergency medical services personnel and return of spontaneous circulation is documented in 30 minutes. After arrival in the hospital hypothermia protocol is instituted. Five days later she remains comatosed and neurological examination is consistent with brain death. Orders are given for medication and ventilatory support to be withdrawn but family refuses saying that she is not dead as long as her heart is still beating. An ethics consultation with the family fails to change their beliefs about brain death leading to a standoff between family and the medical team. What are the clinician’s medical, legal and ethical responsibilities in such cases, not just to the patient but also to the grieving family and the larger society?

Death may be defined as the end of life; the total and permanent cessation of all vital functions of an organism. But this simple definition of death is imbued with strongly held social, cultural and religious beliefs of the patient, the family and our society. Different religions view death and afterlife differently. Hinduism and Buddhism believe in the doctrine of reincarnation. Based on one’s karma either one attains “nirvana” never to be born again and to be finally free of the death/rebirth cycle (moksha)or following death the “atma” (soul) inhabits a new “chola” (body). This is against the Christian held belief of either going to heaven or hell after death. So there exists religious objections to the diagnosis of brain death and in some religions death is thought to have occurred when the heart stops beating. This cardiac definition of death remains far simple to understand by the public at large as compared to brain death. It is readily accepted by family members allowing the process of mourning to begin on the departure of a loved one. Brain death on the other hand is not so readily accepted by family members. How can their loved one be dead when they can still feel, hear and see (on the cardiac monitor) a reassuring heart beat? Terms like apnea test positive, absent brainstem reflexes and flat electroencephalogram make little sense. How can the doctors be so sure that their daughter or son shall never regain consciousness again? Questions like these place a tremendous burden on the family when they are approached for permission to discontinue ventilation. The symbolism of a beating heart slowly flat lining on the cardiac monitor after discontinuation of ventilation is not lost on them. 

From a medical and legal perspective brain death is now a well defined entity. After brain death is confirmed, the law allows (and protects) physicians to discontinue medication and ventilatory support. In many states in the United States and in countries around the world, physicians are not mandated to consult the family prior to withdrawing ventilation though it is recommended that they should. So at least for clinicians there is now little to no ambiguity when it comes to medical (brain death testing is standardized though there remains practice variability in brain death determination among different countries of the world or even among different academic centers in the same country) and legal issues surrounding brain death. Ethical issues surrounding brain death though continue to confront us. Confirmation of brain death makes it obligatory for clinicians to cease all treatment but what if the family refuses to accept the diagnosis. Should we refuse to treat further (after all the patient is dead) or should we continue to treat the dead patient in deference to the family’s wishes? What if we have another alive but critically ill patient who needs that intensive care bed or the ventilator? To who we owe our greatest responsibility-the dead patient, the grieving family or the living critically ill patient who shall die if he does not get care? What to do when brain death is determined in a pregnant woman but whose fetus still has a heartbeat? 1Do we cease treatment (after all the patient is dead) or do we continue to maintain ventilation in this dead patient until the fetus is viable outside the womb? We also have to contend with ethical issues surrounding harvesting of organs from a brain dead patient to extend the life of others. Again to whom we owe greater responsibility-the brain dead patient, the grieving family or the patient in desperate need of that organ?

Determination of brain death raises complex medical, legal and ethical dilemmas for clinicians highlighting the need for medical ethics education during residency training.

 

References

 

  1. Gostin LO. Legal and ethical responsibilities following brain death. JAMA 2014 Jan 24 [Epub ahead of print]

 

 

 

Task specific focal dystonia and dystonic tremor-a question and an answer

A question from one of the readers of my blog. Thank you Melissa and I hope this helps.

 

Question:

 

For a couple years now I have noticed that I have a tremor in my right hand that only acts up when the hand is still or holding something. It shakes really bad and I can stop it when I notice it. It effects my photography and sometimes when I am eating. In motion the tremor stops. I have asked my doctor and he said it is a benign tremor and not to worry about it.. should I be concerned?

 

Answer:

 

Task specific focal dystonia is a not so uncommonly encountered movement disorder. As the name suggests the dystonia occurs or is most prominent only during a specific task. What is dystonia?  Dystonia is a movement disorder characterized by sustained muscle contractions which cause twisting and repetitive movements or abnormal postures. It can affect different parts of the body and be generalized or focal (for example just affecting one hand). There are many causes of dystonia. Task specific focal dystonia is a special type of dystonia which becomes apparent and interferes with the performance of specific tasks such as playing a musical instrument (at times seen in professional violin, piano and guitar players in which it can be career ending at times!), playing a specific sport or while writing (writer’s cramp).

While I do not know if that is what plagues you Melissa, my advice would be to discuss about task specific focal dystonia with your physician or see a neurologist. It is possible that while holding the camera the dystonia becomes apparent and then when you try to grip the camera even more firmly the tremor (dystonic tremor) becomes apparent. I do have a few simple suggestions which may help you:

–try holding the camera in a different way-aka change your/the grip of the camera

–do not grip the camera too hard, hold it lightly.

–use something to support the camera such as a camera stand.

–when you write use a pen/pencil with a thick/broad grip and again do not grip the pen/pencil too hard. Grip it lightly between your thumb and index finger.

 

Nitin K Sethi, MD

Bell’s Palsy-what to expect- a question and an answer

 

varad Submitted on 2013/10/05 at 3:29 pm | In reply to braindiseases.

I’ve been diagnosed with bells palsy and its been around 2 and a half months. Recovery is very slow and at the moment I’m undergoing homeopathic treatment. Kindly advice that what shall I do for fast recovery

 

 

braindiseases
braindiseases.info
Submitted on 2013/10/08 at 1:28 pm | In reply to varad.

Dear Varad,
recovery from Bell’s Palsy at times is slow but in most instances near full recovery takes place. So these are a few things you can do to speed recovery:
EXERCISE YOUR FACIAL MUSCLES: stand in front of the mirror and exercise all your facial muscles-the one that makes you smile, the one that makes you frown, the one which makes you purse your lips and whistle, the one that makes you close your eyes tight shut. You can look up some of these exercises on the Internet and start doing them 3-4 times a day.
–to my knowledge and in my experience-massaging the face with oil does not help or speed up recovery. Likely it does not hamper recovery in any way also.
–eat a healthy diet.
–if you drink or smoke, I would advise you to stop smoking and drinking alcohol as that hampers recovery of facial nerve function.

–supplement your diet with 2 tabs of a good multivitamin every day.

–I am not aware of any homeopathic treatment especially for Bell’s palsy but then my knowledge of homeopathy is limited.

Remain in follow up with your doctor/ neurologist.

I wish you good luck and hope you make a speedy recovery.

Nitin K Sethi, MD

Headaches-know the red flags

Headache is a common complaint for which patients consult a neurologist like me. While headaches can be disabling in themselves they are also the cause of much concern. Many patients are worried that their headache is a sign of a serious condition such as a brain tumor. So in this post I shall discuss what are the red flags one needs to watch out for when it comes to headaches. What are the symptoms and signs that may be a cause for just concern and should warrant a visit to your doctor for evaluation?

–Age of onset of headaches: most primary headaches such as migraine, tension type headaches, cluster headaches start usually in the late teenage years or in the second decade of life. The usual history is of episodic headaches starting from a young age (migraines usually begin in the late teens or the early/mid 20’s). So what is the red flag when it comes to age? If you have never suffered from headaches in your 20s and 30s and suddenly start experiencing headaches in your (40’s, 50s and later years) one should err on the side of caution and seek medical attention.

–character of headache changes: let us assume you suffer from episodic headaches since your 20s. Headaches are unilateral, throbbing in character and associated with light sensitivity (we call this photophobia) and nausea but you were never formally diagnosed with migraine.  You found over the counter ibuprofen helpful and so never sought out medical attention. Now you are in your 50s and the headache character has changed. What do I mean by headache character? Type of headache (now no more unilateral rather the whole head hurts), severity of headache (the pain is either more severe or constant rather than episodic, wakes you up in the middle of the night, you throw up violently when you have the headache episode, it is causing other symptoms–blurring of vision, double vision , problems with balance, memory problems, changes in behavior and so forth. I would advice again to err on the side of caution and do not just assume that this is still migraine, rather seek medical attention and let your doctor reassure you that indeed that is the case.

–headaches which are accompanied by other signs and symptoms: for example-

—————-severe headache and then you pass out/ suffer loss  of consciousness

—————-headache accompanied by visual symptoms (loss of vision, blurring of vision, double vision, pain in the eye–while many of these symptoms may occur along with migraine headaches, I would again advice that you rather err on the side of seeking a timely medical opinion)

—————-headache accompanied by memory and personality changes

—————-headache accompanied by problems with balance, gait and stance

—————-headache accompanied by weakness or numbness on one side of body

—————-headache accompanied by a seizure or vice versa.

 

Nitin K Sethi, MD

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Nitin K Sethi, MD