Hi XXXXXX

Thanks for the query

Individuals who are having psychotic illness, self-medicate themselves with many medications, substances like alcohol, nicotine etc, so as to get relief of such distressing symptoms.

Such individuals do suffer from distress but they may not express it or they may not seem to be distressed

And indulging in consuming alcohol, ghutka etc is a way of coping

At the same time they do not admit that they have any illness nor that they admit that they need treatment

They may have coexistent depression

There are NGOs, social workers attached to mental health services who take care of such issues. And their job is to make the patient available for treatment

I think treating the underlying mental state will automatically help him to get rid off such substances and hence the risk of cancer

And if needed, your psychiatrist will evaluate the risk of oral cancer and will do the relevant tests and will do the needful

Regards

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Thanks for the response

As I mentioned earlier and as you have rightly observed that her ghutka / alcohol intake increases during the period of XXXXXX depression" / "psychosis", shows that the 'Psychiatric illness" is primary and substance intake is secondary.

This emphasizes that adequate and appropriate diagnosis and treatment of mental illness is primary

If your psychiatrist is sure enough that she does not have psychotic illness, then the answer that I have written you earlier may not be fully applied

In such case, "motivation enhancement therapy" for increasing her motivation to decrease or stop ghutka / alcohol would be appropriate along with treatment of depression.

Moreover, if you are not satisfied with your psychiatrist, I think you can consult another psychiatrist for second opinion

Plus, the social service agencies that I mentioned earlier should help you further, in this regard (how to take her to appropriate treatment network)

You can discuss this with your GP, too

Hope this clarifies

Wish her good luck

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Hi,

I can sense and do understand the level of anxiety and concern you are going through.

This is the time to control your anxiety, not feel helpless, to keep patience and courage. I know these are easy to say but difficult to follow.

Indian ghutkha contains nicotine (the same harmful ingredient that cigarette contains) in more crude form. Hence, the harmful effects of ghuthka are more or less same as chronic smoking except that chances of oral cancer are more with ghutkha and chances of lungs problems more with smoking.

Humbly, I want to emphasize and re-emphasise some points that I have repeated. And they are as below:

1. Diagnosis may not be depression, to me seems may be a psychotic illness. Because you have mentioned that she behave psychotic after ghuthka or alcohol. Also because you say medicines for depression have not worked for her, indicates that the diagnosis may not be depression.

2. Such problems after ghuthka / alcohol are called "substance induced psychotic disorder".

What to do?

a) To change the medication from antidepressants to antipsychotics. This will take care of her psychotic behaviour even if she takes ghuthka and alcohol, for a while

b) Take a second opinion from another psychiatrist

c) Take the help of social worker to pursue her to go to hospital

d) You can consider giving benzodiazepine like clonazepam / lorazepamam / oxazepam in moderate doses, for a short time to control her acute behavioural problems.

e) You can request your doctor for considering hospitalization

Hope this will help you.

Wish you patience, courage and her, a good mental health.

Regards,

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