Categories
Featured

From heaven’s door to the emerald isle!

An I Found TriMed Story

Mr. P from Sri Lanka was brought to our attention, by another patient of ours Mr. A, who had benefitted greatly from our therapy. Four months earlier, Mr. P, a successful trader, had found himself developing abnormal sensations in his hands and legs, followed insidiously by progressive weakness. He went on to develop, over a month, problems with swallowing, speech and a host of other brain functions. As the family was concerned about his progressive illness, he was shifted to a major Chennai hospital. There he was diagnosed to have an acute inflammatory disorder of the brain, Acute Disseminating Encephalomyelitis (ADEM). After a fortnight in hospital during which time he received high dose intravenous steroids and a host of life saving procedures, Mr. P was discharged to home care and physiotherapy. A fortnight later, when the family found progress lacking, the TRIMED team was called in.

When we first met Mr. P he was bedridden, needing assistance for all activities of daily living; being fed by a Ryle’s tube, unable to speak, communicate, even indicate his needs. We were very concerned about his health and longevity. A brief admission in our affiliate hospital showed metabolic disturbances, probably a consequence of poor intake, needing immediate correction, as well as (in endoscopy by our discerning ENT consultant) significant oedema (swelling) of the laryngeal structures. He was stabilised in hospital over 5 days and discharged back to home care by the TRIMED team. We started our work with home based rehabilitation using a combination of Ayurveda therapies, mud therapy, physiotherapy, acupuncture, nutritional management and motivational counselling. In a week Mr. P was being mobilised from his bed to a wheelchair and was able to come to the TRIMED centre in his neighbourhood for intensive therapy. He was acknowledging his caregivers and attempting to communicate. In two weeks he started to stand with support and was able to swallow small quantities of blended food. He was able to speak a few words in a low voice. At the end of three weeks Mr. P was able to walk with assistance, eat most foods given to him; speak well enough to be clearly understood, eat normal meals and enjoy watching TV.

Four weeks on, from the time he found TRIMED, Mr. P boarded a flight back to Sri Lanka. He came to Chennai in a stretcher and boarded a hospital ambulance, acutely ill. Six weeks on, he walked through Chennai airport to board his aircraft. We are sure he will continue to practice the TRIMED way, our one hour program combining hatha yoga, progressive muscle relaxation and ergonomic exercises. His wife, besides herself with joy, has pinned an inspirational message on our centre’s notice board.

No doubt Mr. P needed and benefited from acute medical care, which saved his life. But it was our rich TRIMED blend of modern medicine with ancient medical traditions that got him back on his feet, delivering care beyond cure. Mr. P’s journey to Heaven’s Door and his triumphant return to the Emerald Isle, is our continued well-spring of inspiration at TRIMED

Categories
Featured

What lies beneath the beautiful mind?

On John Nash and his Schizophrenia- published in Deccan Chronicle

The famous mathematician John Nash is a prime example, the film, A Beautiful Mind, bringing to engaging life the tumults that affect a person with schizophrenia. For the mind is a construct, not a physical entity. Modern medicine sees the mind as software and the brain as hardware. Millions of neurons, linked by chemicals (neurotransmitters) that establish pathways and communicate through them, form it. But when there is major mental illness, such as schizophrenia, this neurochemical system breaks down and there follows a disintegration of thought processes and reasoning.

What lies beneath?

The person so afflicted suffers from a degeneration of the neurotransmitter systems, of dopamine, serotonin and acetylcholine in particular, which serve like chemical messengers of the brain. They are molecular substances that can affect mood, appetite, anxiety, sleep and other parameters. Schizophrenia causes  atrophy of critical brain structures, such as the hippocampus, which is the storehouse of memory and a device for comparing  emotion. The person is likely to have grown up in an environment that offered limited opportunities for emotional expression or development. He or she also has an inherent over-sensitivity, a tendency to misperceive environmental events and is likely to over-react. It is important though, from a social perspective, for them to be educated, employed and to marry.

Symptoms

Mood swings, happiness or sadness that is out of proportion to the circumstances; hallucinations, seeing or hearing things; beliefs that have no basis in reality or delusions, making assumptions where none are warranted; emotional dyscontrol (anger, laughter, crying, inappropriately); sleep and appetite disturbances; lifestyle issues — these are some of the common symptoms. More severely affected people show a disintegration of language and communication, with stilted speech, odd behaviours and inappropriate gesturing.

Treatment

The advent of chlorpromazine in the middle of the last century signalled the advent of a biological ‘mind cure’, and ever since, many psychotropic drugs have emerged that can help restore normal mental functioning and been found to be quite safe and effective. However, drugs are not without side effects and are by no means universally effective, a proportion of people failing to respond to various permutations and combinations. Further, while drugs control symptoms — even banish them — they do not restore normal functioning or the quality of life on their own. The affected person needs to relearn lost emotional, social and pragmatic skills, regain confidence to engage in social intercourse, learn once again to pay attention, concentrate and commit to memory; indeed function as an integrated whole, in family, at work and in society.

A comprehensive programme of psychological therapy for the person and the family is therefore essential. Occupational therapy to regain lost skills and focus; physical therapy, including exercise, to manage attendant physical symptoms and regain bodily fitness; yoga and meditation to manage anxiety, restore calm and enhance well being, are all helpful.

Largely untapped also, are the secrets ancient medical traditions hold, with potential to enhance physical and mental well being, Shirodhara in Ayurveda and Hydrotherapy from naturopathy, being classic examples.

Reintegrating the mind is thus a task for a multidisciplinary team,  guided by a qualified mental health professional, and such an approach, with well defined goals, can go a long way in helping the patient.

Categories
Featured

A traditional touch alongside an allopath

#Trimedtherapy.com our #innovative #healthcare #enterprise featured in the #start-up files of the Times of India recently- a story by Pushpa Narayan.

After practicing medicine for seven years in India, London returned neuropsychiatrist Dr Ennapadam S Krishnamoorthy understood that while Indians had total trust in modern medicine their heart was often in traditional systems. If an Ayurvedic medicine would work or if a series of yoga sessions seemed to help, they would rather go for that. Like most allopaths, Dr Krishnamoorthy , was initially dismissive but soon realized that he should investigate the science behind “alternative medicine.”

After some years of diligent research and efforts, he launched a small clinic called Trimed, as a pilot, near his house in Sri Nagar Colony in 2009. With seed money from family and friends, Trimed sought to weave allopathy with Ayurveda, yoga, naturopathy and Pilates.

The first task for the integrated medical therapy centre was drawing up treatment protocols that integrate diverse genre whose practitioners have typically worked in silos – with each being mostly dismissive of the other. “In most such integrated centers, we realized that treatment was mostly left to patients’ choice. Many times patients aren’t guided through choices. Ours was a clinic and we decided that treatment protocols will be decided by the doctor,” said Dr Krishnamoorthy , one of the founders of Trimed. For nearly 40 conditions including pain, disability and mental health issues the team has standardized treatment practices.

Patients coming to Trimed meet an allopathic practitioner first, but they are also evaluated by at least four other specialists including a physiotherapist, naturopath, Ayurveda practitioner and a psychologist. The specialists then discuss the treatment plan for each case sheet.”Sometimes treatment plans take more than two hours to formulate,” said Dr Rema Raghu, an epidemiologist/ lifestyle physician, who is one of the core members. The aim is to bridge the limitations of allopathy with the wisdom in traditional medicine. “We made a conscious choice that all medicines prescribed will be only allopathic. Massages and therapy from other traditional streams are integrated with modern medicine. But with every case it is important to offer holistic care,” she adds.

The cloud-based electronic medical records of each patient stored at the hospital showed substantial progress in most patients. For instance, a 92-year-old a wheelchair bound patient walked out of the hospital after 15 days of intensive therapy and young IT professional was taken off the bench and put on projects after he was able to control mood disorders. Soon, Trimed, with its mobile therapy unit -an ambulance converted to therapy centre -extended services to home-care. “When people come to us they realize that almost everyone in the family needs holistic medical management,” said Gayathri Krishnamoorthy, a core administrator at Trimed. The centre, which was exclusively for medical management, is now expanding to offer rejuvenation therapy.

The company received funding of $300,000 from an Indian businessman living abroad. It is planning to start another centre in Coimbatore. “When I first heard about it I was impressed about the holistic approach concept. In fact some members in my family tried and benefited from it. I don’t think such centres should mushroom all over, but I certainly believe they have a place,” said A Vellayan, executive chairman, Murugappa Group, who has invested in his individual capacity.

Categories
Featured

Food for the ageing brain…

The prevention of dementia assumes great significance, especially as we exist in an era of chronic and lifestyle diseases. Indeed, the role of hypertension, obesity, lipidemias (high cholesterol) and diabetes (the HOLD construct) as causative factors of chronic and lifestyle diseases including dementia has assumed great significance in the last decade. The American Dietetic Association has opined that food and nutrition play an important role in maintaining one’s health. It is also well known that sub-clinical deficiency in essential nutrients and nutrition-related disorders can lead to loss of memory and other cognitive functions.

Poor performance in memory tests has been shown to be associated with low levels of a range of nutritional factors:

  • Vit B12 (with elevated homocysteine)
  • plasma lycopene
  • a-carotene, total carotene, b-carotene
  • b-cryptoxanthin
  • a-tocopherol etc. 

Supplementation: 

There is growing evidence that vitamin supplementation has a significant role to play in lowering the risk of dementia. Evidence for vit C, E, B12 and folic acid being given, as supplementation in higher doses, is particularly strong. However, the benefit seems most when supplementation is introduced in people who need it (with low vitamin levels) than in those who do not. These findings and allied research have also resulted in the US FDA recommending folic acid fortification of foods for the elderly, for example flour and bread. It is important to remember that high vitamin levels due to inappropriate supplementation can also be problematic and the taking of supplements should therefore be done with medical supervision.

Diet:

There is mounting evidence that the Mediterranean diet, which includes a high consumption of olive oil and fish — and hence elevated intakes of monounsaturated fatty acids and v–3 polyunsaturated fatty acids — is protective against age-related cognitive decline. This maybe partly due to the antioxidant compounds in olive oil (tocopherols and polyphenols) and in part to the role of fatty acids in maintaining the structural integrity of nerve membranes. 

Red Wine:

There is no doubt that red wine consumed in moderation has been shown to be beneficial to health and well-being; reducing bad cholesterol, preventing blood clots and protecting the heart. In part this has been attributed to the constituents of red wine, which include procyanidins, a class of flavonoids found in plants, fruits and cocoa beans.

Plant Formulations:

It has long been known that certain plant formulations have pro-cognitive properties and may enhance memory function. Many of these are the subject of active research today, Brahmi (Bacopa Monnieri), Tulsi (Basil), Ashwagandha (Withania Somnifera) for example. Curcumin, an active ingredient of turmeric, is also the subject of worldwide research. Among the fruits the pomegranate and walnut are thought to have pro-cognitive properties. While a variety of plants and plant formulations are under study, the jury is still out with regard to their specific benefits. The evidence for over-the-counter plant formulations is, therefore, not yet existent, notwithstanding their many claims.

Lifestyle & Attitude:

The jury is still out as to whether it is the aforementioned constituent factors that render protection, or indeed whether the overall Mediterranean lifestyle — physical activity, healthy food, abundant sunshine, meals eaten at a leisurely pace with plenty of socialisation — is responsible for the health, well being and good levels of memory/ cognitive function in that population. For example, therefore, red wine consumed in moderate quantities may be good for you, but only when it’s accompanied by such a “healthy” lifestyle & attitude.

Categories
Alzhimers Featured Memory Problems

Of menopause & memory

A is a generally healthy and active woman professional of about 48 summers. I know her socially, well, and was curious when she sought an urgent appointment to see me professionally. “I am losing my memory doc”, was A’s first statement as she walked into my office. Probing further I found A was complaining of much more that absent mindedness. Word finding difficulties, struggling with routine skills like driving, becoming disoriented on arriving in a hitherto familiar location, not precisely remembering why she was there anyway, the list seemed endless. “Am I getting Alzheimer’s doc” was her genuine concern, expressed more than once as our interview progressed. 

Different Strokes

I asked her about her general health- whether she had any of the four key lifestyle risk factors which predispose to memory loss: Hypertension, Obesity, Lipid (high cholesterol) or Diabetes. While she did not have high blood pressure, blood sugar or cholesterol, she had been overweight until 2 years ago when she went ahead and elected to have bariatric surgery abroad. Following this she has lost considerable weight and had been on a rather severe diet that was recommended for about 18 months after. “I am slowly resuming a normal diet, but the quantities I eat remain small”, said A. On questioning she reported normal thyroid function, no lupus or other such inflammatory condition, both of which can also predispose to memory problems in younger people. Her heart and kidneys had been declared “fit and well” by her physician, during her last master health evaluation. What about your monthly periods, I demurred? “Menopause finally set in doc, about 2 years ago”, said A. When did the memory problems start, I wondered? A thought for a few moments before responding; “about the same time as my periods started tapering off” she responded. A clarified to leading questions that she was not under any significant emotional stress, nor were there any stressful life events in recent times. Indeed, with both children off to college and her husband having come into considerable wealth recently, A felt life could not be better, especially as they now had the time, resources and freedom to travel, something they both enjoyed. I asked her about neurological events or symptoms during her lifetime: head injury, seizures, fainting episodes, strokes, to all of which she replied in the negative. 

On physical evaluation A was completely well and there were no signs of concern. On the bedside evaluation of memory and cognition, though, I found A struggled a little with tasks of attention (focus), recent memory (recall) & executive function (ability to perform tasks in sequence), resulting in her working memory being somewhat affected. She did manage to remember and perform most tasks: however, she was a little less efficient and speedy than I expected her to be, considering that she was a smart & efficient professional. The obligatory brain scan (as a measure of safety) was normal, but her blood tests revealed that she was deficient in vitamin B12 (an outcome of her dietary restrictions following bariatric surgery) with elevated homocysteine, a brain chemical that is associated with memory problems. I concluded therefore that A had two reversible causes of memory impairment: vitamin B12 deficiency & menopause. 

The Menopause Effect

The World Health Organization defines the perimenopause as the time immediately preceding the menopause, beginning with endocrine, biologic, and clinical changes, and ending a year after the final menstrual period. The Study of Women’s Health Across the Nation (SWAN) published in the American Journal of Epidemiology (2000) showed that of 12425 women aged 45-55 years across sociodemographic categories who participated, between 31 and 44 % of perimenopausal women, endorsed forgetfulness. Overall perimenopausal women were 1.4 times more likely than premenopausal women to be forgetful, this finding not being just due to emotional stress. Indeed, there is considerable research today to show that in the year after the final menstrual period, women do demonstrate deficits in attention, working memory, visual & verbal memory and motor speed. Interestingly, studies like the “Harvard Study of Moods & Cycles” show that in the perimenopausal period, women are twice as likely to be depressed, and while this is not related to negative life events, it is associated with vasomotor symptoms (hot flushes). This links up with the theory that the brain hormone cortisol (which exercises an influence on the reproductive hormones) may be associated with both memory and mood; that higher cortisol levels and/or greater cortisol reactivity may be the biological link between hot flashes, depressive or anxiety symptoms and perimenopausal decrements in memory. Indeed, research has shown that young women have lower reactivity to cortisol than older (perimenopausal) women. This of course brings up the inevitable question, which A asked me “doc, should I be on Hormone Replacement Therapy”? HRT has been both praised and vilified (like many medical procedures) in equal measure. The summary evidence suggests that HRT commenced during the perimenopausal period has the potential to help symptoms of mood, anxiety and perhaps importantly, memory. However, HRT started outside these time periods does not appear to have a similarly beneficial effect, indeed may even be detrimental. 

Prevention & Cure

I had identified in A, apart from menopausal transition, a reversible cause of memory impairment, vit B12 deficiency with elevated homocysteine; which has an impact on memory and makes one vulnerable to having strokes. Other reasons why middle aged individuals like A have problems with memory include depression, infections, inflammations and metabolic (including thyroid) problems (all reversible); cancer, strokes & brain tumours (potentially reversible, at least in part); and  brain degeneration (non- reversible but can be slowed, partly arrested). It is for this reason that people with memory complaints in middle life like A, need to be thoroughly evaluated for a range of causes. A did go through such an evaluation before we concluded that her problems were due to menopausal transition and B12 deficiency, both of which we proceeded to address. We recommended to her, all those things that can help a person stave off memory loss (and indeed lifestyle disease): a healthy and predictable life, an antioxidant rich diet, adequate rest and sleep; regular aerobic exercise (walking, jogging, gymming); yoga, pilates or tai chi as mind-body interventions; moderation in all that one does, including and especially social consumption of alcohol. Turmeric is today in advanced trials and extra virgin coconut oil in early phase trials as a memory protecting agent. The former is adequately present in Indian diets generally; the latter easy to add, admixed with rice etc. We recommended both to A. 

We learnt from her too, as we do from all patients; the links between mood, memory & menopause, preventive health and the importance of holistic evaluation and care. All memory loss is not dementia and women like A in menopausal transition would do well to consider and address that aspect of their health.

Categories
Featured

The four legged stool

Mr. A is one of our “happy stories”. One who has been helped by the four legged stool: self-motivation, a supportive family, a supportive boss and adherence to the therapeutic relationship with the Neurokrish-Trimed team. He found and stayed with TRIMED and in him we find the raison d’être for our professional existence. 

When we first met Mr. A 8 years ago, he was doing his Masters in a prestigious American university. Rather devastatingly for him and his family he was diagnosed with Paranoid Schizophrenia, which had in the previous year impacted severely on his life and academic performance. Confused by his hallucinations and delusions, fearful for his safety and struggling to live alone, Mr. A was brought back to Chennai by his family. We treated his acute illness with psychotropic drugs, relaxation exercises, individual and family counselling and nutritional counselling (for his obesity, in part a consequence of his drug treatment). Within a month, Mr. A was able to return to his university and continue his course. He did of course have a few stable paranoid ideas and occasional mood swings.

Mr. A managed to stay on in university and graduate with a Master’s degree with ample family support. He progressed to secure a suitable technical position in a major multi-national computer manufacturing firm. Here, he was fortunate to be placed under a humane and empathetic boss. Over the past 8 years he has continued to visit Chennai annually for a course of multi-disciplinary therapy with our team. He also remains on fortnightly-monthly skype sessions with our clinical psychologist. He has had periodic exacerbations of mood changes with racing thoughts and paranoid ideas. He has wondered about the intentions of his fellow employees and become agitated in his interactions with them. He has had to take time off work to go and stay with his sister, in another part of the US, for a few days. He has on occasion, especially close to major life events (exams, role transfers) needed his parents to travel to the US and stay with him.

However, thanks to his own efforts, his uniquely supportive parents and sibling, a very supportive boss and mentor at work, and (in our belief) TRIMED therapy, he has managed not only to keep his symptoms under control, but to hold on to a job and climb the ranks at work. Back in India for his review and booster therapy sessions, Mr. A reported that his symptoms have almost remitted over the last year. This, despite his move to a new job at another respected multinational technology major. He is proud to share his weight loss efforts and to seek TRIMED’s assistance in meeting these goals. He has been diligent about his medicines, and has practiced the TRIMED way (relaxation, yoga and ergonomics) diligently, through the past year.

Mr. A is one of our “happy stories”. One who has been helped by the four legged stool: self-motivation, a supportive family, a supportive boss and adherence to the therapeutic relationship with the Neurokrish-Trimed team. He found and stayed with TRIMED and in him we find the raison d’être for our professional existence.

Categories
Depression Dystonia Featured Obsessive Compulsive Disorder

Stimulation for the brain!

What is deep brain stimulation?

Our brain is a wonderful organ. Designed by the chief architect, this is the most complex CPU ever built. Like our computer’s CPU, this CPU in our body can also be thought of a bundle of electrical wires criss-crossing in a highly complex fashion. Every once in a while, there can be something that happens to cause some malfunction in this circuit. DBS can be thought of as an operation to set right this malfunction by inserting a pacemaker into the brain.

Miss J, a 22 year old girl had been diagnosed with a brain tumour as a child and had undergone radiation for that. While the tumour was successfully treated, this radiation to the brain had a nasty side-effect. Some of the circuitry in her midbrain had been altered, leaving her with a permanent tremor in the right hand and leg.

She was suffering silently for more than 10 years, not knowing that this problem has a solution in the form of DBS! While the damage to the brain that is an inevitable consequence of radiation cant be undone, by placing a pacemaker into the brain, the imbalance in her movement circuitry could be modulated.

The result is almost instantaneous since the operation is done with the patient awake in the operating room. Once the electrode reaches the correct area in the brain and electrical current is sent through it, the tremor reduces immediately and her slow movements become rapid.

DBS is helpful in a wide variety of conditions apart from tremors. It is very useful to improve the symptoms of Parkinson’s disease, Dystonia, drug resistant Epilepsy, Obsessive compulsive disorder, major depression and Chronic Pain syndromes.

The deep area in the brain which is stimulated varies according to the condition treated. However, in all conditions the patient is awake during surgery and is being tested with stimulation and a wide variety of observations are done as and when surgery is in progress. Therefore, the success of surgery involves the active co-operation of the patient.

Before surgery is considered, all patients undergo a detailed assessment to look for factors in favour and against surgery.

Each patient and family are thoroughly counselled about what to expect before, during and after surgery. After successful surgery, they need to be followed up for programming sessions where the stimulator is turned on and tuned in order to achieve the best clinical benefit with the least side-effects.

Categories
COVID-19 Epilepsy & Seizures Featured

Managing epilepsy during COVID-19

Epilepsy is the most common serious neurological disease affecting over 50 million people worldwide and an estimated 5 million plus people in India.

People with epilepsy have recurrent, unprovoked seizures and these have to be differentiated from provoked seizures that follow a tumour, stroke, infection, inflammation, metabolic disease (like very low or very high blood sugar) and so on. A seizure is an electrical storm in the brain; a short circuit in the brain’s normal electrochemical activity.

World Epilepsy Day or Purple Day just passed us on 26th March. In this time of COVID let’s ask ourselves what the implications are for people with epilepsy. Here are some common FAQs.

Can COVID-19 cause epilepsy?

According to the International League Against Epilepsy, there is no direct evidence that the coronavirus infection can directly cause epilepsy. However, like all infections that can cause high fever, breathing difficulties and other problems with normal functioning, being infected can result in a person who is susceptible to epilepsy, suffer breakthrough episodes.

Does epilepsy or its treatment make one more susceptible to COVID-19?

At present there is no information to suggest that either epilepsy or epilepsy treatment (anti-epileptic drugs, most commonly) will in any way make a person susceptible to COVID-19. Indeed, there is no suggestion that people with epilepsy have any special immune vulnerability either. However, the stress a pandemic of this nature can induce in people, the sleep deprivation and attendant lifestyle changes, can all make a person already vulnerable to seizures, express them more frequently.

What should I do if I have a seizure in this time of COVID-19?

If one has never had a seizure before in their lives, it is obviously imperative that they consult a neurologist, urgently and undergo relevant investigations as advised. As most routine clinics are cancelled, the emergency room of a hospital may be a better point of access at this time. However, for people with pre-existent epilepsy, a single seizure is no reason for panic. Call your usual doctor and discuss what you can do to manage your epilepsy better; follow your doctors advice.

Avoid visiting clinics and hospitals for single breakthrough seizures unless you feel it is absolutely necessary. However, if seizures cluster together, or indeed a person suffers continuous seizures with no recovery of consciousness in-between, what is called “status epilepticus”, it must be treated as an emergency.

What precautions should a person with epilepsy take at this time?

People with epilepsy are advised to stock up adequately on their anti-epileptic drugs, as even missing a single dose can cause a breakthrough seizure for some. Compliance with drug treatment is extremely important for people with epilepsy. Stress is inevitable and managing it with meditation, yoga, a healthy diet and lifestyle are all possible. Many good online tutorials exist on all the above. If one is very stressed out an online consultation with a psychiatrist or psychologist can be helpful. Sleep deprivation is another risk factor for people with epilepsy; adequate rest and sleep are therefore very important. Sleep can be disturbed due to stress or indeed due to excessive exposure to digital media — televisions, computers, tablets and smartphones.

Good sleep hygiene: making oneself clean and comfortable before going to bed, making the temperature and lighting in the room ambient and suitable to the extent possible, putting way all digital media and retiring to bed with either a book or gentle instrumental music (if one must have a distraction) are all encouraged.

Are there special precautions?

Unless one is a healthcare worker or otherwise at high risk of exposure, no special precautions are recommended. If a person with epilepsy belongs to this category, they are encouraged to speak with their usual doctor about drug prophylaxis and other precautions. For all other people with epilepsy, the principles of social distancing, avoiding unnecessary contact with people outside one’s immediate family, or indeed taking due care around anyone who is symptomatic of COVID, is adequate.

Categories
Traumatic Brain Injury

Traumatic Brain Injury Dialogue- Buddhi Clinic

Buddhi clinic video of Traumatic brain injury dialogue

Categories
Anxiety Depression Stroke & Cardiovascular Diseases

Why mental health problems are growing in India

Dr Samir Parikh and Gayathri Prabhu in conversation with Dr Ennapadam S Krishnamoorthy